The rising number of people living with multiple conditions is a challenge for Scotland's public services writes Ian Welsh.
Living with more than one long term condition can have a considerable impact on many areas of a person’s life. The well-publicised rise in the number of people living with long term conditions is inextricably linked with a rise in the number of people living with more than one long term condition.
This is a challenge not only to health and social care services but will affect Scotland’s existing societal, economic and environmental systems.
While more research and data are required, and the “Living with Multiple Morbidity” programme led by Professor Stewart Mercer at the University of Glasgow (2011) gives a timely reminder of the effects of living with a multiple condition:
- People who live with multiple conditions are more likely to live in poverty with 40% of people living in the most deprived areas of Scotland living with multiple conditions – compared with 22% in the most affluent areas.
- Prevalence of multiple conditions increases with age with nearly 40% of people aged 75 or over living with two or more long term conditions
People who live with multiple conditions are more likely to experience mental health problems.
- Living with multiple conditions contributes significantly to health inequalities and the inverse care law
A recent study of over 3,000 GP consultations showed that people living with multiple conditions often had more complex physical, psychological and social issues to discuss with their doctor but consultations were no longer. This has led to lower rates of patient enablement, worse outcomes for people living in more deprived areas and an increased likelihood of emergency and preventable hospital admissions.
Tackling some of these issues is one of the key priorities outlined in the Scottish Government’s Route Map to the 2020 Vision for Health and Social Care. The Scottish Government has developed drivers to achieve the change required and this work, led by Dr Anne Hendry and the Deputy Chief Medical Officer Frances Eliot, offering welcome high impact changes for Government, Health Boards and local authorities to deliver the complex range of improvements required.
The vision refers to the need to foster “a whole system response” to multiple conditions. This chimes with the experiences of ALLIANCE members, many of whom told us at our “Living with Multiple Conditions: Issues, Challenges and Solutions” conference in 2011, that the often fragmented support they receive can be ineffective and undermine the management of their conditions. Person-centred services that look beyond the long term conditions and approaches that tackle inequalities will be vital to tackling these issues.
Health and social care integration could also offer us an opportunity to focus statutory services on the outcomes that matter to people. The integration agenda could potentially offer a tonic to more effective joint working and communication between the NHS and local authorities and within the NHS itself – but it impact on the ground is still to be seen.
But improving services is not the only solution. Third sector organisations, alongside tools designed and developed within the sector such as ALISS, provide a wealth of information, support and advice and are able to offer day-to-day, community-based support to help people manage their long term conditions. Despite the range, depth and potential they add, signposting from the NHS to the third sector remains patchy.
The ALLIANCE/Deep End/Scottish Government Link Worker Programme will be one very significant practical programme to effect change behaviours in GP practices and community and social settings
On Tuesday 27 May, I’m delighted to be chairing a session on the experiences of people who use support and services, as part of the Royal College of Physicians and Surgeons of Glasgow & the University of Glasgow’s event on the impact of these issues on individuals, professionals and care services. The conference, held in partnership with the Scottish Government and the Joint Improvement Team, will highlight important lessons at home and abroad.
The ALLIANCE is determined to ensure that the continuing development and spread of self management, recovery, independent living, self- directed support, coproduction, shared decision making, asset- based approaches, service- user empowerment and engagement, active and healthy ageing, positive personal outcomes all contribute to the fulfilment of action plan outcomes.