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Healthcare system must adapt to rise in multimorbidity

Healthcare system must adapt to rise in multimorbidity

The NHS needs to respond to the ‘inexorable rise’ of multimorbidity within healthcare systems, the chief medical officer (CMO) for England Professor Chris Whitty has warned.

In the CMO’s annual report, Professor Whitty highlighted the need for NHS organisations to minimise the need for people to attend multiple clinics for a ‘predictable cluster’ of diseases.

Much of the NHS is organised around single diseases or single organ systems in a way that is ill-suited to a future of increasing multimorbidity’, the report said.

Professor Whitty said this means that patients can spend their time going to ‘multiple unrelated specialist clinics, be on several care pathways and are prescribed multiple medications’.

The CMO highlighted inequalities in frailty prevalence, with higher rates and earlier onset in areas of deprivation.

However, opportunities to engage in the prevention of secondary disease exist throughout the NHS and should not be seen solely as a role for general practice or the relevant specialty, such as cardiology, the report suggested.

‘There are many professionals across the health and social care sector and beyond who can play a role in supporting secondary prevention activities,’ Professor Whitty said. ‘This is especially important to consider for older people, who are often in contact with a wide range of services to support their health and wellbeing.’

England’s CMO suggested that initial risk assessment to inform personalised secondary prevention interventions could also take place in a broader range of settings including supermarkets, libraries, pharmacies and ‘other settings that form part of older people’s daily lives’.

While secondary prevention is ‘predominantly the responsibility of the NHS’, it is currently under-prioritised, according to Professor Whitty.

‘Screening programmes help to delay or stop the onset of serious disease and therefore prevent ill health in later life,’ he said. ‘It is essential that we prioritise secondary prevention and screening services, and do more to extend these services to groups with reduced access and historically low uptake.’

The report also warned that older age is becoming increasingly geographically concentrated in England, and services to prevent and treat disease need to be planned on that basis.

‘This should be seen as a national problem and resources should be directed towards areas of greatest need, which include peripheral, rural and coastal regions of the country,’ he said.

A spokesperson from the Queen’s Nursing Institute (QNI) commented: ‘The report clearly shows the extent to which the population of England is ageing, and this will have an increasing impact on community nursing in the coming years.

‘The report is written from a medical perspective, but the lessons for nursing are clear. As nurses are the professionals who will be leading and managing the care of those living with complex, long-term conditions, it is vital that the nursing voice is heard when policymakers and service providers plan how to meet individual and population needs.

Need will be greater in certain areas of the country, suggested QNI. ‘These areas will need more district nurses and general practice nurses, so that people can receive treatment close to where they live, avoiding unnecessary reliance on secondary care.

‘Community nurses are key advocates for healthy lifestyles, supporting people to access opportunities to maximise their physical and mental health and wellbeing.’


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