Multimorbidity in Scotland Dr Frances Elliot Deputy Chief

Multimorbidity in Scotland Dr Frances Elliot Deputy Chief Medical Officer

2020 Vision Everyone is able to live longer healthier lives at home, or in a homely setting. We will have a world-leading healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Multimorbidity in Scotland • Multimorbidity is the presence of two or more long term conditions. • The Alliance for Health and Social Care in Scotland call it ‘having multiple conditions’. It matters because: • Living with multiple conditions is the norm rather than the exception for many people. It is associated with poorer quality of life, more hospital admissions and higher mortality. But… • Health services are largely organised to provide care for single diseases along specific care pathways, generally integrated across primary and secondary health care.

Multimorbidity is common in Scotland – The majority of over-65 s have 2 or more conditions, and the majority of over-75 s have 3 or more conditions – More people have 2 or more conditions than only have 1

Most people with any long term condition have multiple conditions in Scotland

Most people with any long term condition have multiple conditions in Scotland Guidelines and the current organisation of care do not reflect this reality. Guthrie B et al, BMJ 2012; 345: e 6341; Hughes L et al, Age and Ageing 2013; 42: 62 -69

There are more people in Scotland with multimorbidity below 65 years than above Particularly true in more deprived areas There are very few generalist hospital services for the under-65 s

People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas

Mental health problems are strongly associated with the number of physical conditions that people have, particularly in deprived areas in Scotland

International evidence shows that people with multimorbidity experience more problems with the coordination of their care

Multimorbidity in Scotland How can we communicate this knowledge to place multimorbidity on everyone’s agenda? How can multimorbidity be introduced to all our work with adults? Would identifying key trigger points in pathways of care where MM should be raised help?