From Featuring Dr Chris Steele MBE

Rising numbers of people with multiple health problems

NHS unable to cope, experts warn

Having several medical conditions is no longer just a feature of old age, as most patients with multiple illnesses are under the age of 65, according to new research.

The NHS will need “radical change” to cope with the rising number of people suffering from multiple  health conditions, researchers said.

The team analysed data on 40 chronic illnesses from a database of 1.75 million people registered with 314 medical practices in Scotland.

They found that two in five patients (42%) had one or more health conditions, while nearly a quarter (23%) had two or more, known as multimorbidity.

Although the prevalence of multimorbidity increased with age and was present in most people aged over 65, the absolute number of people with multimorbidity was higher in the under-65s.

The study also found that people living in the most deprived areas developed multiple illnesses some 10 to 15 years earlier than those who lived in the most affluent areas.

The risk of having a mental health disorder also increased with the number of illnesses, the study found. 

Those with five or more physical conditions were around four times more likely to have a co-existing mental disorder while those in deprived areas were twice as likely to have a co-existing mental disorder as those in affluent areas. 

The study authors said that patients such as these require more joined-up care than they get at the moment, where each illness is treated by a different doctor or specialist. As the population ages, the strain on NHS resources could be huge.

The study was led by Bruce Guthries, professor of primary care medicine at Dundee University, Professor Stewart Mercer of Glasgow University and Graham Watt, professor of general practice at Glasgow.

They said: "Existing approaches need to be complemented by support for the work of generalists, mainly but not exclusively in primary care, providing continuity, coordination, and above all a personal approach for people with multimorbidity. 

"To avoid widening inequality, this approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common, and more frequently includes physical–mental health comorbidity."

They also added that this was a problem facing many countries other than Scotland.

Dr Chris Salisbury, from the School of Social and Community Medicine, University of Bristol, commented: The population is ageing, so the proportion of people with several co-existing medical problems is increasing rapidly. 

"Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. 

“This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways."

He added that those with multimorbidity should be assigned to a generalist consultant who would be responsible for coordinating their care.

This article was published on Thu 10 May 2012