Director of Public Health Annual Report 2012 [pdf] - Stoke-on-Trent ...

Long-term conditions chapter
LTCs are significantly more prevalent among the more deprived city residents and, as
mentioned earlier, include mental health and coronary heart disease. In the individual patient
multimorbidity is now the norm rather than the exception. Management <strong>of</strong> several chronic
diseases in one patient is the most important challenge facing health and social care
services today. Although multimorbidity is related to age and is commonly found in the
elderly, there are numerically more people with more than one chronic condition under the
age <strong>of</strong> 65.
Prevalence increases with deprivation, to the extent that people in deprived areas have the
same frequency <strong>of</strong> multimorbidity as more affluent patients who are up to 15 years older 13 . In
addition, physical and mental health multimorbidity is almost twice as common in the most
deprived as in the most affluent areas. These findings are highly relevant to <strong>Stoke</strong>-on-Trent,
and do much to explain the reduced quality <strong>of</strong> life and worse health outcomes present in the
city’s deprived areas.
Since the population is ageing and the proportion <strong>of</strong> people with multimorbidity is rapidly
increasing, ever increasing financial pressures are being generated. Therefore, it is clear
that LTCs need to be managed more efficiently. It is also necessary to alter the mindset and
approach <strong>of</strong> practitioners who are trained to deal with single disease-specific situations. The
whole patient concept is essential in order to minimise the expectation for the person with
several chronic conditions to attend several different clinics. The proper co-ordination <strong>of</strong> care
promotes cost savings, efficiency, effectiveness and patient satisfaction.
This chapter raises further issues that invite comment. There is no agreement on definition.
If musculoskeletal conditions were included, this would significantly increase the numbers <strong>of</strong>
affected people. They are not included in the <strong>Stoke</strong>-on-Trent data presented. While
hypertension is shown as the most frequent LTC across the city, other authorities may not
include this condition. So, for consistency and comparison purposes, there is clearly a need
to agree on definition. Costs are rightly highlighted but again, once we have an agreed
definition, it will be useful to collect and analyse future economic data. While NICE guidance
is always useful, it tends to be geared towards disease specific conditions, whereas what we
need is more on multimorbidity. Perhaps we also need to focus more on an available and
effective peer support system that can comfort and further inform the patient with LTCs.
This could include the champions support approach. We require improved recording <strong>of</strong>
ethnicity since, as already described, there is an increased prevalence <strong>of</strong> coronary heart
disease and chronic liver disease in some minority ethnic groups. It would be useful to have
a detailed audit <strong>of</strong> nursing homes so that the challenges faced by social services could be
better appreciated. Again, an audit <strong>of</strong> hospital admissions for LTCs should be done so that
lessons can be learnt. We need to identify LTCs much earlier and delay the deterioration <strong>of</strong>
health that removes the patient from an independent existence. Probably an outcomes
based approach could improve earlier detection and management <strong>of</strong> LTCs. In conclusion,
from the perspective <strong>of</strong> social care and health services, it is clear that we need a resource
shift away from costly institutional and acute care towards prevention.
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