The world has changed beyond recognition since the NHS was founded nearly 70 years ago. The challenges are unprecedented. They are born out of the success of science.
Science has helped to defeat or contain many diseases that used to shorten our lives. This success has come at a cost. Now, rather than medicine primarily fighting viruses and bacteria, we are struggling against ourselves, against our own bodies’ responses to plenty – diabetes, heart disease, high blood pressure.
Although we are able to help people live longer, we cannot yet stop the ageing process. Problems with the cardiovascular, and musculoskeletal system become increasingly common as we age, as do digestive difficulties, memory problems, diabetes, cataracts, joint issues. I could go on, and on.
But what happens when patients present with numerous healthcare problems? People working in the frontline of health and social care often see patients with several of these diseases of lifestyle or ageing.
The King’s Fund estimates that around 15 million people in England have a long term condition. The number of people with three or more long-term conditions could rise from 1.9 million in 2008 to 2.9 million in 2018.
Multimorbidity is not confined to the old – it is also prevalent among younger people – sometimes linked to lifestyle issues, and frequently associated with mental health problems.
But for those with multiple health problems – maybe as many as eight or nine long-term conditions – it’s not just a question of adding all the different guidelines together. You have to work with patients using professional judgement and shared decision-making. Personalising care for the individual is critical.
To make this clear, and after listening to GPs and others, we have updated and made more prominent our advice to health and social care professionals on how they should use our guidance. Text on the introductory page of each guideline explains its value and its importance in offering patients and service users the best care.
It explains that NICE recommendations have been carefully developed, using the best available evidence, by independent experts. And although the guidance should be fully taken into account, the views of the person being cared for and a doctor’s or other professional’s experience can and should affect decisions about care.
The new text reflects NICE’s changed and broader work in social care and it explicitly flags the importance of the views of the patient or person receiving care. It should help clinicians to use NICE guidance with confidence – balancing their experience, the needs and wishes of the patient, and gold-standard evidence-based recommendations.
70 years after the founding of the NHS, we are living in an age when people will increasingly take responsibility for their own health. This right is enshrined in the NHS Constitution. I believe this can only be good – the more people take control of their health, and the earlier they do it, the better it will be in the long run.
To do that, they have to be at the centre of decisions with expert judgment from health professionals and informed by expert guidance.
Decisions can be guided by bodies like NICE where evidence and expertise have dictated our work; but increasingly the old ways of prescriptive, top-down medicine are dead, as our new guidelines recognise. Now we have to bury them.