Paper of the Week: 5th February 2020

This week’s blog is brought to you by: Professor Sir Muir Gray

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Full reference and title from the journal:

Whitty al 2020, BMJ 2020;368:l6964 doi: 10.1136/bmj.l6964 (Published 6 January 2020)

Link to paper:

The paper’s bottom line

“Cluster medicine the shift includes moving from thinking about multimorbidityas a random assortment of individual conditions to recognising it as a series of largely predictable clusters of disease in the same person….Continued increases in healthy longevity depend on this different model. Clustering of diseases, and how we might better tackle management of coexisting physical and mental health problems, should be embedded into medical training and continuous”

3vh bottom line

The Third Dimension of Healthcare is getting clearer with the recognition of multimorbidity.

3VH commentary on the Implications for value improvement 

For decades  health services have been managed along two dimensions, one dimension has been the bureaucratic dimension, the names of which change with each structural re-organisation into a bewildering new set of initials, currently  ICSs , ICPs, PCNs in NHS England. These are necessities but by themselves bureaucracies cannot deliver complex care. The second dimension is the levels of care, ranging from self care to tertiary, or super specialist care, again necessary but not sufficient.

The Third dimension is the population dimension, not the whole population but the sub groups of the population defined by need, for example people with respiratory disease or people in the last year of life but one of the weaknesses has been the fact that secondary care is not a single coherent group a number of craft groups or specialities, largely defined along the lines of the ICD, with the notable exception of geriatric and general medicine. However the call from this very influential group in our Paper of the Week  recognises the importance of multimorbidity, and also recognises a number of clusters within that concept, This is is very welcome, and there is a taxonomy that could be used to align resources  – the Bridges to Health taxonomy

We now need health services to be managed, and the budgets to be realigned, and the clinicians given responsibility for the stewardship of those resources to create 3D healthcare.