Dr Martin McShane, Chief Medical Officer Clinical Delivery, Optum
Jan 15, 2018
The tipping point for me came in a conversation with some General Practitioners a decade ago. As a Primary Care Trust Director of Strategy, I was talking to them about the potential to improve the care of patients with diabetes and reduce costs. One of them looked at me wearily and said, “Martin, our patients don’t have diabetes, they don’t have heart failure, they don’t have COPD, they don’t have dementia. The patients we see every day have diabetes, heart failure, COPD and dementia. We need help dealing with them not just one bit of them.”
I trained in the 1970s. The age for admission to a ‘geriatric ward’ was 65. I remember seeing patients who had uncontrollable hypertension and young men with testicular cancer survival rates of 30-40% (now 90%+). Advances in treatments, technology and public health (especially public health – yes, I used to smoke – everyone did, didn’t they?) have successfully altered the pattern of disease and contributed to demographic change which means the vast majority of us live longer lives. There are half a million more people in the UK over the age of 75 than in 2010 and in another decade it is estimated there will 2 million more. However, the emergence of multimorbidity is dominating health and care expenditure.
Health and care is a human endeavour. It is delivered by human beings for human beings based on a unique feature of the human race – altruism. It blends the humanities and science. I have always felt it a privilege to be invited into people’s lives, informed and equipped by science. The use of data science to help shape the design and delivery of healthcare will inform and equip us to address the problems that the successes of the last 40 years have given us.
The emergence of Population Health Management, as a concept, has reinforced my belief that we need to shift from a focus on condition management to a focus on risk management – for populations and individuals. What are the risks to an individual and how are they best addressed? How do we invest to prevent the emergence of morbidity but also proactively to mitigate its impact on people’s lives? This demands a bio-psycho-social framework of action. It demands team working. It demands the necessity to truly place the individual with their personal and wider social assets as central to care and support. Critically, it demands better information.
We have limited resources to address the needs of individuals within a population. Understanding how best to use them, to best effect, needs to be informed by the best possible data. The NHS and social care are, I believe, uniquely positioned to lead the world. The use of the NHS number gives us the potential to link data and power better health and care. Our inability to link data is, however, sustaining harm to both individuals and our systems of care. Prevention and proactive care means being able to track the value that managing risk delivers for both, individuals and populations.
It is the challenge of using data effectively to change population health that makes me excited to be involved in Guy’s and St Thomas’ Charity’s programme on multiple long-term conditions. It is increasingly becoming the norm that people on our hospital wards and facing ill-health in our communities are affected by more than one chronic condition. It is therefore increasingly vital that we understand more about who is at risk, who is affected and what factors contribute to the development of multiple conditions. The Charity’s work with King’s College London looking at these very issues in the London boroughs of Lambeth and Southwark will no doubt have national relevance. I hope it will help make the case for a new set of measures and a new mindset to meet the challenges of the 21st Century.