One of the great successes of modern
medicine is… …that an increasing proportion of people are now entering old age… …often with multiple conditions. There’s no reason they can’t live
healthy and independent lives,… …but currently science is much better at
dealing with the needs of people,… …who have a single disease in earlier life
than the complex needs of older people. Now this is going to require a different
way of thinking,… …and it’s going to require multiple sciences from multiple disciplines… …but there is no reason why we can’t improve the health of older people with complex conditions… …and address their health and social needs in the way we have those of younger people with single diseases,… …and has such a success to date. Multi-mobility and complex needs are one of the biggest challenges facing health services internationally… …and it’s important to recognise that’s
the price of success. We’ve become better at stopping people dying of acute illnesses, like heart attack,… …but if they survive, you survive with
chronic illness. So, this isn’t a problem as such, but it’s something health services have to respond to. So, I chaired the NICE ‘Multi-Mobility Guideline Development Group’,… …and as part of that we made research recommendations,… …reflecting that much research has not dealt with this population at all… …and many clinical trials explicitly exclude older people and people with complex needs. We made four research recommendations. So the first was that we needed better ways of predicting life expectancy,… …so that we can more accurately adjust treatment in people with short life expectancy. The second was that we needed new evidence about the effectiveness of holistic assessment… …and intervention in the community. The third was we needed new evidence about the best models of care… …in people with complex needs and reflecting that medicines are a major part of treatment burden. The fourth was that we needed evidence about what happens… …when you stop long-term preventative medicine in people with short life expectancy. This is an extremely important area to the NHS, to patients and to the public… …and will remain so for many years to come. And as evidence of that this is our second call in this area. Some of you will remember that we did a themed call in multi-morbidity a few years ago,… …that attracted some proposals but perhaps not the volume we’d hoped for. So, our second call in this broad area of complex needs and multiple morbidities,… …expresses our determination to ensure… …there are answers for the NHS to the public in this really important area. It also expands the brief a little bit. More than just multiple morbidity,… …but also to reflect how this influences health services management… …and how social care affecting health may play a key role in all of this. The five themes in the NIHR call, which relate to frailty, transitions of care and models of care,… …medicines management, including
polypharmacy, promoting healthy aging… …and patient-centered decision-making. This is a very, very broad agenda and NIHR is open to research which addresses one of these,… …all of these, elements of these and so I’d really emphasise… …that there’s a real opportunity for researchers to be creative… …and imaginative in working with
patients in the public and the NHS… …to come up with really great research ideas. The fifth theme, patient-centred care. I think it’s very important not to see
this as a standalone theme though,… …the guideline development group was very clear… …that we should not be making decisions about treatment or decisions about care,… …without really understanding the values… …and priorities and goals that individual patients and their carers have,… …and so I’m really encouraged that any work be done in this call has to account the patient values,… …patient priority and patient goals. The other thing I think I’d like to emphasize,.. …is that there’s no strict age limit. Although the call talks about complex needs in older people,… …age is not really a chronological thing in this context. So, if you live in very deprived areas, if you have serious mental illness, you have learning disabilities… …these are all populations, and there are others, were life expectancy is much shorter than average… …up to 20 years shorter. You can be old without being chronologically old… …and it’s important researchers are willing and able to submit research,… …which addresses those populations as well. So, if you haven’t had time to put your ideas together yet,… …if you haven’t formed your team
properly,… …this is not a one one for all opportunity, you can come back to us again to our programs in the usual way. So, we’re going to continue to push on
this. So, why do we have a themed call at all if we are interested in this indefinitely? Really, because we’re determined that everyone understands… …this is what we need to address for the future in the NHS and across our programs… …and we really need to kick-start this. We want to fund research in these areas. We hope that research will stimulate more research,… …not just as follow on star research but promote other bright ideas, identify other interventions… …that we need to trial and generally create a groundswell of activity in this area,… …which really has been underrepresented over many years,… …because the areas we’re dealing with don’t fit neatly into single categories… …and we don’t have, perhaps, enough research from generalists in this area, both medical and non-medical. So, are really keen that this should be multidisciplinary,… ….but it’s a direction of travel for all our programs… …and one we’re determined to follow
through. So, it’s really important if you’re submitting a bid to this call,… …that you actually go and read the brief… …and the brief summarises very clearly
what it is we want. I would reiterate Bruce’s comment that this is not just about very old people,… …because multiple morbidity and complex care needs occur at every age. We need to address that as a problem for the NHS not just in older patients. But I really hope that you’re going to be stimulated by this call and submit lots of applications to us,… …at the end of the day, we can actually fund.