What is Multimobidity?

A couple of months back, we posted about the NICE scoping consultation on multimorbidities (a combination of two or more diseases or long-term conditions, where none of the conditions dominates).

Why is this important?

The recent Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) and other national and international studies suggest that people with learning disabilities have a greater number of health problems than others, and a greater variety of healthcare concerns than those of the same age and gender in the general population.

This would suggest that particular attention must be paid to this population in any NICE guidance. Indeed, recommendation 3 of the CIPOLD report was that NICE guidance should take into account multimorbidity in relation to people with learning disabilities.

Why were people with learning disabilities excluded?

The draft scope in its first iteration simply stated – ‘Identification and management of specific morbidities associated with learning disabilities’. No justification for this exclusion is given.

Key Issues

This raises four issues:

1. What does ‘associated with’ mean in practice, and what would be the threshold for a disorder to be ‘associated with’ learning disabilities?
2. Some people with the same condition (e.g. autism, cerebral palsy) may or may not have learning disabilities. As it stands, the NICE Guidelines would include people with autism and associated multimorbidity who do not have learning disabilities, but would exclude people with autism and associated multi-morbidity who do have learning disabilities. Clearly, this would be a nonsense.
3. No other groups with protected characteristics under the Equality Act 2010 are excluded.
4. No other groups of people with conditions that themselves have associated comorbidities are excluded.

New draft scope now includes people with learning disabilities

NICE has thankfully listened to the views of a range of organisations and individuals about the inclusion of people with learning disabilities in these guidelines. In the draft scope people with learning disabilities were explicitly excluded – in the final scope they are, rightly, now included.

The consultation process on the draft scope of the guidelines has highlighted how we need to be alert and ready to respond to the unfair and unjust treatment of people with learning disabilities at every level.

One question this raises is the way in which Equality Act implementation is being monitored – should the equality delivery system have picked this issue up?

Key question – Where was the leadership in the Department of Health and NHS England?

Of particular concern is that both the Department of Health and NHS England reported to the scope consultation group that they had ‘no substantive comments to make, regarding this consultation.’

When those in leadership roles are oblivious to the blatant discrimination proposed by the draft scope of the guidelines the only hope we have is for rigorous scrutiny of such consultations by organisations and individuals committed to the support of people with learning disabilities and the protection of their rights.

It is important that we do not underestimate the continuing need for our own role in this.