The case for change
The burden of chronic disease is large and growing
In England, in 2019, 7.6 million people in England aged 60-99 were living with one or more of the most common long-term conditions (diabetes; chest & breathing problems; heart, blood pressure, circulation problems). Add in the cohort aged 16-59 and the total is 12.0 million people. [ONS, 2021]
The UK population aged 60 – 99 years will increase by 19% to 19.6 million in the decade to 2030. In this same decade, the population aged 85+, who use health and social care services much more intensively, will increase by 28% to 2.1 million. [ONS, 2021; Statista, 2022]
People living with long-term conditions consume a high proportion of healthcare resources: this will only increase if a new model of care is not successfully introduced. Data from General Lifestyle Survey 2009: people with long-term conditions account for:
- 50% of GP appointments
- 64% of hospital outpatient appointments
- 70% of hospital bed-days
- 70% of total health and social care spend
Health and Care systems do not have sufficient capacity
“112,000 vacancies across the NHS workforce in March 2023 (8% vacancy rate).
“The workforce shortfall across NHS organisations will grow to between 260,000 to 360,000 FTEs by 2036-37.” [NHS England, Workforce Plan, 2023]
The number of patients (in England) waiting to start treatment stood at 7.4 million. [NHS England, April 2023]
Emergency departments have not met statutory 4-hour waiting times in any month since July 2015.. [King’s Fund, May 2022]
Deprived and rural communities are hit especially badly
“People experiencing health inequalities develop long-term conditions earlier, accumulate them faster and live with them longer. This leads to a loss of productivity and higher healthcare expenditure.” [NHS England, Workforce Plan, 2023]
“The increase in demand from an ageing population is not uniform across the UK, but concentrated outside metropolitan areas and in particular rural areas. In 2037, a third of people aged over 85 will be living in rural communities like Cornwall, Somerset, Cumbria and North Yorkshire, compared to a quarter now. On current trends, by 2037, two-thirds of those over 65 will have multiple health conditions, and a third of those people will also have mental health needs. [NHS England, Workforce Plan, 2023]
“Onset of multimorbidity occurred 10–15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health. The presence of a mental health disorder increased as the number of physical morbidities increased and was much greater in more deprived than in less deprived people. [The Lancet, May 2012]
The most deprived people spend twice as many years in poor health before they die than do the most affluent.” [The Lancet, May 2012]
Multimorbidity and physical-mental comorbidity is disproportionately associated with lower economic status – and with increased rates of GP consultations, prescriptions and hospitalisations. [BJGP, April 2018]
There needs to be a shift towards chronic conditions and preventive care
“The current NHS workforce largely concentrates on responding to care and health needs rather than prevention. The NHS Long Term Plan identified the service changes needed to deliver an NHS fit for the 21st century. These include boosting primary and community care, focusing on population health, integration and prevention, …” [NHS England, Workforce Plan, 2023]
“…we will need to continue the shift over the coming years away from episodic care, towards a newer paradigm of ongoing, chronic care to support the increasing number of people with multimorbidity, frailty and complex needs.” [NHS England, Workforce Plan, 2023]
“We ask systems to work together to…expand evidence-based approaches to population health, focusing on…prevention, self-care and better management of long-term conditions.” [NHS England Priorities and Operational Planning Guidance 2024-25]
Unpaid Carers and VCSEs are an important part of the solution
There are some 4.7 million unpaid carers in England: ~9% of the population aged >5 years. The percentage is higher in the most deprived areas of the country. [ONS Census 2021].
One in seven carers are also juggling care responsibilities with employment. [Carers UK]
One in three NHS staff are also unpaid carers. [NHS Staff Survey 2022]
But this is a fragile resource:
- 60% of carers report having a long term condition or disability [Carers UK]
- 80% of carers say that caring has had a negative impact on their health
- Carers need support in their caring role and in maintaining their own physical and mental health
