The NHS faces a mismatch between demand and resources. This has led to year-round pressures on emergency departments and less visible, but very real, pressures on primary and social care. The extra £20.5bn promised by the government for the NHS in England, while substantial, is only what is required to maintain current levels of care. But demand and cost pressures are likely to increase over the next 5 years.

The increased demand is largely due to two factors: our ageing population and a rise in the number of people living with conditions such as diabetes, cardiovascular disease, and depression. Not only are more people living with health conditions, more people have multiple conditions. The number of people in England with 4+ conditions is predicted to double between 2015 and 2035. In many ways, this is good news: more people are surviving diseases like cancer, stroke and heart disease because of better treatment and therefore living longer. However, this means that people are living with these health conditions, as well as others that arise as they age. The effects of this change are evident across the health care system. For example, the biggest growth in emergency admissions has come from those with multiple conditions. In 2006/07, one in 10 patients admitted to hospital as an emergency had 5+ conditions. In 2015/16, the figure was one in three. Patients with multiple conditions stay longer in hospital and are more likely to be readmitted when finally discharged.

The effects of living with multiple health conditions can be profound. People with multiple conditions have poorer quality of life, difficulties with everyday activities, and greater risk of premature death.,,,, When people talk about the impact of their conditions on their daily lives, some report a loss of mobility, resulting in isolation. The demands of their conditions sometimes do not allow them to remain in work, leading to financial hardship and the loss of valued jobs and colleagues. This then exacerbates inequalities, with loss of income and worklessness contributing to further declines in health. There is a danger that, without action, worsening socioeconomic inequalities will further concentrate this trend among the most disadvantaged.

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