Key points

  • As the number of people with multiple health conditions grows, meeting their needs will be one of the biggest challenges facing the NHS. 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.
  • People with multiple conditions often have poorer quality of life, greater risk of premature death, and may need substantial NHS support. But the ability of the NHS to plan care that responds to these needs has been hampered by a lack of information about the conditions that people have and their existing patterns of care.
  • To fill some of the gaps, we analysed data from 2014 to 2016 for 300,000 people in England. We considered 36 health conditions, including physical and mental health conditions, ongoing symptoms such as chronic pain, sensory impairment and substance misuse.
  • We found that one in four adults had 2+ health conditions. This equates to approximately 14.2 million people in England with multiple conditions.
  • People in disadvantaged areas are at greater risk of having multiple conditions, and are likely to have multiple conditions at younger ages. Around 28% of people in the most-deprived fifth of England have 4+ conditions, compared with 16% in the least-deprived fifth. In the least-deprived fifth of areas, people can expect to have 2+ conditions by the time they are 71 years old, but in the most-deprived fifth, people reach the same level of illness a decade earlier, at 61 years of age.
  • Although having multiple conditions is often thought of as being related to old age, 30% of people with 4+ conditions are under 65 years of age, and this percentage is higher in disadvantaged areas. Improving care for people with multiple conditions requires action across the NHS and other sectors, not just services targeting elderly people.
  • People with multiple conditions have multiple consultations and treatments. We found patients with 4+ conditions had an average of 8.9 outpatient visits across 2.8 different medical specialties. Over the study period, they visited their general practice 24.6 times (or once a month on average) and were prescribed 20.6 different medications. This compares with the 2.8 outpatient visits, 8.8 visits to the general practice, and 5.6 different medications for patients with one condition. However, people with multiple conditions did not seem to have significantly longer GP consultation times despite their more complex needs.
  • Our analysis shows that 82% of people with cancer, 92% with cardiovascular disease, 92% with chronic obstructive pulmonary disease and 70% with a mental health condition have at least one additional condition. But clinical strategies to manage care often focus on single conditions.
  • Care for those with 2+ conditions accounts for a large proportion of NHS costs, including over half of the costs of primary and secondary care, and three-quarters of the costs of primary care prescriptions. Over the next 5 years, the rising number of people with multiple conditions is projected to increase total hospital activity by 14% and costs by £4bn. Therefore, a sustainable NHS will need to improve both the quality and cost-effectiveness of care for people with multiple conditions.
  • Given our findings, long-term planning for the NHS needs to have a clear focus on people with multiple conditions. We suggest six key steps to improve care for this group: supporting those with multiple conditions to live well; developing new models of NHS care for those with multiple conditions; resourcing the vital role of primary care; designing secondary care around those with multiple conditions; using data and sharing information to improve care for those with multiple conditions; and evaluating what works.
  • To ensure that everyone has the best opportunity to live a healthy life, urgent cross-government action is needed to tackle the underlying causes of multiple conditions, along with investment in the public services that affect people’s health.