Understanding the health care needs of people with multiple health conditions

The Health Foundation | November 2018 | Understanding the health care needs of people with multiple health conditions

Meeting the needs of people with multiple conditions at the same time as the NHS
is treating more patients than ever is a complex challenge. Preventing people from
developing conditions or delaying the onset of conditions will have the greatest benefits for individuals, their families, the economy and the NHS.  New research published by The Health Foundation demonstrates the importance of linking anonymised NHS data across primary and secondary care to gain greater insight into people’s care.


  • Analysis of data in the period between 2014 to 2016 of 300,000 people in England found that a quarter of adults (25%) had 2+ health conditions, equivalent to approximately 14.2 million people in England.
  • More than half (55%) of hospital admissions and outpatient visits and three quarters (75%) of primary care prescriptions are for people living with 2+conditions.
  • Those who live in the  most affluent 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.

To improve care for people with multiple conditions it is critical that the NHS long-term plan identifies and addresses the complexity of their needs. The report sets out six steps the NHS could take to achieve this.

These are:

  • supporting those with multiple conditions to live well, for example by investing in
    self-management support for people with multiple conditions
  •  developing new models of NHS care for those with multiple conditions
  • resourcing the vital role of primary care, particularly in deprived areas
  •  designing secondary care around those with multiple conditions
  • using data and sharing information to improve care for those with multiple
    conditions, including greater data linkage
  • robustly evaluating what works.

Key points

  • Analysis of data from 2014 to 2016 for 300,000 people in England found that one in four adults had 2+ health conditions, equating to approximately 14.2 million people in England.
  • Over half (55%) of hospital admissions and outpatient visits and three quarters (75%) of primary care prescriptions are for people living with 2+conditions.
  • 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 (Source: The Health Foundation).

    Read the full report from The Health Foundation 

Are we failing people with learning disabilities? A fair, supportive society: summary report

University College London | November 2018 |Are we failing people with learning disabilities?

A new report published by UCL’s Institute of Health Equity (IHE) highlights that  40 per cent of children with a learning disability remain undiagnosed and that adults with learning disabilities will die 15-20 years earlier (on average) than the general population which is 1,200 premature deaths each year.


Responding to the findings Sir Michael Marmot , director of IHE said:

“This is a direct result of a political choice that destines this vulnerable group to experience some of the worst of what society has to offer: low incomes, no work, poor housing, social isolation and loneliness, bullying and abuse.

“A staggering 40% of people with learning difficulties aren’t even diagnosed in childhood. This is an avoidable sign of a society failing to be fair and supportive to its most vulnerable members. We need to change this. The time to act is now.”

The IHE makes a number of actions and 11 recommendations to improve life expectancy for people with disabilities.  (Source: UCL)

Read the IHE paper 

Easy read version 
In the media:

Guardian Two in five people with learning disabilities not diagnosed in childhood

Study finds North-south divide in early deaths deepening

University of Liverpool| November 2018 | Study finds North-south divide in early deaths deepening

Data analysed as part of new research into the excess mortality and socioeconomic deprivation  reveals a profoundly concerning gap in mortality between the North and the South, especially in men.  The researchers involved from Keele, Liverpool, Manchester and York universities, looked into mortality rates in 5 most northerly government regions (Yorkshire and Humber, North East, North West, East Midlands West Midlands) and 5 most southerly government regions ((East of England, South Central, South West, South East, and London).  Using data from the Office of National Statistics (ONS) they aggregated and compared the northern and southern regions between the years 1981 and 2016. 



The study found that:

• Accounting for age and sex, northerners aged 25-44 were 47% more likely to die from cardiovascular reasons, 109% more likely to die from alcohol misuse and 60% more likely from drug misuse, compared to southerners.

• London had the lowest mortality rates, with the North East having the highest, even after adjusting for age, sex and socio-economic deprivation.

• Suicide among men, especially at ages 30-34, and cancer deaths among women were also important factors.

• National cardiovascular death rates declined over the study period, though the North – South gap persists.

The study also revealed that, although there was little difference between early deaths in the North and the South in the 1990s, by 2016 a gap had opened up nonetheless.

(Source: University of Liverpool)

The study has now been published in the Lancet Health 



Since the mid-1990s, excess mortality has increased markedly for adults aged 25–44 years in the north compared with the south of England. We examined the underlying causes of this excess mortality and the contribution of socioeconomic deprivation.


Mortality data from the Office of National Statistics for adults aged 25–44 years were aggregated and compared between England’s five most northern versus five most southern government office regions between Jan 1, 1981, and Dec 31, 2016. Poisson regression models, adjusted for age and sex, were used to quantify excess mortality in the north compared with the south by underlying cause of death (accidents, alcohol related, cardiovascular disease and diabetes, drug related, suicide, cancer, and other causes). The role of socioeconomic deprivation, as measured by the 2015 Index of Multiple Deprivation, in explaining the excess and regional variability was also explored.


A mortality divide between the north and south appeared in the mid-1990s and rapidly expanded thereafter for deaths attributed to accidents, alcohol misuse, and drug misuse. In the 2014–16 period, the northern excess was incidence rate ratio (IRR) 1·47 for cardiovascular reasons, 2·09 for alcohol misuse, and 1·60 for drug misuse, across both men and women aged 25–44 years. National mortality rates for cardiovascular deaths declined over the study period but a longstanding gap between north and south persisted in 2016 in the north vs from 23·5 to 9·9 in the south. Between 2014 and 2016, estimated excess numbers of death in the north versus the south for those aged 25–44 years were 1881 for women and 3530 for men. Socioeconomic deprivation explained up to two-thirds of the excess mortality in the north. By 2016, in addition to the persistent north–south gap, mortality rates in London were lower than in all other regions, with IRRs ranging from IRR 1·13 for the East England to 1·22  for the North East, even after adjusting for deprivation.


Sharp relative rises in deaths from cardiovascular reasons, alcohol misuse and drug misuse in the north compared with the south seem to have created new health divisions between England’s regions. This gap might be due to exacerbation of existing social and health inequalities that have been experienced for many years. These divisions might suggest increasing psychological distress, despair, and risk taking among young and middle-aged adults, particularly outside of London.
Full reference: Kontopantelis, E., Buchan, I., Webb, R. T., Ashcroft, D. M., Mamas, M. A., & Doran, T. |2018| Disparities in mortality among 25–44-year-olds in England: a longitudinal, population-based study| The Lancet Public Health|DOI:https://doi.org/10.1016/S2468-2667(18)30177-4



Britain’s High Streets are getting unhealthier

New report finds Britain’s High Streets are getting unhealthier, with a clear link between deprived areas and unhealthy High Streets | Royal Society for Public Health

In 2015 the Royal Society for Public Health (RSPH) published the report ‘Health on the High Street’. The publication looked at the impact of different outlets on health and the potential cumulative effect these outlets could have on a local population. This report seeks to rerun the analysis to assess whether there has been much change in the last three years.

high street
Image source: http://www.rsph.org.uk

Based on the findings, the Royal Society for Public Health has ranked 70 of Britain’s major towns and cities by the impact of their high streets on the public’s health and wellbeing. The rankings are based on the prevalence of different types of businesses found in the towns’ main retail areas and rate Grimsby as having the unhealthiest high street, with Edinburgh coming out as the healthiest.

The top 10 “unhealthiest” British high streets were ranked as being in Grimsby; Walsall; Blackpool; Stoke-On-Trent; Sunderland; Northampton; Bolton; Wolverhampton; Huddersfield; and Bradford.

The top 10 “healthiest” British high streets were ranked as Edinburgh; Canterbury; Taunton; Shrewsbury; Cheltenham; York; Brighton & Hove; Eastbourne; Exeter; and Cambridge.

The RSPH said that average life expectancy for people living in areas with the top 10 healthiest high streets was two and a half years longer than for those in the 10 unhealthiest ranked areas.


The report makes the following recommendations that aim to inject new life into our high streets:

  • HM Treasury to review how businesses are taxed to ensure that online businesses are not put at an unfair advantage compared to the high street
  • Facebook and Google to provide discounted advertising opportunities to local, independent health-promoting businesses
  • Local authorities to support meanwhile use of shops by making records on vacant commercial properties publically accessible
  • Vape shops to ensure all customers who smoke are aware of their local stop smoking service
  • Councils to set differential rent classes for tenants based on how health-promoting their business offer is
  • Business rates relief for businesses that try to improve the public’s health
  • Industry and all businesses selling food on the high street – cafés, pubs, fast food outlets, convenience stores, leisure centres – to reduce the calories in their products
  • The Ministry of Housing, Communities and Local Government (MHCLG) to provide local authorities with the power and support to restrict the opening of new betting shops and other unhealthy outlets where there are already clusters
  • Local authorities nationwide to introduce A5 planning restrictions within 400 metres of primary and secondary schools

Full report: Health on the High Street: Running on empty | RSPH


Early deaths twice as common in most deprived parts of England

People in the most deprived parts of England are twice as likely to die prematurely as those in the wealthiest areas, according to research on UK inequality | The Lancet


A study published in The Lancet has looked at death and disability rates across the UK in the period 1990 to 2016. This data was then compared them to life expectancy data to establish how many years were lost to people dying young or living with life-limiting physical and mental health conditions.

This assessment of health across the country revealed a stark division between rich and poor areas, with poorer people dying earlier and getting sicker quicker. The report identifies that over half of premature deaths are linked to behavioural risk factors including tobacco use, obesity, alcohol and drug use.

Full reference: Steel, N. et al. | Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 | The Lancet | published October 24, 2018

See also: Early deaths twice as common in most deprived parts of England, study shows | The Independent


Public health grant funding gap

Taking our health for granted: plugging the public health grant funding gap | The Health Foundation 

This briefing paper assesses the extent of cuts to the public health grant since 2014/15 and projects the amount required per year to plug the funding gap that now exists is £3.2 billion. It highlights that cuts have not protected areas with the greatest deprivation or need. At a time of ongoing wider cuts to public services that directly impact on people’s health, and with the NHS under pressure, this approach risks widening health inequalities.

Full briefing: Taking our health for granted: plugging the public health grant funding gap

Additional link: Health Foundation press release

Health profile for England: 2018, current and future state of nation’s health revealed

Public Health England | September 2018 |Current and future state of nation’s health revealed

PHE has published a new Health Profile for England report giving the most comprehensive picture of the health of England today and into the future. It is the second annual report combining data and knowledge with information from other sources to give a broad picture of the health of people in England in 2018.

joe public.jpg

It covers:

  • population change and trends in life expectancy
  •  trends in mortality
  • trends in morbidity and risk factors
  • health of children in the early years
  • inequalities in health
  • wider determinants of health
  • current and emerging health protection issues
  • Methods, data and definitions

Download each chapter of  the report from Public Health England 


In the news:

BBC News England facing ‘changing health needs’

Sky News Poorest in England suffer ‘avoidable and unfair’ health inequality – report

Onmedica  UK women’s health lags behind much of Europe