Michael Wright, Programme Director, Guy's and St Thomas' Charity
Sep 19, 2017
At the end of 2016, I was asked to lead the development of a programme on multiple long-term conditions here at the Charity. It has been a voyage of discovery for me. How do you get to grips with one of the greatest challenges facing medicine and society today?
The figures speak for themselves: in the UK, one in five people live with one or more long term conditions and one in twenty live with three or more. We all almost certainly live on a street or in a tower block where people with several chronic conditions also live. Do we know who they are? How they live their lives? Whether there is anything in our power to help them live their lives to the full?
We usually think that people living with long term conditions are old, that it is an inevitable consequence of life… It happens to us all in the end, doesn’t it?
It is true that the number of people with long-term conditions increases with age. However, an increasing number of young people are also acquiring and living with multiple long-term conditions. The most recent data for Lambeth and Southwark shows over 25,000 men and women under the age of 35 are living with one or more long term conditions. The data leads us to believe that, unless we act, an ever-increasing number of young people will live their lives with multiple long-term conditions.
The reasons why more younger people are living with long-term conditions are not entirely clear, however we know that earlier onset is particularly prevalent in deprived areas (you can read more about the disproportionate impact of the issue on diverse and deprived communities in this blog by our Chief Executive, Kieron Boyle).
When talking about what’s important to them, they are less likely to talk about having access to more professionals or medications, and more about spending time with their husband of 45 years or their favourite past-time. When asked about what support they want, they speak of being able to cook more or go on a beach holiday, the first in decades.
The most important lesson is that addressing multiple long-term conditions is not exclusively about tackling ill health. It is about understanding what matters to people living with them, which is unsurprisingly the same as what matters to any of us: our lives, friendships, relationships; what we’d like to be able to do, and what is done to us and for us.
There has been a plethora of national policies, announcements and outcomes frameworks that have sought to influence the debate on multiple long-term condition management. I mentioned some of the approaches we’ve looked at in my previous blog.
The NHS Outcomes Framework and the Adult Social Care Outcomes Framework in 2014-15, and more recently the 2016 NICE Guidelines, all talk of supporting people with long-term conditions to live healthy and independently, and taking into account their wants and goals.
Progress is being made, but change is hard. It is clear to us that working to develop and deliver the services and support that people need will require multiple agencies to work together, from the NHS to social services, local authority housing and employment teams, Job Centre Plus, the voluntary sector, citizens and many others.
We have decided to focus our approach on three key aspects: identifying those at risk of developing multiple long-term conditions, intervening early to slow down progression and improving the care of those who already live with several chronic health conditions. You’ll find more about our model and what we want to achieve in Kieron’s latest piece.
A key part of our work will be understanding why some communities are more affected than others and how to minimise risk factors, learning what works and sharing this knowledge. If we are to impact on the lives of people living with multiple long-term conditions, then we will need to work with communities and the places where people live and spend the majority of their time.
This is a new experience for us, we will need to build the trust and confidence of those communities with whom we will engage. We plan to do this from a place of openness, and a willingness to build partnerships for the long term, and to work and learn together.
23 April, 2020
As a funder, our priority is to support our partners and the communities most affected by COVID-19. Our Portfolio Director, Louise Mousseau, sets out the actions we've taken to date and how we're adapting our work in response to a changing environment.
25 February, 2020
Our Programme Director for multiple long-term conditions, Barbara Reichwein, reflects on persisting health inequalities ten years on from the Marmot Review.