In Lambeth, just one person out of every five people who has diabetes only has diabetes.

That is to say, living with many long-term illnesses - chronic conditions like hypertension, coronary heart and kidney disease - is increasingly the norm. Less and less is the question about how do you deal with one condition in isolation, but rather how do you deal with a number at a time, often which interact in complicated ways.

And we believe this has quite profound implications for how all of us should be thinking about health.
 

Why we care about the issue 

Multi-morbidity is one of the biggest emerging health challenges in the UK. That's for three reasons: because of cost, because it's poorly understood; and because it is unequally distributed.

First, left unaddressed, this really does have the capacity to bankrupt our public finances.

Tackling long-term conditions makes up for 70% of all NHS spending in England. In Lambeth and Southwark, the average cost to the NHS of treating somebody with one long-term condition is £2,000. The average cost of treating somebody with five long-term conditions is £21,000. And that's just the cost to the NHS; not employers, families or other statutory services.

Second, and more troubling still, it is not well understood. By way of comparison with another complex health issue we focus on - childhood obesity - multiple-long term conditions has has less than 20 really high quality international research studies. Childhood obesity has well over 100.

Third, and what is perhaps most motivating about this issue, is that it is unequal. We know that in Lambeth and Southwark, people in the poorest areas are developing long-term conditions at least 10 or 15 years earlier than people in richer areas. And once they do, they progress more quickly from one condition to multiple conditions. Black and minority ethnic communities, and those suffering from poor mental health, are also disproportionately affected.

In short, people may be living longer, but they are not living well - particularly in diverse and deprived areas.

And as an organisation focused on urban health and on one of the country’s leading NHS Foundation Trusts, we want to do something about that.
 

What we hope to achieve

So what can even one of the largest place-based foundations do about this? Well, much more in partnership than we can achieve alone.

We hope to connect with partners who can help us build the evidence-base on what works in improving the lives of people with multiple long-term conditions. Our programme model suggests to us this will require four things:

• Working across sectors: multiple long-term conditions are a huge health issue, but it would be a mistake to see them purely as a healthcare challenge. Arguably they are as much about care, housing, employment and, ultimately, social capital. This requires a much wider set of partners, potentially working together in new and different ways
• Linking closely with communities: our work in health tells us that context matters, especially when looking to bring in ideas from elsewhere or scale up promising local activities. At the beginning of our programme, we therefore plan to focus much of our work with a few communities to really understand where we can make most progress
• Effectively using data: over many years, Lambeth and Southwark have developed some of the best data in the UK on the prevalence of multiple-long term conditions, albeit with important gaps to address. These data give a unique platform to build from in understanding risk factors and distribution in urban, diverse and deprived environments - insights which could be of relevance in many other places
• Intervening early: most work on multiple long-term conditions rightly prioritises addressing acute need, often through new models of person-centred coordinated care. We can go further than that. Our programme will be focusing much of its energy on understanding how people progress from one condition to many, and what can be done to slow this down

So: not a small challenge, but a crucial one, and an area we will be focusing on for many years.

If you would like to help us in this work then we’d be delighted to hear from you. The easiest way is to contact us through our website, or send an e-mail to our Programme Director Mike Wright.