Introduction

The health gains experienced over the past 50 or so years are now presenting health systems around the world with a new challenge: how best to support people with long term conditions. An ageing population is testimony to improvements in public health through improved housing, sanitation and diet, and better health services—resulting in more patients surviving previously fatal events like serious infections but creating increasing numbers with long term conditions (fig 1). Over the past few years the British government has responded to issues that are foremost in the minds of the electorate, such as access to specialist services, especially in patient waiting times. This has evidently paid off.1 Now the NHS is waking to the challenge of chronic diseases. The NHS Improvement Plan, launched in June 2004, outlined the importance of supporting people with long term conditions. In the foreword, John Reid, the secretary of state for health, outlines how a “major investment in services closer to home will ensure much better support for patients who have long-term conditions, enabling them to minimise the impact of these on their lives.”2 We discuss how the NHS might rise to this challenge.

The scale of the problem

Analysis of the British household panel survey (2001), the health survey for England (2001), and general household survey (2002) has given us a great insight into how long term conditions affect people in England.3^–5 The data show that:

• Around 6 in 10 adults in the household population …