Intended for healthcare professionals


Major conditions strategy needs more support to be achievable, say health leaders

BMJ 2023; 382 doi: (Published 15 August 2023) Cite this as: BMJ 2023;382:p1883
  1. Adrian O’Dowd
  1. London

Plans to have a major conditions strategy for England that covers multiple serious conditions with a more preventive and earlier diagnosis approach will require more support to make it happen, according to health experts.

The government published an interim report1 on its still to be finalised major conditions strategy on 14 August in which it outlined some of the messages it has received from a call for evidence launched in May.

The strategy, which is expected next year, will be a five year blueprint designed to tackle the main causes of ill health and early mortality, focused on six disease groups—cancer, cardiovascular disease (including stroke and diabetes), chronic respiratory diseases, dementia, mental health conditions, and musculoskeletal conditions.

The interim report says that together the conditions account for more than 60% of ill health and early death in England and increasing numbers of people have multiple long term conditions. Evidence suggested that by 2035, two thirds of adults aged over 65 would have two or more conditions and 17% would have four conditions or more. In addition, people with two or more conditions account for around 50% of hospital admissions, outpatient visits, and primary care consultations, over half of NHS costs and around three quarters of the costs of primary care prescriptions.

The government wants to focus on improving the health of the population through “lifestyle drivers” such as schemes that encourage physical activity, early diagnosis, and other preventative action including NHS health checks and weight management programmes.

In the report’s foreword, England’s health and social care secretary Steve Barclay said, “This wide ranging engagement has provided food for thought.

“We have heard how our citizens are not always empowered to live as healthily as they could, how people can find it difficult to navigate a fragmented system, and that our present services are not always well placed to support people with more than one risk or condition.”

Health experts welcomed the direction of the strategy so far, but had some concerns about how much the health service would be supported to make it happen.

The Nuffield Trust’s senior policy analyst, Sally Gainsbury, said the government was right to focus on the six conditions, but added, “The health and care system will need to shift more of its focus towards primary prevention, early diagnosis, and symptom management.

“What’s less clear is how government will support health and care systems to do this in the context of severe pressures on staff and other resources, as well as a political culture that tends to place far more focus on what happens inside hospitals than what happens in community healthcare services, GP practices, and pharmacies.”

Danny Mortimer, deputy chief executive of NHS Confederation, which represents NHS organisations, said that the premise of using prevention to improve care for people was welcome, but he was concerned that the government was stepping back from some of its previous promises.

“The cross-government strategy on mental health was, for example, also absorbed into this work and was critical to shifting the dial to focus on prevention and aimed to make services more sustainable in the future. Worryingly the government is currently only committed to providing mental health support teams in just over one in four schools,” he said.

Association of Directors of Public Health president Jim McManus said, “Preventative action remains better than cure for people’s health, the NHS, and the economy.

“While public health and the work of local authorities is mentioned throughout the report, directors of public health, who are responsible for the health of their population and provide leadership for its improvement and protection, have disappointingly not been acknowledged.”