People Living With Long Term Conditions

• Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes, chronic obstructive pulmonary disease, arthritis and hypertension.
• About 26 million people in England have at least one Long Term Condition (LTC).
• 10 million have two or more LTCs, 1 million with frailty, 0.5 million at end of life.
• There’s a three-fold increase in cost of health care for those with frailty.
• 15% of young adults aged 11-15 have an LTC.
• Only 59% of people living with LTCs are in work, compared with 72% of the general population.

• SNEE has a higher prevalence than the England average for a number of long term conditions, including;
• Hypertension
• COPD
• Heart Failure
• Atrial Fibrillation
• Asthma
• The trend for the majority of them shows an increase
• Possible reasons for high prevalence may include the comparatively older age profile found in Suffolk and North East Essex, or that clinical services are more successful at identifying and diagnosing these conditions

• Heart and circulatory disease is an umbrella term for all diseases of the heart and circulation.
• It includes everything from conditions that are inherited or that a person is born with, to those that are develop later, such as coronary heart disease, atrial fibrillation, heart failure, and stroke
• There are around 6.4 million people living with CVD in England – an ageing and growing population and improved survival rates from heart and circulatory events could see these numbers rise still further
• Heart and circulatory diseases cause a quarter (25 per cent) of all deaths in England; that’s nearly 140,000 deaths each year – an average of 375 people each day or one death every four minutes.
• Around 80 per cent of people with heart and circulatory diseases have at least one other condition
• risk of diabetes increases among people from white ethnicities aged over 40 years old and among people from African-Caribbean, Black African and South Asian ethnicities aged over 25 – type 2 diabetes is 2-4 times more likely among people of South Asian, African-Caribbean and Black African descent

• Although there has been a substantial reduction in deaths from cardiovascular disease in the past 20 years, it remains the second highest cause of death in England.
• Cardiovascular disease will account for around 1 in 4 of all premature deaths before the age of 75. In 2019, CVD accounted for more than 15% of total disability adjusted life years (DALYs) both locally and for England, making it the second largest disease burden in the country behind cancer.
• Prevention is the ideal, however, early diagnosis, treatment and proactive management can help reduce premature death

For more data http://Cardiovascular Disease – OHID (phe.org.uk)

• Lung disease is one of the top three killer diseases in the UK
• 1 in 5 people in the UK have been diagnosed with a lung disease
• Every day, 1,500 new people are diagnosed with a lung disease
• Somebody dies from lung disease in the UK every 5 minutes
• Approximately one in five people in the UK has ever developed asthma, COPD or another long-term respiratory illness. Half of them are currently on treatment (mainly inhalers) for lung disease.
• Mortality figures are roughly the same as 10 years ago, yet heart disease has fallen 15%
• COPD prevalence in SNEE is increasing in all alliance areas
• Asthma affects one in every 11 people – prevalence is higher than average in SNEE
• More women than men are living with a diagnosed lung disease, while marginally
• More men die from lung disease.
• Lung disease is less common in children than in adults

For more data : http://Inhale – INteractive Health Atlas of Lung conditions in England – Data – OHID (phe.org.uk)

• Over 20 million people in the UK (around a third of the population) live with a musculoskeletal condition, such as arthritis and low back pain. Musculoskeletal (MSK)conditions are more common among females than males.
• Musculoskeletal disorders cause the most years spent in poor health for people aged 50 and over
• The prevalence of back pain for people in SNEE is significantly higher than that for England
• Musculoskeletal conditions account for 3 in 10 GP consultations and over 1 in 4 surgical interventions in the NHS
• The Tendring has the highest prevalence of people with a long term MSK condition, with East Suffolk having the second highest

For more data: http://Musculoskeletal Conditions – Data – OHID (phe.org.uk)

• Liver disease is the biggest cause of death in those aged between 35-49 years old.
• Liver disease is on the rise. Since 1970, deaths due to liver disease have increased by 400%. Every day, over 40 people die from liver disease in the UK. This is in stark contrast to other major killer diseases, such as heart disease and cancer, in which the number of deaths have either remained stable or decreased.
• Liver disease is the third leading cause of premature death in the UK
• 90% of liver disease is preventable
• Three quarters of people are currently diagnosed at a late stage when it is too late for lifestyle changes or intervention
• Most people with liver disease die aged between 18 to 65 years. This makes liver disease the third biggest cause of premature death in working age, with 62,000 years of working life lost every year.

• 90% of liver disease in the UK is due to alcohol, obesity and viral hepatitis and is therefore preventable.
• People who live in more deprived areas are up to six times more likely to die from alcohol-related liver disease than those who live in wealthier areas
• Liver disease is expected to overtake heart disease as the biggest cause of premature death in the next few years. It is the only major cause of death, including heart disease and cancer, on the increase in the UK

• Frailty is linked to long-term conditions in middle-aged and older adults.
• Deprived communities, coastal communities, rural communities, and people from minority ethnic communities face some of the biggest health inequalities
• People who live in more deprived areas are up to six times more likely to die from alcohol-related liver disease than those who live in wealthier areas
• Lung disease continues to be a major factor in health inequalities. Someone from the most deprived section of society is two-and-a-half times more likely to have COPD
• Type 2 diabetes is 2-4 times more likely among people of South Asian, African-Caribbean and Black African descent
• People from some ethnic minority groups, especially Pakistani and Bangladeshi groups, are more likely than White British to report long-term illness and poor health. But on some measures Black Caribbean and Black African communities report better outcomes
  than their white peers.
• People from ethnic minority groups are more likely to live in deprived
  areas.

• Compared to the wealthiest, the poorest women and men over 50 are twice as likely to have type 2 diabetes, twice as likely to have respiratory illness, two-and-a-half times more likely to have COPD and more likely to report a long term MSK condition. People who live in more deprived areas are up to six times more likely to die from liver disease than those who live in wealthier areas.

• Increases in life expectancy and advances in healthcare have led to increasing numbers of people living with multiple long-term health conditions or ‘multi-morbidity’. This has significant implications for the appropriate management of these conditions. There are also increases in the number of people who are frail – those who are less able to cope and recover from accidents, physical illness or other stressful events
• Frailty is linked to long-term conditions in middle-aged and older adults.
• Multimorbidity increases costs more than ageing.

• As we also have an ageing population, by 2037 we will have 10 times the number of people living with two or more conditions.
• Multimorbidity is significantly associated with higher deprivation. People living in the most deprived areas are significantly more likely to report two or more conditions and can expect to develop them 10-15 years earlier than those in the least deprived – there is a 43% greater risk of having multimorbidity in midlife (46-48 years)

Research published in 2021 into what matters to people and their carers living with long term conditions found a range of issues:

Organisation of health and social care services – A lack of joined-up care and support. Poor communication between services and across sectors. Relating their story multiple times at each appointment. Need to tackle wider determinants.

Challenges in primary care – Limited time available within standard 10-minute primary care consultations. A lack of understanding of patient and carer needs, abilities and lived experiences.

Managing conditions, pain and medication – Patients and carers want a better understanding of symptoms and prescribed medications, the interactions between different health conditions, and alternatives to pharmaceuticals.

Carers’ needs – Carers wanted easy-to-access information on caring, navigating the system and where to get help, eligibility for time off work for caring, health conditions and their inter-relationships, and medications.

Social isolation and mental health – The fear and reality of social isolation due to increased needs and difficulties in getting out of the house. Carers need to support those grieving as well as expressing their own loss and isolation.

Financial impact and funding for care – Concern about the costs of care having to sell their home, financing care, taking time out of work to attend medical appointments, losing their job and financial security.

Exercise and physical activity – Need for tailored advice on diet and the type and amount of physical activity to undertake. Fatigue and lethargy made it difficult to engage in physical activity.

Support for independent living – Maintaining independence was challenging. Need for well-trained support staff and timely access to equipment such as wheelchairs.

Preventing multiple conditions – This was felt to be the number one priority.

Sir Michael Marmot’s Fair Society, Healthy Lives highlighted

• People’s health can be damaged at work by factors including exposure to physical hazards, physically demanding or dangerous work, long or irregular working hours, shift work, health-adverse posture, repetitive injury and extended sedentary work.
• ‘precarious jobs’ … are defined by a lack of safety at work, by exposure to multiple stressors including strenuous tasks which the worker has little control over, low wages and high job instability. There is ample evidence on the adverse effects on health and well- being produced by these conditions.
• A range of research relates issues such as job security, job satisfaction and supervisor and peer support to various psychological and physical health impacts, such as general ill health, depression, cardiovascular disease, coronary heart disease and musculoskeletal disorders.

Sir Michael Marmot highlighted in his Fair Society, Healthy Lives report:

• Climate change is predicted to result in an increase in deaths, disability and injury from extreme temperature and weather conditions, heat- waves, floods and storms including health hazards from chemical and sewage pollution.
• It is estimated there will be an increase in respiratory problems from the damaging effects of surface ozone during the summer as well as an increase in skin cancers and cataracts.

Gypsies and Travellers have far higher rates of poor health than the general population. An in-depth qualitative survey by the Travellers Movement across sites in England in 2016 on the impact of insecure accommodation on health found:

• 55% of respondents cited poor quality sites/accommodation as a barrier to health care. Poor air quality, proximity to industrial sites, asthma and repeated chest infections (particularly amongst children and the elderly) were noted in around half of all interviews undertaken on local authority sites. At roadside and tolerated unauthorized sites, residents were living with minimal services in conditions of considerable environmental hazard.
• Busy roads and noise pollution were the most prominent environmental health and safety issues raised on all sites surveyed, particular in the context of child/pedestrian safety.
• 62.5% of respondents living at local authority sites indicated that they had concerns about the environmental conditions or level of services provided.

An editorial in the Lancet ‘Rethinking Chronic Pain’ in 2021 explains:

• Chronic pain is often a product of abnormal neural signalling, with biopsychosocial dimensions; a multimodal treatment approach is needed.
• Many clinicians and patients lack an understanding of treatment options.
• Over-reliance on drugs or devices may be spurred on by aggressive industry marketing, lack of access to multidisciplinary services such as physiotherapy or psychology, and perverse financial incentives for shorter consultations, drug prescribing, and invasive interventions.

It recommends that thinking on chronic pain needs to be reset, including:

• Clinicians need to help patients understand their pain, shift expectations, and set realistic, individualised goals that prioritise function and quality of life.
• Shared decision making can empower people to better manage their pain.
• Patients need reassurance that they will be believed, respected, and supported, and not blamed if a treatment does not work.
• Care for chronic pain should provided in the community by well trained, multidisciplinary teams.
• Financial incentives for quick fixes must be removed and longer consults and high-value care rewarded.
• Policy makers and regulators must prioritise pain, seeing the cost of inaction.
• Better public awareness of chronic pain, dispelling misconceptions that discourage care seeking and removing stigma.

A small study of people with skin disease (primarily psoriasis and eczema) published in 2019 found a range of social and psychological impacts of living with their condition:

Aspects of life impacted by chronic skin conditions

Emotions associated with skin conditions

The British Heart Foundation’s recent ‘Tipping Point’ report highlights:

• 30,000 excess deaths between March 2020 – August 2022 involving ischaemic heart disease.

Contributory factors include:

• Heart/circulatory disease risk factors (e,g. obesity, hypertension, diabetes) raise the risk of severe illness from Covid.
• People with previous Covid infection have a higher risk of developing subsequent cardiovascular disease.
• More recently, external factors – sustained bottlenecks in access to and delivery of NHS services; ‘missing’ patients and lost opportunities to manage risk factors for CVD; and more patients are waiting longer for tests, treatments, ambulance and other emergency services.

What heart patients want:

• Better information to help them manage their condition – in particular after diagnosis, while awaiting treatment, and managing their condition.
• To know the NHS has time to see them – otherwise they might continue to stay away.
• More mental health support – negative impacts of the pandemic and ending of restrictions.
• The NHS to prioritise access to GPs, making it easier to communicate with healthcare professionals, and increasing workforce numbers – both cardiovascular care specialists and the wider workforce including prevention, community-based services.

Long Covid is a global problem. The World Health Organisation highlights research by the  University of Washington’s Institute of Health Metrics and Evaluation, which found:

• Nearly 145 million people around the world in the first two years of the pandemic suffered from any of three symptom clusters of long COVID: fatigue with bodily pain and mood swings, cognitive problems, and shortness of breath.
• An estimated 17 million people met the WHO criteria of a new case of long COVID with symptom duration of at least three months in 2020 and 2021.
• Females are twice as likely as males to experience long COVID.

The World Health Organisation and Long Covid Europe recommend 3 R’s:

• Recognition and knowledge sharing, where all services are adequately equipped, and no patient is left alone or having to struggle to navigate through a system that is not prepared, or not capable of, recognizing this debilitating condition.
• Research and reporting, through data gathering and reporting of cases, and well-coordinated research with full participation of patients needed to advance understanding of the prevalence, causes, and costs of long COVID.
• Rehabilitation, that is based on evidence and effectiveness, and is safe for both patients and carers.

Long-term conditions and multi-morbidity | The King’s Fund (kingsfund.org.uk)

People with long-term health conditions, UK: January to December 2019 – Office for National Statistics

Health in England – Office for National Statistics (ons.gov.uk)

Musculoskeletal health: trends, risk factors and disparities in England (phe.org.uk)

Essential facts, stats and quotes relating to long-term conditions – PSNC Website

ltc-infographic.pdf (england.nhs.uk) PowerPoint Presentation (psnc.org.uk)

State of Suffolk – Healthy Suffolk

Musculoskeletal Conditions – Data – OHID (phe.org.uk)

Local Statistics – BHF

Cardiovascular Disease – OHID (phe.org.uk)

Statistics – British Liver Trust

Lung disease in the UK | British Lung Foundation (blf.org.uk)

Data and statistics | Bulletins and reports (versusarthritis.org)

Mortality Profile – Data – OHID (phe.org.uk)

When we get ill: cardiovascular disease – Healthy Suffolk

When we get ill: diabetes – Healthy Suffolk

PowerPoint Presentation (healthysuffolk.org.uk)

Productive Healthy Ageing Profile – Data – OHID (phe.org.uk)