Multiple long-term conditions

The multiple conditions guidebook – one year on

8 December 2020

A report from the Taskforce on Multiple Conditions

In brief

The Taskforce on Multiple Conditions published the Multiple Conditions Guidebook in November 2019. It profiled 10 practical approaches that work with and for people living with multiple health conditions. In Autumn 2020 the Taskforce revisited a number of the original Guidebook case studies. This was to find out what happened in the year since their original publication.

Executive summary

COVID-19 has upended all our lives. However, for people with multiple conditions, the pandemic presents additional challenges. Across all the case studies revisited we heard how:

There is fear and anxiety from the increased risk to life from the virus for people with pre-existing health conditions. Additionally, for some, there exists sentiment that these health conditions mean their lives are less valuable in context of COVID-19. As one practitioner put it “the way the death toll was reported for example, with the number of people dying and then the number of them that had long-term conditions, made many of our patients ask do people think it is okay to die from COVID-19 just because you have a pre-existing health condition?” For those affected by inequality, especially in Black and other minoritised ethnic communities, these feelings of fear and anxiety are often amplified.

The restrictions in place to keep people safe, including for the 2 million people recommended to shield (many of whom have multiple conditions), mean that people’s health conditions are, more than ever, affecting their ability to go about their life as normal. Even shopping for food and picking up prescriptions is classed as ‘dangerous’ let alone seeing friends or joining an exercise class. For many people it has affected their ability to do their job as well as their mental health and wellbeing.

Changes in health

The disruption to the health and care services that many rely on to keep well – including access to regular appointments, clinicians or treatment – not only causes stress and worry but also a deterioration in people’s health. Practitioners report concerns that many people have gone downhill. For some this is literally life-threatening; others are now not well enough to benefit from wider practical and emotional support to improve health and wellbeing and face an uphill struggle to get back to where they were. On a more positive note there are also reports that the pandemic has triggered a change in mindset with some people more actively looking at ways they can improve their own health and wellbeing through exercise, diet, spending time in nature and more.

It is harder now, at this time of year, because of the dark nights. You really don’t get to see anybody, especially if you are on your own.

Norma 72 years old, lives alone, and amongst other conditions has asthma and type 2 diabetes

Listening to practitioners

From practitioners we heard how:

Even with the risks and restrictions from COVID-19 many people, professionals, communities and services adapted almost overnight. New relationships and ways of working were quickly established. In many cases the development of place-based partnership working accelerated and expanded to involve all, from neighbours to senior commissioners. All hope that this place-based partnership working becomes permanent. There is also hope that the NHS takes the opportunity to be part of these community partnerships, rather than apart from them.

Technologies

Digital and online technologies played, and continue to play, an important role in the transformation of services. Yet all practitioners caution against an over-reliance on this. This is due to inequality in access whether from a lack of skills, equipment, broadband and mobile coverage, or ability to pay for digital connectivity. The good old-fashioned phone has proven a vital tool for many, with practitioners welcoming opportunities to develop new phone skills. For certain people, whether because of this lack of digital access or because of physical impairment, medical condition or safeguarding concerns, face-to-face always needs to be available as an option.

Wider needs

The wider social and practical needs of individuals with health conditions were recognised and addressed. The interplay between people’s social, economic, environmental and health circumstances has become pressingly apparent. Recognising, for example, that without food nothing else really matters, a focus on sorting basic needs first was often taken.

The pandemic is driving practitioners to think more about how they can address inequality by increasing access to hardly reached groups, provide culturally and language appropriate support, and collect better data on ethnicity and inequality. Many are focusing on identifying, and working through, existing champions and organisations within affected communities, building partnerships and giving them a platform rather than trying to do everything themselves.

We realised that the virus is not going anywhere soon and if we did not restart our ongoing system of care for people with multiple conditions, in a way that was COVID-secure, we would never catch up.

Dr Rebecca Haines GP