Closed call for evidence

Major conditions strategy: call for evidence

Updated 31 May 2023

Applies to England

Ministerial foreword: Helen Whately

In the past 30 years we have seen extraordinary advances in the health of the nation - many of the conditions that once ended lives prematurely can be managed much more effectively. A combination of new treatments and ways of working, collaboration between professionals and public health interventions have given many people more years of healthier life. This is something that our health and care system should be immensely proud of. There are, of course, still enormous challenges ahead, but these achievements should give us confidence that we can meet them.

As people live for longer, in part thanks to advances in healthcare, public health and society, an increasing number of us live with one or more of the major groups of conditions: cancers, cardiovascular disease (CVD) including stroke and diabetes, musculoskeletal (MSK) conditions, chronic respiratory diseases (CRDs), mental health conditions and dementia.

Currently in England:

• 5.4 million people live with CVD
• around 8.6 million live with CRDs
• 8.2 million people live with mental health issues

Many of us suffering from one condition also suffer from another. For example, half of people with a heart or lung condition also suffer from an MSK condition.

Tackling the major conditions that drive ill health in England provides an enormous opportunity to improve the lives of millions of people. Reducing suffering from these conditions will not only move us towards our objective of increasing healthy life expectancy by 2035, but also help us to ease pressure on the health system and reduce the number of people out of work due to ill health. That is why my department is publishing the major conditions strategy and launching this call for evidence.

I would like to thank each one of you who responded to our calls for evidence on cancer and mental health last year. I would also like to thank all of you who contributed evidence on dementia and health disparities in the last year. We have listened and your insights will inform both the major conditions strategy and the suicide prevention strategy.

The major conditions strategy will build on government action that has already helped to tackle major conditions and improve health outcomes. This includes work to tackle waiting lists for planned NHS treatments through the elective recovery plan and to improve cancer treatment and survival rates. Thanks to the incredible work of NHS staff, the total number of patients waiting more than 78 weeks for planned NHS treatments has fallen by more than 90% from its peak in September 2021. Cancer checks are up around a fifth compared to pre-pandemic levels and the one-year cancer survival rate has increased steadily from 65.6% for patients diagnosed in 2005 to 74.6% in 2020.

The strategy will also build on the work of the NHS Health Check programme, which helps over 1 million people at risk of cardiovascular disease by supporting these individuals to make behavioural changes and access the clinical care they need to improve health outcomes.

It also complements government work underway including:

• the launch of the Dame Barbara Windsor Dementia Mission to speed up the development of new dementia treatments
• the investment of over £113 million to fund research into 4 life sciences healthcare missions - cancer, obesity, mental health and addiction - to unlock the next generation of medicines and diagnostics
• the appointment of Professor John Deanfield as Government Champion for Personalised Prevention, to review how technology, intelligence and data can be used to predict, prevent and diagnose risk factors for CVD
• the commissioning of Rt Hon Patricia Hewitt to consider how the governance and oversight of integrated care systems can best enable them to succeed in their objective to improve health outcomes for their population - the government will be considering the recommendations from the Hewitt Review and the inquiry by the Health and Social Care Committee into integrated care systems as we continue to support local areas to improve health outcomes for patients

I urge you to respond to this call for evidence. By responding, you can help inform the strategy and play a vital role in helping individuals to live longer, healthier and more prosperous lives.

Helen Whately, Minister for Social Care

Executive summary

This call for evidence will inform the development of the government’s major conditions strategy designed to improve the health of the nation and ease pressure on the health system.

We are seeking your views and ideas on how to prevent, diagnose, treat and manage the groups of major conditions that contribute to ill health in England, namely:

• cancers
• cardiovascular disease (CVD), including stroke and diabetes
• chronic respiratory diseases (CRDs)
• dementia
• mental ill health
• musculoskeletal (MSK) disorders

This call for evidence follows on from last year’s cancer call for evidence and mental health call for evidence. We have published summaries of what we heard in these calls today and the responses to these will be fully considered and inform the development of the major conditions strategy.

As well as seeking views on individual condition groups, this new call for evidence requests ideas on how to tackle the behavioural risk factors common to the major condition groups and how to improve the care and outcomes for those suffering with one or multiple conditions.

You can respond on behalf of an organisation or as an individual. The easiest way to participate in this call for evidence is by completing the online survey.

The major conditions strategy

On 24 January 2023, we announced our plan to publish the major conditions strategy. This will focus on what can be delivered over the next 5 years in England combining our commitments on mental health, cancer, dementia and health disparities and further cross-cutting commitments into a single, powerful strategy. It will also align with the government’s ambitious life sciences missions and take a life-course approach to improving health outcomes. 

The condition groups we are focusing on account for around 60% of ill health and early mortality in England. Tackling them is essential if we are to make progress on delivery of our levelling-up mission to gain 5 extra years of healthy life expectancy by 2035 and narrow the gap in healthy life expectancy by 2030.

People living in England’s most deprived places live, on average, 19 fewer years in good health than those in the least deprived places. The strategy will set out the supporting and enabling interventions government can make to ensure that integrated care systems and the organisations within them maximise opportunities to tackle disadvantage in their local areas. This will include addressing unwarranted variation in health outcomes and care.

Healthy, fulfilled, independent and longer lives for the people of England will require health and care services, local government, NHS bodies, the voluntary and community sector, and industry to work ever more closely together. In developing this strategy, we are committed to working collaboratively across these different organisations and sectors and pooling their expertise.

We also want to ensure this strategy responds to and reflects the views of individuals with lived experiences. This includes individuals as service users and patients, as well as those caring for individuals with one or more of the groups of major condition.

Scope of the call for evidence

We are committed to ensuring that the major conditions strategy is underpinned by the evidence and informed by a broad set of views on the priority areas for action.

This call for evidence complements and will build upon the 2 calls for evidence on mental health and cancer. These provided very useful insights, which we will be considering in the development of the major conditions strategy.

While this survey therefore predominantly focuses on the other groups of conditions we are seeking to tackle in the strategy, those who responded to the mental health and cancer calls for evidence will have the opportunity to provide further insights and suggestions. We are particularly interested in stakeholder suggestions on:

• how to improve outcomes for people suffering from a combination of conditions
• what impactful interventions can be adopted and scaled quickly - that is, in the next 1 to 2 years
• how we can tackle disparities in health outcomes and experiences - including disparities that exist by gender, ethnicity, and geography. This particularly includes building on our Women’s Health Strategy for England and suggestions that can support improving men’s health.

The Department of Health and Social Care (DHSC) is seeking views on what the current and future priorities should be. The set of questions should not be taken to present that DHSC has a settled position on the relevant priorities.

Questions

Cardiovascular disease

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. It is one of the main causes of death and disability in the UK, and includes coronary heart disease, strokes, peripheral arterial disease and aortic disease. Atrial fibrillation (an irregular, and sometimes fast heartbeat), high blood pressure and high cholesterol are all risk factors for CVD. Evidence suggests taking action on these 3 risk factors will significantly reduce the number of strokes, heart attacks and other types of CVD.

Question

In your opinion, which of these areas would you like to see prioritised for CVD? (Select up to 3)

• Preventing the onset of CVD through population-wide action on risk factors and wider influences on health (sometimes referred to as primary prevention)
• Stopping or delaying the progression of CVD through clinical interventions for individuals at high risk (sometimes referred to as secondary prevention)
• Getting more people diagnosed quicker
• Improving treatment provided by urgent and emergency care
• Improving non-urgent and long-term treatment and care to support the management of CVD

Question

How can we successfully identify, engage and treat groups at high risk of developing CVD through delivery of services that target clinical risk factors (atrial fibrillation, high blood pressure and high cholesterol)? (Please do not exceed 500 words)

Chronic respiratory diseases

Chronic respiratory diseases (CRDs) affect the airways and other structures of the lungs. Some of the most common are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension. Respiratory diseases contribute to around 8,000 preventable deaths in the under 75s in England each year, and the UK has the highest prevalence of asthma in the world at around 9 to 10% of the adult population.

Question

In your opinion, which of these areas would you like to see prioritised for CRD? (Select up to 3)

• Preventing the onset of CRDs through population-wide action on risk factors and wider influences on health (sometimes referred to as primary prevention)
• Stopping or delaying the progression of CRDs through clinical interventions for individuals at high risk (sometimes referred to as secondary prevention)
• Getting more people diagnosed quicker
• Improving treatment provided by urgent and emergency care
• Improving non-urgent and long-term treatment and care to support the management of CRD

Dementia

Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning. There are many different causes of dementia, and many different types. We recognise that dementia is a growing challenge. The number of people in England estimated to have dementia is set to rise to almost 900,000 in 2025 and to more than 1.3 million by 2040.

Question

In your opinion, which of these areas would you like to see prioritised for dementia? (Select up to 3)

• Preventing the onset of dementia through population-wide action on risk factors and wider influences on health (sometimes referred to as primary prevention)
• Delaying the progression of dementia through clinical interventions for individuals at high risk (sometimes referred to as secondary prevention)
• Getting more people diagnosed quicker
• Improving treatment provided by urgent and emergency care
• Improving non-urgent and long-term treatment and care to support the management of dementia

Musculoskeletal conditions

Musculoskeletal (MSK) conditions affect the bones, joints, muscles and spine, and are a common cause of severe long-term pain and physical disability. There are 3 groups of MSK conditions:

• conditions of MSK pain, for example, osteoarthritis and back pain
• inflammatory conditions, for example, rheumatoid arthritis
• osteoporosis and fragility fractures, for example, a fracture after a fall from standing height

Each year, 1 in 5 people in the UK consult a doctor about an MSK problem, and MSK is the leading cause of disability.

Question

In your opinion, which of these areas would you like to see prioritised for MSK? (Select up to 3)

• Preventing the onset of MSK through population-wide action on risk factors and wider influences on health (sometimes referred to as primary prevention)
• Stopping or delaying the progression of MSK through clinical interventions for individuals at high risk (sometimes referred to as secondary prevention)
• Getting more people diagnosed quicker
• Improving treatment provided by urgent and emergency care
• Improving non-urgent and long-term treatment and care to support the management of MSK

Tackling the risk factors for ill health

The condition groups we are focusing on are often driven by preventable risk factors, with nearly half (42%) of ill health and early death being due to them. This includes tobacco, alcohol, physical activity and diet-related risk factors. Action on preventable risk factors is also central to our work on tackling health disparities, since people living in more deprived areas are more likely to partake in these behaviours.

Question

Do you have any suggestions on how we can support people to tackle these risk factors?

• Yes
• No

Question

How can we support people to tackle these risk factors? (Please do not exceed 500 words)

You might consider suggestions on how we could:

• make changes at a local level to improve the food offer and support people to achieve or maintain a healthy weight and eat a healthy diet
• identify and support inactive people to be more physically active
• support people to quit smoking, including through increasing referrals to stop smoking support and uptake of tobacco dependency treatment
• support people who want to drink less alcohol to do so

Supporting those with conditions

This part of the survey seeks to understand how we can improve outcomes for people with any of the major conditions, or a combination of them, across their life course.

For these questions, we ask for you to consider the following in your responses:

• how we can improve outcomes for people across the life course, from pre-conception, early years, childhood and young adulthood, into adulthood and older age
• how we can target population groups most in need - including addressing disparities in health outcomes and experiences by gender, ethnicity and geography
• what could be adopted and scaled quickly (that is, in the next 1 to 2 years) with impact
• what we can learn from local, national and international examples of good practice, and what wider factors are either enabling them to be a success or are blocking them from being even more successful
• if you’ve tried a particular approach with success, please indicate the cost and be as specific as possible about how the approach was implemented

You have the option of suggesting ideas for:

• multiple conditions
• CVD
• CRDs
• MSK conditions
• dementia

Question

How can we better support local areas to diagnose more people at an earlier stage?

You might consider suggestions to increase capacity available for diagnostic testing or identify people who need a diagnosis sooner.

Question

How can we better support and provide treatment for people after a diagnosis?

You might consider suggestions that help people to manage and live well with their conditions, with support from both medical and non-medical settings.

Question

How can we better enable health and social care teams to deliver person-centred and joined-up services?

You might consider suggestions to improve the skill mix and training of the health and social care workforce.

Question

How can we make better use of research, data and digital technologies to improve outcomes for people with, or at risk of developing, the major conditions?

Question

How can we improve access to palliative and end of life care?

You might consider suggestions for how best to involve individuals in conversations about their future care.

Cancer

The cancer call for evidence published in 2022 provided useful insights that will shape the development of the major conditions strategy. However, if you wish to, we wanted to provide an opportunity to provide any further insights in this call for evidence.

Question

How can we better support those with cancer? (Please do not exceed 500 words)

Mental health

The mental health call for evidence published in 2022 provided useful insights that will shape the development of the major conditions strategy. However, if you wish to, we wanted to provide an opportunity to provide any further insights in this call for evidence.

Question

How can we better support those with mental ill health? (Please do not exceed 500 words)

How to respond

The easiest way to participate in the call for evidence is by completing the online survey.

If you responded to the cancer and/or mental health calls for evidence last year, you do not need to resubmit your response - we have captured those contributions already. However, there is an opportunity to provide any further suggestions on priorities, building on the evidence submitted last year and highlighting any new developments.

If you have any technical problems with using the online survey, log the issue by emailing majorconditionsstrategy@dhsc.gov.uk.

Do not send any personal information to this email address.

An easy read version of the survey is available.

Next steps

The views and ideas gathered through this exercise will inform the priorities, content and actions in the major conditions strategy, which we will be publishing later this year.

We will be publishing an interim report in the summer.

Privacy notice

See the DHSC privacy notice.