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  • 9.1 million people in England are projected to be living with major illness by 2040, an increase of 2.5 million people compared to 2019.
  • This is an increase of 37%, nine times the rate at which the working age population (20-69 year-olds) is expected to grow over the same period (4%).
  • 80% (2 million people) of the projected increase in major illness will affect people aged 70 and over as the baby boomers reach old age and life expectancy increases.

9.1 million people will be living with major illness by 2040, 2.5 million more than in 2019, according to a new report published today by the Health Foundation.

The ground-breaking new analysis is part of a four-year project led by the Health Foundation’s Real Centre in partnership with the University of Liverpool, focusing on levels of ill health in the adult population in England up to 2040. It lays out the scale and impact of the growth in the number of people living with major illness as the population ages.

The analysis finds that 19 of the 20 health conditions studied* are projected to increase in prevalence, including a rise of more than 30% in the number of people living with conditions such as cancer, diabetes and kidney disease. Overall, the number of people living with major disease is set to increase from almost 1 in 6 of the adult population in 2019, to nearly 1 in 5 by 2040, with significant implications for the NHS, other public services and the public finances.

The challenges of improving care for an ageing population and enabling people to live independent lives for longer are not unique to England, with countries across the globe facing similar pressures on their health services. However, with the NHS already under unprecedented strain, the findings point to big changes in how care should be delivered in future.

Much of the projected growth in illness relates to conditions such as anxiety and depression, chronic pain and diabetes, which are predominantly managed outside hospitals in primary care and the community. This reinforces the need for investment in general practice and community-based services, focusing on prevention and early intervention to reduce the impact of illness and improve the quality of people’s lives.

The analysis finds that 80% of the projected increase in major illness (2 million people) will be among people aged 70 and over, with the remaining 20 per cent (500,000 people) among the working-age population (20-69 years old). It also projects that improvements in some of the main causes of poor health, such as fewer people smoking and lower cholesterol rates, will be offset by the impact of obesity as many people who have been obese for long periods of their lives reach old age.

The report warns that there is no silver bullet to reduce the growth in people living with major illness and that supporting people to live well with illness will increasingly be an essential function of health care and other services in the future. Its findings underline the need for a long-term plan to reform, modernise and invest in the NHS alongside a bold, new approach that invests in the nation’s health and wellbeing.

Toby Watt, Lead Economist: Demand, REAL Centre, said,

‘The findings from this report give us new insight into the future demand for health care in England. It is crucial to emphasise that these are projections, not forecasts, which are designed to support policymakers in preparing for the future.

‘The rise in people living with major illness will not occur overnight. Managing these pressures is achievable with careful planning, investment and changes in how care is delivered.’

Anita Charlesworth, Director of the REAL Centre, said,

‘The challenge of an ageing population with rising levels of major illness is not unique to the NHS. Countries across the globe face the same pressures. How well prepared we are to meet the challenge is what will set us apart.

‘Over the next two decades, the growth in major illness will place additional demand on all parts of the NHS, particularly primary care, where services are already under extreme pressure. But with 1 in 5 people projected to be living with major illness in less than two decades’ time, the impact will extend well beyond the health service and has significant implications for other public services, the labour market and the public finances.’

The report is the first in a new programme of research from the Health Foundation’s REAL Centre, which aims to support policymakers by looking at patterns of illness over the next two decades. Following in the autumn, a second report will focus on the implications for health inequalities.

Notes to editors

Cambridge Multimorbidity Score (CMS)*

The score assigns a weight or score to 20 conditions* based on how the illness is likely to affect people’s use of primary care and emergency health services and the likelihood of their death. For instance, cancer, dementia and heart failure are given higher scores than hypertension (high blood pressure) or hearing loss because they are more likely to lead to death, unplanned hospital admissions or greater primary care needs. For those with multimorbidity, scores are added together, meaning people with the same score can have a different number and combination of conditions. This provides a common metric across illnesses and allows us to aggregate multimorbidity. We then use the average score for different population groups to define average illness levels. Major illness is defined as a score of 1.5 or above.  Only 2 conditions, cancer and dementia have a score of 1.5 as a single condition.

These conditions are dementia, cancer (all types), COPD, atrial fibrillation, heart failure, constipation, epilepsy, chronic pain, stroke/transient ischaemic attack (TIA), diabetes (type 1 or 2), alcohol problems, psychosis and bipolar disorder, chronic kidney disease, anxiety/depression, coronary heart disease, connective tissue disorders, irritable bowel syndrome, asthma, hearing loss, and hypertension.

About the REAL Centre

The Health Foundation’s REAL Centre (research and economic analysis for the long term) provides independent analysis and research to support better long-term decision-making in health and social care.

Media contact

Billie Morgan
020 7257 8000

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