Briefing for the debate on Supporting people with chronic conditions

Priorities

Prevention

Primary prevention is identified as crucial for tackling the rising prevalence of chronic 
conditions in Wales, aiming to stop these conditions from developing through measures like 
increased screening and addressing risk factors. Addressing the wider determinants of 
health, including diet, physical activity, and socioeconomic factors, is key, requiring a multi-sectoral approach. Primary prevention of long-term conditions is a shared responsibility that 
extends beyond the NHS in Wales. Factors within society like education, housing, and 
employment significantly influence both physical and mental health, thereby affecting the 
likelihood of developing these conditions. While increased collaboration across government 
is positive, more targeted action is needed across local authorities, the private and third 
sector to tackle these broader societal factors that impact overall health and wellbeing.
 

Disadvantaged and minority ethnic groups face a higher burden of chronic conditions and 
poorer health outcomes, necessitating culturally sensitive and accessible services. The 
critical role of health literacy in empowering individuals to manage their health and wellbeing 
is essential for early intervention and prevention as well as for the long-term sustainability of 
the health and care system in Wales.

Workforce

Workforce pressures are affecting health and social care in Wales, including specialist 
mental health services, domiciliary care, and social work. The Covid-19 pandemic has had 
lasting effects on staff as they have reported significant fatigue and exhaustion in the 
aftermath. These workforce challenges hinder the delivery of high-quality, integrated, 
person-centred care for those with chronic conditions.

Multi-disciplinary teams are crucial for delivering comprehensive and effective patient care. 
By bringing together professionals from diverse disciplines, the complex health and social 
needs of individuals can be addressed. This collaborative model facilitates better 
communication, shared decision-making, and coordinated care plans, ultimately leading to 
improved patient outcomes, enhanced satisfaction, and more efficient use of resources 
within the healthcare system.

Workforce planning based on projected population needs, particularly for an ageing 
population and rural communities, is vital. To ensure the future sustainability of services, the 
Welsh Government must invest in a long-term plan for the NHS and social care workforce.
The Welsh Government should continue to prioritise the investment in student education and 
staff training across various professional groups, including alternative pathways like 
apprenticeships and upskilling existing staff.

Social Care

The increasing number of people with long-term illnesses places substantial pressure on the 
Welsh NHS, social services, and the third sector. Current health and care services are often 
structured around single conditions, failing to adequately address the complexities of 
multimorbidity. Furthermore, unpaid carers are essential in supporting individuals with 
chronic conditions. Recognition and support for unpaid carers are vital and respite services 
for carers are crucial.

Social care plays a vital role in managing and providing care to individuals with chronic 
conditions. Social care offers essential support beyond medical treatment and facilitates a 
more holistic and person-centred approach to care. By increasing integration between social 
care with healthcare, it will improve patient outcomes, reduce hospital admissions, and 
ensure a more sustainable and effective system for managing chronic conditions. 

Social Prescribing Framework 

Social prescribing connects people to community resources and support. While available in 
all 22 local authorities in Wales, there is variation in capacity and waiting lists. The 
effectiveness of social prescribing relies on the availability of community activities and 
resources. 

Moreover, social prescribing offers an asset-based approach, facilitating community 
engagement for positive change by leveraging skills, knowledge, and lived experiences. It 
represents a shift from traditional hospital and GP care to a non-medical, networked 
approach that places the patient at the centre and promotes independence. It is therefore 
crucial that the implementation of the social prescribing framework is carefully monitored to 
ensure it effectively meets the specific needs of individuals living with chronic conditions.

Mental Health

Mental health problems can hinder self-management and engagement with healthcare, 
worsening physical conditions. There is a strong link between chronic conditions and mental 
health problems, with at least 30% of people with a chronic condition also experiencing 
mental health issues. Also, adults with Severe Mental Illness (SMI) have a higher risk of 
premature death from physical illnesses, and this mortality gap is widening. People with SMI 
may develop chronic illnesses 20-30 years earlier, partly due to medication and lifestyle 
factors.

The lack of parity between mental and physical health services has been a longstanding 
issue, particularly impacting individuals living with chronic conditions. The profound 
psychological effect of receiving a chronic illness diagnosis necessitates a much greater 
integration of mental health support from the outset. However, signposting to mental health 
services is not standard practice at the point of diagnosis for long-term physical conditions. 
Furthermore, some individuals with chronic conditions may benefit from wellbeing support 
that does not require formal mental health intervention; however, the limited number of social 
prescribing link workers and the lack of available community facilities are significant barriers.
Greater integration of mental and physical health services is needed for those with chronic conditions. Mental health support should be routinely signposted at the point of diagnosis for 
all chronic conditions.

Conclusion

The Welsh healthcare landscape faces significant challenges due to a rising prevalence of 
chronic conditions, demanding a fundamental shift towards person-centred, coordinated care
in the community and closer to home. 

The key priorities for a sustainable future include a multi-sectoral focus on prevention, 
addressing health inequalities and promoting health literacy; a robust workforce plan for the 
NHS and social care; a radical transformation of social care with prioritised funding to enable 
person-centred, community-based care; effective implementation and monitoring of the 
Social Prescribing Framework and the integration of mental health support into chronic 
condition care pathways. 

Further information

If you would like further information on any of the issues raised in the briefing, please contact 
Haleema Khan on haleema.khan@welshconfed.org

The Welsh NHS Confederation is the only membership body representing all the 
organisations making up the NHS in Wales: the seven local health boards, three NHS trusts 
(Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public
Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales 
and Health Education and Improvement Wales). We also host NHS Wales Employers and 
are part of the NHS Confederation.