We recognise that difficult choices will have to be made about where we prioritise our efforts. We want to build on our engagement, the call for evidence and all the comments we have heard in the development of this document to ensure that the major conditions strategy will have real impact in changing how the health and care system operates over the next 5 years. With that in mind, we intend to focus our efforts on exploring how we can make real change in 5 key areas, which we think will have the greatest impact across all the groups of conditions. These are:
rebalancing the health and care system, over time, towards a personalised approach to prevention through the management of risk factors
embedding early diagnosis and treatment delivery in the community
managing multiple conditions effectively - including embedding generalist and specialist skills within teams, organisations and individual clinicians
seeking much closer alignment and integration between physical and mental health services
shaping services and support around the lives of people, giving them greater choice and control where they need and want it and real clarity about their choices and next steps in their care
Across all 5 of these priority areas, we will work to reduce inequalities in health outcomes, so the community you live in does not make it more likely you will experience ill health. As chapter 2 sets out, we will focus on how we bear down on the principal lifestyle drivers of ill health and disease, such as obesity and smoking, as well intervening early to reduce exacerbations and complications. We will consider how we can rebalance the health and care system, over time, towards a personalised approach to prevention. We know this can have real benefits in stopping or delaying the progress of conditions - for example, by more effectively identifying and managing conditions such as hypertension, as well as risk factors such as obesity and smoking. As part of this, we will explore how we can empower people to make healthier choices - giving them the information they need and the freedom to decide what is best for them. Furthermore, for the reasons we set out in chapter 4, we are also keen to evaluate how we can proactively identify and support people at risk, including actively identifying frailer people and supporting them before they experience a crisis. As part of this, we will also continue to assess how we can best support people to lead the lives they want to live, including supporting people to stay in, or return to, work. We will consider how we can better embed early diagnosis and treatment delivery in the community. As chapter 3 sets out, if we are able to identify major conditions early, the outcomes for treatment are far better and the negative impact on people’s lives is much reduced. We will explore the potential here for using new technology such as AI, developing new patient pathways of care to enable earlier diagnosis and the opportunities for earlier diagnoses created by screening programmes. We will also explore how we can support people to manage multiple conditions most effectively, as we explored in chapter 4. For example, we will consider how we can embed both generalist and specialist skills within teams, organisations and individual clinicians, as well as considering how we could explore patient pathways (or portions of those pathways) that better reflect the needs and symptoms of patients in the round, rather than being tied to - or having to move between - siloes defined by specialisms. We will investigate how we can drive stronger alignment and integration between physical and mental health services. This will include exploring how we can better support people with serious mental health conditions to manage their physical health, as well as better supporting the mental health of people suffering from a physical condition. Finally, we will consider how we can best shape services and support around the lives of people, giving them - and their carers - greater control where they need and want it and real clarity about their choices and next steps in their care. As part of this, we will consider how we can develop more robust models of person-centred care, as well as how we can use technology to make the experience of interacting with the NHS more seamless. We also see great potential in further work on developing effective models of rehabilitation and pre-habilitation, as well working to develop more holistic approaches to pain and distress management, and palliative and end of life care. As we develop the final strategy, we will also want to consider how we can drive improvement across individual groups of conditions, where these require specific interventions. We will also ensure that all of the further work over the coming months responds to the importance of tackling health disparities and promoting inclusion in health, as articulated through the UK-wide levelling up mission on healthy life expectancy and the NHS Core20PLUS5 framework, NHSE will be developing a handbook to support Core20PLUS5 implementation. We recognise that this has to be a collective endeavour, with contributions from citizens, the health and social care sector, the wider public sector (including national and local government and devolved governments), industry and all with an interest. We recognise that in many areas there is excellent work happening already, and we want to draw on that knowledge and experience, as well as identify examples of existing best practice we can spread and share across the health and care system. In the next phase we will continue to engage closely with people with lived experience, academic and other experts and representative organisations. We will work within the framework set out in this document and further develop the themes and issues we have identified. We will also draw on the recently closed call for evidence and potentially add further themes and issues suggested by that process within the overall framework. Furthermore, while this report is focused on England, and we recognise that health is a devolved matter, we are keen to engage across the UK on health inequalities, take joined-up action wherever possible and share knowledge on what works.  We are keen to continue our engagement with clinicians, stakeholders, charities, carers and people with lived experience. If you want to be involved, you can contact us at majorconditionsstrategy@dhsc.gov.uk.