As we saw earlier, the majority of spending in the NHS is on long-term conditions such as diabetes, arthritis, COPD and depression that cannot be cured but have to be managed on a day-to-day basis. Figure 4.1 shows the proportion of people in England who report having a long-term condition at different ages, and highlights how the proportion living with a long-term condition increases with age, with older people typically living with more than one condition. Up to 80 per cent of GP consultations in England are with people with long-term conditions, and the 15 per cent of people with three or more long-term conditions account for almost 30 per cent of inpatient days in hospitals (Wilson, 2005).

Much of the cost of long-term conditions stems from avoidable hospitalisations when day-to-day management at home breaks down. Effective management of long-term conditions falls more to individuals and their families than to healthcare professionals. If there are 8,760 hours in a year, the average person with a long-term condition in the UK spends no more than three or four hours a year with a health professional (Hannan, 2010). Even someone receiving intensive treatment, for example, from an assertive outreach team for a serious mental health problem, would see that team for no more than three hours a week – less than 2 per cent of the hours in the year (Alakeson and Perkins, 2012).

The evidence base for the positive impact of individual engagement in the management of long-term conditions is strong. Research has demonstrated that enabling patients to actively participate in all aspects of their care, such as choices about treatment and self-management, results in better adherence to medications and improved management of long-term conditions without increasing costs (Hibbard et al, 2004). There is evidence of less use of hospital services (Gibson et al, 2004; Newman et al, 2004) and better outcomes associated with support for self-care (Lorig et al, 1999). Patient engagement contributes to patient safety by ensuring that patients’ behaviour, choices and needs are accurately communicated to clinical professionals, and it reduces anxiety and depression for individuals and improves their ability to cope with adversity (Epstein et al, 2010).