The number of people in Wales living with a chronic health condition is rising, putting increasing pressure on health and social care services that are already under strain.
Health services in Wales, originally developed to treat acute illness and historically designed around single diseases or organs, must now adapt to meet the needs of a growing population requiring ongoing care for one or more long-term conditions.
The Health and Social Care Committee published its report on chronic conditions in January 2025, following a two-stage inquiry. Members heard evidence from those providing treatment and support for those with chronic conditions. They also heard from people living with chronic conditions sharing their experiences of accessing the care they need to live well.
As well as considering the long-term challenges facing health and social care services in Wales, the Committee identified improvements that could be made now to better support people currently living with chronic health conditions.
Improving care for people living with chronic conditions
An increasing number of people are living with more than one chronic condition, sometimes called “multimorbidity.” This poses a challenge for traditional medical systems. Patients might take multiple medicines and see multiple specialists who may fail to see the overall picture of their health.
To address this, the Committee recommended that the Welsh Government work with local health boards to develop services that “wrap around” patients, providing a “one-stop-shop” model that brings together multiple health services and professionals.
The Welsh Government rejected this recommendation, explaining that although one-stop-shop clinics increasingly feature in service development, they are currently designed “primarily to improve symptom-based diagnosis, such as investigating urinary tract symptoms or breathlessness rather than multimorbidity management.”
The Welsh Government says that, on average, people living in the most deprived areas of Wales spend around nine more years living in less than good health compared to those in the least deprived areas. Data from the National Survey for Wales in 2023, shows that adults living in more deprived areas are more likely to report longstanding and limiting illnesses.
To tackle these inequalities, the Committee recommended that the Welsh Government work with partners, including local authorities and third sector organisations, to better connect different sources of support and address issues beyond healthcare, including housing, debt, and employment.
The Welsh Government accepted this recommendation, and said that local authorities and health boards have a duty to “co-operate” in planning, commissioning and delivering services for people with care and support needs, facilitated through Regional Partnership Boards.
A key finding of the inquiry was the need to improve mental health support for those living with chronic conditions across several levels by:
- Offering better support to improve the wellbeing of those living with chronic conditions, even if they do not have a diagnosed mental health condition;
- Providing better understanding from healthcare professionals and more communication and integration between physical and mental health services, for those living with both mental and physical health conditions; and
- Increasing the availability of physical health checks for people with severe mental illness, to address poorer physical health outcomes.
The Welsh Government responded by stating that the forthcoming Mental Health and Wellbeing Strategy will recognise the mental health impact of living with a long-term physical health condition and take an early-intervention approach to signpost support earlier.
Are health and social care services sustainable?
The growing number of people living with chronic conditions raises questions about the future sustainability of health and social care services in Wales. With demand rising and care becoming increasing complex, can the system adapt to keep up?
Professor Jim McManus, Public Health Wales (PHW), told Committee:
we have significant and ongoing rising prevalence of long-term conditions, most of which are preventable (…) We also talk about the significant rise in diabetes, so that we may have one in 11 people by 2035. If that continues for all long-term conditions, we won't have a sustainable health and care system and it will impact significantly on the workforce and the economy.
Currently, the NHS spends an estimated 10% of its budget on diabetes. According to PHW, the number of adults living with diabetes increased by 40% between 2009/10 and 2021/22. They estimate a further 22% increase by 2035/36.
PHW has made similar predictions about a number of other non-communicable diseases. The prevalence of several chronic conditions, including heart failure, stroke, and asthma, has risen over the past decade. PHW warns that “if nothing changes, such as the introduction of a health or policy intervention, all diseases and cancer incidence for both sexes will continue to increase”.
Shifting services towards prevention
The Committee heard that a shift towards prevention to address some of the key risk factors for developing chronic conditions is essential to make health and social care services sustainable.
A Healthier Wales, the Welsh Government’s long term plan for health and social care, says that over 10 years more emphasis will be placed on prevention. Last year the Welsh Government also published a set of refreshed actions to support the delivery of A Healthier Wales with “preventive” as a core principle.
Several preventative programmes are already in place, like the All Wales Diabetes Prevention Programme, and initiatives like Healthy Weight: Healthy Wales and A Smoke-Free Wales.
Yet, the Committee’s report on the draft budget 2025-26 concluded that “it is disappointing that the Welsh Government has yet to demonstrate a significant shift in health spending allocations toward prevention, despite identifying it as a priority.”
Time will tell whether enough is being done to tip the balance towards prevention. If not, health and social care services in Wales may struggle to meet future demand. In the meantime, the Committee’s report outlines steps the Welsh Government and the NHS could take now to improve life for people currently living with health chronic conditions.
The Committee’s recommendations and the Welsh Government’s response will be debated in Plenary on 30 April.
Article by Angharad Lewis, Senedd Research, Welsh Parliament
