The Scottish Government

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EXECUTIVE SUMMARY

This research was commissioned following the publication of Delivering for Health (2005) to provide a robust evidence base to underpin the Scottish Government's (formerly Scottish Executive) strategy on the management of long-term health conditions.

A detailed profile of the characteristics, circumstances and support needs of adults in Scotland with long-term health conditions was produced from analysis of the Scottish Household Surveys ( SHS) (1999-2006) and the Scottish Health Survey ( SHeS) (2003).

Key Findings

• According to SHS estimates, in 2005-2006, 23.6% of adults (aged 16+), and 33.8% of households in Scotland reported some form of long-term condition. The proportion of households containing someone with a long-term condition showed an increase from 30% in 1999-2000.
• Although overall prevalence of long-term conditions amongst adults showed little change since 1999, the proportion of adults in the oldest age group (75+) reporting long-term health conditions rose. This increase could be due to the fact that this age group is also getting older (the average (mean) age increased from 1999-2006).
• SHeS estimated that in 2003, 26.5% of adults in Scotland had a long-standing ¹ illness, disability or infirmity which limited their activities in some way (limiting long-term conditions). This is comparable with the SHS figures. A further 14.7% reported long-term conditions that were not limiting.
• The most commonly reported impairments in 2005-2006 were related to heart, blood pressure or circulation problems (35.5% of all adults with a long-term condition) and to arthritis (31.6% of adults with a long-term condition). Analysis over time suggests that the incidence of heart problems and diabetes have increased.

In general, adults with long-term conditions (especially those with disabilities or limiting conditions):

• were socially and economically disadvantaged across a range of indicators (less likely than adults without long-term conditions to be employed; lower occupational status amongst those who were employed; fewer formal educational qualifications; less likely to own their own homes; lower household income; more likely to live in locations associated with deprivation; less likely to have savings)
• had more negative perceptions about their neighbourhood (less likely to rate their neighbourhood positively; more likely to feel unsafe in their neighbourhood or home)
• experienced restricted physical and technical access to services (difficulty accessing a range of day-to-day services, including public transport and medically-related services such as GP or chemist; less likely to have a car or to drive; less likely to have home internet access)
• faced difficulty with a range of daily activities (were most likely to be cared for by a relative and less likely to receive assistance from a home help since 1999-2000)
• had a poorer health-related quality of life (poorer physical and mental health; more likely to experience acute illness; more likely to attend GP or hospital; more likely to be taking medication)
• reported less healthy lifestyles (more likely to be current and heavier smokers; less likely to be physically active; more likely to be obese)

This profile has significant implications for the delivery of health-care services and longer-term management of illnesses/disabilities across Scotland. Within the general profile, attention needs to be given to the variation in needs and circumstances of adults with long-term conditions. To this end, the report draws attention to the importance of considering the health-care requirements of people with non-limiting long-term conditions. It also considers the policy implications of a possible widening gap between employment rates amongst adults with long-term conditions and those without, and the implications of trends towards more informal, unpaid caring. The policy challenges associated with accommodating an ageing population and managing the nature and extent of long-term conditions are highlighted.

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