Multiple long-term conditions research

We aim to improve the lives of people with multiple long-term conditions and their carers, through research.

What are multiple long-term conditions?

The term ‘multiple long-term conditions’ (MLTC) refers to the co-existence of two or more chronic conditions (physical or mental) in a person.

In medical and research circles, this has often been referred to as 'multimorbidity'. We use the term MLTC as we find it is better understood and preferred by patients, carers and the public.

The importance of MLTC research

MLTC research is everyone’s business.

There are an estimated 14 million people in England living with MLTC. This number is growing, in line with our ageing population.

It also affects young people, with almost 20% of 25–64-year-olds having more than one condition. We know that those living in the most deprived areas are more likely to develop MLTC earlier in life.

It is already estimated that people with MLTC account for more than half of NHS primary and secondary care costs.

Clinical services are typically organised around single conditions. This means the health and care system does not work as well for people living with MLTC. People are often passed between specialists, having to repeat their stories and feel the management of their conditions fails to take account of their needs.

These factors make managing MLTC a challenge for health and social care services. It also places a huge burden on people with MLTC and their carers.

This presents an opportunity for research to provide the evidence needed to improve the lives of people with MLTC.

Our 2023 evidence collection explores the intersection of MLTC and health inequalities and how we can address the challenges.

We also published an evidence collection in 2021 about the risks of MLTC, and its impact on people and health and care services.

Our aims and strategic framework

We are undertaking work to foster a change in NIHR culture and practices to promote and enable research into MLTC.

Our strategic framework sets out what we will do to drive forward MLTC research. It is informed by a series of workshops with people with MLTC, their families and carers. It outlines what we need to do to create a common understanding of the issues. This includes broad evidence aims but also cultural aims, to support MLTC research over the coming decades.

NIHR Strategic Framework for Multiple Long-Term Conditions Research

We have established a series of task and finish groups which focus on:

• reviewing funding processes to support MLTC research applications
• supporting studies to be inclusive of people with MLTC
• fostering a multi-disciplinary workforce, working beyond usual single disease specialisms

A Multiple Long-Term Conditions Cross-NIHR Collaboration (MLTC CNC) programme has been established to bring together the NIHR’s translational, applied and policy research infrastructure to respond to the NIHR Strategic Framework for MLTC Research; and work together to tackle the MLTC research questions that could not be achieved without this cross-disciplinary collaborative endeavour.

We are working in partnership with a number of medical research funders and charities to overcome the structural and cultural challenges in MLTC research, including the Academy of Medical Sciences and Medical Research Council.
We have a shared webpage of MLTC: helpful resources between our partners.

Our work will support the research needed to better understand the trends, clusters, mechanisms and causes, burden, prevention and management of MLTC. Our interest in MLTC research also includes children and young people with complex care needs, who experience the health and social care system in a similar way to people living with MLTC.

Funding for MLTC research

All our funding programmes encourage applications for MLTC research. We do offer some MLTC-specific research funding opportunities:

• Systems Engineering Innovation hubs for Multiple long-term Conditions (SEISMIC) - a large-scale programme of research to consider how to better configure services
• MLTC SWAP Call - we encourage studies within a project which look at multiple long-term conditions
• The NIHR Grants for Applied Research Programme - this includes a highlight notice calling for varied approaches to research into MLTC, to address the NIHR Strategic Framework MLTC research and NICE priorities in MLTC
• The NIHR Team Science Camp and Award aims to bring together researchers with an interest in MLTC from a variety of disciplines and with a wide range of experiences to tackle complex current and emerging health and care challenges

In addition, we are funding two large-scale, multidisciplinary programmes to identify and map common clusters of disease and their trajectories:

• The AI for MLTC (AIM) programme, using artificial intelligence and data science methods
• The Strategic Priorities Fund for ‘tackling multimorbidity at scale’, co-funded with UKRI and covering mechanistic and biological pathways research

Both programmes look at wider causes, including health inequalities. We are also funding research to support the rapid uptake of research findings into routine practice.

Support for MLTC research