Scotland’s Long-Term Conditions Bill Comes Due as Framework Stalls

Half of Scotland’s adults now live with at least one long-term condition, and Public Health Scotland still forecasts a 21% rise in the annual disease burden by 2043 even as the population edges down. The integrated Long Term Conditions Framework once promised by the end of 2025 has not appeared.

The numbers land as the latest reckoning for a system built around single diseases rather than the overlapping realities most patients actually face.

Half of Adults Already Carry a Long-Term Condition

The Scottish Health Survey 2024, published in October 2025, found that half of all adults now have at least one long-term condition. That is the highest share in the series. Almost two in five (39%) said the condition limited their day-to-day activities.

Of those with a long-term condition, 81% reported at least one resulting impairment. Mobility problems topped the list at 41%, followed by stamina, breathing or fatigue at 37% and mental health effects at 32%.

• 50% of adults report any long-term condition
• 39% report a limiting long-term condition
• 28% of adults live with two or more long-term conditions
• 8% have doctor-diagnosed diabetes, a series high

Asthma reached 18%, also a record. Seven per cent still reported current long COVID. General health rated “very good or good” sat at 70%, the low end of the range seen since 2008.

Burden Climbs While the Population Falls

Despite a projected population decline, the Scottish Burden of Disease study and later Public Health Scotland updates point to a clear rise in overall ill-health. The Chief Medical Officer’s 2025-2026 report restates the core forecast: a 21% increase in annual disease burden between 2019 and 2043, driven mainly by ageing if prevalence rates stay put.

Condition-specific projections to 2044 show sharp jumps in the number of people living with several major diseases.

Heart disease numbers are projected to fall 15%, but cardiovascular diseases, cancers and neurological conditions together still account for more than two-thirds of the overall burden rise. The largest growth in total burden falls on people aged 65-84. Around 55% of the increase is expected among males.

Public Health Scotland notes the figures are not inevitable. They assume no change in risk factors, services or prevention.

The Framework That Stayed on the Drawing Board

For years Scottish policy has run through separate strategies, frameworks and funding streams for individual conditions. The government itself has described the approach as one that “do not join up actions or prioritise according to burden of disease or impact.”

In 2025 it consulted on an integrated Long Term Conditions Framework. The independent analysis, published 29 October 2025, showed strong backing for change: 80% of respondents backed a shift toward cross-cutting improvement work alongside necessary condition-specific work. Benefits cited included better coordination, less siloed pathways and more person-centred care. A minority worried about losing focus on specific diseases.

Respondents repeatedly stressed prevention, early intervention, equitable access, digital records that actually talk to each other, and the third sector’s role in non-medical support. Six focus groups with seldom-heard communities produced the same themes.

Publication of the framework and action plans was expected before the end of 2025. By late July 2026 it had not appeared.

1. April-July 2025, public consultation open, 371 validated responses
2. 29 October 2025, consultation analysis published
3. End 2025, original target window for framework and plans
4. May-June 2026, parliamentary questions on publication date
5. July 2026, still unpublished; government points to upcoming Programme for Government

In answer to a written question from Miles Briggs MSP, Minister for Mental Wellbeing, Public Health, Sport, Alcohol and Drugs Maree Todd said the government remained committed and was “carefully considering the recommendations shared by various Advisory Groups.” She added that the Programme for Government for 2026-27 will be put to Parliament in due course.

The Scottish Government is committed to improving the experience of those living with long term conditions in Scotland. That is why we have committed to continue working with people with lived experience, the third sector and clinicians to develop our way forward for long term conditions.

That is the full core of the ministerial reply. No firm date was offered.

Deprivation and Multimorbidity Carry Extra Weight

Long-term conditions are not evenly spread. In 2023 adults in Scotland’s most deprived areas were twice as likely to report a limiting long-term illness as those in the least deprived. The pattern holds across later data on mental health scores, obesity, smoking and premature mortality.

Healthy life expectancy gaps are stark. People in the most deprived communities experience roughly 25-27 fewer years in good health than those in the least deprived, depending on sex. Multimorbidity also starts earlier in poorer areas. Of adults with at least one long-term condition, 51% already have two or more.

Unpaid carers feel the knock-on. Fifteen per cent of adults provided unpaid care in 2023/24 combined; the share is higher among women. Mental wellbeing scores drop as care hours rise.

These are the groups the old siloed model struggled to serve. A person with diabetes, arthritis and depression rarely fits neatly into three separate pathways. Third-sector organisations have long filled gaps with peer support, advice and practical help; consultation responses called for them to be treated as equal partners with stable funding.

Prevention Delivered Gains Before, Yet Core Risks Persist

Scotland has run successful population measures. The smoking ban and minimum unit pricing cut harms. Adult smoking prevalence sits at 14%, half the 2003 level. Hazardous or harmful drinking is down to 20% from 34%.

Other levers have slipped. Only 11% of adults met the five-a-day fruit and vegetable target in 2024, the lowest on record and well below the 20% seen in 2021. Obesity affects 31% of adults, higher among women. Physical activity guidelines are met by 62%, but the share falls to 50% in the most deprived areas. Free-sugar and fibre intakes remain far from goals.

Public Health Scotland stresses that the 21% burden rise can still be bent by cutting new cases and slowing severity. Building blocks outside the NHS, income, housing, environment, matter as much as clinical care. The Collaboration for Health Equity is one recent attempt to join those dots locally.

Without faster progress on the fundamentals, the projections harden into demand.

Hospital Beds and System Strain Already Reflect the Load

Unplanned acute inpatient admissions are projected to rise 11.8% between 2024 and 2034. Demographic ageing is the main driver for older adults. Complexity rises with multimorbidity: higher mortality, lower function, heavier service use.

The same conditions driving the future burden, cancers, cardiovascular disease, neurological disorders, already dominate inequalities in premature death. Avoidable cancer mortality remains at least twice as high in the most deprived fifth of the population.

Calls for system-wide change have grown louder. An open letter from senior figures demand long-term reform of Scotland’s health system sits in the same landscape: capacity, workforce, prevention and joined-up care all under pressure at once.

Third-sector conferences in mid-2026 were already billed around “the Scottish Government’s new long-term conditions framework,” treating publication as imminent and focusing on delivery models and community roles. The document itself has yet to catch up.

What the Delay Leaves on the Table

Every month without a published framework leaves resource allocation still shaped by historical condition-specific streams rather than current burden or equity impact. Consultation respondents were clear that prevention and early intervention needed to sit at the centre, not the edge. Multimorbidity and deprivation gradients will keep compounding until care pathways match the lives people actually lead.

The Programme for Government 2026-27 is now the next public checkpoint. Public Health Scotland’s condition papers keep updating the map: diabetes projected to rise 36%, COPD 63%, dementia more than half again. The people already managing several conditions at once do not get a pause button while the paperwork catches up.

Scotland has the data, the consultation consensus and the demographic warning. The reckoning is no longer theoretical.