Wrecked Bodies, Specialist Wards: What Patients With Multiple Conditions Really Experience in Hospital

When a patient with several long-term conditions is admitted to hospital, they often expect care only for the condition that brought them in. A new qualitative study published in BMC Medicine reveals that people living with multiple long-term conditions (MLTC) largely view hospitals as specialist, short-stay environments configured to resolve acute problems rather than to address the full spectrum of their health needs. The research, led by Sue Bellass of Newcastle University and colleagues, offers a vivid, sometimes uncomfortable portrait of inpatient care in the English National Health Service at a time when multimorbidity is rising sharply among hospital populations.

The study interviewed 44 adults aged 34 to 87 years, with a mean age of 68.4 years, who had experienced an inpatient stay in an NHS hospital within the previous six months. Participants reported living with between two and eleven long-term conditions, spanning physical, mental and long-term infectious conditions. Recruitment took place through three NHS sites in England, two in the North East and one in the North West, supplemented by patient networks. Nearly all participants, 96 percent, had experienced an unplanned admission during their most recent hospital stay, and 86 percent had stayed in hospital for less than a week. Data collection ran from November 2023 to December 2024, making the findings directly relevant to post-COVID hospital care.

Using semi-structured one-to-one interviews and inductive thematic analysis, the researchers constructed three interrelated themes reflecting perceptions at individual, interpersonal and organisational levels. The first theme, internalised narratives of NHS hospital care, captures how public narratives of hospitals as inherently specialised and resource-constrained environments shape patient expectations. The second theme, alignment between clinician and patient knowledge, distinguishes positive from negative care experiences based on whether patients felt their experiential knowledge was recognised and incorporated. The third theme, organisational constraints to holistic care, illuminates system-level barriers including fragmented services, information transmission failures and rigid clinical guidelines.

Participants generally understood hospitals to be specialist, short-stay environments where acute problems would be resolved and they could return to their prior life on discharge. Apart from expecting medication for their long-term conditions, they did not anticipate that care would be provided for conditions that had not precipitated their admission. One man with eleven long-term conditions explained that hospitals monitor specific organs with machines but patients are specifically there for whatever they went in for, unable to ask for checks on unrelated body parts. Another participant with three conditions noted that hospitals specialise in one thing and that is all they do. This biomedical framing, where patients adopt language relating to body systems, diagnostic labels or specialisms, mirrors the single-condition focus of hospital care itself.

A prominent sub-theme was hospital as a resource-constrained environment due to insufficient staffing for high demand. Media reports or personal experience of long waits on hospital corridors in emergency departments were commonly referenced, with participants perceiving beds as the currency of the hospital care system. This could result in patients questioning the legitimacy of their own bed occupation. One woman with four conditions described feeling like a fraud because she did not feel ill, only very tired with a dry mouth, while worrying that others needed the bed more. Discharge processes could be delayed waiting for advice from another specialism, leading to frustration at being unable to surrender the bed. Participants frequently sympathetically described nursing staff as rushed off their feet, and this awareness of system pressures shaped the level of care they expected to receive, with some perceiving that staff would only respond to other conditions if they became problematic during the stay.

The second theme reveals that the degree of alignment between clinician and patient knowledge was a key contributor to whether hospital care was experienced positively or negatively. Participants giving positive narratives generally felt involved in the care process, confident that their medications were well-managed, trusting their clinicians and able to use their agency to shape decisions. One man with a childhood-onset kidney disorder described having a two-way conversation with every doctor, where they listen and give feedback. In contrast, people giving negative accounts felt excluded from care decisions, unable to influence the process, and doubtful of clinicians’ knowledge. Participants reported frustration when clinicians did not take other conditions into consideration, with one woman noting she was concerned about her tummy the whole time but nobody else was. Another described constantly having to explain sleep apnoea, breathing issues, Crohn’s disease and kidney problems to each new clinician who came in.

Medication management emerged as the primary mechanism through which care for other long-term conditions was achieved in hospital, rather than contact with specialist teams. Experiences varied considerably. Some participants received timely medication for all conditions, while others reported not receiving the right medication or receiving it at the wrong time of day, leading them to use medication they had brought into hospital or to ask family members to bring it from home. One woman with four conditions described staff not reading her notes properly and giving insufficient doses of Baclofen, which she takes three times daily. Another participant with severe chronic obstructive pulmonary disease and emphysema reported that her nebulisers were not provided four times a day as prescribed, fortunately having her own portable equipment. These tensions highlight how established self-management practices, accrued through tacit experience, can be disrupted when hospital routines fail to sustain medication regimens.

The third theme illuminates organisational constraints to holistic care, including integration of services and perceptions of clinical training and guidelines. Some participants described receiving integrated care, but effectiveness depended on how well specialties communicated with each other. One man described how his kidney transplant required renal and neurology specialists to integrate on a very regular basis to balance steroid doses against nerve condition control. However, hidden difficulties could create concerns, particularly regarding self-management. One participant with diabetes described difficulties waiting for multiple specialists to come at different times, with instructions not to eat lunch until seen by a particular doctor, while his food intake bore directly on when he took his insulin, potentially putting more insulin in than his body could stand. Information transmission failures, including missing information, medication errors and receiving conflicting advice, required participants to repeat their problems to multiple clinicians. One participant split across two boroughs noted that different systems had no link, with bits of information on one system and bits on another. Discharge summaries ranged from comprehensive to containing unexplained medication changes, inaccurate information, or conditions participants were unaware they had been diagnosed with. One participant reported a potentially serious information error where a letter contained somebody else’s full details in the middle.

Participants also perceived that clinicians were limited in their ability to deliver MLTC care due to their training and the clinical guidelines they were expected to use, described as tick box approaches that could constrain flexible decision-making. One participant acknowledged that staff autonomy was constrained by the organisational context, with clinicians following certain pathways until they say no, trying to bend the rules but ultimately having masters to speak to. Participants with rare conditions such as Still’s disease and uncommon tumours remarked on delayed diagnoses and a need for greater clinical training and awareness to improve care and avoid potential medication interactions. These findings strikingly parallel a companion qualitative study of frontline hospital clinicians within the same research programme, with both identifying tension between care for acute and chronic conditions within the predominantly specialist model of hospital care.

The study’s findings carry important policy implications at a time when healthcare systems worldwide face challenges sustaining services originally designed to treat single conditions. In England, an independent investigation has recently described the NHS as being in serious trouble, identifying the inexorable rise in MLTC as a key factor intensifying pressures on service delivery. The 10 Year Health Plan for England has set out radical transformations including a shift from hospitals to community settings, with care provided at home wherever possible and in neighbourhood health centres when further support is required. The researchers propose that clinicians discuss self-management practices with people living with MLTC as soon as possible after admission, identifying which established practices could be continued in the hospital setting or advising how self-management could be adapted during and after the inpatient stay. Redesigning hospital services to provide joined-up, person-centred care will require flexibility to respond to the wide spectrum of MLTC experiences, and involving people with lived experience in the redesign of these processes is essential to ensure hospital services can adequately meet their needs.

Subject of Research: Health

Article Title: ‘People need to be a bit more understanding that my body is wrecked’: A qualitative exploration of inpatient hospital care for people living with multiple long-term conditions

Article References: Bellass, S., Scharf, T., Witham, M. D., Threlfall, L., Plummer, C., Sayer, A. A., Cooper, R., & on behalf of the ADMISSION Research Collaborative (2026). ‘People need to be a bit more understanding that my body is wrecked’: A qualitative exploration of inpatient hospital care for people living with multiple long-term conditions. BMC Medicine, 24(1), Article 567. https://doi.org/10.1186/s12916-026-05181-4

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05181-4

Keywords: multimorbidity, hospital care, qualitative research, NHS, patient experience, health services, People, need, understanding, body, wrecked, qualitative