Hospitals can expect a huge rise in the work they have to do because the number of people suffering more than one condition at the same time is increasing, according to experts.
The Health Foundation says hospital activity will increase by 14% over the next five years, costing an extra £4bn.
It says the NHS will need to improve the quality and cost effectiveness of care for people suffering several health problems.
The foundation's research found that people in the most deprived areas suffer multiple conditions 10 years earlier than those from better off regions.
It says a sustainable NHS will need to improve both the quality and cost effectiveness of care for people with more than one condition.
Sarah Deeny, assistant director of data analytics at the Health Foundation said: ‘Nearly one in four people living in England have two or more health conditions, which may lead to poorer quality of life and a greater risk of premature death.
'This number is expected to grow. To care for people living with multiple conditions effectively, it is critical that the NHS long-term plan identifies the complexity of their needs.'