‘The fundamental promise of the NHS, that it will be there for us when we need it, has been broken’. These were recent words from the Secretary of State for Health and Social Care, Wes Streeting. Regardless of your stance on this, the founding principle that the NHS is available to all is being challenged. When looking at who is accessing healthcare services and what their experiences are, it’s clear that not all groups experience healthcare equally.
People living in the most deprived areas of England are more than twice as likely to wait over a year for elective care, or even die prematurely from cardiovascular disease (CVD), than people in the most affluent areas. These statistics highlight stark health inequalities – avoidable, unfair, and systematic differences in health between different groups of people.
Despite successive governments recognising the issues, little progress on health inequalities has been made over the past decade. Life expectancy has stalled, and is even declining in some parts of the country.
Following an extensive review of The King’s Fund’s work on health inequalities, our new analysis outlines how the NHS can make a significant contribution through its anticipated 10-year health plan. We set out seven key priorities, which although may sound familiar to many, are crucial for achieving radical change.
1. Develop a cross-government health inequalities strategy for the 10-year health plan to feed into.
2. Reorientate the NHS to focus on prevention.
3. Radically change the relationships the NHS has with people and communities, from ‘power over’ to ‘power with’.
4. Tackle racism and discrimination in the NHS and cultivate a culture of compassion.
5. Enable staff to identify and act on health inequalities and capture learning.
6. Empower place-based partnerships to take more decisions about how NHS money is spent.
7. Actively support local voluntary, community, and social enterprise (VCSE) organisations through changes in financial planning and commissioning.
One key priority outlined above is a shift to prevention, given that preventable diseases, like CVD, significantly contribute to health inequalities and account for a large part of the life expectancy gap between the most and least deprived communities. This shift has broad support across government, as highlighted by Wes Streeting who recently said that “without action on prevention, the NHS will be overwhelmed”.
A crucial step is investing in community-based care. Community health services are more accessible and can provide tailored support to individuals in their local context. This facilitates early detection of potential health issues, easier monitoring, and management of chronic diseases, and promotes healthier lifestyles. Ensuring these services are adequately funded is essential.
However, our previous research has highlighted the lack of growth and investment in primary and community health services as “one of the most significant and long-running failures of policy and implementation in the NHS and social care for more than 30 years”. Without a shift to a preventative model, health outcomes worsen, and the NHS faces increased costs.
Our report calls for the health and care system to adopt longer-term planning to help Integrated Care Boards (ICBs) – partnerships that bring together NHS services with local authorities and other local partners – to plan, co-ordinate and commission health and care services. Sustained prioritisation and longer planning cycles are important because the impacts of preventative initiatives tend to be seen over longer time periods. ICBs must be held accountable for investing in, and making progress on, prevention, and NHS England should support ICBs to develop strategies focusing on care in the community, and on empowering local health leaders to take decisions on how funding is spent based on what the community’s needs are.
Immediate pressures on the NHS could pose a risk to progressing the shift from treatment to prevention. But the development of the government’s 10-year health reform plan, alongside their new ‘mission-led’ cross-government approach to health, is a welcome signal of a commitment to tackling health inequalities and providing strategic direction for improving health outcomes.
However, real and lasting change occurs at the local level, within organisations and communities, so it is vital for staff to be equipped with the skills they need to identify and address inequalities. The NHS should be there for everyone when they need it, and nobody should be left behind.
