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Healthcare delivery


Addressing the uneven playing field in health


Kate Woodhead considers the actions needed to tackle an uneven playing field in health and to shift the emphasis on to prevention. She looks at some of the key ambitions that have been outlined by NHSE, the Government and Integrated Care Boards, to tackle health inequalities.


The new government is working, we understand, on the production of its ten-year plan for healthcare. We have reached an inflection point and it will be fascinating to see how much care is targeted from the centre or is allowed by the Department of Health and Social Care to be enabled locally by the Integrated Care Boards. The targets, if they come, are likely to be mostly around the Darzi report which focused on ‘diagnosis not treatment’ and excluded most areas of the state of social care, public health services or on improving the health of the population. The wider determinants of health, which have so much impact on individuals, families and across the whole health and economy of the country, may be left out of the plan for now. NHS England (NHSE) has asked Integrated


Care Boards to take a long-term approach to preventing ill health but the targets it has set, so far, are on short-term improvements principally on elective care recovery. NHSE has allocated £97m across all 42 ICSs for efforts to improve prevention – an additional £200m for tackling health inequalities compared with £2 billion to tackle elective care backlogs.1


We


await the balance highlighted going forward by the ten-year plan. The ICSs were largely set up to improve health, to take on inequalities in outcomes and enhance productivity and value for money by joining up health and care services. Included on their Boards are representatives from across the field to help the NHS support broader social and economic development.


Health inequalities have been highlighted by successive governments for many years, but a review of its status, at present, shows little sign of major progress. Indeed, using relative poverty as a measure, it was estimated that in 2022/23 just under one third of children (30%) in the UK were living in poverty – which equates to 4.3 million children.2


Understanding the scale of the


challenge is fundamental to how the NHS can respond to the current situation.


Health inequalities They are defined as avoidable, unfair and systematic differences in health between different groups of people.3


Health inequalities


reflect the inequalities in society at large. They are closely related to personal and socio- economic factors such as income, education, housing, gender, age, ethnicity, disability, geography and social inclusion. They are the result of differences in health status, access to care, quality and experience of care, behavioural risks to health (i.e. alcohol and smoking), and wider determinants of health – such as housing. The groups who experience the worst health include, but are not limited to, black and ethnic minority groups, people sleeping rough, people living in poverty, disabled people or those with long-term health conditions and those who are part of the LGBT community. To make matters worse, there are barriers to accessing services faced by those who need the most care and support. The barriers cited included: l Not being treated with empathy or genuinely listened to.


l Lack of communication from services.


l Feeling of powerlessness. l Practical barriers e.g. travel costs. l Shame and stigma. l Services not being flexible, holistic or inclusive enough.


l Lack of trust and engagement due to negative experiences in the past. l Discrimination and racism.


These have an impact on many aspects of life including life expectancy. For example, the difference in life expectancy for people living in the most deprived areas of England compared with the least deprived is 9.7 years for males and 7.9 years for women.4


The most common


summary measure of these circumstances across a population is deprivation. Infant mortality is twice as high for Black infants and nearly twice as high for Asian infants compared with White infants. Figures show that deaths per 1,000 infants in England and Wales in 2022 were: 6.6 Black infants; 5.7 Asian infants; 3.1 White infants.5


A further measure of health inequality is how much time people spend in good health over


November 2024 I www.clinicalservicesjournal.com 15


Pierrette Guertin - stock.adobe.com


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