A new health inequalities improvement dashboard will help track progress (although this should be opened up to local citizens and non-governmental organisations to build public understanding of inequalities), and NHS England’s survey on what practical further support the NHS needs to help deliver has recently closed and should help answer practical questions like what sort of support from the centre is required. So what to make of this?
NHS England has clearly understood that inequalities is not one thing and has sought to develop a genuinely nuanced approach. Core20plus5, covers key aspects and different lenses on health inequalities, giving a steer and direction from the top while also recognising local systems will understand their populations far better than the centre. The approach and dashboard provide a way in for leaders and non-experts in public health to have oversight of what communities have a right to expect as the NHS seeks to move forward on health inequalities. But if it is going to have a chance of making a difference it needs more than practical support, welcome though this is. There are some key risks and some further changes to help that happen.
First, the approach must be ‘and 5’, not ‘5 first’. If push comes to shove the temptation and incentives will be for areas to focus most efforts on ‘the 5’, since these are clinical, known to the system, have specific targets and have existing accountability arrangements. This risks reverting to highly medicalised and siloed single-disease and condition-focused models of inequalities only, failing to recognise the many millions for whom inequalities in health do not come through these five routes alone but from multiple long-term conditions and the complexities that underly them.
Second, the lack of clarity on accountability for the elements beyond ‘the 5’ and lack of specificity on the focus within them risks efforts being confused. Integrated care partnerships, as the alliance of local leaders within the ICS, need to embrace the Core20plus5 model as their lever to set strategy for the integrated care board to enact, as the Health and Care Bill currently at second reading in the Lords intends them to do.
Finally, Core20plus5 must not be the sole source or focus for action on health inequalities. The NHS is not an island, either nationally or locally, though sometimes it can feel like it is and is often perceived as one. The NHS cannot tackle health inequalities alone, but the NHS can make a greater impact itself by being a stronger partner for health inequality reduction in place, contributing to tackling wider issues such as poverty, through acting as an anchor and understanding the social value it can help create. This is where the ambition and commitment behind Core20plus5 needs to go next, and where some, such as the West Yorkshire Partnership are already going, including through the development of a health inequalities academy. This is one reason why we have argued for parliament to amend the Health and Care Bill to incorporate reducing health inequalities within the new duty on NHS organisations to have regard to the ‘triple aim’ of ensuring better health and wellbeing, improving the quality of services and making efficient use of resources. So Core20plus5 is a good start and needs to be supported and applauded, but it is the first few rungs on the NHS’s new journey on health inequality reduction, not the whole ladder.
we too welcome this report, and are looking to see where kidney health can become a key focus as part of it. I agree that there is a whole area not covered. We are keen to explore pre and post natal care for mums and babies that could add insight and then change practise that would reduce the inequalities.
Once again it is a framework built around adults & leaves and untapped potential in terms of sustainability by leaving out newborn care.
As a consultant practicing in an area with significant socio economic deprivation I would love to see funding & support directed to these babies & future adults to bring our projects to fruition