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Tackling poverty: making more of the NHS in England

Importantly for potential poverty reduction, the NHS has immense economic power as well as massive scale and reach in the population. As a country we are now spending more than £100 billion on the NHS in England, and there are more than 300 million consultations in general practice every year alone, and more in hospital and other community services.

But it is far less clear that the most is being made of that potential in terms of the effect on poverty.

Key findings

  • The NHS has some institutional characteristics that ‘get in the way of’ tackling poverty. These include an imbalance towards medical rather than social models of health, a focus on processes of care rather than on outcomes, and payment systems that incentivise viewing the patient as a series of conditions and diseases, rather than as an individual living within a broader social context.

  • A more poverty-aware and focused NHS requires stronger leadership, better aligned system design, and stronger engagement with other public services and civic society.

  • This means stronger leadership from NHS England, especially in setting out its expectations and narrative on poverty, and from clinicians.

  • It also means a more poverty-aligned system including an NHS that is aware of its existing impact on poverty; clear what the new inequalities duties mean and how they relate to poverty reduction; rewarded and accountable for doing better for people with mental health problems, long-term conditions and child poverty; and where primary care is proactive and sees its role as changing the wider determinants of health as well as reacting to illness.

About the paper

The research on which this paper is based was commissioned by the Joseph Rowntree Foundation (JRF) to inform its work to develop an anti-poverty strategy for the United Kingdom.