Dr Mark Ratnarajah
UK Managing Director, C2-AiA national inquiry into maternity safety. Changing roles for ICBs and foundation trusts. Dialling up access to clinical trials. And new expectations around the NHS App. All trailed items expected to be included in the imminent and highly anticipated 10 Year Plan.
Now a new vision for tackling NHS inequalities has been outlined and entered into the mix, in Wes Streeting’s latest speech. So why does this matter to the future of the health service, and the plans that the health and social care secretary is driving forward?
Health inequalities between different groups in our society arise because of the differences in the conditions and environments in which we grow up and live. These in turn are fundamental to our physical and mental health and wellbeing.
The reality though is that this inequality is avoidable, as evidenced by a clutch of successful local initiatives to address waiting lists. Work for instance by NHS Cheshire and Merseyside in tackling inequity in access and outcomes and recognised as an exemplar by The King’s Fund, has used technology to find hidden high-risk patients on waiting lists, and enabled effective interventions before patients deteriorate. In many ways it demonstrates success in action in all of the above themes likely to be incorporated in the 10 Year Plan.
The initiative also revealed a direct correlation between those on waiting lists, and those facing the greatest levels of health inequity. Nearly half of all patients on waiting lists (47 per cent) fell into deprivation deciles one and two – the most deprived.
In other words – those with the greatest hardship also had the greatest health needs. That might sound like an obvious statement. But with current national initiatives targeting the core 20 per cent of the population, measurement of reality on the ground suggests health inequity is for different geographies a bigger challenge that requires greater investment of resource. Not just from the perspective of doing what is right for the benefit of population, but in understanding how to target resources effectively at earlier points in health, in social care, in housing, and in society, in order to prevent those patient cohorts from placing downstream unsustainable demand on the busiest and most costly parts of the NHS.
Using patient-level analytics across elective care pathways, the ICB was able to develop a clearer picture of patients facing the worst: longer waits, gaps in access, poorer outcomes and experience, and how that aligned with deprivation and ethnicity. Such findings may not be comfortable – but they can be actionable.
This is about fundamentally making informed decisions on how to plan services – based on the evidence on where they can have biggest impact. With foundation trusts set to become ‘integrated healthcare organisations’, that will manage funding for the health and care of a designated population – measuring health equity could have a significant impact in understanding how to get the most for the public’s pound at a time when global instability requires closer examination of where it is being spent than at any time in recent history.
It is this actionable insight that could prove valuable to many more as new policy emerges. The current draft of the 10 Year Plan is heavily suggestive that new money for the health service will not be available, according to media reports. Ahead of its unveiling that is likely just days away, the NHS will be expected to innovate, create new models of care, and adopt new technologies, without further investment than has already been set out.
So, can we measure health equity, and should we? Yes – but only if we look beyond national averages and measure what matters locally, and individually at-scale. And only if we see this as more than a compliance exercise, but as a foundation for better decision-making, and for enabling one of the three shifts for future delivery of healthcare: prevention. Data alone won’t close the gap – but it can allow us to better assess the gap and the action needed to close it, and prevent significantly compounded cost, both for patients and for the NHS.
Featured image via House of Commons.
