Addressing the uneven playing field in health

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.