The NHS collects, analyses and monitors data about the people we serve. This includes information on the conditions they have, their journey through care and their health outcomes. We also record information about the person including where they live, their age, ethnicity and gender. This helps us to understand more about people’s experiences, both as individuals and a collective, as well as helping us to identify trends and areas for improvement.
To inform development of the Core20PLUS5 approach, a number of different sources of data and evidence were examined, including public health profiles and tools from the Office for Health Improvement and Disparities and The Global Burden of Disease study, highlighting five clinical areas with potential to make substantial improvements for those experiencing healthcare inequalities. Policy priorities were also considered to understand areas where large gains were possible. The clinical areas identified are:
• Hypertension case-finding: to allow for interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke.
• Early cancer diagnosis: 75% of cases diagnosed at stage 1 or 2 by 2028.
• Chronic respiratory disease: a clear focus on chronic obstructive pulmonary disease (COPD) driving up uptake of COVID-19, flu and pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.
• Maternity: ensuring continuity of care for women from Black, Asian and minority ethnic communities and from the most deprived groups.
• Severe mental illness (SMI): ensuring annual health checks for 60% of those living with SMI (bringing SMI in line with the success seen in learning disabilities).
Information on the evidence base for these areas of focus is available below.
Hypertension case finding
High blood pressure, also known as hypertension, is a key priority within the NHS Long Term Plan and a risk factor for hospitalisation or death from heart attack or stroke.
In 2016-18, around one in five avoidable deaths from cardiovascular disease in people under the age of 75 were among people in the most deprived decile of communities in England. Research suggests that the incidence of high blood pressure within the most deprived communities is roughly double that of the most affluent areas and people living in the most deprived areas are nearly twice as likely to have a stroke.
The British Heart Foundation has a helpful visualisation which shows the correlation between heart and circulatory disease death and deprivation.
Finding people with hypertension allows early intervention to optimise blood pressure and reduce the risk of heart attacks and stroke. It also presents an opportunity to offer preventative measures to those at risk of developing the condition.
Cancer is one of the biggest contributors to inequalities in life expectancy with people from the most deprived communities more likely to get cancer, be diagnosed at a late stage for certain types of cancer and to die from the disease.
Early presentation, referral, screening and diagnosis are key to addressing this and the Long Term Plan sets out an ambition for 75% of cancers to be diagnosed at stage one or two by 2028.
Local and national interventions to drive early diagnosis have the opportunity to help address this. For example, a targeted lung health check programme is currently being piloted in the most disadvantaged areas of the country where rates of mortality from lung cancer are high.
Chronic Respiratory Disease
Chronic respiratory disease is the third biggest cause of the life-expectancy gap between the most and least deprived groups. In 2020, the rate of premature mortality due to respiratory disease among people living in the most deprived quintile of areas was a least twice the average for England.
Acute exacerbations of chronic obstructive pulmonary disease account for roughly 1 in 8 emergency hospital admissions in England and deprivation is linked with increased emergency health care use among people with COPD.
The LTP respiratory programme aims to improve diagnosis, treatment and pulmonary rehabilitation with the Core20PLUS5 approach focusing on accelerating flu, COVID-19 and pneumonia vaccine uptake which will help to minimise emergency admission winter pressures arising from COPD exacerbation and reduce avoidable deaths.
The Long Term Plan and the MBRRACE-UK reports highlight the significant differences in maternal mortality between different ethnic groups and those from the most deprived areas. Black and Asian mothers are more likely to die as a result of childbirth than their white counterparts and this gap has widened since 2010.
Evidence suggests that mothers who receive continuity of carer are less likely to lose their baby or experience preterm birth. Their experience of care during pregnancy and birth also improves.
Ensuring continuity of care for Black, Asian and Mixed ethnicity women and those living in deprived areas by 2024 will help to meet the government’s national maternity safety strategy ambition, which includes halving rates of stillbirths, neonatal deaths and reducing the rate of preterm births from 8% to 6% by 2025. This model of care requires appropriate staffing levels to be implemented safely.
Severe Mental Illness (SMI)
People with a mental illness such as schizophrenia or bipolar disorder die on average 15-20 years sooner than the general population. The prevalence of SMI within the most deprived areas is triple that of those living in the least deprived areas. SMI is also more common in Black-British people – 71% of psychosis diagnosis in the UK are among this group.
Young adults with SMI are more likely to be overweight and experience physical health conditions including obesity, hypertension and diabetes which are linked with premature mortality.
Annual health checks for people with SMI support the early detection of physical health conditions and help to improve access to evidence-based physical care, assessment and intervention.