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Closing the gap on health inequality

NHS England’s Director for Experience, Participation and Equalities looks at how the Long Term Plan for the NHS will tackle health inequality:

The NHS is here for everyone. Yet whilst life expectancy is growing for some, it has stalled or is falling for others.

People in the most deprived areas develop long-term conditions 10 to 15 years earlier than the general population and those with a Learning Disability or severe mental illness die a decade or more earlier.

That’s why health inequality has a much stronger emphasis in the new NHS Long Term Plan, not only with its own chapter but also running as a thread throughout the whole document. It includes significant new initiatives to reduce smoking, alcohol and obesity, which are the main causes of preventable ill-health as well as improve outcomes for cancer, stroke and heart disease, which make up half of the gap in outcomes between richest and poorest.

The planning process has required clinicians and managers to think about how to adapt their programmes to better address health inequalities. They have been supported in this task by people with deep personal experience of exclusion, as well as social entrepreneurs, academics and voluntary organisations with ideas about how to make a difference.

The goal to achieve three quarters of all cancer diagnoses at stages one and two, for example, is not just good for the general population, it will also help us reduce health inequality, as people in deprived areas are more likely to be diagnosed late after an emergency admission. Specific commitments have also been made to new mothers, people with Learning Disabilities or severe mental illness and rough sleepers.

Major national programmes like these will make a difference but most of the work to reduce inequality will come from targeted approaches in neighbourhoods, developed and delivered with the communities themselves.

Councils, voluntary organisations and general practices were among those who told us about effective interventions that can be replicated. Now all health systems will be asked to set out how they will reduce health inequalities in their areas over a five and ten-year period. The starting point must be conversations with those people who are seldom heard, where we have most to learn.

This renewed approach is underpinned by additional funding channelled to the poorest parts of the country worth over £1 billion a year over and above what they would ordinarily have received by 2023/24. We’ve also published data to show where the variations are most acute.

We know the NHS cannot treat people out of inequality but we know we can close the gap if we are focused, determined and work in partnership with councils, the voluntary sector and communities themselves.

Dr Neil Churchill

Dr Neil Churchill is Director for Experience, Participation and Equalities at NHS England.

His brief includes insight and feedback, patient participation in decision-making, improvement programmes on cancer, learning disability and support for carers and national partnerships with volunteers and the voluntary sector.

Neil joined NHS England in 2013 after a 25 year career in the voluntary sector at organisations including Barnardo’s, Age Concern, Crisis and Asthma UK. He has been a Non-Executive Director for NHS South of England, an appointed member of the National Information Governance Board and a trustee of a number of charities across the UK.

Neil is a member of the Executive Board for the Beryl Institute, a change agent from the School for Change Agents and a member of Q, the quality improvement collaborative from the Health Foundation. He tweets as @neilgchurchill.

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