In recent weeks, the government had made a series of piecemeal announcements that seem to be aimed at making a dent in the biggest crisis in NHS history.
Do you remember, for example, the £1bn investment for emergency care – extra beds for A&E and more ambulances – announced at the end of January? What about the £150m committed to “boost” the NHS’s mental health services, announced only a week prior to that? Or perhaps, two weeks before even that, the £250m pledged to speed up hospital discharges?
You would be forgiven for forgetting these announcements, however: they have been drowned out by the torrent of health-related headlines charting the impact of the NHS’s record backlog and overstretched A&E departments. These announcements, though welcomed as being at least something, have nevertheless been criticised from sector experts for not being enough to solve the health service’s underlying problems. (The extra £1bn for emergency care while making for a good headline, represents less that 0.6 per cent of the annual NHS budget.) And none of these policies represent what politicians and health professions increasingly agree is needed for the NHS in the long term: “reform”.
The effects of more than a decade of Conservative austerity on the NHS are clear, and it is agreed that greater funding wouldn’t necessarily fix the health service. But what NHS “reform” should look like is where the consensus fades. And there is another underlying problem the government seems to have dropped along with more meaningful reform: Britain’s glaring health inequality.
Who you are – your ethnicity, where you were born and live, your financial circumstances – has a direct effect on your healthy life expectancy. This was brought into sharp focus during the pandemic when people from BAME backgrounds, people in the north of England, and those on lower incomes were disproportionately impacted by higher infection and death rates from Covid-19.
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Less than a year ago, the government acknowledged and promised to tackle the causes and symptoms of these underlying health inequalities. Ahead of a promised white paper on health inequalities, Sajid Javid, the former health secretary, promised “bold action” to “break the link between people’s background and their prospect for a healthy life”.
But that commitment from the government has now officially been scrapped. Neil O’Brien, the health and social care under secretary, confirmed last month that the government will “no longer be publishing” the white paper. In its place, the government has announced a review to look into improving treatment for people already experiencing ill health, and said this would take into account regional disparities. But as Martin McKee, the president of the British Medical Association noted: “We also desperately need a plan to stop people getting ill in the first place.”
The white paper was ready to be unveiled last summer, after Javid departed from his role, but his successors – Steve Barclay, who took the post in the final days of the Boris Johnson administration, then Thérèse Coffey, before Barclay’s return – refused to publish what was promised to be, according another government white paper on levelling up, a coordinated and holistic strategy by the “whole of government to consider health disparities at each stage at which they arise… [including] the wider determinants of health”.
These health disparities – along lines of race, location and income – are the result of systemic, structural failures and wider inequalities. Areas of higher deprivation have higher mortality rates from heart and respiratory disease, lung cancer, obesity levels and a stronger prevalence of unhealthy behaviours linked to ill health, including excessive alcohol consumption, poorer diets and a lack of exercise.
Austerity has only widened the health gap between those at opposite ends of the socio-economic spectrum. A girl born today in one of the most deprived 10 per cent of local areas is expected to live 19 fewer years in good health than a girl born in the least deprived, according to the Health Foundation.
We may never know the full contents of the white paper: which causes, drivers and solutions to ill health it identified. Coffey reportedly thought its conclusions were “an affront to this government’s view of what makes for health”.
Those solutions, whether they are ideologically or politically unpalatable for the government or not, cannot wait. The same groups that were negatively affected by the worst of the pandemic are those most at risk from ill health during the current cost-of-living crisis. As the crisis bites and people are pushed into further financial hardship, more people will continue to pay for this inaction with their health.
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