A change in government and the development of the 10-year health plan offers a real opportunity to tackle health inequalities for people with a disability and long-term health conditions, according to a new report from health thinktank The King’s Fund.
The report says the NHS has a central role to play in delivering care equitably and working with others to tackle health inequalities. To do this, the NHS must radically transform the way it works with communities and staff, while reorientating services to focus on prevention.
It added that it was deeply unjust that some groups of people have significantly worse health and worse experiences of the NHS than others, especially as this could be preventable. These groups include black and ethnic minority groups, people sleeping rough, people living in poverty, people with disabilities or long-term health conditions, and those who are part of the LGBTQ+ community.
The King’s Fund told Learning Disability Today that they hope the work published this week highlights the widening health inequalities faced by many people in the country and what the NHS should be focusing on to urgently tackle this and improve health and wellbeing outcomes for people with learning disabilities and all those who experience health inequalities.
Ruth Robertson, Senior Fellow, The King’s Fund added: “Disabled people are more likely to face poorer experiences of – and worse access to – health and care services than people who aren’t disabled, and among disabled people, some groups – for example those with learning disabilities – experience particularly poor outcomes. These health inequalities have been exacerbated by the Covid-19 pandemic and the rising cost of living.”
After reviewing evidence, it has identified seven key areas for action. These are:
Over the past five years, The King’s Fund has heard from lots of different people who experience the worst health outcomes about their experiences of using health and care services in the UK. It said that there are common themes in the stories they shared including discrimination and racism, not being treated with empathy or genuinely listened to, lack of communication from services, feeling of powerlessness, and lack of trust and engagement due to negative experiences in the past.
The report added: “While meaningful progress requires much more than a written strategy, not least the capabilities and capacity to enable its effective implementation, devising a new national plan for the NHS is an opportunity to refocus and prioritise longer-term strategies for tackling inequalities and the worst health outcomes.
“It is a positive step that the government’s health mission (published when the Labour party was in opposition) acknowledges the importance of prevention and a joined-up, long-term approach across government, alongside partnerships with local communities. These conditions are necessary for the success of the new 10-year health plan that tackles health inequalities and supports the health of future generations.”
It said that an important enabler of delivering a prevention agenda is investment in community-based care, as local provision can reduce access barriers for those most in need. In addition, primary and community care staff are best placed to identify and address health issues early. Examples include heath centres that are situated on the high street, and ‘one-stop-shops’ where multiple services (health and other welfare services) are housed under one roof.
Despite successive governments repeating a vision of health and care services focused on communities rather than hospitals, that vision is very far from being achieved. It says if this shift in focus does not happen, more expensive hospitals will need to be built to manage people with acute needs that could have been prevented or better managed in the community.
The cost of failing to put prevention first can be seen across all areas of public services – and results in higher acute demand for other public services, not just the NHS. Failing to invest in prevention not only costs the economy, it also results in loss of opportunities for people and loss of life.
As the NHS develops more community-based services, there is also an opportunity to plan and train a workforce skilled in understanding and working with the complex needs of many individuals and communities in a way that supports people with the worst health outcomes and reduces inequalities.
The report also said that the NHS must learn from past failures. Some groups of people are systematically not listened to by authorities. This can have significant, and sometimes deadly, consequences. The devastating fire at Grenfell Tower is one such example: residents repeatedly raised concerns about health and safety that the authorities did not listen to and so opportunities to prevent the tragedy were missed.
The story behind the introduction of Martha’s rule is another example of the tragic consequences of health services ignoring the concerns of patients. All voices need to be heard and concerns need to be consistently taken seriously. This requires a recognition of the history of structural racism in the NHS and an ongoing commitment to transparency, particularly around the allocation of health service funding.
