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Guest Blog: Health inequalities – always someone else’s problem?

Written by: Michael Wood - 10th February 2020

A common challenge for our leaders is understanding the difference between what you can control and what you can influence. This is particularly the case in times of austerity where the resources and reach of our local statutory sectors often diminishes, resulting in a lack of strategic focus on those stubborn, yet critical, wider ‘place’ problems.

Here Michael Wood reflects on our YHealth for Growth conference, held in Leeds in partnership with the NHS Confederation and Yorkshire Universities and highlights some of the necessary next steps needed to address health inequalities.

Inequalities matter

Health inequalities certainly counts as one issue for which, while no one sector can claim a uniform responsibility, it can render pretty much every local strategic plan undeliverable. The geographical health gap in the UK, one of the widest amongst OECD countries, is as much a problem for those tasked with increasing economic productivity as it is for those providing health and care services. A shared problem for Yorkshire and the Humber certainly, requiring a shared regional solution.

The intention of the YHealth for Growth campaign is to take inequalities in Yorkshire and the Humber out of the ‘too difficult’ box and to map out a plan for what we can all do within our own organisations and sectors that could form part of a wider, more inclusive, place-based solution – a sort of ‘an ask and an offer’ approach that blends what we can control with what we can influence.

Winter all year round

For a health and social care system under severe strain the benefits of a collective focus on narrowing health inequalities are clear. Demand for services continues to rise with few NHS leaders believing the end of the traditionally difficult winter period will bring any light relief for those monitoring system performance. This pessimism is not helped by the lack of a national plan for addressing the glaring funding gaps within social care.

So where does the spring optimism come from then? As Rob Webster, NHS CEO and ICS lead for West Yorkshire and Harrogate, told the audience of national and regional leaders: ‘around 80 per cent of the factors that impact on people’s health are nothing to do with medical conditions – they involve the need to have somewhere to live, something to do and someone to love.’ Knowing your sector’s limitations is the first step to building an answer (and in this case a place) that is more than the sum of your parts. Here is where some of the sector’s ask comes in – how can health and care leaders play more of a role in guiding the development of local industrial policy, shaping the region’s R&D focus and creating the opportunities for good work.

Anchoring communities

While there is clearly respect and admiration for the health and care services provided across Yorkshire many of those present were particularly keen to talk about the influence the NHS could have on the local economy. This ‘offer’ becomes clear when considering the size and scale of the sector’s workforce, procurement budget, estate and industrial pull. Even an incremental approach to focusing the many local and regional NHS organisations that make up Yorkshire and the Humber as anchor institutions could have transformational impacts on communities.

When looking for inspiration on what institutions can achieve locally then the Leeds Anchor Network stood out. Eleven organisations, including 4 NHS organisations, that routinely work together to maximise the local benefits from their spending, services and recruitment. The Network’s most recent, and potentially most exciting, development will look at how the anchors can collaboratively target mainstream services and discretionary interventions to best meet the needs of local residents living in the city’s most disadvantaged communities. This approach should be rolled out more widely across the region.

Needing to influence the national picture

A more collaborative Yorkshire leadership base can certainly achieve much together locally, however there remains the challenge of how best to influence national policy in a way that fully benefits the region. With a new government focused on ‘levelling up’ the economy and reviewing how financial decisions are made, there is an important opportunity to plant wellbeing firmly on the national agenda in a way that can unlock future local investments. The ability and maturity of local leaders to address health and wealth inequalities in a way which influences Whitehall will be the real test of whether YHealth for Growth has contributed to not just a sense of togetherness but also one of empowerment.

Michael Wood is Head of Health Economic Partnerships at the NHS Confederation. Follow him on @NHSLocalGrowth