A society is only as healthy as its most vulnerable
By healthy, I mean strong, balanced, resilient, empowered/with agency, open and interconnected. And by vulnerable, I mean those who can’t voice for themselves, those who lack resources and those who are less able to care for themselves independently.
With over a decade of working in Inclusion Health and sixteen years in healthcare both in hospital and the community, it's clear to see how health inequity persists. The reality is that the scales are tipped so that poor health disproportionately affects some groups of people over others.
Today, the government released the 10 Year Health Plan for England. It promises to shift the focus from:
hospital to community care
analogue to digitised systems
treatment to prevention
An ambitious plan to turnaround the NHS and improve healthcare for all. Reading the Executive Summary, I would have said that it sets out ideas to get people excited but skimps on the how-to. But, if you read the detailed version, there are some clues to how they plan to implement this.
Proposed Neighbourhood Health Centres are set to become hubs that will lead on preventative care but the emphasis seems to be on AI predictive technologies, genomics, wearables and diagnostics. There is no mention of health promotion upstream, before symptoms surface or devices are triggered. The kind of health promotion that uses human nurses to go into community centres, schools and other local spaces, make meaningful connections with people where they are at, and have conversations about the real life challenges that are shaping their day-to-day health.
The answer to health disparities seems to lie in looking to private care:
“...we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.”
Yet, we know from experience how disjointed services can be when they are run by multiple different organisations. We have also already seen community services managed by private companies with anecdotal concerns raised by staff. The BMA has cautioned that outsourcing services to the private sector can undermine clinical and financial sustainability of the NHS. What I’d like to know though is whether the people living in these areas have been consulted on this.
Accessibility is fundamental to inclusion and the plan to digitise services can widen access. However, we can’t afford to ignore the reality of digital poverty and literacy. Services need to take this into account at the design stage so that the most vulnerable in society aren’t left behind.
To make all this happen, we need a strong workforce. The plan aims to reduce the reliance on internationally trained nurses and to make 2,000 nursing apprenticeships available over the next three years. But if the profession itself is not appealing and already has a burnt-out workforce, how realistic is this? While increasing opportunities for professional development, as suggested, is welcome, it doesn’t address the underlying issues. Staff are overworked in services that are overstretched. Calling for more creativity in the workplace to build efficiencies is a temporary solution.
Pressure will ease on the NHS when people feel confident and empowered in managing their health, supported by some big societal shifts such as:
A more health-focused education curriculum (physical, mental, emotional, financial health)
Improved real food availability and affordability
Responsible advertising
Careful local authority decisions about establishments like fast food restaurants and betting shops (planning permission)
Nutritious school and hospital meals
Safe and suitable living conditions
Health is all-encompassing, not just something that happens in isolation in a clinic room. We need hospitals and clinics for all the life-saving procedures and care they give. But if we can invest in these wider determinants of health, we might find that there is less burden on the healthcare system and a society where everyone has the opportunity to thrive.