The pandemic has come amid a noticeable shift in national policy which has made health inequalities a key priority for trusts and systems. COVID-19 has laid bare the limited impact of previous efforts to tackle the issue. The pandemic has increased the prominence of health inequalities, both within and beyond the NHS, and has intensified policymakers’ focus on the need for change.
Before the pandemic, the NHS Long term plan (NHS England 2019) emphasised preventative care and reducing health inequalities. It laid the basis for a more systematic approach for the NHS to tackle inequalities – for example making a commitment to continuing to target a higher share of funding towards geographies with high health inequalities and ensuring no area would be more than 5% below its new target funding share. The plan set out how the NHS would shift from a reactive model of care towards one built around active population health management, with ICSs laying the foundations for stronger partnerships between the NHS, local government and the voluntary sector. The long term plan set the basis for a national commitment to addressing health inequalities, but at the time of publication there were not clear governance, regulatory or legislative structures in place to support this work, and initiatives often relied on good relationships, a history of joint working, and the presence of a local 'champion' for the work.
The NHS people plan for 2020/21 (NHS England, 2020) detailed the inequalities prevalent within the NHS workforce. It set out how the treatment of staff from minority groups often falls short of expectations and prevents the NHS from closing the gap on health inequalities, and from achieving the service changes that are needed to improve population health. It acknowledged that the pandemic has had a disproportionate impact on people from minority backgrounds, on older people, on men, on those with obesity and on those with a disability or long-term condition. It also notes the role of ICSs in building on NHS organisations as anchor institutions - large, public sector organisations that are unlikely to relocate and have a significant stake in a geographical area (The Health Foundation, 2019) - to address inequalities.
The long term plan set the basis for a national commitment to addressing health inequalities, but at the time of publication there were not clear governance, regulatory or legislative structures in place to support this work, and initiatives often relied on good relationships, a history of joint working, and the presence of a local ‘champion’ for the work.
More recently, national public health reform has also brought focus to the role of the NHS in improving population health and tackling health inequalities. In April 2021, Public Health England (PHE) was disbanded and the UK Health Security Agency was formed, with responsibilities around health protection, pandemic response and preparedness, and COVID-19 test and trace services (Department of Health and Social Care, 2021). PHE’s health improvement functions have transferred to several bodies including the Department of Health and Social Care, NHS England and NHS Improvement and the Office for Health Improvement and Disparities (OHID). The health and care bill provides for the secretary of state to delegate the exercise of public health to NHS England or an integrated care board, meaning that ICSs and trusts may have a more direct role in the operation of public health services in the future.
Despite a gradual move towards embedding health inequalities and the wider determinants of health as a core responsibility of the health and care system, the NHS's potential to contribute towards a comprehensive approach to population health and narrowing health inequalities will take time and continued focus to be fully realised. There is now a clear opportunity to build on the lessons learned during the pandemic and take advantage of numerous new policy drivers for a collective emphasis on reducing inequity in healthcare access, experience and outcomes.