The Marmot review: 10 Years On was published in February 2020 just as the world was beginning to recognise the magnitude of coronavirus. The report set out how, since 2010, the health inequalities gap had widened, and those who experience greater inequality also spend more time in ill health than they did ten years ago and can expect to live with a greater number of health conditions from a younger age. It concluded that health is very closely linked to the ”conditions in which people are born, grow, live, work and age and inequities in power, money and resources”. COVID-19 has only widened existing faultlines: the impact of the pandemic has fallen unequally across society, and people’s experience has been influenced by their circumstances and health. Those who were most disadvantaged before the pandemic have borne the brunt of the virus and have been hit hardest by the measures that have needed to be taken to control it.
The pandemic has played out against a backdrop of multiple inequalities driven by a range of factors, including levels of poverty and deprivation, defined by the index of multiple deprivation (IMD 2019), safe and healthy housing, education, employment. These factors can also restrict access to healthy food and green spaces. The NHS has an important role to play in improving people’s health beyond the services it provides: as an employer, an anchor institution for the communities it serves, and as a key partner within the integrated care system working with communities, local government, and VCSE to address the wider determinants of health. This multi-faceted role has become clearer over the past 18 months as collaborative working has strengthened and the role of the NHS in helping staff and communities cope with the pandemic has become more visible and more widely understood. National NHS leaders are now looking to systems and trusts to take concerted action on the inequalities faced by those from deprived backgrounds, minority ethnic groups, autistic people and people with learning disabilities, and other protected characteristics.
COVID-19 has only widened existing faultlines: the impact of the pandemic has fallen unequally across society, and people’s experience has been influenced by their circumstances and health.
There is an increasing policy focus on health inequalities and a commitment to addressing them from all angles is writ large across national leaders’ efforts to shape the way the health service recovers from the pandemic. Tackling health inequalities is being woven into primary legislation in the form of the Health and Care Bill, to the way finances are allocated and how national regulators will measure trusts’ performance and quality of care. This briefing maps how the impact of health inequalities is therefore becoming integral to how the NHS will operate in the years to come and explores what this means for trusts as they work to balance the challenging task ahead. It sets out principles for a supportive policy framework, as a crucial underpinning for local action at the level of system, place and individual trusts.
Trusts must recover from the impact of the pandemic, which has resulted in long waiting lists and high unmet need, operate within a tight financial settlement, and accelerate integration and collaborative working in preparation for (ICSs to become statutory bodies in 2022. Although health inequalities will be front of mind for trust leaders as they navigate this process, there are unanswered questions about how trusts will be able to prioritise these issues when financial objectives and operational targets create conflicting priorities. However, there is also a clear opportunity for trusts to make use of this focus and momentum to contribute to a lasting change in how inequalities in care are understood, acknowledged and dealt with across the NHS.