The Health and Social Care Act 2012 enshrined into law duties for the Secretary of State (both in relation to the NHS and public health), NHS England and clinical commissioning groups (CCGs) to have regard to the need to reduce health inequalities.
The duty for NHS England and CCGs relates to 'inequalities between patients with respect to their ability to access health services' and 'with respect to the outcomes achieved for them by the provision of health services.'
A 'health premium' has also been incorporated into the Act, which is intended to provide additional resources to areas that alleivate inequalities. The first payments of the premium are due to be made in 2015-16.
The NHS Confederation has expressed concern about how this initiative may work in practice, as it risks diverting resources away from areas where fundamental issues may slow progress. We urged the Government to review the policy in to mitigate those risks.
Health Equalities Alliance
The NHS Confederation is part of the Health Equalities Alliance (HEA), a collation of voluntary sector organisations aimed at reducing health inequalities in the UK. The HEA aims to raise awareness of health inequalities in the UK and promote support for implementation of the recommendations made in the Marmot Review.
Strategic Review of Health Inequalities in England post 2010
In February 2010 Professor Sir Michael Marmot published his Strategic Review of Health Inequalities in England post 2010. This report followed his work chairing the World Health Organization’s Commission on the Social Determinants of Health. Marmot advocated ‘proportionate universalism’, whereby actions to improve health and the social and economic determinants of health must be applied to all, but with greater intensity to those towards the bottom of the gradient. Furthermore, action is necessary across all determinants of health.
The report proposed six policy objectives:
- giving every child the best start in life: weight public spending more towards the early years, especially among the more disadvantaged, and provide a year of parental leave paid at minimum income for healthy living
- enable all...to maximise their capabilities and have control over their lives: especially through early elimination of inequalities in educational outcomes through a ‘whole child’ approach in schools and closer links between schools, families and communities; increase availability of lifelong learning
- create fair employment and good work for all: improve access to and availability of ‘good quality jobs’ and promote greater security and flexibility in work
- ensure a healthy standard of living for all: establish a ‘minimum income for healthy living (for good nutrition, exercise, medical care, housing, social interaction and transport); decrease tax rates for those on lower incomes as the current tax structure disadvantages the worst off; overhaul the benefit system to remove disincentives to work
- create and develop healthy and sustainable places and communities: build people’s participation in their local communities (social capital); policies to improve community sustainability and environment can also help reduce health inequalities (e.g. ‘active transport’, green spaces, energy efficient housing)
- strengthen the role and impact of ill health prevention: four per cent of the NHS budget is currently spent on prevention activities.
The NHS Confederation submitted a letter during the consultation period for the review, expressing our wholehearted support for the approach taken by Professor Marmot. However we did call for greater attention to be paid towards the wider context of the economic downturn.