NHS Reset: Challenging structural inequality | Dame Jackie Daniel

Dame Jackie Daniel

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog, part of a series of comment pieces from NHS Confederation members and partners, Dame Jackie discusses the measures Newcastle is taking to tackle the health inequalities in its region.

I’ve been thinking a lot recently about my city of Newcastle and the legacy that myself and my colleagues want to create following the COVID-19 pandemic. It’s clear that the North East has been hard hit by coronavirus and, given the levels of deprivation experienced by our population, that’s not a surprise. It’s another stark example of the challenges we see every day.

As the anchor health organisation for the North East, we are rightly proud of our ‘outstanding’ services and high standards, but we also know that our local population continues to have some of the worst public health outcomes in the UK.

Local people die earlier than they should and have more years of life lost to disability than in more affluent parts of the UK. This has to change, and I hope that the nation’s response to the pandemic will be an opportunity to re-balance and refocus the health of our city.

The Northern Health Science Alliance, along with NHS researchers, recently published an analysis showing the impact of the virus on different communities. They looked at death rates from COVID-19, death rates from all causes and also the impact of job losses, which is important because unemployment rates are an indicator of future health inequalities, especially in relation to mental health and suicide.

The team analysed data from the Office for National Statistics to map figures over six weeks to build up a picture of how the virus is affecting different parts of England. The figures were then plotted on to the main train routes to give a visual representation of the impact across the UK.

Sadly, this work shows that deprived urban areas in the north of England, including Newcastle, have been hit with high rates of COVID-19 deaths, higher death rates from all causes and are suffering from greater rates of increases in unemployment.

Challenging structural inequality

We have a clear challenge as we reset NHS services in the North East and the city. How can we provide services in a way that challenges and minimises this structural inequality and begins to turn the tide?

We’ve been working very closely with our partners in Newcastle – particularly the city council, universities, GPs and the mental health trust over the last two years. As the largest institutions in the city, we recognise the positive impact that we can have, not only through the services we are responsible for delivering, but also through the range of other roles that we fulfil, such as employers and as the procurers of goods and services.

Together, we are committed to exercising this combined power to significantly improve the health, wealth and wellbeing of those who live and work in our city. We have now formed Collaborative Newcastle, a partnership of the local organisations delivering services, which we hope to formalise in a partnership agreement.

Throughout the COVID-19 response, the key managers from the council, clinical commissioning group and trust have been meeting daily to support our communities – particularly our care homes and other vulnerable residents.

We have also been working much more closely together in children’s services to help support and protect our young people and vulnerable families. This is a vital and urgent area of work, both for our current response and for the future of our population.

Through Collaborative Newcastle, we have been asked to work as a city to help support our care homes as part of a pilot of a national programme. This includes support for care home residents with COVID-19, testing, personal protective equipment and system resilience, and we have the opportunity to set the standard for an improved national response.

Rejecting status quo

My thoughts have also been very much with my black and minority ethnic (BME) colleagues and patients. Here in the UK, this was made evident in Public Health England’s recent report on disparities in the risk and outcomes from COVID-19. It shows that while age remains the biggest risk factor, BME people are at a higher risk of dying from COVID-19.

We should never for a moment forget that we don’t all have the same chance in life and do not all have equal opportunities. And I would like to say very clearly that in Newcastle hospitals, black lives matter.

I was pleased to see that NHS England, with the NHS Confederation, announced the creation of the NHS Health and Race Observatory –  a new centre to investigate the impact of race and ethnicity on people’s health, as well as producing a summary of actions that the NHS had taken to address the disproportionate impact of COVID-19 on NHS staff. We have taken action locally with our own BME network to support staff and influence change, and I encourage my staff to get involved.

I am convinced that working together ‘as a city, for our city’ is the right approach to tackle the long-term inequalities that we in Newcastle face. None of us should accept the status quo, and I and all of my colleagues will be thinking about the role we each play in improving health in the North East so that we can tell a different story in the future.

Dame Jackie Daniel is chief executive of Newcastle Upon Tyne Hospitals NHS Foundation Trust. Follow them on Twitter @JackieDanielNHS and @NewcastleHosps

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