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.
Alan Higgins, head of programme for Public Health England in the north west, shares how Liverpool’s wealth and wellbeing programme is creating discussion on the relationship between health and wealth, how the pandemic has brought this relationship into sharp focus, and how NHS leaders need to be involved in economic policies in order to reduce health inequality.
Economic recovery plans for the country, regions and city regions are being put together now. Given that the functioning of the economy has a big part in determining health and demand for health services, the NHS has a stake in economic planning. But is it being brought to play?
The Liverpool city region (LCR) wealth and wellbeing programme was established in July 2018 as an 18-month programme. Supported by Public Health England (PHE), it has a remit to develop thinking about the relationship between health and wealth, and to create discussion and action at city region level.
By November 2019, progress had been recognised by the city region’s mayor and PHE had agreed to a request to fund a further 12 months’ developmental work.
Joint working with national bodies developed, and a workshop was planned for 19 March 2020 with the Department of Work and Pensions to discuss closer working between primary care and Jobcentre Plus. Of course, it never happened.
We are now taking stock of the impact of an international health and economic crisis and resetting the wealth and wellbeing programme. It took a few weeks to get our breath back, but a shape to this reset is emerging.
Before the pandemic hit, the programme had achieved influence through research findings, evidence reviews and engagement events:
- Analysis with the University of Liverpool found that 33 per cent of the productivity gap between the LCR and the rest of the country can be attributed to ill health. This equates to £3.2bn in lost GVA (gross value added), which is about 10 per cent of the LCR’s total annual economic output.
- Further analysis by PHE made it clear that the major impact is mental ill health.
- A public narrative was developed based upon the experience of people with health problems in the world of work.
As the work moved into 2020, the discussion settled on three themes for further development. One, a service development to work on NHS England’s individual placement and support schemes. Action on employee support programmes would be taken forward by the LCR combined authority, working with the economy and employment leads in local authorities and in partnership with the Cheshire and Mersey Health and Care Partnership.
A second theme on transforming the workplace would pick up on existing work to develop a Fair Employment Charter, to better identify and make explicit the health-enhancing aspects of good quality work.
The third theme, action on developing the concept of wellbeing economics in the city region, would be a visionary development. It could lead to the city region adopting wellbeing outcomes as the key measures in economic planning, similar to work underway in New Zealand, Scotland and Iceland.
The pandemic has reinforced the need to deal with the challenges posed by inequality. Impacts have and will disproportionately affect a range of population groups and are likely to follow the social gradient, widening health and social inequalities within the context of economic downturn.
Now add the impact of the Black Lives Matter movement to this context and social inequality, economic inequality and structural racism is a mix of challenges that demands a response from our major institutions. And they don’t come more major than the NHS.
Investment in health is an economic imperative. If we want to close the productivity gap between LCR and the rest of the country, then we must pay attention to the significant contribution that poor health makes to that gap. The close connection between sustaining population health and sustaining the economy has been brought into sharper focus, and the experience of dealing with the pandemic has highlighted the need to invest in a health system that can deal with such a crisis as a health goal.
It is widely accepted that economic deprivation is a major cause of ill health and that this puts pressure on health and care services. Given this, shouldn’t NHS leaders take an active interest in local and regional economic planning? Shouldn’t NHS leaders be asking for economic policies and investment that targets relief of poverty for their catchment population? It’s too important to leave to economists and planners.
Arguably, the impact of COVID-19 has forced one of the goals of the programme, to put health and wellbeing at the centre of economic planning, into the national limelight. As we reset the wealth and wellbeing programme, our ambition is to make health and wellbeing the main goal of economic planning at the city region level. An economy that functions effectively for everyone is better for health and wellbeing, and a population with better health and wellbeing is better for an effective and fair economy. We need NHS leaders to ask more of economic plans to reduce inequality in health.
Alan Higgins is head of programme at Public Health England in the north west. Follow the organisation on Twitter @PHE_NorthWest
*Visual summary of the Liverpool City Region Wealth and Wellbeing Programme Summit held in February 2020.
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