In this blog Jen Hewitt, Health and Wellbeing Project Manager at VONNE, discusses the main themes of The Kings Fund’s recent ‘Tackling Health Inequalities’ conference, including falling life expectancy and ways to tackle it, the impact of English devolution on health, and examples of Neighbourhood Health working well in practice.
In May, I had the pleasure of attending The King's Fund’s ‘Tackling Health Inequalities’ conference, covering the status quo relating to health inequalities in the UK, and exploring the potential for positive impact from devolution in England, Neighbourhood Health and other key initiatives. Some of the main themes of the day were as follows:
Falling healthy life expectancy
It was alarming to hear from several speakers how healthy life expectancy has fallen significantly. This means in practice, for the most deprived areas, the years expected to be lived in poor health begin well before retirement age. Notably, Sumina Azam, National Director of Policy and International Health for Public Health Wales, highlighted that healthy life expectancy was lower in Wales compared to the UK and G7, with expected outcomes worse for females than males and the deprivation gap increasing.
Diane Addei, Director of National Healthcare Inequalities Improvement Programme at NHS England, talked through what drives healthy life expectancy and questioned who is being held accountable for 10.2% of the population falling into the ‘health inequalities and unmet need’ category within Integrated Care Board (ICB) Core Services’ utilisation model. Diane noted that the most deprived neighbourhoods cost an estimated £29.8 billion a year to the economy in lost productivity. She also made reference to the North East and North Cumbria’s Health and Growth Accelerator, which aims to identify unmet health needs and support people early on who have or are at risk of falling out of work due to ill health, and in turn could be at greater risk of financial difficulty and/or poverty without intervention.
Diane outlined the ambition of the NHS 10-year Health Plan, including the commitment to halving the healthy life expectancy (HLE) gap between the richest and the poorest regions, whilst increasing it for everyone. David Buck, Senior Fellow, Public Health and Inequalities at The King's Fund, also referenced the Health Equals campaign, which makes the case that good quality work matters in terms of positive health outcomes.
There was recognition from several speakers of the need for legislative action, with the acknowledgment that if something doesn’t get measured, it doesn’t get done. David highlighted that 80% of people’s food come from supermarkets and we should therefore hold such retailers to account to provide affordable healthier choices. Diane Addei in turn is calling for a Health Inequalities bill to put health at the heart of government.
There were some straight-talking speakers including Sheffield’s Director of Public Health, Greg Fell OBE, who stressed the importance of clear, straight forward language to communicate these messages, such as ‘lives cut short’ and ‘left behind communities’. Diane Addei also stressed the ‘how to’ of delivery is as important as the ‘what’, arguing that we don’t have ‘hard to reach groups’ but rather underserved groups that we are not doing enough for. This included not digitally excluding people by design but instead knowing what a community is and designing services around it. Moreover, David Buck referenced the ‘Do with’ call to action, led by The King's Fund, which is calling for radical and hopeful change in how public services work with people and communities.
Childhood health and wellbeing
David Buck called the current health inequality drivers a ‘code red’, highlighting that child poverty has risen more in the UK than in other countries, that child health outcomes are a cause for alarm, and the likelihood of living with less than good health has increased dramatically for people in poverty aged 16-34.
Dame Rachel de Souza, Children’s Commissioner for England, outlined how she used her statutory powers to launch the largest-ever survey of schools and colleges in England, The Children’s Plan, which sought to better understand the challenges that children are bringing into school, how schools support them and what more is needed to make sure every child, everywhere, has what they need to thrive. Building on this work, she has been pushing for more effective data sharing to identify if a child has been bereaved and who has a parent in prison. Moreover, she is advocating for services to be delivered in local, trusted settings, such as asthma clinics in schools and other proactive approaches in early years, drawing on findings from The Family Review 2022.
I was particularly struck by her passion and determination to ask children directly what it’s like to be a child today and what changes they would like to see in their communities via The Big Future survey. She kicked off the campaign hiking with 60 scouts along Hadrian’s wall, and is striving to hear the views of one million children. Considering some of these young people will be able to vote soon, this is a wealth of information for politicians to consider.
English devolution and the impact on health inequalities
The English Devolution and Community Empowerment Act 2026 is seeking to both spread and deepen devolution. In particular, with the new Strategic Authorities, mayors will have health duties. There were discussions around whether it is possible to have cross-sector accountability through Health and Wellbeing Boards and what ‘devo max’ might mean for control of health spending, i.e. horizontal accountability with Strategic Authorities. Devolution was seen as a huge opportunity for regional structures through giving health powers to strategic authorities and the potential to use the NHS, as the UK’s largest employer, to empower supply chains.
Examples of good practice include:
- The Realise Route to Success bus driver training programme in West Yorkshire, where training is available to communities that need it most.
- The lift of the ban on municipal bus ownership, enabling Reading Buses to tackle affordability issues through its public ownership.
- Learning from commissioners in Greater Manchester and South Yorkshire, where mayors sit on ICB Boards.
Neighbourhood health
There were positive discussions around Neighbourhood Health throughout the day, with examples of how this approach is already working well in practice and enthusiasm to see how it will develop in other areas across the country. It was stressed repeatedly that Neighbourhood Health cannot operate without the VCSE sector.
Examples of best practice included:
- The High Intensity Use programme, which seeks to address the root causes of demand, given that the correlation between deprivation and use of A&E is stark. Evidence from the national rollout and evaluation shows up to 90% reductions in A&E attendances and 408% return on investment.
- Morecambe Bay, Barrow, one of the 43 sites as part of the National Neighbourhood Health implementation programme (NNHIP). Beforehand, some children were reportedly playing with sticks and rats in the streets, and the suicide rate was high. Moreover, many children had never seen the sea despite being a mile away. The community was provided with a community purse and involved in deciding what would make the best use of the funds. They opted for skips in the streets and eradicated the rats. In turn, support around tackling obesity, smoking prevention/cessation advice and dental care were provided in schools and GP clinics started popping up in those estates. As a result, the suicide rate fell to zero. It was noted that being more neighbourly was the driver.
Overall, I am excited by the many examples of bold, proactive approaches taking place across the UK via Strategic/Combined Authorities and Neighbourhood Health initiatives as well as the work of ICBs, NHS Trusts, and public health and care services to affect real change. Much of this learning can be drawn on and adapted to suit different localities and ensure better outcomes for people at place, with a shift to more meaningful interventions being provided in the community and the vital involvement of the VCSE sector to deliver this change. There is much still to do to tackle health inequalities, but the quality of data being gathered such as the Big Survey and the many strategic and community voices calling tenaciously for change is sure to drive the conversation forward and lead to positive change in the future.
A wealth of resources are available on The King’s Fund’s website, including further analysis of the NHS’ 10 year plan. Neighbourhood Health, and suggested priorities for the NHS around Tackling health inequalities.
Find out more about VONNE's Health and Wellbeing programmes of work across the North East and North Cumbria on our Health and Wellbeing Hub.