70 years of the NHS, but unjust and avoidable health inequalities remain
In this, our introductory policy blog on the topic of health inequalities, we consider what inequalities people living with cancer are experiencing in England and what is being done to address them.
Free healthcare to all
The NHS was created out of the ambition that good healthcare should be available to all, regardless of wealth. When it was launched in 1948 it was based on 3 core principles:
- that it meet the needs of everyone
- that it be free at the point of delivery
- that it be based on clinical need, not ability to pay
In this its 70th year and as we approach announcements on a long term funding settlement for the NHS, it is timely to consider whether the NHS today is adequately fulfilling these principles for some of the most deprived and isolated members of society.
What are health inequalities?
Health inequalities are defined by NHS England as the
“the preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies.”¹
Put simply, some people are living shorter lives with longer periods of ill health as a result of where they live or who they are. As the NHS definition clearly explains, in the majority of cases this is avoidable and preventable.
NHS England focus on health inequalities
It is therefore to be welcomed that at the two most recent NHS England Board meetings the topic of health inequalities came under close scrutiny.
At the March meeting, the NHS England (NHSE) Board were presented with some startling figures illustrating exactly what health inequalities in England currently look like. For example:
- If you are male and from the most deprived communities² in England, you will have almost two decades less of life spent in good health than those from the least deprived communities.³
The board also learnt that these inequalities are particularly acute for many people living with cancer:
- The under 75 mortality rate for cancer is more than twice as high for the most deprived areas compared to the least deprived areas.⁴
- 70% more lung and cervical cancers are diagnosed in the most deprived areas and 25% more liver and stomach cancers.⁵
- Black people living with cancer are considerably less likely to be diagnosed through screening.
- For almost all cancers, people in the most deprived areas are more likely to be diagnosed through emergency presentations.
- People from a BME background report less positive overall experience of their cancer care, in particular regarding access to services and waiting for treatment.
The evidence set out in the NHSE Board paper is clearly unacceptable, particularly at a time when we are half way through a five-year plan for the NHS and a five-year Cancer Strategy for England, both of which aimed to reduce the health inequalities that exist in England.
It is therefore important that the NHSE Board at their May meeting considered an action plan to address these health inequalities up to 2020, including for people living with cancer. This plan also set out the focus of the NHSE Cancer Programme Team in tackling inequalities up to 2019 and beyond. This includes a focus on better understanding the causes of the inequalities that exist for people living with cancer through data and engaging with communities.
There is also an intention to improve screening uptake and diagnosis services, particularly ensuring people from deprived communities and from certain ethnic backgrounds have equal access to care and support across their cancer journey. The action plan also suggests that further details on tackling health inequalities will be made available in the NHS long term plan.
What can be done to tackle health inequalities?
At Macmillan, we believe it is vital that national policies and commitments such as these are translated into local action. Local areas including CCGs, Sustainability and Transformation Partnerships and Cancer Alliances must be effectively supported to not only understand but also address the distinct inequalities that exist in their local areas. This should after all be one of the main benefits of ‘place-based care’, delivering tailored and targeted care and support to those who need it most.
Furthermore, it is essential that in tackling health inequalities, NHSE work closely with partners such as Public Health England, Local Government etc. but also with communities and the voluntary sector, to not only seek to understand the impact of the health inequalities that exist but to address the underlying causes of them.
What is Macmillan doing to tackle inequalities?
At Macmillan, we too have an important part to play in raising awareness of and tackling the inequalities that exist in cancer care and support. We want to ensure that all people living with cancer have access to the support and information they need from the point of diagnosis and throughout their cancer experiences. There are many ways we can and already do this, particularly through our Macmillan services and engaging directly with people living with cancer.
However, we recognise the need to take further action. We want to play a more significant role in exposing the inequalities that exist in cancer care and support and to bring about meaningful change for all people living with cancer.
In the coming months, we will be proactively working as a Policy Team to look at how we can have the greatest impact in tackling inequalities in cancer care and support across the whole of the UK. Watch this space!
The NHS at 70
So let us again consider the founding principles of the NHS. To coincide with the 70th birthday of the NHS, the English Government has declared its intention to outline a new long-term funding settlement for the NHS. The settlement will likely be announced in July with further details from the NHS on how they plan to utilise the funding in autumn.
As we await announcements Macmillan are calling on the government and NHSE to ensure that central to the funding settlement and the longer term plan for the NHS is a strong commitment to tackle the enduring health inequalities that exist, including for people living with cancer. We want this commitment to particularly focus on improving outcomes and quality of life, ensuring equal access to cancer care and support across the cancer pathway and improving cancer patient experience for all. This would indeed be a true acknowledgement and a fitting tribute to the founding principles of the NHS.
Niamh Kelleher is Policy Manager (Health Inequalities) at Macmillan Cancer Support.
References
[1] https://www.england.nhs.uk/about/equality/equality-hub/resources/
[2] Different indicators or measures of deprivation are used in different types of analysis. Here the English ‘Index of Multiple Deprivation’ 2015 (IMD 2015) is used and is the official measure of relative deprivation for small areas or neighbourhoods in England. It combines information from seven domain indices to produce an overall relative measure of deprivation
[3] ONS “Health state life expectancies by national deprivation deciles, England and Wales: 2014 to 2016” Released on 1 March 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstateli feexpectanciesbyindexofmultipledeprivationimd/englandandwales2014to2016 a
[4] NHS Digital Indicator Portal, with analysis of SII from Department of Health and Social Care. Currently available at https://indicators.hscic.gov.uk/webview/
[5] Remainder of bullet points from NHS England — Board Paper: “Scene setter” on current trends in health inequalities 29th March 2018 https://www.england.nhs.uk/wp-content/uploads/2018/03/09-pb-29-03-2018-scene-setter-on-current-trends-health-inequalities.pdf
