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NHS structure is ‘misaligned’ with plan to tackle health inequalities, think tank says

Healthcare setting

By Jess Hacker
19 October 2021

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The ‘centralised’ structure of the NHS is ‘misaligned’ with its broader ambition to tackle health inequality, a think tank has claimed.

In its new blueprint, published today (19 October), the Institute for Public Policy Research (IPPR) outlined areas where policy incentives are ‘misaligned with an ambition to tackle health inequality’ in order to try and make progress on health disparities which are currently ‘widening’.

Notably, it warned that the health service’s structure creates a ‘one-size-fits-all approach’ which makes local drivers of inequality ‘harder to act on’.

The NHS has remained a centralised system since its formation, intended to ‘avoid inequality’ by standardising services, the IPPR said.

However, the NHS’ centralisation of power is likely ‘stalling progress today’, it claimed, as evidenced by the fact different parts of the country experience different levels of health need.

These needs are in turn underpinned by local factors, which cannot be addressed by a national, standardised approach, it determined.

When the NHS was first created, it reflected the health needs of the mid-20th century, such as tuberculosis and diphtheria, the authors of the IPPR report said. But it added that the NHS is now ‘behind the curve’, as it has never fully addressed preventable illnesses, and neither is it organised around helping people manage chronic illnesses.

‘This is a clear driver of inequality, with avoidable illness, avoidable mortality and the total burden of preventable illness all highest among people in the most deprived parts of the country,’ the report said.

The Government should therefore invest in holistic, integrated community health services, which the IPPR said would help alleviate barriers to accessing centralised healthcare settings.

The report proposed the government formally pilot a ‘more ambitious form of hub working’ which would combine general practice services and social care assessments from local authorities, through Primary Care Networks (PCNs) working in the most deprived parts of the country.

‘If successful, the government should aim to develop the hub model – on a basis of one hub per PCN.’

The report comes in light of a pandemic which has repeatedly been shown to have produced worse outcomes based on level of deprivation and less-advantaged socio-economic status.

Recent reports have found that life expectancy had stalled for the first time in over a century in some areas, and for the poorest 10% of women it had begun to decline.

In the summer, researchers found most deprived areas in England had almost one and a half fewer FTE GPs (1.41) per 10,000 patients than the least derived areas.

A similar study published earlier this year argued that new allied health professionals are likely to be ‘skewed’ to wealthier areas without appropriate intervention.

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