- Health inequalities are a consequence of economic inequalities. We need to address the cause not the symptoms. Perhaps the NHS can become the first employer that has no more than a 20 fold income differential for all its staff!!
- This is basically not an NHS issue, although the NHS is the key stakeholder. It has to do with poverty, inequality and disadvantage and requires a serious effort at social change, not just tinkering with a system that destroys lives and planet.
- Use the Marmot insights. Combine tackling key health issues with a social determinants of health approach.
- Start with strengthening communities through community development. This is something all HWBs and CCGs should see as a routine part of their work in the most deprived communities in their areas.
- Health should be considered in respect of every policy area. Housing, Transport, Education Leisure and Employment all affect health. The NHS cannot be expected to take responsibility for problems caused by unhealthy policies.
- Part of the answer lies in prioritising “deep end” work – deploying the resources needed to work in deprived communities, developing the social marketing methods that reach deprived populations, and establishing an inclusive community orientation within the local NHS. The US experience of working with underserved populations may help us here.
- A problem that is difficult to approach is that of income differentials. Narrowing the income gap is critical to reducing health inequalities, and this is likely to have an impact on the income of highly-paid professionals. For example, we have the highest paid family doctors in the world, who are providing less continuity of care and weaker gate-keeping to specialist services than at any time in their discipline’s history. There is a clear question about value for money in this situation, and the market will ask it. This government’s policies seem likely to bring it into conflict with the medical profession over pensions, but also over erosion of professional income in an increasingly competitive environment.
- A Labour government elected in 2015 could face very hostile professional groups wanting the restoration of their privileged position. This may not be possible and it may not be desirable either, since the professions (medicine in particular) have no given right to salaries in the top 10% of incomes. How this is handled politically may determine whether the rising generation of professionals remain faithful to the NHS. If they do, it will be because they trade income for something else, like more autonomy (control over their work) or more power (control over resources). The discussions about trade-off’s need to begin soon.
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