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Hospital trusts must focus on narrowing health inequalities

4 min read

NHS Trusts that move resource from disadvantaged to advantaged areas have a moral and statutory duty to evidence how they are narrowing health inequalities, writes Lucy Allan 

The inequality of health outcomes between affluent areas and areas of deprivation continues to widen. This injustice has many causes, from unemployment to poor housing. As the Government announces its NHS 10-year plan, it is right to expect healthcare spending to be focused on tackling this issue.

The previous Health Secretary was committed to tackling the widening gap in health outcomes between rich and poor saying: “everyone should have the same opportunity to live a healthy life no matter where they live or who they are”.

This Government has just committed to the largest longest funding settlement in history, with a long-term plan to spend £20.5bn by 2023/24. So, it is timely to remind the new Secretary of State of the legal obligations he has to narrow health inequalities and to ask him to reinforce the importance of this obligation with Commissioners and NHS England.

 The Health and Social Care Act 2012 introduced these legal duties and has a requirement “to move towards greater investment where levels of deprivation are higher”. Health inequalities “must be properly and seriously taken into account when making decisions”.

I know, as a former Non-Executive Director of an NHS Trust, that the NHS constitution requires the NHS to pay particular attention to sections of society where improvement in health and life expectancy are not keeping pace with the rest of the population.

Which brings me on to whether this is happening in practice. It is my experience that some NHS decision makers are ignoring these duties when it comes to major capital spending decisions for hospital reconfigurations. 

Across the country from Lewisham to Huddersfield the NHS is carrying out controversial restructuring of hospital care. If what is happening in the area I represent is happening across the country, and fellow parliamentarians report similar experiences, then healthcare providers are ignoring these duties or are merely paying lip service to them.

In Telford, the local hospital trust has announced that it intends to remove Telford’s Women and Children’s Care and Emergency Care and relocate these services 19 miles away, in the leafy affluent shire town of Shrewsbury. 

Telford, a post-war new town created on the East Shropshire coalfield, has areas that are amongst the most deprived in the country. It has by every measure, significantly worse health outcomes than Shrewsbury, which by almost every indicator has better health outcomes than the national average and significantly better outcomes than Telford.

NHS database has the figures there for all to see. When it comes to Health outcomes, Telford and Shrewsbury are two ends of the spectrum. If you live in Telford, the premature mortality rate is 25% higher than if you live in Shropshire, children in Telford are far more likely to suffer from obesity, or to be hospitalised for dental decay. Tragically rates of suicide and cancer in Telford are significantly higher than in rural Shropshire. Smoking rates, inactivity in adults and other such categories show the same disparity. 

The simple truth is that a shire town in rural England is healthier than a New Town built on a collection of former mining villages on the East Shropshire Coalfield. NHS spending is required to recognise the greater need. It is that simple.

So, it is surprising that the local hospital trust is “pleased to announce” after five years of deliberations that it is to invest most of £312m in a state-of-the-art critical care unit in Shrewsbury, and relocate the Women and Children’s unit and emergency care there too. 

The solution to the stark injustice of unequal health outcomes is of course not simply about spending more. Poor health is of course not just about healthcare, but if the NHS is overlooking its statutory, constitutional and moral duty to properly consider health inequalities when making major spending decisions, then the Secretary of State has a duty to intervene.

My debate on Wednesday will ask the Secretary of State to remind hospital trusts generally, and the Shrewsbury and Telford Hospital Trust specifically, to give due regard to their duty to demonstrate how their spending decisions narrow health inequalities.

My health trust has repeatedly failed to respond to my questions on health inequalities, treating the issue as somehow irrelevant to their plan. 

NHS Trusts that move resource from disadvantaged areas, with high need and poor health, and instead invest heavily in advantaged areas with affluent hinterlands, have a moral and statutory duty to evidence how they are narrowing health inequalities.

NHS funding must always focus on the greatest need. Where this is not happening, we cannot ignore it.

Lucy Allan is Conservative MP for Telford. Her Westminster Hall debate takes place on Wednesday 20 March.

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