The health service does sterling work treating the consequences of poverty but can do much to address the causes, too, writes David Buck
The Joseph Rowntree Foundation recently released research showing the costs of poverty to public services. Of the grand total cost of £78bn every year, the largest portion by far was the £29bn estimated impact on the NHS.
These findings come on the heels of other studies by the York University, estimating that inequalities in health cost the NHS inpatient budget almost £5bn, and from Citizens Advice, suggesting that around 20 per cent of GP time is spent dealing with social problems related to anxiety and illness, conditions highly correlated with poverty and inequalities.
Health spending accounts for 15.7 per cent of the gross value added (the goods and services produced) in the north east compared to 8.4 per cent in London
Despite these figures, it is not all bad news. When we stop to think about the NHS and the enormous social influence it wields, it becomes clear that it is actually an anti-poverty machine. The health service certainly treats the consequences of poverty but it also tackles poverty in several crucial ways.
Most obviously, its founding principle means it has adapted to poverty by being mostly free at the point of use – and where it isn’t, such as for prescriptions or dentistry, there are low-income related exceptions.
Insulation from debt
We have got used to taking this for granted, but look at the US system where healthcare costs are the leading cause of personal bankruptcy. The insulation from debt that the NHS provides is a form of mitigation from poverty.
The NHS helps reduce poverty for the individual through treating conditions that have an effect on the likelihood of work, and through the receipt of benefits in kind.
The latter also has important effects for society as a whole; the Organisation for Economic Cooperation and Development has shown that income inequalities in the UK (among the highest in the developed world) would be wider still if the NHS didn’t exist and we all had to pay directly for healthcare.
When we stop to think about the NHS and the enormous social influence it wields, it becomes clear that it is actually an anti-poverty machine
The NHS also prevents poverty through its actions helping to maintain people’s health, and therefore economic activity, throughout their lives.
Finally, it can also be seen as a part of a compensating regional economic policy. Although the NHS is an important contributor to local economies and employment across the UK, poorer parts of the country are far more dependent on health spending than wealthier areas.
Health spending accounts for 15.7 per cent of the gross value added (the goods and services produced) in the north east compared to 8.4 per cent in London.
Room for improvement
There is, however, much more that could be done in the NHS to help tackle poverty. From looking at, for example, the experiences of families with children with severe disabilities, certain types of care for black and minority ethnic groups, and the impact of long-term conditions on people of working age, it is clear that there are problems in accessing health care for groups more likely to be in, or at greater risk of, poverty.
The £29bn cost of poverty to the NHS means that surely now is the time for the NHS and its leadership to take action
The NHS must take more action to help people in these groups, which could reduce the risk of poverty and therefore the cost burden to itself of that poverty. To do this more effectively, tackling poverty needs to be part of the national policy debate on the NHS.
Unfortunately this isn’t the case at the moment.
The NHS’s positive contribution is not recognised, despite it being the largest economic entity in the country and one of the largest employers in the world.
There is some excellent NHS practice taking place at a local level that can lead the way to a more systematic and co-ordinated anti-poverty response. For example, several clinical commissioning groups are pioneering commissioning on the basis of local social value, rather than simply lowest cost and short-term cost-effectiveness.
Numerous NHS providers offer apprenticeships and other forms of assistance to help people with health challenges and lower skills, which put them at risk of poverty, into employment.
There are many examples too of the NHS proactively working with others, such as financial advice providers, like Citizens Advice, which help to alleviate people’s anxiety and support their wider wellbeing.
Tackling poverty needs to be part of the national policy debate on the NHS
This sort of partnership work can tackle poverty and reduce demand on the health service.
We include these in a wider range of more than 20 case studies and ideas in our paper that fed into the Joseph Rowntree Foundation’s anti-poverty strategy work.
The £29bn cost of poverty to the NHS means that surely now is the time for the NHS and its leadership to take action.
As well as fulfilling its role in treating the victims of poverty, the NHS could be a prouder, louder and stronger part of the solution to the problem of poverty and its associated costs.
David Buck is a senior fellow in public health and inequalities at The King’s Fund