At the 'Access to all areas' event speakers will address the uneven picture of public health, and ask why - despite some progress - gaps are still widening. Helen Mooney reports

It has been five years since Sir Derek Wanless issued a stark warning to government and the NHS - address the nation's public health, or risk losing a health service that is free at the point of need in 20 years.

Sir Derek submitted Securing Our Future Health - his report on the long-term funding of the NHS - to the Treasury back in 2002. He diagnosed the need for real reform as well as much higher spending to tackle inequalities. His original report looked at spending for the next 20 years, and envisaged three scenarios. These were designed to capture some significant uncertainties, particularly success or failure in using resources more efficiently, and changing lifestyles.

The 'fully engaged' scenario, in which people take much greater responsibility for their own health, is designed to be sustainable in the long term. In this view of the future obesity would have a smaller impact, and there would be much less binge drinking and smoking - meaning that by 2022 funding would need to rise to around 10.6 per cent of GDP.

The two other scenarios, 'solid progress' and 'slow uptake', indicate lower levels of engagement by the public in maintaining their own health. According to the worst-case 'slow uptake' scenario, funding would need to rise to at least 12.5 per cent of GDP by 2022.

It is a bleak vision. Sir Derek warned it could have a dramatic impact on the future of the NHS and how much the public is prepared to pay for it. What's more, a recent King's Fund report by Sir Derek on progress so far suggests that reduced productivity is undermining future success.

'If people begin to believe it's a terribly inefficient service, they may begin to question what they are prepared to pay for,' he said. 'There will be pressure to improve delivery and that could lead to a reduction in services or a change in the method of funding. It could herald the social insurance revolution, who knows? It is very important that we get to the fully engaged or solid progress type of area.'

So what has changed in 2007? The Health Hotel event 'Access All Areas: how can we tackle health inequalities' asks what progress has been made and what needs to happen next to reduce the population's health gap.

Measuring the gap

Healthcare Commission chief executive Anna Walker will chair the discussion. She says the government is to be congratulated for what it has so far achieved: 'It is very positive that the government has a series of targets which address health inequalities and fundamentally address the gap in life expectancy based on infant mortality.'

It is brave of the government to do this, she adds, when there is a sizeable political risk that it may fail to close the gap. The government's proposed new outcomes framework will continue to measure the gap, including infant mortality, reductions in heart disease, stroke, cancer, smoking rates and conception in under-18s.

Ms Walker acknowledges there has been progress in driving down health inequalities. 'The work that has been done in primary care trusts on smoking cessation shows that some are doing very well and as many are doing as well in deprived areas as in more affluent ones,' she says. She is keen to tell NHS managers that it is not simply a case of more money to address the population's health gap - organisations now need to invest time in tackling the problems.

But it will not all be praise. Ms Walker will use the health inequalities event to issue a warning to the government on health regulation. She says it is important that when the new regulator Ofcare is established in 2009, it must be charged with regulating both the health service and public health.

'There has been some concern as to whether this has been thought about sufficiently clearly and rationally,' she warns. For example, there is a risk that if the new regulator does not measure how organisations are performing on reducing health inequalities then the gap will continue to widen. 'You tend to get what you measure. This goes back to what Wanless said, which is that people who look after healthcare are really important in looking after health,' Ms Walker says.

She is keen that more effort be made to reach parts of the population being missed in the health inequalities debate, in particular people with learning disabilities. She wants to see a specific performance measure for this area.

Certain groups being blocked out of the health inequalities debate is also a key concern of mental health charity Rethink, whose public health director Paul Corry speaks at the event.

He says: 'We want to make it clear that mental health issues need to be addressed as part of [the health inequalities debate]; we need to get mental health out of the ghetto and into the mainstream agenda.

'There is a major issue about the access of people with mental health issues to physical health services - on average these people will die 10 years younger. People in these groups have less access to treatment for their physical well-being and are being discriminated against.'

Simple steps can be taken to change this situation, adds Mr Corry. For example medical professionals can be better educated in recognising the needs of patients with mental health issues. A model for this is the work done around the needs of patients from black and minority ethnic groups.

Rethink will also be looking for a commitment from all the political parties that mental health will be a priority. 'We will particularly be looking to Labour, as the party of government, to make an early statement on what the future for mental health is over the next three or four years. Now the Mental Health Bill is out of the way we think it is timely to set out how they will treat mental health in the future,' says Mr Corry.

The government should allocate a 'disproportionate increase' in mental health spending during its next three-year comprehensive spending review, Rethink will argue. Mr Corry says that compared with other parts of the NHS, mental health has been historically under-funded. This is despite the fact that the field is one of the government's three priorities along with obesity and cancer. Rethink also wants a commitment to support its partnership work with Mental Health Media and the Institute of Psychiatry - a public campaign is being set up to eliminate discrimination against those with mental health issues.

Asthma UK chief executive Neil Churchill will be calling for the NHS and government to understand that they need to treat the person, not just the condition.

'People with asthma often have complex problems, so [for example] they will have asthma and mental health issues and diabetes. At the moment the NHS is not looking at these people and their conditions in the round,' he says. Mr Churchill adds that, given the right tools, people with multiple conditions including asthma would not need to access services as frequently as they do now. 'There are currently 77,000 emergency admissions because of asthma, three-quarters of which could be avoided if people were helped to manage their care better,' he says.

The NHS should examine why there is a ten-fold gap between the rate of admissions to hospital for people with asthma between the best and the worst primary care trusts, he says. 'Often this is related to areas of disadvantaged and ethnic groups and those with complex needs.'

PCT managers, meanwhile, need to make sure they address and better target those groups: 'We need to get to a point where people can self-manage effectively and this depends on the information they get at crucial points when they come into contact with the service.'

In-depth analysis

The government has gone some way to tackling the issue of care for those with long-term conditions, stipulating that they should all have a care plan. This is undeniably a good thing, but Mr Churchill adds that only 20 per cent of people with asthma currently have their own plan.

For Cancer Research UK policy and public affairs director Richard Davidson, getting the government and the NHS to concentrate on targeting population groups in more depth is key. Cancer Research UK is running a campaign, Screening Matters, to get the message across that PCTs need to target screening programmes at lower socio-economic groups - and tailor the way they raise awareness of them.

The organisation also plans to launch a report during the conference season, looking at the wider picture around health inequalities and cancer.

'We want to raise the issue of access and outcomes and make sure a debate is had about this,' says Mr Davidson. 'Although there has been a shift in the last six or seven years and some progress has been made, if we are going to make any real headway we need to address the wider issues of why there are health inequalities and what needs to be done to address them.'

It is telling that the events at all three party conferences are once again asking the question about how health inequalities should be tackled. The government may have made some progress, but it still has a large hill to climb, if not a mountain, if it is to achieve Sir Derek's 'fully engaged' scenario by 2022.

The overall message of the three events will be, in Ms Walker's words, that 'health inequalities matter'. She says the government's introduction of comprehensive area assessments - which will measure the partnership working between PCT and local authorities on reducing health inequalities - is an important step.

But she stresses that reducing health inequalities is as much about PCT management and the identification and targeting of areas of deprivation as it is about investing more money.

What is clear is that health inequalities are not going away - and in many cases the gaps are getting wider. Government targets and initiatives have helped to get the issue of public health a higher profile, but it will be up to the NHS to guard against a demotion in the list of priorities when the government argues that money has been allocated.