'Concerted radical action' is required to plug the growing health inequalities gap across Greater Manchester, a damning report has warned.

An Audit Commission review of health inequalities paints a bleak picture of efforts to improve the health of its population. Those living in Manchester have the third shortest life-expectancy in England, ranked by local authority.

The report, seen by HSJ but which has yet to be published, states that there is no 'health vision' across the patch and criticises the 'lack of champions' for health.

The review, part of a programme of work being carried out by North West strategic health authority, the regional government office for the North West, and the Audit Commission, interviewed more than 100 members of staff in 41 organisations including NHS acute and primary care trusts and local authorities.

It found there is 'no clear leadership for the health inequalities agenda' in the region.

The report concludes that leadership of the health inequalities agenda in Greater Manchester is often via the director of public health and says that changes to acute services are driven by new builds and clinical services without any 'explicit' expectation that change will lead to improved health.

It criticises 'constant' local and national reconfiguration for preventing progress in reducing the health inequalities gap and says reconfiguration in the NHS 'is damaging the potential for more successful joint developments'.

The review highlights the variance in spending between PCTs on public health. The disparity is for reasons which are 'not well understood' and the report says a 'great deal of management time is exerted on planning for and spending relatively small amounts of money'.

PCT public health directors have 'too wide a range of responsibilities to be able to provide suitable and sufficient advice and guidance' and the role of public health directors and Greater Manchester's public health network is 'unclear'.

More positively, the report says organisations in Greater Manchester know what their health inequalities issues are, and are 'moving in the right direction' to collaborate.

Will Blandamer, director of health improvement for the Association of Greater Manchester PCTs, told HSJ that many of the review's recommendations had already been implemented across the region and 'significant progress' had been made.

'We know we have a problem with health inequalities and we invited the Audit Commission to come and do a total review of the issue,' he said.

'We have secured£750,000 in funding from the Greater Manchester PCTs to develop a comprehensive public health programme, for local delivery plans and for a dedicated public health senior management team,' he added.

Mr Blandamer insisted that the current PCT reorganisation, which will see the 14 PCTs in Manchester reduced to 10, would not disrupt the new public health programme. 'One of the points of having an association of PCTs leading on this is that we will be able to maintain the focus and momentum.'

He said that the programme would primarily focus on reducing health inequalities in chronic heart disease, smoking prevalence and cancer.

'The health inequalities position continues to be unacceptable. Public health has to be up there; we need a step-change,' he said.

Commenting on the review, UK Public Health Association president Professor David Hunter said it had raised issues that were mirrored in public health nationally.

'Directors of public health have too much responsibility and not enough support. Many are finding it difficult to build adequate business cases for public health investment,' he said.

Faculty of Public Health president Professor Rod Griffiths said he was not surprised by the findings: 'A lot of this is to do with the government's manic desire to keep reorganising the health service it does not say much for the government's vision that health inequalities in Greater Manchester are still so bad.'

Meanwhile, public health directors across the North West will be told on Friday whether they have been successful in the first stage assessment for appointment to the reconfigured PCTs.

Key recommendations from the review

  • Develop a health inequalities vision for Greater Manchester.
  • Clarify the role of directors of public health and the focus of the Public Health Network.
  • Improve use and co-ordination of information.
  • Develop pan-Greater Manchester measures that support regular monitoring, comparison, and evaluation of health inequalities.
  • Engage more widely to understand the barriers to access facing the population of more diverse groups.
  • Develop arrangements to share good practice as a matter of course across Greater Manchester.