• NHS plan provides for welcome interventions but alone will not be enough to reduce inequalities
  • Prevention agenda in the long-term plan a positive step but ultimately wider political intervention will be key
  • Greater integration will be crucial to future success of healthcare but only part of the picture without the social care green paper

Historically ingrained health inequalities in England won’t be reversed by measures in the long-term plan, which require bigger “political and societal” interventions, according to a public health expert whose work contributed to the plan.

Putting more funding into areas with the greatest inequalities makes sense but is “small stuff” compared with the entrenched inequalities in health in England, Nicholas Steel of the University of East Anglia told HSJ.

Increasing the allocation of funding to areas with high inequalities is welcome but “clearly it’s not going to make those inequalities go away”.

It will not reverse “all the reasons why the historical embedded reasons why people in Blackpool have premature mortality twice as high as people in Wokingham and Richmond”. However, “it is a recognition that the causes of these widespread inequalities are deeply embedded long-term intractable problems”.

“It responds to the fact that because of these social inequalities, people are sicker younger and there is a greater need for healthcare in those areas,” he added.

Last year, Professor Steel was a co-lead author of a systematic review of the Global Burden of Disease, published in The Lancet, that was used as the evidence base for the long-term plan’s work on inequalities and prevention.

The research highlighted the leading causes of ill health and early death as smoking, obesity and diabetes, and alcohol, which are all top priorities for prevention in the long-term plan.

However, “the NHS does have a limited impact on this, it’s picking up the pieces of a broader societal problem,” Professor Steel added.

“There isn’t evidence to support individual behavioural interventions, really, in terms of reducing smoking, reducing obesity, reducing alcohol and drug problems,” he explained.

“I think the evidence supports that these are environmental problems that require political and societal ways to address them… The NHS plan can only, inevitably, cover a little of that.”

Beyond the specifics, the plan lacks details of how proposals will be made to happen, and it is also only one part of the picture, Professor Steel said. It is not enough for the NHS to announce it will integrate extensively with social care, without a corresponding commitment from social care. “At the moment, it’s wishful thinking without that.”

Professor Steel first spoke to HSJ in October about where he felt the evidence of the burden of disease in England should lead the NHS in its plans for treatment and prevention in the next 10 years.

He said there needed to be greater emphasis on the causes of morbidity and not just premature mortality. This would mean the NHS “thinking about giving a higher priority to services for musculoskeletal problems, for skin problems, for mental health problems that traditionally have not been seen as the high priority services”.

He said he “looked in vain” for references to skin diseases in the long-term plan, which seem “destined to be a low priority”.

However, he welcomed the measures for tackling low back and neck pain, as well as other musculoskeletal problems. There is “good stuff in there, simple practical stuff about improving back and neck pain”.

There’s a lot about mental health in there, which is really good to see, particularly for young people,” he added.