For too many children in the UK, their health in childhood and long into adulthood is affected by inequality.
More than 4 million children – 10 in every classroom – are growing up in poverty, with families facing a desperate struggle to afford the basics like food, warmth or even a place to sleep.
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In my role at Barnardo’s, I am often asking how the NHS can play its part in tackling the social determinants of health. And while the problem may seem too big, too hard to tackle without major systemic change, the solutions may be easier than many of us think.
For years, leaders have acknowledged the importance of tackling the social determinants of health – the housing, financial, family and environmental factors that shape people’s wellbeing. Across the NHS, trusts are under enormous pressure to meet targets, deliver value for money and demonstrate sustainable change.
Faced with these demands, it can be tempting to assume that addressing social determinants requires large-scale structural reform that will take years, if not decades, to deliver. The result is often inertia: everyone agrees it matters, but little changes on the ground.
In reality, meaningful improvements can happen far more quickly than many assume – if organisations are willing to rethink how they work and who they work with.
Partnerships are central to this shift. Health services cannot solve complex social challenges alone, but they do not need to. Voluntary sector organisations, community groups and charities already possess expertise, relationships and practical tools to help address the non-medical factors driving poor health outcomes.
When the right partnerships are in place, change can happen surprisingly fast.
One example comes from our Barnardo’s and Modality Partnership trial of family support workers embedded in GP settings, where the early results are promising. In just a handful of sessions, family support workers were able to help make significant improvements in the lives of families who had previously struggled to navigate complex systems.
They helped secure rehousing for families living in unsuitable accommodation, identified issues that had gone unnoticed for years and advocated on behalf of families with local decision-makers. Their role went far beyond traditional clinical care, involving connecting with local decision-makers, helping families understand their housing rights and supporting them in finding alternative accommodation. In doing so, they tackled the root causes behind many of the health problems that repeatedly bring people into the NHS.
This kind of intervention demonstrates that addressing social determinants does not always require long-term programmes before benefits appear. With the right workforce model and the right partners, it is possible to deliver real, measurable improvements in relatively short periods of time.
However, achieving this requires a shift in thinking.
Too often, organisations attempt to solve new problems using old models. Workforce structures and funding mechanisms are designed primarily around clinical interventions, yet the issues presenting in GP surgeries and emergency departments increasingly have social origins. Trying to address these problems with the same tools, roles and approaches will inevitably limit what can be achieved.
If trusts are serious about tackling social determinants, they must also be serious about changing their workforce models. This means recognising that roles focused on advocacy, family support and community navigation can be just as important as traditional healthcare roles when it comes to improving outcomes and reducing demand.
Crucially, this is not about replacing clinical expertise but complementing it. Doctors and nurses cannot fix damp housing, insecure employment or family crises during a 10-minute appointment. But they can work alongside professionals who are equipped to tackle those challenges.
The need for this kind of approach is obvious in many everyday scenarios. Consider a patient who visits their GP 17 times with the same respiratory problems. The clinical response might involve prescriptions, referrals, or repeat appointments. But if the underlying cause is damp and mould in the patient’s home, those interventions will never fully resolve the issue.
The real solution lies beyond the clinic walls.
Importantly, health inequalities are not just a moral issue – they are estimated to cost the NHS £4.8bn annually and tens of billions more to the wider economy.
When people receive the right support early, they are less likely to require repeated GP visits, hospital admissions or long-term treatment for preventable conditions. In other words, tackling social determinants is not just the right thing to do for patients – it also represents a strong return on investment for the health system.
If the NHS wants to deliver better outcomes for children and families, integration must move from aspiration to action. That means embracing partnerships, rethinking workforce models and recognising that better health often begins outside the clinic. Only then can we truly start changing the future for our children and their health.
