Can Do Health & Care - NHS Uncomfortable Truths Report

6 | ICS System Learning: Uncomfortable Truths Dean: Reducing inequalities is not about our strategic direction, we already know that. Marmot told us about that 13 years ago and since then inequalities have widened. If we look internationally at the places which spend less than we do on health but have more centenarians and more comfortable, dignified deaths, we know the strategic direction we should take. When I look at the data pack for this event, I ask myself what one thing could change it all. The research repeatedly tells us that it is to get communities involved. “We should shift leftward into the community, the question is how far and how fast? This takes courageous leadership.” The differences people experience in care are not due to the intelligence of the doctors, but whether the doctors engage communities and trust them to tell us whether we are getting it right or not. Listening to that brutal honesty allows us to respond faster. We might waste our learning from the crisis we had in Covid, and the crises now and to come, if we only focus on the strategic direction. We need to move now, and fast. Jeptepkeny: When I started my training in public health 20 years ago, I was involved in a population health needs assessment in Clacton. I remember going to Jaywick with environmental health officers who were working to improve the quality of housing, and they spoke about the lack of trust between local people and public sector organisations. Local GPs told me about high GP turnover. I saw the Surestart centres doing good work, teaching young mothers how to cook, for example. The data then showed issues of poverty, teenage pregnancy, lone parent families, and low educational attainment. At that time the Wanless report had been recently published, which talked about taking a long term view to securing our public health. Wanless highlighted that the UK had fallen below other countries in health outcomes and outlined three scenarios for a vision for the NHS in 20 years’ time, which would be 2022. At one extreme, ‘slow uptake’ is the most expensive scenario where there is no change in public engagement, life expectancy rises only minimally, people’s health is constant or deteriorates, and there is low uptake of technology and low NHS productivity. At the other extreme, ‘fully engaged’ is the least expensive option, with high public engagement where life expectancy increases beyond forecasts, health improves dramatically, people are confident in the health system and want high quality care, the health system is efficient and responsive and uses technology especially in disease prevention. Reflecting on my experiences in Clacton and the Wanless report, if I did the same needs assessment today the data shows there is still a life expectancy gap nationally, and that gap is worse in some areas. In Tendring the gap is just over 10 years for men and almost 8 years for women, and it is increasing.

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