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Health inequalities a ‘national disgrace’ says NHSCB deputy medical director

The difference in life expectancy between affluent and poorer parts of the country is a ‘national disgrace’, the deputy national medical director of the NHS Commissioning board said at the NAPC conference.

Professor Steve Field urged CCGs and general practice to make health inequalities a priority.

And he heavily criticised practices that turned away homeless people, travellers and other vulnerable groups.

‘It is a national disgrace that the expected age of death of people in Blackpool is 20 years less than those in Somerset.

‘We need to do better, instead of accepting variation in everything we do,’ he told delegates in Birmingham.

Speaking within a debate on achieving and monitoring equal access to care he said the NHS Commissioning Board mandate and NHS Constitution, a new draft of which is due next week, would mean ‘unacceptable variation’ can no longer be ignored.

Professor Field agreed that CCGs would face an uphill battle in spreading a change in culture but said there was no other option if the NHS was to improve quality at the same time as making savings.

Increasing capacity within primary care rather than just looking at cutting referrals to hospital was the solution, he told delegates.

‘If you look at the graphs it is blindingly obvious that people need to work differently. ‘We need to improve skill mix and build capacity in primary care.’

He added that PCTs in some areas were already cutting very good services for the vulnerable, when in reality their needs were often greatest.

‘To look after the homeless you need more money to do that so we need to look at commissioning new services.

‘Resources need to be targeted. It is a disgrace and we should have done better.’

Dr Judith Smith, head of policy at the Nuffield Trust said health and wellbeing boards could be a vital driver for improving population health and pushing forward radical changes in the way services are delivered.

‘If they work together cleverly with local authorities they could be powerful and influential on the strategic view and making those difficult decisions.

‘CCGs will be pulled into productivity and quality domains.

‘It won’t always be popular or easy to do that long-term work so I would think about how you work with the health and wellbeing board.’

Speaking within the same session, Dr Gillian Leng, deputy chief executive at NICE, said their focus in the past had been on single quality guidelines but they needed to support primary care in managing multiple morbidities.

‘We have been having lots of conversations with clinicians about this and we will see the results of that through our quality standards portfolio and the increasing requirement to provide service guidance looking at the management of a group of people in general.’

She said that NICE had first-hand experience of the difficulties in getting change implemented but to improve quality primary care would need ‘champions, evidence, and incentives.’