We have a UK Government and NHS who say they are committed to reducing health inequalities. The problem is doing so – and, by extension, addressing systemic racism – actually requires a strong will and a lot of hard work.
It involves viewing every policy through this lens. It includes producing an impact assessment that isn’t an afterthought, but instead becomes something that could stop a policy in its tracks. Sadly, I don’t think ministers and NHS managers have the stomach for this.
Our story this week on childhood immunisations is a perfect illustration of this. As part of the 2021/22 GP contract negotiations, NHS England made some tweaks to the payments for childhood immunisations. They introduced new thresholds for vaccination uptake that practices needed to meet to receive certain payments and, is some cases, avoid having money clawed back. They removed ‘exception reporting’ for the QOF domains – meaning that practices had to actually vaccinate the children on their patient list, and couldn’t rely on simply having made efforts to do so.
On the face of it, these tweaks were understandable. Childhood immunisation uptake has been decreasing and this was a carrot and a stick for practices – the rewards for actually achieving the targets were improved.
But this is where the commitment to reduce health inequalities becomes more than a pithy soundbite. Because it has become apparent that these tweaks could have catastrophic consequences, and is likely to widen such inequalities. We spoke to scores of GPs before this story and, at the Pulse PCN event in London yesterday, I spoke to a number of clinical directors in deprived areas with a high number of non-white patients. These were really impressive GPs, finding innovative ways of reaching those families who might be vaccine hesitant.
They had to be innovative to meet the previous targets. But the removal of exception reporting and implementation of higher thresholds has left them with a huge dent in funding, as there are some families who are simply unreachable when it comes to vaccinations. This could be due to cultural reasons or even because they are on a different schedule from their previous country of residence. Yet failure to bring in a single family is costing them tens of thousands of pounds.
This policy won’t result in practices ‘working harder’ to reach these families (they are already working as hard as they can). What it will mean is these practices in deprived areas will inevitably miss out on funding and will therefore have to either reduce their team, reduce their earnings (and thus making it harder to recruit new partners) or – most likely – concede that they won’t get due rewards for their efforts to vaccinate as many children as they can, and as a result won’t bother chasing the families that are reachable. Any one of these scenarios will increase the health inequality gap.
There is a similar issue in our story this morning, where a technical detail around visas – brought in because the Government wanted to show it is hardline on unskilled immigration – is leaving practices in deprived areas with recruitment problems.
White papers on reducing inequalities, and resources for ‘place-based initiatives’ (ugh) are all very well. But if health managers and ministers are serious about this aim, they need to start thinking about it at all times, including when their favoured policies are deemed unworkable. My fear is that ‘reducing health inequalities’ will simply remain a nice soundbite to trot out.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org