Andrew Haldenby is co-founder of Aiming for Health Success, a new health research body.
What does “levelling up” mean for health and the NHS? The Prime Minister’s main speech on levelling up so far referred to differences in life expectancy between regions but stopped there. The forthcoming levelling up white paper could give health much more attention.
Improved health is key to rising local incomes and living standards. Poor health takes older people out of the workforce, reducing local incomes and buying power. It takes children and young people out of school and reduces achievement. From one generation to the next, it undermines the attractiveness of the community to employers.
New Aiming for Health Success research shows that the Red Wall seats have high levels of need in regard to long-term conditions such as asthma, COPD, coronary heart disease and diabetes. As the table above shows, the combined prevalence is close to 45 per cent of the population.
Prevalence of risk factors for disease is also very high. Obesity affects 14.2 per cent of the population and depression 13.8 per cent. This means that more than half of the population is affected by illness, for themselves or for their neighbours.
The data also show that the level of need is higher in the Red Wall than in other parts of the country. The combined prevalence for long-term conditions is around 37 per cent for England as a whole.
These demands point to new services delivered through expanded primary care teams, led by GPs, rather than the over-stressed hospital system. Some local patients are in a revolving door of repeated hospital admissions and very poor results. A&E attendances are twice as high in Red Wall areas.
New services can include personal and intensive programmes for the occupational health of adults, traditionally underserved by the NHS. As a long-term COPD patient said to the research authors: “We are in a rut.”
New programmes would be for people in all age groups who want to get into work including both younger people and over 45s who want to stay in their jobs. They would collaborate with local fitness centres and leisure centres and where needed could involve counselling as well as advice on diet and activity. They can be helped by GPs through social prescribing as a complement or alternative to traditional medicines.
Too many young people in the next generation are growing up with poor health and poor confidence. The child obesity rate at 10-11 years old is 31 per cent in low-income communities. With poor health goes a high absence rate and low school achievement, all of which affects retention of teachers.
Primary care teams can work with local schools and colleges to design some attractive new programmes with additional funding via integrated care systems. These would fund local sports events and organise internships and visits to local sports teams. They would help with reading and maths skills as well as testing for any sight or dyslexia problems. They would show children that somebody minds how you perform and wants to help you to do better.
Local voluntary groups such as the Scouts and other youth groups could also be encouraged to expand their activities. Helping younger people also has positive effects for older people as they can take pride in their positive energies and achievement.
These programmes recommended above could produce results in less than two years. They would increase the local sense of achievement and show results from local initiative. They would also help with the very serious and usually ignored problem of high crime rates among young people.
Speed of delivery is key. In the last few days, Conservative MPs such as Anne Marie Morris have asked in Commons debates why NHS capacity has not been increased in order to help the service cope with the pandemic and prevent lockdowns. Ministers may point to the programme of refurbishment of 40 hospitals but these are massive projects not due to complete until eight years from now on the very best estimate.
To put it another way, two general elections will likely come and go before the refurbishments come on stream. Primary care improvement can happen much more quickly, as well as being more cost efficient and tailored to the needs of the Red Wall.
The other key step to increase capacity is to redirect funds from the NHS to social care and other providers. Care home standards in Red Wall areas are falling and there is a shortage of home care support. As new national figures showed last week, over ten per cent of hospital beds are occupied by people that are medically fit but cannot be discharged. Eliminating that number would be the equivalent of building 25 new hospitals overnight.
A national programme of hospital refurbishment does not speak to the needs of the Red Wall. Boost the new primary care and social care to make a difference before the next election, Prime Minister.
Red Wall seats included in this research
East Midlands: Bassetlaw, Ashfield, Bolsover
North West: Workington, Leigh, Heywood and Middleton
North East: Sedgefield, Bishop Auckland, Blyth Valley
Yorkshire and the Humber: Great Grimsby, Wakefield, Don Valley
W Midlands: Dudley North