Dr Rob Sutton is an incoming junior doctor in Wales and a former Parliamentary staffer.
Much discussion of the Department for Levelling Up, Housing and Communities’ (DLUHC) anticipated Levelling Up white paper has been regarding its sheer breadth of scope.
The all-encompassing character of the mission it sets out, a liability in the hands of a less capable Secretary of State, should prove an asset under Michael Gove, a reformer with an instinct for the big picture. But there is a risk, by folding so much into the levelling up narrative, particularly in this latter half of the Parliament, that DLUHC ends up overstretched.
How exactly does the paper connect to health services? Much discussion of levelling up has been in terms of infrastructure and investment, but as stated in the opening paragraphs, “Levelling up means giving everyone the opportunity to flourish. It means people everywhere living longer and more fulfilling lives, and benefitting from sustained rises in living standards and well-being.” It is under this definition that the paper makes the case that health policy is part of the broader levelling up project and should not escape its gravitational pull.
The specific “Levelling Up Missions” for health services are stated under the headings of “Health” and “Well-being”: “By 2030, the gap in Healthy Life Expectancy (HLE) between local areas … will have narrowed, and by 2035 HLE will rise by five years” and “By 2030, well-being will have improved in every area of the UK, with the gap between top performing and other areas closing,” respectively.
The cynic would point out that the most ambitious of these goals to achieve, the rise in HLE by five years, has a deadline which falls beyond any immediate political horizon. Those pledges to be achieved by 2030 should, sparing some catastrophe, be comfortably met. But rightly, the Government is saying that it has chosen to tackle some of the major disparities in health outcomes between the most affluent and the most deprived areas in the UK.
How will the levelling up deliver these objectives? And what does the white paper identify as the Government’s ambitions for the NHS? The policy programme is set out under three specific areas: public health, food and diet, and tackling the diagnostic backlog.
The first area, public health, is uncontroversial, if somewhat unambitious: smoking cessation, a new drugs strategy, and weight loss programmes. The disbanded Public Health England has been reconfigured as the Office for Health Improvement and Disparities, with similar goals and leadership. Some of the more paternalistic aspects will grate with the libertarian faction of the Conservative party, but there isn’t much to be aggrieved or excited about either way.
The second point, food and diet, suggests that the Government has identified a major vulnerability, and is acting to remedy it. Food insecurity, particularly amongst children, is an area on which Labour managed to inflict damage during the current parliament. Marcus Rashford’s campaigns struck a chord with the public, and Conservative messaging on our strategy to tackle this appeared to have fallen flat. As cost-of-living pressures continue to gain prominence, it is an issue which isn’t going away.
The white paper sets out a sensible and coherent strategy: a “forthcoming Food Strategy White Paper,” a “new £200m per year Holiday Activities and Food Programme,” “assuring and supporting compliance with school food standards,” and “a Community Eatwell programme” are some of the headlines. A confident and measured approach which identifies and remedies genuine food insecurity will give activists and elected officials something positive to talk about on this sensitive area. This is a genuine opportunity to achieve social good while cutting off an effective avenue of attack from the opposition.
The final aspect of the programme addresses the diagnostic backlog. The public have been extremely understanding regarding the delays incurred by the response to Covid, but there is a growing awareness of the scale of the challenge which has been (necessarily) kicked down the line during the pandemic.
The extent of delayed diagnostic procedures over the course of the pandemic makes for worrying reading. There will be two aspects to tackling it: personnel and infrastructure. We obviously need the medical staff to perform and interpret diagnostic tests. I have recently written regarding the need to get doctors out of locum work and back into training. For the infrastructure, the paper sets out its vision in the form of diagnostic service hubs.
By choosing the location of these “Community Diagnostic Centres” (at least 100 of which will be in England by 2025) and other new healthcare infrastructure carefully, we might boost the standard of care in those deprived areas which have fallen behind in health outcomes. While there has been a trend towards centralisation of services over the last two decades, here we have a proposal for a fundamental shift in the relationship between health services and the communities they serve.
Centralising services is popular among policymakers and NHS management. But for the general public it erodes their sense of pride in place and leaves patients feeling like figures on a balance sheet rather than individuals. And controversial attempts at centralisation undermine this approach. Levelling up could see the vital infrastructure and personnel returning to the communities on the sharp end of the UK’s health disparities.
That is the real strength of this paper – it has taken existing policies, supplemented them with new ones, and pulled the strands together into a coherent overarching agenda. If Gove’s programme allows for the return of health services to left behind communities, then levelling up will have a significant and lasting effect on the delivery of health services.