Next government should commit to halving healthy life expectancy gap

The next government must make halving the 18-year healthy life expectancy gap as part of a commitment to improve the health of the nation, the leader of the NHS Confederation has said.

Matthew Taylor told delegates at the NHS ConfedExpo conference in Manchester that there is a danger of the country falling into a vicious cycle of higher sickness, lower growth and an NHS stuck in perpetual crisis management.

The most recent Office for National Statistics (ONS) data shows that from 2013 to 2020, female healthy life expectancy ranged from 51.8 to 52.3 years in the most deprived areas and 70.4 to 71.3 years in the least deprived areas. Male healthy life expectancy ranged from 51.4 to 52.3 years in the most deprived areas and 70.4 to 71.2 years in the least deprived areas.

This means the inequality gaps between the most deprived and most affluent areas ranges from 18.4 to 19.1 years for females and 18.2 to 19.8 years for males.

Mr Taylor said that there needs to be a long-term shift over the next decade from a reactive healthcare model where people get care when they fall ill, to a proactive model where people are supported to stay healthy.   

This will build upon previous public health successes such as removing lead from petrol, slashing smoking rates and halving teenage pregnancy. Mr Taylor added that the next priority needed to be tackling the “obesity crisis”, with obesity a key factor in a number of long-term health conditions.  

Mr Taylor said: “Unless we improve the health of the nation the NHS will be stuck and the country’s economy with be held back.

 "Now the failure to act on this irrefutable facts is made more frustrating when important wins could be achieved at relatively little cost.

“History tells us that concerted and determined action can make a difference.

“There are areas of prevention such as vaccines, cardiovascular diagnosis and treatment, and type two diabetes where we know that a concerted national drive – supported by the whole of government – could reap rapid gains in health outcomes and investment returns. Remember, 40% of the NHS budget is being spent on treating preventable disease.

“Yet, still too often we measure success in terms of NHS activity not health outcomes. The major parties make commitments to improve population health but day to day policy rarely reflects such commitments.

"There is an 18 year difference, shocking, an 18 year difference, in healthy life expectancy between the most deprived and affluent communities. Halving that gap should be the centrepiece of health policy over the next decade."

Mr Taylor said that the reactive model of care responds to demand not need, and that waiting until people feel worried or sick is generally the least clinically effective and most expensive way of improving health outcomes.

The NHS and its partners are working on integrating services and investing in population health management, but this focus is not being matched by central government, Mr Taylor added.  

He said: "As a society we are, over the long term, living longer but we are not living longer with good health. Figures yesterday show nearly a quarter of working age people are not in employment, mainly for health and care related reasons. Add to this modest economic growth, hostility to high rates of immigration, and we face the NHS and care system eating up a higher and higher proportion of public spending and one in five of our national workforce.

"So this is the danger we see unfolding before us - a vicious cycle of higher sickness, lower growth and an NHS stuck in perpetual crisis management."

An analysis commissioned by the NHS Confederation, published last year, found that for every £1 invested in community or primary care, there was up to a £14 return back into the economy. This shows that investment in the NHS, particularly in primary and community care, is very beneficial to the wider economy.

The NHS Confederation has been calling on politicians of all stripes to commit to a cross-government plan to improve the nation’s health if they are elected. This needs to recognise the importance of both the social determinants of health and of health promotion and prevention outside the NHS.

Mr Taylor said that the shift from a reactive to a proactive model of health policy and care would represent the biggest change in the way we think about health policy and the role of the NHS in its 75-year history.

He added: "I hear a yearning for a vision of a health service that, as well as balancing the books and investing wisely, is achieving ever better outcomes and restoring that lost public confidence.

"At the centre of such a vision there needs to a recognition that our current approach to health policy and the NHS - it’s no longer fit for purpose.

"It is time not just for new policies and commitments but for a fundamental re-imagining.

“We could be at the dawning of the biggest change in the way we think about health policy and the role of the NHS in our 75 year history.

"Since 1948 our method has been fundamentally reactive. Over the next ten years we have to make a decisive move to proactive health."

Mr Taylor also said that the the five day junior doctor strikes from 27 June to 2 July would be "futile and very damaging".

The NHS Confederation is urging political parties to promise to re-open negotiations with junior doctors within 10 days of forming a new government and in return the British Medical Association (BMA) would then call off its planned strikes.