Council Aims to Tackle Health Inequalities
By Merlin Betts
Just last week, Kay Green and Lorraine Murphy started a petition titled – plain and simple – We need help using our NHS. It was addressed to East Sussex County Council and Hastings Borough Council (HBC), asking for practical aid with the day-to-day flaws in the local NHS that many of us have experienced.
Have you rung your GP lately and had to wait about two and a half minutes before the call actually starts, and then found yourself number 21 in the queue? Maybe you’ve heard your anger and exhaustion mirrored in the beleaguered receptionist who finally greets you. Or had to get a late night taxi home from A&E because your GP couldn’t see you all day and sent you up to Conquest instead? And when you are at last seen by a specialist – what was your name again? No I can’t find your notes – something about the whole experience leaves you… unsatisfied?
Kay and Lorraine write, “We appreciate the excellent work that our NHS medical staff do, and the value of their expertise, but we constantly see signs that contractors and government policy-makers do not need those services, and do not understand or care about the needs of less well-off citizens.”
If you answered yes to any of those questions above – sign the petition www.change.org/p/we-need-help-using-our-nhs.
CREDIT: National Cancer Institute
Its authors also ask what local government is doing to protect and improve existing services. Well, as it happens, I have a spare report I wrote on an HBC cabinet meeting back on August 1 just gathering dust. And it might help to explain some of what’s going on.
Doom and Despair
To quote the HBC motion from back in August, “Hastings is the most deprived lower tier local authority in Sussex and one of the most deprived in the country. The experiences of deprivation contribute to higher rates of long-term illness, disabilities, cancer, lung disease and heart problems compared with the rest of England. Men in the most deprived areas of Hastings are expected to live 11.5 years less than those in other areas of the town – the biggest gap in the southeast of England. Life expectancy for both men and women is lower here than the England average.” As I understand it those deprived areas are especially represented by Ore, Hollington and Central St Leonards.
The motion talks about, “the benefits of exercise, healthy eating, and access to quality outside spaces… vital for physical health and mental well-being”.
Hastings residents generally have minimal access to quality outside spaces and nutrition. The parks and beaches are there, sure, and the foodbanks too, but you try and tell us that that equates to “access” and “quality”.
The NHS is Changing
Our failed system of Clinical Commissioning Groups (CCGs) was dissolved in July. They’re being replaced by brand new Integrated Care Systems (ICSs). Acronym central. Where the CCGs were almost hegemonic, looking at populations as best as they could and then making decisions on behalf of everyone, the ICSs plan to involve service users – read “people” – and community organisations in their own healthcare. At long last, right? But the ICSs are currently more hierarchical than their inefficient and problematic predecessors.
The plan is to have ICSs replace CCGs in one fell swoop (still rolling out now), so apparently they need to be centrally-organised, monolithic organisations, just for the moment, while the coup d’etat is underway. Steadily they are being partitioned into localised systems and partnerships that’ll finally “integrate” with the people using NHS services.
I’m pessimistic about this whole process. I think we’re going to see the NHS privatised within a decade, and it’s disgusting that horrific and deadly mismanage-ment will be rewarded with a kind of equally horrific mismanagement (privatisation). Something that’s even more profitable for the so-called ‘managers’. But enough of that…
Universal Healthcare
Over the past year HBC’s informal action group, the Hastings and St Leonards Local Strategic Partnership (LSP), has been making recommendations in line with the ICS rollout. It says a ‘whole system’ approach is needed and, “key to success will be collaboration, peer support… scaling up community-centred approaches to tackling inequality and poverty”.
The LSP held a workshop of healthcare aficionados on 14 September, which featured a speech from Professor Chris Witty (I recommend looking up his report on ill health in coastal communities). But, “as ever, the issue of resources and capacity to achieve the objectives set out by the group was identified.” In other words, will there be the people and money to actually get anything done?
Before our local CCG departed, Cllr Mike Turner (Hasting’s man in East Sussex County Council) secured £3.4m of funding, most of which is going to be used for a Universal Healthcare Programme: a year-long initiative working with Bradford local authority and Southbank University. This, it is hoped, will start the kind of good work that ICSs are supposed to be bringing to us in the near future. It’s an experiment that will get national attention.
A local design team is supposed to start things off. Cllr Hilton (recently thrown out of the HBC leadership coalition on orders from national Labour) wondered whether service users themselves might be included on this team, to help design their own services – isn’t that what all these reports are saying should happen, after all? Possibly, the answer was.
In fairness to the council, gathering information from service users is no simple task. How do you even begin to understand and average out what thousands of people are thinking and saying about a service, or a platform? HBC might consider questionnaires and focus groups – practical measures, but ones that won’t really satisfy the Borough’s itch for action. There doesn’t seem to be any quick solution for that.
Regenerating Like Nature
The Hastings Health Equity, Wellbeing and Prosperity Group, establised in June 2021, has some interesting comments to make, maybe clarifying a little of what this Universal Healthcare thing might mean for us. It’s another LSP initiative. They’re about “solution-focussed” (maybe read preventatve) and “whole system” (i.e. holistic) change. Their scope is “Community Wealth Building”, “Regenerative Economy”, and creating “Healthy Places”. What does any of that mean? Even if this latest sub group is too young to be a driver of it, the buzzphrases are referring to a lot of the good progress we’ve already seen in the town.
I’m talking about housing co-operatives and community associations, about HBC committing to build more council houses, even if the numbers are currently destined to be small. I’m thinking of the Hastings Commons community-led development area, which people ran themselves and didn’t need to be created by the council. I’m even talking about Transition Town Hastings greening up our stations and streets to make them nicer places to be, at Warrior Square, and in the Town Centre by the Trinity Triangle, say.
We have an extensive web of local community organisations that are by now experienced enough to make most of the changes HBC want to encourage on the ground. A lot of these organisations haven’t lost their ambition yet, despite sometimes fierce opposition.
Universal Healthcare is about stretching our understanding of what affects health. It assumes we already have universal healthcare in terms of getting care to people (debatable I know). Instead it’s saying healthcare doesn’t start and end in the surgery, in the hospital. It also happens in peoples’ homes, meeting places from cafes to parks, in schools and workplaces. Everything affects how healthy you are.
But when they say, “£2.4m will… be used to support a new innovative Hastings-focused programme which starts with the recognition that access to healthcare is currently unequal, and poverty is a key driver of poor health,” I struggle to see how this disparate web of community activity can work with NHS bureaucracy.
You can’t quantify how a garden in the town centre, clean beaches or warm community spaces reduce hospital admissions by, X% annually. The survey necessary to work it out might be possible, but it would be too complicated and cost too much. Yet there’s ample evidence not involving percentages that shows it to be true.
So will the NHS management ever be able to acknowledge what’s going on right in front of them? We’ll just have to wait and see.
But back to the petition mentioned above: I’ll be asking Cllr Andy Batsford – who’s rather appropriately gone from Housing to Health – and anyone else who wants to be involved to give us at HIP a proper briefing on plans for local healthcare, in the vain hope that we might be able to translate it for you. Watch this space.
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