HFMA 2021: structure needed in inequalities battle

09 December 2021 Seamus Ward

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Sanjay Agrawal lProfessor Agrawal (pictured), who is consultant in respiratory and intensive care medicine at University Hospitals of Leicester NHS Trust, said: ‘When I began my medical residency, the training director told me that when starting something new you need a structure. As you get more experience you need less structure. I think we need to do that with health inequalities. How do we structure it so it makes sense and we can start addressing it?’

That structure was beginning to emerge. Health inequalities had become a priority, featuring in NHS documents and guidance, while the NHS England and NHS Improvement Core20plus5 approach had also been published.

Core20plus5 seeks to focus efforts on the most deprived 20% of the population, plus the local populations that integrated care systems wish to address, and five clinical areas. The five areas are: maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis, and hypertension case-finding.

Health inequalities groups and a named board member with responsibility for addressing the issue were also contributing to the emerging structure.

Finance teams must link in with these groups and individuals. He suggested they could play a part by assessing the cost of doing nothing, by disaggregating the data to uncover disparities locally, and triangulating the data. Allocation of resources could then be based on this information, together with an understanding of inequalities from the patient viewpoint.

Lee Outhwaite said there were sound financial, as well as moral and ethical, reasons for addressing inequalities. Tackling health inequalities had greater allocative efficiency – there was ‘more bang for the buck’, he said.

‘This has everything to do with how we allocate resources,’ he added.

Usman Niazi, chief financial officer at South East London Clinical Commissioning Group, said the financial environment would probably get tougher next year. There will be many calls on growth funding as, for example, providers seek to recover elective waiting times, but finance staff must ensure tackling health inequalities is a key part of their organisation’s financial framework.

Data will play a key role in these discussions. Finance teams must inform colleagues of the cost of health inequalities to their local system. 

‘It's really important we are able to articulate what it means in our own system,’ he said. 

‘In South East London we spend three times as much on people from the lowest decile on the index of deprivation compared with the average. That’s because they are not accessing preventative services,’ he added.