Its not fair! Inequality, the NHS and CCGs

In Sheffield some of us met recently to wrestle with what a Clinical Commissioning Group (CCG) health inequalities strategy should look like.

At the moment this is still very much a discussion rather than a strategy or policy – however, I think that some useful insights are beginning to emerge.

We thought that there are potentially three areas of focus that a Clinical Commissioning Group should be considering, these are:

Membership

As we move towards ‘co-commissioning’ of primary care it becomes even more important to consider what the roles of primary care and General Practice specifically should be in a local health system. This means building on the strengths that the General Practitioner membership of CCGs brings. This could include:

• developing closer partnerships with community organisations to help address the social determinants of health
• using social prescribing systematically
• consistent use of practice champions to create pathways of support and connection

There might also be a need to work with the CCG membership to develop a shared view of what we understand health inequalities to be – this is because it does still feel that people hold different views about what words like inequality and equality mean. For example sometimes conflating a focus on ‘protected characteristics’ with work on health inequality.

Regrettably there is also a minority within the medical profession who still find it too easy to blame the poor for their ill health – as a generally dispiriting list of comments from in response an article in Pulse about food banks shows – these views need to be challenged.

Commissioning

This is of course the official role of Clinical Commissioning Groups however more needs to be done, for example:

• How do CCGs ensure that big NHS providers in particular take a clear responsibility for ensuring that that their services respond to the needs of people with multiple disadvantage? There is a real issue of people failing to engage with secondary services because of their complexity, language and cultural barriers and issues like access to transport.
• What can CCGs do to ensure that big NHS providers have a coherent health inequalities strategy that goes further than a focus on protected characteristics and HR policy?
• We need to avoid tackling health inequalities being seen as something that is done through small stand alone procurement exercises.

System Leadership

The third strand is the CCGs relationship with the wider local health system. This includes a wide range of issues – but particularly connection through the Health and Wellbeing Board with work to address the Social Determinants of Health. So here we might expect to see connections with:

• Strategic work on voluntary sector and volunteer development
• Work on income, debt and poverty
• Strategic work on voice and advocacy

It could also mean considering the relationship that a CCG Health Inequalities Strategy has to key local plans such as priorities that might emerge from Fairness Commissions – where these have been carried out.
What do you think?

I would be very interested in ideas and approaches from other CCGs who are trying to take a more strategic approach here.

With thanks to Susan Hird, Leigh Sorsbie and Ted Turner