Read: Low vaccination rates will add to existing health inequality

As we reach the end of the year and, despite a world-beating mass vaccination programme, the pandemic continues to disrupt lives and cause sickness and loss of life across the country. It has particularly adversely affected those already most disadvantaged. The health inequalities that already existed have been exacerbated and become further entrenched. There is no doubt that poor take up of the vaccine in some areas will also have a hugely negative impact on health and wellbeing.

 Areas with poverty, high unemployment, poor housing, low rates of education and a high degree of social isolation will always be where health outcomes are worst. That inequality can’t be resolved without also addressing these wider factors. Low life expectancy, fewer healthy life years and a higher risk of maternal or neonatal deaths are now also joined by a low COVID vaccination rate as features of some of our most deprived communities.

 The disadvantage already experienced by the most vulnerable will have been heightened. Poor physical or mental health is a huge barrier to people being able to access the opportunities in life that will help them get on. The short-term effects of COVID have become clear to us over the last couple of years but the long-term impact is still largely unknown. It is likely, of course, to have a detrimental effect on physical and mental health outcomes but also on education and employment, hitting those that are already struggling the hardest.

 The Levelling Up Health Coalition, as part of the wider Purpose Coalition, is working with NHS Trusts across the country to break down those barriers to opportunity and provide equality of provision and care to everyone who needs it, wherever they are. As anchor institutions in their local areas, NHS Trusts have a deep and authentic knowledge of the challenges that their local communities face. That expertise means they are well placed to directly address the health inequalities that exist in health outcomes and experiences as part of broader levelling up. 

 The influential and practical role that NHS Trusts can play is even more crucial as the country continues to deal with the impact of COVID. One of the members of the Coalition we are working with is Barts Health NHS Trust in London. As an organisation that serves 2.4 million people, and with a workforce of some 24,000, it has the status and the community reach to play a leading role in levelling up London.

 With some of the worst vaccination take up rates in the country – only 58.2% of people in the area Barts serves have received two vaccinations – London clearly illustrates how health inequality is not just about the north versus the south . There are often significant differences within the same area and London is a prime example of a place where there are streets of huge wealth sitting alongside the poorest communities. According to the charitable foundation Trust for London, life expectancy for men in Westminster is 84.9 years compared to 78.1 years in Barking and Dagenham. Healthy life expectancy shows an even greater difference, ranging from 58.6 years for men in Hackney to 74.9 years in Richmond.

Barts Health is doing much to address the inequalities in the area it serves, particularly in terms of diversity and inclusion, not only for its patients but also for its staff. As the largest single employer in the UK, the NHS has huge potential to provide jobs and career progression on a large scale, not just in healthcare provision but also in the wide variety of sectors that are part of the NHS for example, information technology, science, and administrative and managerial services. The Trust is focusing on making sure that it uses all the talent that can be found in the area, no matter what their background is or where they live, underpinning its approach on levelling up. Barts is aiming to create a culturally intelligent leadership community and to increase the proportion of ethnic minority staff in higher pay bands. It is also working towards achieving 95% ethnicity coding of its patient data by March 2022 to ensure no one is disadvantaged in accessing services, and they are reviewing waiting lists by ethnicity and deprivation. That is vital as we see much poorer outcomes for those from an ethnic minority background in London, and right across the country.

 Another NHS Trust, University Hospitals Birmingham NHS Foundation Trust, has joined the Levelling Up Health Coalition to improve the prospects for its communities and bring meaningful change to the area. Like London, it is a city which has pockets of wealth alongside areas of poverty. It has similarly poor vaccination take up rates – only 58.5% people in the area it serves have been double vaccinated. Recent figures from Birmingham Public Health based on ONS figures show that life expectancy figures are also lower than average. Again, there is a huge variation within the region, with life expectancy for men ranging from 84 years in Sutton Coldfield to just 74 years in Aston.

 The Trust is leading the way in its local community as a major employer in the area with its work to encourage employability through its outreach work in local schools and its provision of a variety of apprenticeship programmes. It has also adapted its recruitment process to ensure that it is fair, and career progression and training within the Trust is similarly based on ability and potential. 

 In our work with these and other Levelling Up Health Coalition partners, we are encouraging them to assess and measure the value of their social impact and the good they do for their local communities. By leveraging their unique position in those communities, they can be the agents for positive change so that everyone has the same access to the health and care services they need, and everyone can benefit from the same opportunities and life chances. A better vaccination take-up rate will also help protect the futures of the most vulnerable.

 Delivering health care and supporting people with long term conditions in the face of the pandemic has brought huge challenges to the NHS. But despite this our Levelling Up Health Coalition partners are responding to the call to arms to bring a much wider impact to the communities they serve. Their efforts are to be applauded and their efforts will make the difference to levelling up this country.

Rt Hon Anne Milton