Major Conditions Strategy fails to adequately tackle health inequalities, say experts

NHS leaders are concerned that the government is “stepping back from some of the ambitions it has previously set out”, following the publication of the Major Conditions Strategy (MCS).

The strategy aims to narrow health inequalities, improve healthy life expectancy by 2035, and ensure the needs of our ageing population, who are living with an increasing number of conditions, are better met.

Six health conditions drive 60% of mortality and morbidity

According to the report, six groups of major health conditions drive over 60% of mortality and morbidity in England, and it is increasingly common for patients to experience two or more of these conditions at the same time.

These groups of conditions are cancer, chronic respiratory disease, dementia, cardiovascular disease, musculoskeletal disorders and mental ill health.

The Major Conditions Strategy has five key areas of focus that, together, aim to reduce the incidence and the suffering caused by these major conditions. These are:

1. Primary prevention: acting across the population to reduce risk of disease
2. Secondary prevention: halting progression of conditions or risk factors for an individual
3. Early diagnosis: identifying health conditions early to make treatment quicker and easier
4. Prompt and urgent care: treating conditions before they become crises
5. Long-term care and treatment in both NHS and social care settings

The strategy argues that we have grown accustomed to planning our health and care delivery around treating a person based on an individual health condition.

While the government acknowledges that this approach has been beneficial in many ways, and has given us world-leading cancer institutions, they argue it is time to move away from single disease strategies and towards a model built around whole-person care.

While NHS leaders have welcomed the “direction of travel” set out in the strategy, they are concerned that this new strategy loses sight of the need to address the health disparities between different communities.

More emphasis on tackling health inequalities needed

Health leaders say that since the white paper on health disparities and the cross-government strategy on mental health were both absorbed into the MCS, there needs to be ‘more emphasis’ on how the government plans to tackle these problems.

Nuffield Trust Senior Policy Analyst Sally Gainsbury said: “This initiative is both long overdue and its emphasis has shifted over time: the Major Conditions Strategy is being developed in place of a white paper on Health Inequalities originally promised over 18 months ago.

“While the strategy’s six major conditions are also those conditions which form the immediate drivers of health inequalities in England, a perennial problem in health care – as with other public services – is that those who need help the most are often the least likely to access it.

“There is a risk that without more explicit emphasis on how the MCS can be used to tackle health inequalities – for example through focusing resources on deprived areas and tailoring services to excluded groups – life expectancy for those already well off will continue to increase, but there will be little or no reduction in the 19-year gap found between the most and least deprived neighbourhoods in England.”

Gainsbury also says there is a lack of clarity on how the government will support health and care systems act on the recommendations set out in the plan.

Just one in four schools have mental health support teams

The NHS Confederation has voiced similar concerns, and Danny Mortimer, deputy chief executive of NHS Confederation says there is an urgent need to “ensure that all parts of nationally driven public policy and investment also play their part in creating healthier communities.”

Mortimer says the government must now ensure the strategy translates into “decisive action” that tackles chronic comorbidities and the disparities between different communities, as well as reducing demand for NHS services for the longer term.

He says joint working will be vital to the delivery of the MCS, and urges the government to ensure mental health services are not left behind.

“Worryingly, the government is currently only committed to providing mental health support teams in just over one in four schools. To fully assist children and to reduce regional inequality, healthcare leaders want to see a commitment from government to fund mental health support teams in all schools,” he said.