During the pandemic people living in the poorest areas saw double the death rate from Covid-19 as those living in the most well-off localities, yet again tragically demonstrating the link between poor health and poverty.

The Centre for Progressive Policy (CPP) has previously shown that 80m life years are lost due to inequalities in education, income, employment, crime and housing in England, and over the coming 12 months, the cost of living crisis is set to push an additional 1.3 million people into poverty. Far from levelling up, this latest crisis threatens to leave vulnerable people and places further behind with damaging long-term implications for health.

Against this incredibly challenging background, The Kings Fund and CPP have joined forces to explore how places can bring together local economic and health levers to best address the causes and consequences of poverty. They brought together 13 NHS and local government leaders to reflect on their own experience in population health and economic development.

What are the opportunities?

1. The roll out of Integrated Care Systems in England

Many in the health space saw this collaboration as a way to provoke strategic discussions on poverty in Integrated Care Partnerships (ICPs), which will include local authorities, NHS trusts and other partners and receive statutory backing from 01 July 2022. These partnerships will plan how to meet public health and social care needs in their areas and were viewed as an opportunity to agree shared outcomes, commitments and resources.

2. The integration of public health into mainstream economic development

Places are building inclusive economic strategies to help tackle poverty and inequality. These aim to integrate health alongside skills and sustainability objectives into economic development, recognising the interdependence of, for example, job quality and security and health. There is an opportunity for health care systems to plug into these developments and jointly focus public health and economic regeneration through the lens of poverty.

Bart’s Health described work that they had done in partnership with local further education partners to create pathways into the health and care workforce and locate facilities in the more excluded communities within East London.
Leeds City Council and West Yorkshire Combined Authority have developed an index focusing on social progress, while also tackling inter-generational worklessness and developing private sector anchor institutions.

3. NHS and local government as anchor institutions

The concept of public sector organisations as local economic anchors is well established and provides opportunities to link into and influence business networks. Many local and combined authorities are quite advanced in this space, with comprehensive social value led procurement frameworks.

There were also lots of examples of trusts using their influence to promote the Real Living Wage, both among directly employed and contracted staff, including social care providers.

Last winter Leicester, Leicestershire, and Rutland Integrated Care System invested in changing pay rates across the care sector, moving money from traditional NHS budgets. They have now reformulated primary care budgets to ensure money is better targeted at the most deprived communities in the city, addressing the lack of recognition for deprivation in the Carr-Hill funding formula which is the mainstay of general practice funding allocations. In the long term this is expected to reduce recruitment costs in areas where churn and knowledge loss is high.
A number of places had also trialled locating welfare service hubs in healthcare spaces.

4. Co-producing with communities

Co-production is important for ensuring programmes are fit for purpose and informed by the lived experiences of those that they are designed to support. Healthcare professionals tend to be trusted and should be using this social capital to co-produce services and intervention programmes with communities. Where there is more reticence from communities to engage with health professionals, some had found delivering messages through trusted community voices a good way to build rapport.

5. Knowledge sharing between places

Places used existing frameworks for partnership, such as Health and Wellbeing Boards, with varying levels of success and expressed interest in sharing indicators and procurement experiences between them.

What are the barriers and enablers?

1. Political and public interest

National advocacy is required to help health and local government systems prioritise the poverty prevention agenda and understand the practical next steps. It is important to making a compelling and consistent case to the public and politicians such as by highlighting the costs of poverty and linking poverty reduction firmly to wealth creation within places. This means coalescing around a common language and potentially common metrics.

2. Measuring progress

Inequality is widening and poverty is likely to worsen. Metrics therefore need to be measured in the long term. Places’ approach to monitoring was varied, with some local government leaders having made significant advances such as building ward level social progress indices to use alongside economic indicators. It was felt that common, locally driven metrics could stimulate targeted action and help organisations to hold each other to account.

3. Competing objectives

Competing objectives between and within local government and NHS trusts are holding places back from doubling down on poverty and inequality. Some health leaders had experienced territorial interactions with their local government partners, while within the health system itself the absence of an inequalities lens means that some interventions actually generate inequalities.

4. Capacity to take this work forward

Both local government and NHS organisations are experiencing high demand for their services and are under financial strain. As a result, there is a danger that waiting lists and money dominate conversations and misdirect partnerships, fixing us into a historical legacy of health inequality. In order for this agenda to succeed, it is important that organisations make space to have this discussion.