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28 October 2022

A message to the new health secretary: don’t scrap the health inequalities review

Steve Barclay should revive the nixed plans on tackling thealth disparities brought to light by the pandemic.

By Harry Clarke-Ezzidio

“Get Brexit done”, “Levelling up”, “Build Back Better” – the list of empty Tory slogans is long. But, after the government’s botched early response to Covid-19 – which a 2021 report by MPs declared one of the country’s worst public health failures – you’d hope that the government would, at the very least, still commit to its repeated pledge to “learn the lessons of the pandemic”. 

Yet the future of the Health Inequalities white paper, a document which would set out plans to address the various disparities that meant certain societal groups were disproportionately affected by Covid-19, is in doubt. It was ready to be published by the summer but Thérèse Coffey, Liz Truss’s health secretary, was widely reported to have decided to scrap the publication of the paper altogether.

Rishi Sunak, on becoming Prime Minister, has replaced Coffey with Steve Barclay, who also briefly served in the post in the last weeks of Boris Johnson’s administration. A different health secretary will inevitably have different priorities, and key among them should be the release of the white paper.

The Health Inequalities paper was commissioned in February 2022 by Sajid Javid, the health secretary at the time. It was green-lighted as a direct response to the “unacceptable disparities in health outcomes” that became apparent at the height of the pandemic, Javid told parliament. 

The paper aimed to address the stark differences in life expectancy between communities throughout the UK – which were seen across class, racial and regional lines.

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Given the realities of the pandemic, speculation that the white paper had been axed was met with unsurprising upset. When reports first arose in the summer, Wes Streeting, the shadow health secretary, said that closing health disparities “ought to be a national mission”. Meanwhile William Roberts, the chief executive of the Royal Society for Public Health, said that the paper was a “clear opportunity” to tackle health inequality, and warned that disparities have “[increased] over the last two years and are only set to worsen with the cost-of-living crisis”. 

These inequalities often overlap and are well known to affected groups – notably people from black and ethnic minority communities, who had significantly higher rates of death from Covid-19 than other groups, and those living on lower incomes. There are also regional health disparities, with inequalities along the north-south divide.

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Under Boris Johnson, it appeared that the government was acknowledging these realities. When Javid announced the commissioning of the white paper earlier this year he promised “bold action” on reducing health disparities and to “break the link between people’s background and their prospect for a healthy life”. 

Yet if Coffey’s alleged plans are retained by Barclay, and the white paper remains cancelled, all that has been broken is the promise from the Conservatives – made only eight months ago – to outline and take action to end health disparities. Barclay himself has a lot of bridges to build. In the summer, when he initially took the role, the editor of the Health Service Journal noted that “never has a politician arrived in the post of health secretary trailing a worse reputation among NHS leaders”.

Surely then, a positive way for Barclay to start his second run would be to listen to healthcare experts and publish the white paper.

According to the reports, Coffey’s reasoning behind cancelling the white paper was because it was “an affront to this government’s view of what makes for health”. Could it be that the Conservatives have reneged because they fear what the report’s conclusions might say about the government’s role in persistent inequalities? Are they hesitant because it might suggest unConservative solutions? 

The austerity programme – brought in by David Cameron’s government in 2010 – prompted drastic cuts to public services and welfare, and pushed vulnerable groups into relative deprivation. In his first speech as prime minister, Rishi Sunak spoke of a need to make “hard choices”, as the prospect of austerity lingers. More cuts will have devastating effects on the groups the Conservatives promised to help only a few months ago. And as a result, people will continue to pay with their health.

[See also: “This is just not safe for anyone”: the NHS doctors at breaking point]