‘Inequality is the biggest problem we face’ – New plans to tackle health gap between city’s rich and poor

Sheffielders who are born in poorer parts of the city live on average 10 years less than those who come from better-off areas – but there is hope that a new collaborative system of neighbourhood working could finally address the huge inequality in life expectancy between rich and poor.
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In 2013, a documentary called Fairness on the 83 showed how increasing poverty between the wealthier south and west of Sheffield and the more deprived north and east of the city has a profound impact on people’s health.

The film showed that from Millhouses to Ecclesfield – the number 83 bus route – life expectancy dropped by 10 years, while the population’s healthy life expectancy, which means the age to which people can expect to live illness-free, drops by a massive 20 years.

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Staniforth Road in Darnall and Crookes Valley Park illustrate the stark divide in Sheffield between the have and have nots.Staniforth Road in Darnall and Crookes Valley Park illustrate the stark divide in Sheffield between the have and have nots.
Staniforth Road in Darnall and Crookes Valley Park illustrate the stark divide in Sheffield between the have and have nots.
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But as well as the obvious human cost of premature death, these inequalities have profound consequences for the NHS, with services in poorer areas stretched by health problems, while other parts of the city with less ill populations prosper.

The geographical history of Sheffield with its wealthier west and south and poorer north and east is a legacy of the city’s famous industrial past and has produced what is almost a border through the city separating the haves from the have nots.

And the problem of wealthier middle-class people getting a better service from the state has been considered intractable for decades, with all previous attempts to address it foundering on the better-off’s ability to game the system for themselves.

But now, NHS bosses in Sheffield hope a new system of neighbourhood working could herald a more collaborative approach in health care, with different practices and areas sharing services and expertise, and finally addressing the deep-seated divides in the city.

Dr Anthony Gore.Dr Anthony Gore.
Dr Anthony Gore.
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The change is being led by Dr Anthony Gore, clinical director for care outside hospital at Sheffield’s Clinical Commissioning Group, who said the NHS nationally had now put its full weight behind a system that had been in operation in Sheffield for some time already.

He said: “Inequality is the biggest problem we face. Sheffield overall looks very average but that masks huge differences between well-off and less well-off parts of the city.

“One way we could counter that is by redistributing money - if people were richer they would be healthier.

“But we as the NHS can’t solve that problem so what we try to do is put things in place to lessen the impact.”

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Part of this, Dr Gore said, is the new accountable care partnership in the city, which brings together key health and care providers in Sheffield – the CCG, the council, Sheffield Teaching Hospitals, the Health and Social Care Trust, and the voluntary sector – into one body.

Another is working with other CCGs at regional level to deliver some services at scale and a third is shifting funds away from expensive parts of the NHS into preventative services which aim to address people’s health problems before they become expensive to treat.

But equally important, says Dr Gore, are new primary care networks, groups of GP practices serving populations of between 30,000-50,000 people coming together to share resources and how to allocate them.

“It is more collaborative that the system has been in years and runs contrary to previous models of internal markets and competition in the health service,” he said.

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“The primary care networks will allow us to focus on mental health more, do more innovative ‘social prescribing’ and to partner better with children’s services and social care.”

Two city GP surgeries - one in the wealthier west and the other in the more deprived east - illustrate how the neighbourhood approach is working in practice, but also reveal potential pitfalls.

Dr Tom McAnea is the clinical director of a network of five practices centred on the Crookes Practice in S10.

He said the new primary care networks would have an impact on every person in the city but that collaboration across areas would be needed as well.

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“GPs are under huge pressure,” he said. “We want to treat patients but there are other things affecting their health as well.

“It is about trying to understand your population and what their needs are – and getting GP practices in the area to work together to come up with solutions.”

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Mr McAnea said that as a result of the new system, the network the Crookes Practice is in now has a dedicated mental health practitioner covering the five practices in the network.

They are also doing more so-called ‘social prescribing’, like recommending patients get involved in Parkruns or pointing them in the direction of voluntary or third sector organisations which may be able to help them.

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However, Dr McAnea said the networks alone would not solve inequalities between different parts of the city and, as certain networks forge ahead with new ways of working, others could be left to struggle.

“The challenges faced by GPs in poorer parts of the city are in getting their patients to come in,” he said.

“If we are to make networks successful not only on our patch but also across the city we need it to be collaborative between networks as well as within them.

“This will mean working together and learning from each other - not competing with each other.”

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On the other side of the city in Darnall, Lucy Cormack, clinical director of a network serving 31,000 people in five practices in the deprived east of the city, agreed.

“The biggest thing about being a doctor here is that patients are less involved and have less understanding of their own conditions,” she said.

“We see people with Chronic Obstructive Pulmonary Disease – COPD – and diabetes at 40. And diabetes rates among BME – black and minority ethnic – communities are huge.

“The neighbourhoods themselves are not going to solve that problem but working together is the really exciting part of this for me.

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“If you can look at the system as a whole and bring it all together that could be transformational and really improve the lives of patients.”

In some ways the new neighbourhood system can be viewed as a product of the long years of austerity, with health bodies realising they needed to work more closely together in order to get the most out of a dwindling public purse.

But despite the recent increases in funding made available to the NHS, the funding squeeze is still not over, and obvious dangers remain that the new system simply won’t be given enough money to succeed.

Nevertheless, there does seem some genuine excitement about the potential of primary care networks, and a belief that its collaborative ethos could go some way to addressing the deep-seated problems of inequality Sheffield has historically faced.

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