England should become a Marmot Nation

By Phil Hope and Steve Barwick | 30 January 2024

Speaking at the annual meeting of the Health Devolution Commission held in Parliament on 17 January, Professor Sir Michael Marmot described how over 40 cities and local authorities have adopted the ‘Marmot’ approach to improving the health of people in their area.

This requires cross-departmental action – by national Government, local Government and by ICSs - to adopt and achieve six key policy objectives:

  1. Give every child the best start in life
  2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
  3. Create fair employment and good work for all
  4. Ensure healthy standard of living for all
  5. Create and develop healthy and sustainable places and communities
  6. Strengthen the role and impact of ill-health prevention.

The Shadow Minister for Social Care and Integration Care, Andrew Gwynne MP, said that a future Labour government would go as far as to make England a Marmot Nation. Professor Marmot welcomed this commitment, describing to a crowded committee room his concerns that the public’s health has got worse in recent years, with poor health directly linked to high levels of austerity and evidence of a rise in both relative and absolute child poverty. He said that if all areas of the country had the same health outcomes as the top 10% of areas there would have been 1 million fewer deaths over the years 2011-2019.

The meeting of over 60 organisations also heard contributions from  Helen Whately MP, Minister for Social Care and Integration, Matthew Taylor, chief executive of the NHS Confederation, Dr Nik Johnson, GP and Mayor of Cambridgeshire & Peterborough Combined Authority, Steve Brine MP, chair of the Health and Social Care Select Committee, Daisy Cooper MP, spokesperson on Health for the Liberal Democrats, Jason Yiannikkou, director, Systems, Integration and Reform Directorate, DHSC and Rt Hon Patricia Hewitt, Author of the Hewitt Review and chair, Norfolk and Waveney ICB

In a wide-ranging discussion of current challenges and opportunities there was a consensus that there should not be another major structural re-organisation of the NHS. Integrated Care Systems are the right platform for the future improvement of NHS and social care services and starting to show evidence of good progress in delivering on their four purposes. This was in the face of the tough challenge of insufficient resources to meet increasing demands for acute, primary, mental health and social care services.

However, the Commission believes that ICSs will need to get firmly onto the front foot if they are to deliver the goal of shifting care away from institutions and into the community, alongside improving the public’s health and delivering more seamless health and social care services. It was recognised that achieving significant policy and resources shifts of this kind requires co-ordinated action at every level: supportive top-down priorities and funding; system-wide peer support and challenge for change and implementing best practice; and bottom-up action by local partners and communities.

The Commission identified the need to improve the governance of ICSs in order to achieve their goals as a key development task for 2024. This should include developing greater democratic accountability – strengthening the role of local government within ICSs – as well as supporting the voice of people with lived experience of care, building stronger partnership working and joint decision making with social care providers and the VCFSE, and including a senior public health representative on every IC Board.

Although there is no appetite for further structural reform of ICSs, the Commission believes change is needed in the organisation and delivery of primary and community care. There are many different examples of best practice models of primary care that could be replicated across the country to facilitate more joined-up and better care; and community neighbourhood models led by the local VCFSE sector. This issue will be the central focus of the Commission’s online meeting on 28th March 2024.

The Commission believes that better pay and development of the social care workforce should be a priority nationally and locally, alongside the implementation of the NHS workforce plan, ensuring the two plans are fully aligned. The Commission would also like to see ICSs and Government jointly identify ways of supporting collaborative leadership within the NHS, and between local system partners including local government and the VCFSE sector.

The Commission is concerned that the children’s health and care workforce is not being given the recognition or support it needs within ICSs to deliver effective integrated care, particularly care for children from families in low-income areas or with the most complex needs. Collaborative working with education providers and staff is essential if a family-centred, life-course approach is to be successful.

The Commission would also like to see ICSs explicitly giving priority to the needs of particular groups or health conditions that are often overlooked such as people with learning disabilities and autism, people with mental health needs, and communities experiencing health inequalities.

The Commission strongly supports the very high ambitions of the new ICS system as the right ambitions. National NHS priorities should not be allowed to crowd out locally identified priorities. And where the Government does say what should be achieved, it should be for local partners to decide how.

Phil Hope and Steve Barwick, Secretariat of the Health Devolution Commission

To read in detail the consensus conclusions please see here

To find out more about the Commission contact SteveBarwickPC@outlook.com

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Health Local democracy NHS Early intervention Health and Care Integration inequality governance ICSs