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Inequalities in health outcomes between the most affluent and disadvantaged members of society are longstanding, deep-seated and have proved difficult to change. In 1997, the Government put tackling health inequalities at the heart of its health agenda and subsequently published a number of policy documents and related targets. In 2004 the Government set the Department of Health (the Department) the target of reducing the gap in life expectancy between 70 'spearhead' local authorities with high deprivation and the population as a whole by 10 per cent by 2010. The Department has not met this target and has been exceptionally slow to tackle health inequalities.
Whilst it is heartening to recognise the overall improvements in health over the last decade it is of great concern that inequality in health has increased. The Department should be commended for setting out to tackle a problem that has proved historically to be so intractable. However, we find it unacceptable that it took it until 2006—nine years after it announced the importance of tackling health inequalities—to establish this as an NHS priority. Although it was known in 1997 that certain key interventions such as smoking cessation had the most impact on the health of those living in deprived areas, it took the Department until 2007 to produce evidence about how such treatments could be delivered cost-effectively.
GPs are crucial to improving the health of people in the most deprived areas. However, in many of these areas the number of GPs per head of population is well below the number in more affluent areas. The Department missed an opportunity to use the revised GP contract to ensure more doctors work in deprived areas, and has not focused its attention sufficiently on implementing the key interventions that would make a difference.
"Equity and Excellence: Liberating the NHS" sets out the Government's long-term vision for the NHS. In the transitional period while this change is managed, it is important that tackling health inequalities does not slip down the Department's agenda. The Department will need to set a clear framework of accountability at all levels of the health service if it is to be successful in addressing health inequalities in future.
On the basis of a Report by the Comptroller and Auditor General,1[1] we took evidence from the Department on why it had failed to meet its health inequalities target, the role of GPs, and the lessons of this for the new NHS.
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