Pier Pressure: Does NHS Funding need to change to address health inequalities?

Coastal towns need their own health strategy, England’s top medic has said.

A national strategy to tackle poor health and lower life expectancy in seaside towns is needed, according to a report from England’s chief medical officer Chris Whitty. 

Despite their unique settings, these communities tend to suffer from higher rates of serious illness and long-term conditions, including comorbidities. 

According to Professor Whitty, the government has “overlooked” these places and had their “ill health hidden” and called for cross-government action to address overlapping issues which affect health such as education, employment and housing. 

Towns such as Blackpool, Skegness and Hastings have more in common with each other than their neighbouring inland towns, yet their governing health bodies – CCGs and ICSs – will cover geographical areas. 

But why are seaside towns so different from their inland neighbours? 

Firstly, there is a demographic time bomb – and with that aging population comes the myriad of health conditions which time deals all of us.  Thirty-seven thousand men aged 55-64, and 18,000 women aged 55-59, moved to seaside towns between 1971 and 1991, in comparison to just 2,000 aged 25-34. Those people are now very firmly ‘elderly’. 

This goes some way to explaining why, of the 20 local authorities in England and Wales with the highest proportion of individuals in poor health, ten are in coastal communities. 

According to figures from the Office of National Statistics Six of the 10 local authority districts in England and Wales with the highest rates of heroin- (and/or morphine-misuse deaths) are coastal holiday resorts.

Young adults and those starting families are struggling to see how they can stay in these communities in the long term. Many of the jobs are low paid, in the hospitality or distribution sectors which have all been hit very hard by the pandemic and are seasonal. Staycations may have provided some bounce but long term it’s hard to see how the trend will be reversed. 

And according to Ofsted’s 20 year review, “the distribution of underachievement has shifted from deprived inner city areas to deprived coastal towns and rural areas.”

Seaside and coastal towns often have older populations with more complex health needs – but at the same time local NHS services can suffer from recruitment problems, leaving gaps in health services where they are needed most.

 

  • Blackpool: Most deprived local authority in England, lowest life expectancy for both males and females; highest rates of hospital admissions for alcohol-related harm and drug-related deaths
  • Torbay: High rates of heart disease, respiratory problems and diabetes; high density of low-quality private rented accommodation and reliance on caravan parks
  • Hull: A high economic impact and loss of jobs from Covid on an already “fragile” local economy, forecast to have a long-term detrimental impact on health.

The Digital First strategy was designed to help address issues of health inequalities and problems with recruitment and retention in different parts of the country, and nowhere is that felt more than in these deprived coastal areas. They are designed to allow access for patients to predominantly planned healthcare needs such as advice and treatment for long term conditions such as diabetes or COPD. A healthcare professional such as a clinical pharmacist, first contact physio or nurse can often help patients virtually without the need for face to face appointments if they have the right technology. 

The report warns that heart disease, strokes, mental health problems, diabetes and higher rates of smoking are all more prevalent in seaside populations.

For primary care in particular, patients with these diseases or suffering from long term conditions (they often go hand in hand) are the patients who will cost more money to treat and monitor. They will need more regular appointments for tests and reviews – although often they do not need to be done in person. 

NHS providers have a balancing act to ensure they can treat their patients with long term health needs as well as the urgent ‘on the day’ patients who contact them.

For healthcare providers such as those in primary care, it can mean there is a huge financial burden whereby their patient population is in much greater need of healthcare provision, from long term condition reviews to medical interventions – but they receive the same funding from national government as an area with a healthier population. 

Tackling these health inequalities is vital if we are to indeed ‘level up’ as the government has set as a key policy. But it will mean looking at different ways of funding in healthcare to ensure we don’t have a situation where those most at need are the ones fighting for scarce resources. 

 

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