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Politics of Geography….

17 September 2018

I was struck this week by a number of reports that have come out focussing firstly on the geography of poverty, and secondly how central and local government actions have impacted on communities of the most disadvantaged adults around the country.

The first of these is the long awaited update to the Public Health England, Health Profile for England. Duncan Selbie, CEO of Public Health England states in his latest blog:

“The new report tells us that people are living longer and are healthier at every age group, which is undeniably good news. However, it also tells us, amongst many things, that the poor are experiencing the health that the wealthy enjoyed twenty years ago, that our ageing population means the number of people with long-term health conditions has increased…”

You only need to go to the core of the report to find more concerning evidence around health inequalities including the following statements:-

“There is no evidence that inequalities in life expectancy have narrowed in recent years. Inequality in life expectancy for females has widened since 2001 to 2003, and for males, although inequality has fluctuated over time, it remains the same as that in 2001 to 2003.”

“The gap in healthy life expectancy (years lived in good health) between the most and least deprived areas of England was around 19 years for both males and females in 2014 to 2016. People living in the most deprived areas spend nearly a third of their lives in poor health, compared with only about a sixth for those in the least deprived areas.”

This is not ‘news’ in the sense we have understood for many years that health inequality is a significant factor within England, and the detailed research and wide ranging approaches outlined within the report ‘Fair Society Healthy Lives’ by Sir Andrew Marmot in 2010 showed not only the reality, but also how things could be changed.

However, another report released last week, showcased just how far we are from implementing some of the key approaches advocated by Marmot – particularly around care and housing. The report produced by the New Policy Institute entitled, A Quiet Crisis: Changes in local government spending on disadvantage, tells the tale of just how significant regional variations to spending on non-statutory preventative services have become.

Whilst the ADASS budget survey 2018 showed the depth of concern amongst Directors of Social Services about their ability to invest in prevention, the budget survey represented that as a relatively universal concern. However, the NPI report cites MHCLG figures which appear to show the actual reduction in spend on prevention has been almost entirely (97%) focussed on the 20% more deprived council areas.

This report particularly hones in on working age adult care services, and how in recent years councils have sought, as a result of budget reductions, to decrease spending through a range of mechanisms including reducing services, reducing universality and introducing charges for previously free services.

The well-made cost benefit case for prevention is reiterated, plus of course, the well-researched and rehearsed argument that ‘given reductions in preventive work, there may be further pressures on need coming down the line.’ 

I think for everyone working on the front line of social care, the ‘may’ caveat of this sentence is not needed. Everyday NCF members see the impact of reductions of vital community based preventive services which have a central place in sustaining independence and keeping people well within their own homes, or in residential settings.

I was very interested to read the latest think piece by Future Care Capital that highlights just some of the challenges of locality based care systems. The paper, Facilitating Insight to Developing Care Economies, argues strongly for the increase in prevention but recognises the ease with which it has been removed because of our inability to count the impact.

Our reliance on monitoring systems that focus only on the ‘standard’ interactions means that the complexity of the care infrastructure is not acknowledged and individual connections with the ecosystem are missed.

This invisibility from formal reporting could be seen to be part of the picture that had allowed the reduction in funding of preventative services with the impact felt be individuals in the short term and, inevitably, by both individuals and statutory services in the long term.

The paper points to the potential for data gathered across the care infrastructure to enable localities to move beyond the politics of ‘short termism’ and seeks government support to incentivise prevention. The summary of the paper can be found here

Matt Hancock, Secretary of State for Health and Social Care has highlighted prevention as his third key priority, and what all these reports show, is that this shift in emphasis to reinforce the centrality of prevention in government care and health policy cannot come soon enough.


The new workforce portal championed by Secretary of State Matt Hancock has been running for just over a week. If, like me, you have logged on to find out what it is all about, then you will know that the structure of the site is intended to direct people to comment on their own experience of the workforce under five specific themes. These are:

  • Feeling empowered and achieving their full potential
  • Working without fear of bullying, discrimination or violence
  • Having access to the training, development and support staff need
  • Belonging to an organisation that respects and values everyone's contribution
  • Getting the basics right

The portal is intended to capture the views of both social care and health staff, and really seeking views from the front line. Do take a look at some of the ideas and perspectives shared on the site, and encourage those that you work with to get involved so that we can ensure that the views of social care staff are heard loud and clear. You can visit the site here

Members may have noted that the workforce portal was in fact launched during the Secretary of State’s visit to an NHS Trust in Bristol. However, his earlier visit of the day received less coverage – but was great to see – where he visited NCF member St Monica Trust, and created a series of very positive footage of the excellent care and services on site.

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