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Health inequalities – a sobering lesson for ICS leads

Spring 2021 is shaping up to be a critical moment for health and social care. As well as managing the ongoing impact of Covid, the sector will need to respond to the needs of people who have delayed getting help during winter, and roll out a Covid vaccination programme. And in the midst of this – in April – Integrated Care Systems (ICSs) will come into being across England, most probably backed up a new legislative framework.

The challenge ahead of ICSs is to build back better from the pandemic – and ICS leaders will have to learn some sobering lessons. For example, the crisis has highlighted the stark health inequalities ingrained into our society. The poorest communities in the country have seen the highest transmission of the virus, and have experienced the most severe economic impacts. For ICSs to build back better, they must invest time and resource into tackling these health inequalities by focusing on some of the wider social determinants of health and wellbeing.

In theory, ICSs will bring all the right partners to the table – from NHS organisations, local government and the voluntary and community sector – to take on this complex challenge. But there is a huge risk that ICS conversations will be dominated by the immediate urgency of supporting acute hospitals or large capital programmes. These topics dominated the first stage of the Covid response so strongly that Jeanelle de Gruchy, President of the Association of Directors of Public Health, reflected on ‘a historic lack of understanding of the importance of public health’. As ICSs emerge, they must reframe their ambition so that a public health approach to wellbeing is central to their plan.

At IMPOWER, we have been learning from international markets to consider how best each part of the ICS can build that inclusive ambition. It is difficult for organisational leaders to work in the grey areas between their domains of responsibility, but reducing inequalities demands this. We are currently developing an approach to support ICS leads to reframe their ambition, based on our 5 Fast-Forwards approach. This tool will include healthcare-specific content to enable ICS leads to go forward as a wholly integrated system, using their combined resources to improve the lives of the most vulnerable in our society.

As Amartya Sen, the Nobel Prize winning economist said: “I believe that virtually all the problems in the world come from inequality of one kind or another.” We share this view and believe this is the most important challenge for ICSs to grip in order to drive long-term health benefits.

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