A reflection on the UK’s deprivation, its impact & the Gov's CORE20PLUS5 strategy – what to do next?

By Jon Corr


With the quality of living evolving and healthcare improving, the average life expectancy in the UK is around 83 years old and continues to rise.


But what if I told you, if you were a woman living in Warrington, with good health, you could expect to live up to 15 years longer than a woman with good health living in Blackpool. That is a tough pill to swallow, especially if you’re from that part of the country. But the fact remains that 50% of people in the UK’s most deprived areas report poor health by the age of 55-59; that is 10 years sooner than those in the least deprived areas.


Life expectancy vs healthy life expectancy


When it comes to life expectancy, not one shoe fits all. Life expectancy will naturally differ between everyone. However, what has become very apparent is how your social status and/or the level of deprivation in the area you live in can play a significant part in your life expectancy.


The Health Foundation published an article in January 2022 surrounding the life expectancy and healthy life expectancy at birth by deprivation for England, Scotland, and Wales. It provides a comparison between males and females in the most to the least deprived areas regarding life expectancy and healthy life expectancy.


But what is the difference between life expectancy and healthy life expectancy? Whilst both are important headline measures of the health status of the population, healthy life expectancy additionally measures the 'quality of life' as well, which estimates life expectancy by dividing it into time spent in different levels of health.


Unfortunately, the difference of life expectancy as well as healthy life expectancy does differ significantly within the three countries. After having a closer look at the findings of The Health Foundation, I summarised the following for each country:


England


In England, life expectancy at birth for men living in the most deprived areas is 74.1 years, compared to 83.5 years for men in the least deprived, which is a difference of 9.4 years, that’s nearly a decade! However, for women, the difference is slightly smaller, at 7.7 years.


When it comes to healthy life expectancy, women living in the most deprived areas of England have a healthy life expectancy at birth of 51.4 years compared to 71.2 years living in the least deprived which is a difference of 19.7 years, whilst men, have a slightly smaller difference of 18.4 years.


Scotland


In Scotland, female life expectancy at birth in the most deprived areas is 75.6 years, compared to 85.6 years for those in the least deprived areas. Women born in the least deprived areas not only live 10 years longer on average, but they also live 21.5 more years of life in good health.


Men’s life expectancy at birth in the most deprived areas is 69.5 years, compared to 82.8 years for those in the least deprived. Men born in the least deprived areas not only live 13.3 years longer on average, but they also live 25.1 more years of life in good health.


Wales


In Wales, life expectancy at birth for men living in the most deprived areas is 73.3 years, compared to 82.3 years for men in the least deprived, which is a difference of 9.0 years. For women, the difference is slightly smaller, at 7.5 years, which is overall the smallest difference of this data.


For women living in the most deprived areas, their healthy life expectancy lies at birth of 50.1 years compared to 68.4 years for women living in the least deprived, that is a difference of 18.3 years. For men, the difference is slightly smaller at 16.9 years.


The differences in (healthy) life expectancies are as shocking as they are unfair. While it is a complex interaction of factors that cause these differences, the fact remains that a significant percentage of the UK’s population has a life expectancy that is up to a decade shorter than average and a healthy life expectancy that is up to 25.1 years shorter. To mitigate these differences and reduce health inequalities, the Government and NHS have developed a new data-based approach.


The Government’s CORE20PLUS5 Strategy


The already existing health inequalities across the UK only worsened since the start of the Covid-19 pandemic, with people in the most deprived areas being affected more than any other demographic.


Thus, in reflection of the data, the UK Government has implemented a new improvement strategy called ‘CORE20PLUS5’, which targets the most deprived 20% of the national population, as identified by the Index of Multiple Deprivation (IMD), known as the ‘Core20’. The approach aims to accelerate the much-needed improvement of five clinical areas of healthcare and improve the impact of deprivation on healthcare access, experience, and outcomes.


The ’PLUS5’ bracket of this strategy targets those population groups that are experiencing poorer-than-average health access, experience and/or outcomes but that may not be entirely covered by the ‘Core20’ bracket.


Overall, the aim of the strategy is to improve the key areas of healthcare inequalities and overcome relevant issues by supporting the 42 newly appointed Integrated Care System services. The 5 clinical areas in need of improvement include:


Maternity:


Ensuring continuity of care for 75% of women from BAME communities and from the most deprived groups.


Severe Mental Illness:


Ensuring annual health checks for 60% of those living with SMI (bringing SMI in line with the success seen in Learning Disabilities).


Chronic Respiratory Disease:


A clear focus on Chronic Obstructive Pulmonary Disease (COPD), driving up the uptake of COVID, Flu and Pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.


Early Cancer Diagnosis:


75% of cases diagnosed at stage 1 or 2 by 2028


Hypertension Case Finding:


To allow for interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke.


The data for this implemented strategy is yet to be released as to how effective this will be, however, this is a much-needed step in the right direction.


Population growth and infrastructure


Our population not only continues to age, but also to grow. However, the necessary infrastructure has yet to be put in place for the NHS to cope with the rising demand.


GP practices, dental services and general health services are massively overrun already, resulting in unacceptably long waiting times: People currently have to wait between two to three weeks for a routine check-up at their GP’s and waiting times to access mental health services throughout the UK are on average as long as 18 months. To adapt to the demand and reduce inequalities, the Government and the NHS are progressively moving towards setting up ‘Integrated Care Systems’.


At Safe as Houses Care, we recently visited such a service. It was set up as a community healthcare hub; a large facility built in the heart of a community. Its purpose is to drastically cut hospital admissions by offering key services to the people in their local community. Services included were:


- Basic A&E services such as x-rays and ultrasound

- Maternity services

- A percentage of hospital beds (to get people back to their homes)

- Respiratory services

- A small mental health service

- On-site Elderly care services (residential & Nursing)

- Learning disability services

- GP Practice and dentist


This model of service realises the potential to offer a fantastic facility within, and for, the community. The UK has the ability to realise this on a national scale and with the government’s level-up initiative there’s never been a better time to end healthcare inequalities.