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A call for comprehensive change | blog from Dr Sarah Clarke

The NHS is on life support. The GMC’s National Training Survey found that two thirds of trainees are at high or moderate risk of burnout and the recent RCP census confirmed the large number of doctors grappling with overwhelming service demand and staffing shortages. We have record waiting lists and times, and growing numbers of patients who say their health is deteriorating because of this, as revealed by the most recent inpatient survey. Ongoing industrial action underscores the discontent felt among the medical workforce which feels undervalued. With a dearth of doctors and relentless demand, the crisis persists.

This summer, the long-awaited workforce plan emerged – the first of its kind. It aims to bolster the medical workforce, projecting workforce needs in 5, 10, and 15 years. Doubling medical school places – a welcome inclusion in the plan – is a positive step to addressing future doctor shortages. However, these changes will take time and we read about the worrying number of young doctors intending to leave the profession. It feels like the workforce is left flying kites in a hurricane.

Alongside more workforce numbers we must address the social drivers of ill health which play a significant role in creating the need for healthcare. Smoking, obesity, deprivation, poor living conditions, air quality, pollution, alcohol, and drug misuse all put additional – and avoidable – pressure on healthcare services and worsen health inequalities.

An RCP survey in 2022 showed that a third of doctors had witnessed patients' health issues which stemmed from their poor living conditions in the prior three months. One of our own members recently saw more than 10 patients with diabetes present with potentially life-threatening complications in just 10 days. The reasons were eating poorly due to the cost of living, living in cold spaces and becoming sick, and being unable to afford the cost of prescriptions. This is avoidable and unacceptable in one of the world’s richest countries.

Tackling ill health requires addressing its root causes. The Health Foundation recently projected there will be 2.5 million more people in England living with a major illness by 2040. Without bold action now, we risk further entrenching existing health inequalities. Leading causes of early death – cancer, heart disease, respiratory illnesses, mental health conditions, and more – often stem from social circumstances and our environments. Women in deprived areas are twice as likely to die in pregnancy or a year after, while deprived youth face higher adolescent mortality. I was pleased to see the interim report on the Department for Health and Social Care (DHSC)'s major conditions strategy recognise the impact of social determinants. Its commitment to addressing health inequalities gives some hope, but ultimately the NHS and DHSC are in the unsustainable position of having responsibility for treating illnesses that are caused by ‘non-health’ factors.

In 2020, the RCP formed the Inequalities in Health Alliance to tackle this very issue. Together, with almost 250 organisations, we are calling for a cross-government strategy that uses every policy lever to combat health inequalities. Disparities and their social roots are entwined with socioeconomic factors: education, employment (including how much money someone has), and living conditions. Later this year we will publish an update on progress so far – keep an eye on our website for more.

In a world of quick fixes and superficial solutions, this is a clarion call for comprehensive change. It’s not about sticking plaster responses to isolated issues. We must pursue a society in which good health is not determined by a postcode. Bridging gaps between healthcare, housing, education, and employment policies is necessary for real progress. Collaboration and a coordinated approach across government departments is not a mere option but a vital step forward. A piecemeal approach will no longer suffice.

Find out more about the RCP's call to tackle health inequalities and the social determinants of ill health