Ruw Abeyratne: Health Inequality: Why my business is your business

In my role as University Hospitals of Leicester’s first Director of Health Equality and Inclusion, I often find myself explaining why. Why does this matter? Why do I do this work? Why should we change how we do things?

We live in a time of crisis; we are emerging from a global health crisis, we face a daily cost of living crisis, the NHS faces a workforce and funding crisis that make it increasingly hard to deliver excellent care. It is easy in these difficult times to feel that very little is under control, let alone within our personal control.

Health inequalities cost the NHS an estimated £4.8bn a year in hospital episodes alone. The broader economic cost is several multiples greater. Yet we know that health inequalities are avoidable; the differential outcomes experienced by different groups can be prevented. In Leicester we have demonstrated that simple interventions in response to disparities highlighted by local data can lead to objective improvements in productivity and financial efficiency whilst enabling access to care. Taking an improvement approach to this work is vital to embed change as ‘business as usual’ but incremental transformative acts have the potential to reform whole systems. The case for action is compelling; tackling health inequalities is critical to the stewardship and sustainability of the NHS.

The NHS exists to provide care for all, but we know that in 2023, this does not mean the same care for all.  It is a privilege to advocate for those who cannot advocate for themselves, it is one of the principal reasons why I chose geriatrics. An even greater privilege is the daily reminder that people are not defined by one characteristic – such as being older – but are the sum of many intersecting parts, including the environment that they live in, otherwise known as the wider determinants of health. All of these parts influence how an individual interacts and engages with healthcare and the services we provide. The joy of Medicine is found at the confluence of science and art, where complex physiology, pharmacology and biology collide with human nature, behaviour and culture. When we fail to recognise and act on this, we do ourselves, and our patients a disservice. Working to understand and address health inequality leads to a future where we practice medicine in the way it was meant to be practised; to treat each patient as an individual, as the sum of their parts and tailor the care they receive to their specific needs. We are a long way from being able to do this consistently, but we have a duty to try.

Inequalities in opportunity and experience limit our collective potential to excel. The multi-disciplinary team is made up of experts from a variety of professions. It is central to my work as a geriatrician. But we know that individuals have variable experiences of the workplace; reliable and consistent data tells us that colleagues continue to experience discrimination in their daily work and career progression. Uniting colleagues in a shared ambition to address health inequality demands difficult but vital conversations about the systemic barriers that people face in our workplaces. More importantly, working to address health inequality requires meaningful action to dismantle these barriers. When we recognise the synergy and overlap between our workforce and populations we serve, ultimately this will translate into better quality care, for all.

Tackling health inequality is hard. Real change and progress take time and considerable resolve. But it is also an unmissable opportunity to individually contribute to redressing the balance in how we deliver healthcare, to realign ourselves with the NHS vision and mission and take back some control.