The way in which NHS services are provided today does not take account of changes in the population since the Health Service was created. People are living longer than ever before and there have been huge advances in medicine and treatments for various conditions.
While this is good news, it means that the NHS is now treating many more people than ever before. The population is getting older and many more people are living with long term conditions such as diabetes, high blood pressure and mental illnesses.
Too many people live with preventable ill health or die too early
Premature death and differences in life expectancy are both significant issues in south east London. There is a difference in life expectancy between the wards of 11.8 years for women and 11.4 years for men (data for years 2008-2012).
Serious mental illness also reduces a person’s life expectancy by 15-20 years. About 11,000 people died prematurely across south east London between 2009 and 2011, with four of our boroughs being classed in the worst category for premature death in England.
The biggest causes of early death are heart disease, cancer and respiratory diseases. While the mortality rates for these illnesses have decreased significantly in our area in recent years, they are still considerably higher than the London average.
To address this problem, we need to improve the health of people who live in south east London. Keeping well is critically important for people of all ages. Although the UK’s health delivery system – the NHS and social care services – is widely regarded as among the best in the world, the health of our population is poor and worse than comparable countries.
The south east London health 'tree'
This diagram, shaped like a tree, breaks the population up into five broad groups: people known to be nearing the end of life (1%), people with three or more long term conditions (9%), people in the early stages of a long term condition (25%), people experiencing inequalities at risk of developing long term conditions (50%) and people who are healthy and well.
Importantly, it shows that just 16% of people are in the healthy and well group.
The higher up the ‘tree’ a group is, the more money is spent on them. Our aim is to help more people to move towards the trunk of the tree, in the healthy and well group.
The diagram is a helpful way for us to think about our communities. It tells us that only about one in six people are healthy and well without being at risk of poor health. Half of all people are at risk of having a long term condition (a disability or an illness like diabetes, a heart condition or a long term mental illness). As people get older, they are often more likely to develop long term conditions.
A major goal of our work is to change the shape of this diagram – we need to support people so that they do not move up the diagram and help them to become healthier, like the 16% at the bottom.
We must support the 50% of the population who are affected by inequalities and who are at risk of developing long term conditions due to inequalities or lifestyle factors.
Poor health is a major factor in generating the demand for care which is putting the NHS and social care under such well-publicised pressure. The way in which health services are provided today does not take account of changes in the population since the NHS was created.
The NHS in south east London urgently needs to change the way it delivers services to support its 1.7 million people.
The key issues are smoking, excess alcohol and drug use, not enough exercise and obesity, and poor mental health. These problems are the major causes of ‘health inequalities’ between people in south east London and elsewhere in the UK.