Department of Health and Social Care
The hidden costs of COVID-19: the social backlog
I’m so grateful to the Centre for Social Justice and the Grange for hosting us today. I know you’re doing phenomenal things here at the Grange. You’ve been working non-stop for the last 18 months, getting thousands of food parcels and ‘meals on wheels’ out to some of the most vulnerable people in the community. It’s a remarkable achievement.
I’m happy to be here – and proud too. I’m proud to get the chance to finish the job as Secretary of State for Health and Social Care.
I’ve faced some challenges in my time in government. The crisis of rough sleeping. The tragedy of Grenfell. The injustice of Windrush. But becoming responsible for health and care in a pandemic has been uniquely challenging. I’ve not even been in this job for 3 months. I can tell you, it feels much longer!
I had to face tough decisions from the start. The first was: should we remove the restrictions – restrictions that we know have saved thousands of lives? I knew that we had to. In hindsight, that choice looks inevitable. I can assure you it wasn’t. A lot of people were telling me not to go forward. They said: “Saj, don’t you think we should stay locked down for longer”. I knew we mustn’t. I couldn’t simply be the ‘Minister for COVID’, because we had to turn and face all the other challenges too.
Challenges like the backlog. More than 5 and a half million people are on the waiting list for elective treatment – that is a record high. I arrived prepared for the worst, but I admit that even I was a bit shocked when officials told me that figure could rise to 13 million.
I’m so impressed by what NHS colleagues are doing – including here in Blackpool and across the country – to get treatment for those who need it most. I saw some of that phenomenal work in action just this morning at Blackpool Teaching Hospital. It’s these kinds of incredible efforts have helped us catch up on cancer referrals, diagnosis and treatment.
But the latest data suggest that through the pandemic there have been 300,000 fewer urgent cancer referrals than were expected – and this could mean as many as 20,000 missed cancer diagnoses. We also have nearly a quarter of a million people waiting for heart-related surgery – that’s up by over 40%.
I think we can all understand why the backlog has grown. We’ve had to meet the greatest public health challenge that this country has seen in living memory. And I know from speaking to other health ministers in places like France, Germany and Italy and elsewhere, that we’re all in the same boat. But doing nothing would be inexcusable. It cannot be business as usual. The responsible thing to do is to act now.
So even while we faced the immediate threat of the pandemic, I was determined to secure the funding that we needed for the long term. The majority of the funds from the new Health and Care Levy will initially go into the health service. It’s an investment in the biggest catch-up plan in the history of the NHS. We’re going to do some 9 million more checks, scans and treatments. We’re going to set up surgical hubs, so routine operations – things like hip replacements and cataract surgery – never stop. We’re investing in the next generation of scanners and screening equipment, so that we’re even quicker at finding diseases like cancer. And we’re ending the lottery of how people pay for social care – something successive governments have ducked.
It shows we’re serious about tackling the challenges that we all face – and serious about our responsibilities to the NHS and social care.
The social backlog
But the backlog in elective care is only one part of the story. COVID-19 has had many hidden costs.
We’ve seen that Black and Asian British people were more likely to die from COVID-19 than White British people. We’ve seen that our weight could determine whether we are hospitalised by COVID-19. We’ve seen that our mental wellbeing and our mental health can be so fragile when the scaffolding of our daily lives is taken away. And we’ve seen horrific incidences of domestic violence and child sexual abuse.
So even as we move forward and recover, it would be a mistake to pretend like none of this ever happened. Because the truth is, we’re actually facing 2 backlogs. The first is the waiting lists. But the second is a social backlog – in mental health and public health. It’s much harder to quantify – and it’s less evenly spread.
Passing the peak of the pandemic has been like a receding tide, revealing the underlying health of our nation. It’s revealed some fractures within. And in many cases, the pandemic has deepened those fractures.
COVID-19 admission rates for the most deprived in England were 2.9 times higher than the least deprived – and the mortality rate was 2.4 times higher.
Despite making up less than 14% of the UK population, Black, Asian and minority ethnic groups made up more than a third of critical care admissions from COVID.
95% of White British people over 50 have accepted the offer of 2 doses of the COVID-19 jab, while only 67% of Black Caribbean people have accepted that same offer. When you look at Black Caribbean people over the age of 18, that number goes down further – to a little over half.
These are symptoms of a different disease: the disease of disparity.
As we recover, we face a choice: do we create a more level playing field in our society? Or do we simply return to what was there before? It’s this government’s mission to unite and level up across the whole of the UK, to build back better and to build back fairer. So our recovery from COVID-19 can’t be limited to supporting the economy. Afterall, we can only level up economically if we level up in terms of health too.
That means returning to the noble idea on which the National Health Service was founded – “that it meet the needs of everyone” – and taking that to the next logical step: ensuring everyone is given the same opportunity to live healthy and happy lives. That’s what levelling up in health means to me.
Now, as we get to work on that mission, I can’t help reflecting on my own past. I was born 50 miles away, in Rochdale. I grew up in Bristol, a family of 7 living in a 2-bed flat above the shop.
My first interactions with the NHS were when I’d go and translate for my Mum at the GP surgery. Now I’m the one whose responsibility it is to make sure the system works for everyone. Not just my Mum.
If you think my Mum is proud, you’re right. Like many Asian mothers, she wanted me to be a doctor. She said: “I’m proud of you. You’re not quite a doctor, but at least you’re working in healthcare”.
I got ahead in life because of family, hard work and public services. I’m so lucky to have had that strong family foundation. But I have seen real deprivation, and I know what it’s like to feel as if you’re on the outside of the country looking in. I know some people in Blackpool still feel that way today.
We’ve got 8 of the 10 most deprived neighbourhoods in England right here. 40% of the neighbourhoods are classed as ‘highly deprived’. While life expectancy is rising across the UK, here in Blackpool, it’s been declining. It’s now the lowest in England: it’s 74 years for men and 79 for women. Compare that to somewhere like East Dorset, where the figures are 83 and 86 respectively – when you do that, the disparity is clear.
Blackpool was one of the places the Chief Medical Officer, Chris Whitty, came to last year, when he looked at the health of people living in coastal communities across the UK for his annual report. I share his belief that it is entirely possible “to raise the health outcomes of the least healthy closer to the outcomes of the healthiest”. That’s precisely what levelling up in health should achieve.
So the story I want to tell here in Blackpool is not the one you might be expecting. Because Blackpool has actually bucked the trend in many other ways when it comes to COVID-19. Despite having the lowest life expectancy in England, deaths from COVID were actually lower than in surrounding areas. Testing rates were higher than the national average. Despite the deprivation, we saw vaccination rates as high as anywhere in England – and some of the highest vaccine uptake in care homes nationally.
All of this has been achieved because every part of government and society has joined up to make that difference.
Now we can see it here at the Grange today, where you’re doing walk in vaccinations. No appointment needed. Just pop in.
So for me, whether it’s Blackpool or Bristol, Rochdale or Ruislip, the real message of the pandemic is that health interventions, they can work. We really can make a difference when we work together and we’re all focused on our goals. Realising our mission to level up in health means tackling our social backlog – in mental health and public health – with the same spirit and sense of urgency with which we all tackled the pandemic.
Nowhere is this mission more urgent than when it comes to our mental health and wellbeing.
This morning’s mental health roundtable was so valuable, I heard about the hugely important role of third sector organisations in helping with mental health challenges and mental health wellbeing. We also talked about the experiences of young people in this pandemic. Back at the hospital, I heard how the number of young people waiting for urgent treatment for eating disorders has more than tripled during the pandemic, while the number waiting for routine treatment has more than quadrupled. And too many young people have experienced loneliness and isolation these past 18 months.
A lot is said of ‘young people nowadays’. But let’s just think about it for a moment. They’ve overwhelmingly stuck to the rules. They’ve kept their distance. They’ve stopped seeing friends. All so that lives could be saved. That’s a remarkable thing – and I think it’s not fully appreciated in some quarters. We owe young people an enormous debt of gratitude.
And loneliness and isolation are challenges faced by people of all ages. 3.7 million adults reported feeling either often or always lonely – that’s up by more than a million since the start of the pandemic. And for older people, for whom these experiences are nothing new, the pandemic has been especially difficult.
People living in care homes, for example, have found it hard when they’ve been unable to hug, to hold hands or sometimes even just see the people they love. Social care staff have taken on difficult burdens of comfort and care. It’s been such a relief to expand the number of named visitors so that care homes and help families come together once again.
Together, NHS and social care staff have been outstanding. And on meeting so many colleagues this morning I’m mindful of the debt we owe them all. They’ve been under extraordinary pressure. Some of them have had to care for 2, 3 or even 4 times as many patients as normal times. People kept coming in, night after night, struggling to breathe. Too many of them never came out again. I know it’s taken an enormous toll – and I’m determined to look after the people who’ve looked after us.
The People Recovery Task Force is helping us make interventions and support staff. Forty mental health and wellbeing hubs are being set up in every region of England. They’re working quickly to make assessments and reach out to the people who need help, including those working in social care – and we’ve backed them with some £37 million of funds this year. Colleagues facing mental health challenges like PTSD need and deserve the specialist support on offer, while for others, time off work may be enough.
Because whether it’s in the NHS or across the country, it’s vital people are getting the right kinds of support, and I want to bolster our efforts in mental health across the board. It’s an indispensable part of levelling up in health – and the key to a safer, fairer and more supportive society.
We’re ending historic injustices by updating our Mental Health Act, ensuring people in acute mental distress are still met with the compassion and choice they deserve. At the same time, we’re looking at those resources that can help everyone. We know that 1 in 4 people living in deprived areas has a common mental health disorder, so we need to look at everything that’s holding people back from living their very best lives.
Our long-term plan commits an extra £2.3 billion a year to transforming mental health services by 2023 – expanding them to reach families, communities, workplaces, and schools. And we’re launching brilliant new resources, like Every Mind Matters.
I value mental health as much as I value physical health. I believe in the ‘parity of esteem’. Because when you’re healthier, you’re happier; and when you’re happier, you’re healthier.
It’s my job to ensure that virtuous circle is right at the heart of health policy.
We know mental health has such a vital part to play in public health and healthy behaviours we all want to see. Yet through the pandemic, we’ve seen alcohol-related deaths go up, an increase in young smokers not seen for over a decade, and less physical activity across the country.
For a lot of people, COVID-19 was a wake-up call to get fit and get healthy. For others, it went the other way. In simple terms, it looks like healthy people were getting healthier, while unhealthy people were becoming unhealthier still. We need to reverse that trend – and we need to do it fast.
COVID highlighted so starkly that our underlying health and lifestyle determine how resilient we are to new risks and diseases. It didn’t strike randomly or evenly. It hit much harder those people, places, communities whose underlying health was poorer. People who smoked, who were overweight, or who struggled with chronic conditions.
The genius of universal healthcare is just that: it’s universal. So as Secretary of State, I’m determined everyone gets access to the health and care they need – especially the kind of preventive action that will stop them from becoming ill in the first place. That’s another way we ensure, not just a healthier society, but a fairer society too.
Even before the pandemic, it was clear that we needed a new approach to public health. We have an ageing population and an increase in people with multiple health conditions. We’re living longer yet spending more of our life in poor health. And the poorer you are, the greater the proportion of your life is spent in ill health.
I know that here in Blackpool, for example, the demographics have been shifting for some time. Younger, more physically able people are leaving, while we’ve seen more people with disabilities and long-term health problems come in. One in 10 working-age people is deemed to be too sick to work. It shouldn’t be this way. And it doesn’t have to be this way.
From 1 October, public health work in England will be led by a new body. We originally called it the Office for Health Promotion, but when I came into this job, my thoughts turned to what this office – with that weighty responsibility of shifting the dial on how we improve health and prevent disease – would really need to focus on to achieve its mission and achieve its goals.
So when it formally launches on 1 October, it will be called the Office for Health Improvement and Disparities, or OHID. It’s not just a change of name but a statement of intent – a driving mission to ‘level up’ health and ensure everyone has the chance to live happy and healthy lives.
It will sit in the heart of my department and be jointly led by our new Deputy Chief Medical Officer, Jeanelle de Gruchy and the Director-General, Jonathan Marron. They’ll be working closely with me and England’s Chief Medical Officer, Chris Whitty. It’s a dream team – it’s the kind of people you’d want focused on this vital mission. And there are 3 things I’m want them to really focus on.
First, I want them to look at how we prevent poor mental and physical health – and help people live healthier lives. Because we know prevention is better than cure. That means being bold to tackle the biggest killers – especially the preventable ones.
Like tobacco, which continues to account for the biggest share of avoidable premature death and contributes half the difference in life expectancy between richest and poorest.
Or obesity and poor diet, which together cause almost half of all years of life lost prematurely due to modifiable factors, and impacts deprived areas and black communities far more than others.
Or the harmful use of alcohol and drugs, which have killed more people in recent years than ever – and have harmed deprived communities in particular.
Second, I want OHID to work with whoever it takes – from the NHS to industry, life sciences to academia – to tackle health inequalities and improve access to health services particularly the services that detect and act on health conditions as early as possible. Like cancers and cardiovascular disease, for example, which are the leading causes of premature death. Together they account for over 60% of years of life lost to premature death. The fact is, your chances of dying early from cardiovascular disease or cancer vary greatly depending on where you live in the country.
So we need to do more to understand and tackle these inequalities. We need to make it easier for people to access screening services and diagnostics. And we need to make sure that everyone can get the support they need from primary care – which is often the first to spot the early signs of a problem.
And third, I’ll be asking OHID to work with partners right across government and beyond to act on the wider factors that contribute to people’s health outcomes. Because we know our health depends on so many factors: your job, your house, your environment, your education and so much more. It has to be a truly cross-government approach. And we’re going to build on the brilliant work of Dame Andrea Leadsom’s ‘Early Years Review’ and ensure every child gets the best possible start in life.
So while I said at the start that we can’t level up economically without levelling up in health, it’s equally true that we can’t tackle health disparities without tackling wider disparities too.
I would like to end this afternoon with this reflection. When I look back at my own life, I often think about how I got here. Yes, I’m the product of a good family – and I have my parents to thank for that. And I’ve worked hard along the way. But like most of the British public, I’m also the product of our public services.
Whether it was being with my Mum in that NHS waiting room, or going to the local library because there wasn’t enough space to study at home, or going to further education – it was our public services have shaped me and the course of my life.
I’ve now led 6 government departments – but being in charge of Health and Social Care is a particular honour. For me, there is no greater example of what public service really means.
We’ve experienced it in each of our lives – and never more so than these past 18 months. I’m very pleased I now get to see this job through. This is not simply a ‘department that needs to be managed’ – it’s a lifeline for so many people in our country.
Yet even before COVID-19, too many people felt the system wasn’t working for them. We may have heard the pandemic described as a ‘great leveller’. It was anything but. It’s made things harder. It’s exacerbated our disparities.
So tackling the backlog; addressing our social backlog – in mental health and public health, facing up to the disparities in our country. These are tasks I know we must take on.
And we must succeed. And working together, we can be the great levellers, levelling up in health and bringing about the healthier, fairer and more supportive society. Just what we all deserve.
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