Dr Ian Campbell has been a GP in Carlton for 30 years. Here he has his say on the government’s recent Levelling Up white paper…

In my article published by Gedling Eye on January 26, I raised my concerns about the current “winter crisis” in the NHS but also set out my concerns for the future of NHS, and for our ability to address falling life expectancy and the worsening health inequity – the “health gap” – we are now seeing both here in Gedling and nationally. It was therefore, initially at least, great to receive the Government’s much anticipated Levelling-up White Paper, published earlier this month.

The socio-economic circumstances in which we are born, grow, live, and age have a profound impact on our health, and when we die. An example I gave within the Gedling borough area, cited the gap in life expectancy between the richest and poorest areas, meaning that, for example, a man in Netherfield can expect to die eight years earlier than a man in Burton Joyce, and have an even greater disparity of healthy-life expectancy, meaning he would also spend more of his life living with ill health.

This discrepancy in life expectancy is colossally unfair, immoral and, avoidable. The drivers of ill-health, what we call the “causes of the causes” or “social determinants of health” – housing, education and a fair living wage for example – are critical if we are to tackle this gross unfairness.

We desperately need, here in Gedling, access to greater funding to vastly improve community infrastructure, housing, transport and to strengthen our public services, in education, health and social services. And, of course, we need to stimulate our local economy to help provide sustainable, rewarding and fulfilling jobs, which pay a minimum income for healthy living.

Improving health and living standards for everyone, has profound socio-economic benefits for the whole of society, would take immense pressure of the NHS, and is both morally, and economically fair. We need to build back, but not just build back better, we need to Build Back Fairer.

It is now time to reverse course. The Levelling Up plan sets out in part what needs to be done and there is a lot to like within its’ more than 300 pages, citing plans to boost productivity, pay, jobs and living standards across society, to increase opportunity and improve public services, to restore a sense of community and local pride and empower local leaders and communities.

The White Paper also sets out 12 “missions” – to impact on living standards, transport, research, internet access, education, skills, health, well-being, pride in place, housing, crime and local leadership. If these “missions” were achieved I have no doubt health equity will improve too.

But here’s the problem…

This white paper has been prepared by a political party that has been in power in Britain for 30 of the last 43 years and was responsible for much of the damage it now wants to reverse. And since 2010 the austerity policies of the government have only accelerated that hardship. Public sector funding has fallen sharply, child poverty has risen, and there have been successive regressive cuts to tax and benefits. In 2020 almost 2 million children in the UK went hungry, prompting the United Nations agency UNICEF to develop a child feeding programme in the UK for the first time in its 70 year history! The Food Foundation reports that 1 in every 11 households, that’s 4.7 million adults, experienced food insecurity in the last month. 

In the context of levelling up, the post-2010 cuts to local government, including here in Gedling, expose the harsh truth – the more deprived the area the steeper the cuts. Nationally, it has been estimated that cuts to local government in the North of England amounted to £413 per person. By contrast the 2021 allocation from the levelling up fund amounts to a poultry £32 for every man woman and child.

On the face of it, the Levelling Up objectives and missions are exactly what is needed. However, as the Chancellor of the Exchequer has made clear the regressive cuts to public expenditure will not be reversed and the government remains more interested in cutting taxes than levelling up.

What we are really witnessing is not a level of investment that will have a significant impact on social and health inequities; it is, instead, a woeful, shameful, drop in the ocean, and a token reaction to a, literally, life threatening crisis. As a doctor who cares passionately about the NHS, and someone who wants so much more for his community, I am bitterly disappointed that we can expect health inequalities to continue unabated. The Levelling Up white paper is a huge disappointment, and a huge opportunity wasted. 

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