Many thousands of words have been written about how the UK leaving the European Union will impact on the provision of Health and Social Care services. I don’t want to go over the implications for funding services or work force planning as I think that, as things stand, they are unknown. I believe one of the most profound impacts of the referendum is what the vote itself told us in terms of the consistency of concerns raised by different communities and how well placed the country is to respond to these concerns.
As more data is becoming available, about how different parts of the country voted, we are now able to draw certain correlations between what people told us in the campaign and common characteristics of communities. Birmingham, where we are based, has been a really helpful barometer in looking at a how a population, that roughly matched the national breakdown in terms of percentages, voted. Birmingham City Council has very helpfully released ward based data on how the referendum broke down as an open data set. This is helpful because it helps to look at how the breakdown of the vote matches assumptions that have been made about communities which have voted either leave or remain. As is pointed out in the BBC article, linked to above, there isn’t necessarily the relationship between a leave vote and poverty as might have been expected. Some of the most emphatic remain votes were in some of the poorest wards in the City. Whereas there appears to be some relationship between educational attainment and housing availability and a strong leave vote. This shouldn’t be a surprise as the consistent media reported messages throughout the campaign seemed to revolve around three factors:-
- Availability of housing
- Employment opportunities
- Access to healthcare
Leaving aside whether or how the European Union impacts these three concerns, these should be familiar to all of us. Housing, employment and healthcare are the bedrock of good public health and we have been given a clear message that for large parts of the country they are failing. We know from Michael Marmot’s 2010 Review that the neglect of post industrialised communities has stored up significant problems of people living longer but managing long term conditions. The problems we are seeing in managing long term conditions are ones that have followed from policy decisions that were made in the 1980s.
The message we are getting from the referendum should be a wake up call to stop us storing up these problems so we can only react to them when more of the population reach points of critical need. This will only be resolved through a focus on investing in prevention. In turn, true prevention will only be achieved through recognising that this needs an investment in housing and fulfilling employment.
Since the result of the referendum I’ve seen a common thread from service providers that they were only too aware of the seam of discontent that runs through communities in the UK. If this is that case then why isn’t this knowledge reflected in the strategic plans for those communities? How many Joint Strategic Needs Assessments set out dissatisfaction with housing quality AND availability? How many Health and Wellbeing Strategies look at the quality of jobs rather than crude numbers of jobs available?
We have a situation where it has suddenly become obvious that people in the UK have been crying out to tell all of us something about the quality of their lives. This nuance is simply not reflected in the qualitative data sets that are used to develop services and provide support to communities. A referendum might not have been the best medium to get this message but now is not the time to ignore it.
If we take one message from the result of the referendum it is that we need to listen to the stories that people are telling us about the quality of their lives if we want to really improve health and wellbeing.