Everyone counts…but some might count more than others?

We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind. We accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources we waste opportunities for others.

NHS Constitution – Values
Mike Chitty Realise Development

I think the NHS Constitution is a wonderful document. Beautifully written, it speaks powerfully to many of us about the NHS that we want to use and work in.

One of my frustrations in working with the NHS is the infrequency with which we consult the values explicitly to help us with decision making. The values are beautiful, but in my experience, appear to be used infrequently as a management and leadership tool.

There are 7 values in all and they set an incredibly high bar. Take this one – Everyone Counts. It is the value that to my mind speaks most explicitly about the NHS ambition with respect to diversity, inclusion and equality.

I think that, in practice, we often stop reading after the first clause. We maximise our resources for the benefit of the whole community. We do our best with limited resources to provide the greatest health gains for the greatest number of people that we can. We work on ‘population health’ But in practice this means that the second clause of the value often gets neglected – We… make sure nobody is excluded, discriminated against or left behind.

Because, in practice, in terms of health outcomes we have been ‘leaving behind’ the same groups for decades. Whether this is through processes of exclusion or discrimination, or just lack of clinical knowledge I am not certain. I suspect that many factors, mostly found in wider society, play a part.

But until our health and care strategies start with a real commitment to help those that have been systematically ‘left behind’ to catch up as quickly as possible we will have widening health inequalities.

So let us re-visit the third clause in the value We accept that some people need more help, that difficult decisions have to be taken. When we take these difficult decisions, what will benefit the ‘whole community’? A focus on creating as much health gain as we can, for as many as we can, for a fixed cost? Or spending our money in a way that helps those that have been historically and systematically left behind by the system to catch up? How do we find the balance?

Who are we choosing to ‘leave behind’?

This is becoming an increasingly pivotal question for me as I work in primary care networks, integrated care systems and NHS Trusts. And if you care about equality and inclusion then perhaps its need to be a question that you are prepared to ask too.

I am also increasingly striving to increase ‘community engagement‘ not through the usual processes of patient participation groups and so on but by going directly in to communities and engaging them in playful conversation, often with academics, clinicians, commissioners and managers so that their voices can be heard directly and relationships formed that will start to change the system.

I would love to hear what you do, in your practice that helps to raise awareness, interest and action in tackling health inequalities.

Please leave us a comment!

3 thoughts to “Everyone counts…but some might count more than others?”

  1. These conversations are really valuable. It maybe useful to include/invite residents – especially older (increasing aged popn etc) & not necessarily as Service Users cos they often have a wealth of info and maybe come from a different angle…??

  2. It is the small day to day things that raise awareness and model practice. Being back working at the frontline I thread into the conversations which of our babies are being born premature and dying. I promote targeted interventions that understand who is most vulnerable. Where practice is unhelpful and tick box especially in, for instance, in not using interpretation where necessary; I model using one despite the hurdles. I believe small leaderful actions make a difference

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