Health inequalities lead to different health outcomes between certain groups and individuals, with some groups more likely than others to experience poorer health outcomes in comparison to others. Legal duties state that trusts must have regard to the health and wellbeing of people and the quality of services provided to individuals, including in relation to inequalities (NHS Providers, 2022). Through their role as anchor institutions (NHS Providers, 2023a), trusts are encouraged to come together with their community partners and local communities to jointly understand and respond to local challenges. Engagement with communities is one way in which NHS trusts can strengthen their role as anchors within communities, by ensuring that they are reactive and responsive to the needs of their local population.
As discussed in this report, the very definition of co-production rests on an equality between the organisations gathering views and the individuals sharing their experiences. The Social Care Institute for Excellence (SCIE) (2022) place equality and diversity as central values to co-production work – as co-production principles recognise that all individuals are equal and can contribute to the process. Similarly, NHSE have explicitly linked patient involvement to "addressing health inequalities and improving quality" (NHS England, 2022).
Health inequalities can stem from barriers individuals experience when accessing healthcare services, or poor experiences of healthcare that deter individuals from future engagement. These scenarios can contribute to delayed healthcare access and poorer outcomes as a result. Engagement with communities via co-production can potentially work as a solution to health inequalities, by providing a means for health services to increase their understanding of these barriers and co-developing solutions to overcome them. This approach would ensure that services are tailored to meet the needs of the local population. Engaging with a diverse group of individuals will offer perspectives and insights that are not traditionally considered by healthcare leaders or professionals. This is particularly important where representation from certain groups or communities is low among the NHS workforce and within senior leadership positions.
Yet, applying engagement or co-production methodologies won't in and of itself reduce health inequalities – in actuality, if done wrong, inequalities could potentially be exacerbated. The design and delivery of co-production and engagement activities requires an equality and inclusivity lens.
Individuals involved in engagement should be appropriately reimbursed for their involvement, which could cover payment for their time and necessary expenses. Without this, individuals that face barriers relating to finances will be unlikely to engage, potentially limiting the likelihood of hearing from those that are more likely to experience health inequalities.
It is understood that some individuals will feel more comfortable than others in sharing their views and experiences. Individuals experiencing inequalities may require additional support to participate. This could include language and translation support, sensory considerations, attending engagement sessions with advocates, or other considerations.
SCIE (2022) have identified the following groups as being more likely to be excluded from engagement activities:
- ethnic minority communities
- LGBTQ+ communities
- people who communicate differently
- people with dementia
- older people who need a high level of support
- people who are not affiliated to an organised group or 'community'
- people living in residential homes
- homeless people
- Gypsy, Roma and Traveller communities
- people in prison.
This list is not exhaustive and there may be other groups that also face barriers when accessing engagement activities.