National NHS leaders are now looking to systems and trusts to take concerted action on the inequalities faced by those from deprived backgrounds, ethnic minorities, autistic people and people with learning disabilities, and other protected characteristics. To support this, the mission to address health inequalities has been woven into primary legislation in the Health and Care Act 2022, and is embedded into operational guidance such as the elective recovery plan.
As part of our commitment to embedding a focus on health inequalities and race equality as a pillar of effective and sustainable healthcare, we have now developed a support offer for trust boards on health inequalities aimed at supporting trusts' work to reduce health inequalities in their services and across the wider system. This work, alongside our race equality programme, will support trusts to make sense of health inequalities and how they can begin to embed a focus on narrowing the health inequalities gap as part of their 'core business'.
What trusts told us
Our support for trusts on health inequalities needs to be evidence based. We have been working closely with members over the course of the past six months to understand the opportunities for progress, and barriers to change, as they continue their work to tackle health inequalities. In these conversations, we have sought to understand how trusts see their role in reducing health inequalities developing over the coming months and years, and how we can support this work. A survey of trust leaders, representing around two thirds of the sector, shaped our insights further.
These conversations have shown how trust leaders bring ambition and commitment to their work on health inequalities. They described many effective enablers of progress, including building public health expertise, engaging with people and communities, and maintaining a focus on health inequalities at board level through data, patient stories, and increasing board diversity.
But there are clear challenges along the way, and with a wealth of evidence showing the scale and complexity of health inequalities and the social determinants of health, we know that there is much more to do.
To help inform sustainable, long-term progress, trust leaders told us that they would welcome our support to:
- Make sense of health inequalities – trust board agendas are complex and busy, and while there is a wealth of information about health inequalities available, it can be challenging to prioritise the issues and know where to begin in a local area, particularly while balancing other pressures. Trust leaders told us that resources to simplify information about key changes in the national landscape would be welcome.
- Share good practice and facilitate collaboration – trusts are committed to developing their role on health inequalities, as active leaders, partners in the system, and as anchor institutions, but knowing where to begin is a key challenge and trust leaders told us they would welcome support to share experiences with their peers, and hear stories of successful, creative interventions around health inequalities.
- Make use of valuable partnerships in systems, and clarify their role in ICSs. Far from simply having a responsibility to provide equitable healthcare, trusts see themselves as playing a role as leaders in systems and as anchor institutions, making a key contribution to system-wide ambitions to improve the health of local communities. System partnerships are crucial, and trusts are clear that an engrained, system-wide problem needs bold, system-wide solutions.
Alongside this, the need for an honest conversation about the wider determinants of health rings loud and clear. Trusts acknowledge their role in rising to the challenge of improving health inequalities, especially those which persist in their services, but would like to see national leaders recognise social inequalities which perpetuate worse health for the most marginalised communities.
How we plan to support trusts with their work on health inequalities
Through a series of resources and events, we will support trusts to move from analysis to action on health inequalities, provide a forum for trust leaders to come together to discuss the challenges and opportunities to address health inequalities, and offer easily digestible insights on health inequalities to facilitate reflective conversations at board level.
A series of briefings will set out examples of trusts working in collaboration with partners across the system, exploring how different organisations can fulfil their varied roles as a collective, on issues around housing, employment, justice and other social determinants of health. These resources will explore how data and analysis to address health inequalities, underpinned by high quality assurance and challenge, can support progress in making services equitable, as well as the role trust boards play in leading their workforce to take ownership of health inequalities in their clinical and operational practice.
Webinars will bring together trust leaders to hear from leaders across the system and from other sectors to learn what it means to be an anchor institution, as well as how to build on insights from Core20PLUS5 analysis to make the impact of health inequalities real and tangible.
Peer learning events will enable smaller groups of trust leaders, focused on health inequalities in their board roles, to share learning and begin to innovate together on issues such as evidence-based interventions, building relationships with public health colleagues, and taking a quality improvement lens to this agenda in order to achieve and evaluate progress.
Finally, we know that this issue runs through the breadth of challenges the NHS is facing, from the financial squeeze, to workforce challenges, to capital funding issues and beyond. Health inequalities touches on everything trusts do, and so alongside this programme of events and resources to support trusts with their efforts on health inequalities, we are committed to embedding health inequalities as a core focus of our influencing and support work across the health policy landscape. We hope that in ensuring health inequalities is reflected as a key priority across our work, we can support trusts to lead progress towards more equitable health outcomes for the communities they serve.