Health inequalities are unjust and avoidable differences in health outcomes across the population and between specific groups. The need and desire to tackle health inequalities rose up the agenda in the wake of the Covid-19 pandemic as inequalities in outcomes were laid bare – with Covid-19 death rates almost double in the most deprived areas of England, compared to the least deprived. There are stark inequalities for those living in deprived areas, minority ethnic groups, and for those with severe mental illness or learning disabilities, among others. For example, maternal mortality for Black women is currently almost four times higher than for White women and the most deprived areas are seeing faster growth in elective waiting lists and longer waiting times.
Yet the role of NHS trusts in taking concerted action has arguably not been clearly articulated. Though willing, NHS leaders have struggled to identify where to start - grappling with this complex issue can feel like navigating uncharted waters. Tackling health inequalities requires long-term commitment and measuring progress is challenging. NHS Providers has just published ‘Reducing health inequalities – a guide for NHS trust board members’, designed to empower NHS boards in their efforts to tackle health inequalities.
Though willing, NHS leaders have struggled to identify where to start - grappling with this complex issue can feel like navigating uncharted waters.
The guide offers a roadmap for action for trusts seeking to make meaningful strides towards health equity. Drawing on NHS England policy and guidance, the guide provides a comprehensive framework for identifying, prioritising, and addressing health inequalities – including a self-assessment tool and a set of suggested actions. As stewards of healthcare delivery, trust board members influence strategic decision-making and resource allocation. By articulating clear objectives and priorities for addressing health inequalities, board members can catalyse action at all levels of the organisation, from frontline service delivery to policy formulation.
Dr Rafik Bedair, Chief Medical Officer at the Northern Care Alliance NHS Foundation Trust, said: "At the NCA one of our key ambitions is to improve population health in all our places. This requires a concerted effort both at board level and throughout the organisation, in many cases viewing our responsibilities through a different set of lenses.
"We are mapping out the organisational framework within our trust to effectively implement initiatives aimed at achieving health equity and promoting population health. This guide will serve as a valuable resource for our board through this process."
Many trusts will be in the early stages of their journey, so what does ‘good’ look like?
Firstly, it involves recognising that inequalities should be understood and considered across all aspects of the organisation.
Trusts should articulate their commitment to reducing health inequalities within their organisational strategy. NHSE has mandated trusts to appoint a board-level executive lead for health inequalities, to provide effective leadership and accountability.
Mature trusts will set specific objectives relating to health inequalities for board members, underpinned by ongoing training and a governance structure that enables progress reporting.
The Chair and Non-Executive Directors should be deeply engaged on the topic, fostering a culture of curiosity, education, and active involvement in organisational efforts to address health inequalities.
Trusts need robust systems and infrastructure in place to support enhanced data capture and reporting on health inequalities at board level to facilitate data-driven decision making. This requires optimising electronic patient records for population health analysis and providing training for staff on data capture and recording. By triangulating data from various sources and actively involving communities and service users, trusts can gain deeper insights and drive innovations in fairer service delivery.
Across our many discussions with trusts, it is clear that organisations who employ public health specialists are leading the way on this agenda.
Delivering change on health inequalities should be considered as core business for trusts. Dedicated resources and expertise are required to ensure a focus on health inequalities, prevention, and health promotion. Across our many discussions with trusts, it is clear that organisations who employ public health specialists are leading the way on this agenda.
Ultimately, 'good' for NHS trust boards transcends mere compliance — it entails a steadfast commitment to championing health equity, fostering a culture of accountability and innovation, and driving tangible progress towards a future where addressing health inequalities is woven into the fabric of organisational culture.
We know that some trusts have taken strides towards embedding an equity lens across the work of their organisation. Dr Dominique Allwood, director of population health at Imperial College Healthcare NHS Trust, said: "The scale of health inequalities is huge, so we first worked with lay partners and staff to develop a strategic health and equity framework to guide our approach. This includes an initial two-year, targeted work programme, with a number of specific projects, such as implementing a Trust-wide intervention to support patients to stop smoking, tackling inequities in how long patients are waiting for care and increasing community engagement in our work.
"This is a really exciting long-term programme. Working in partnership with our communities and local health and care partners, we believe we can start to make a big difference to people's lives over the coming years."
There’s a long way to go in ensuring equality of outcomes for patients across all NHS organisations, but this NHS Providers guide outlines the role of trusts in improving access, experiences and outcomes. For real change in reversing inequalities, we also need the government to commit to long-term strategic action on addressing prevention and the wider determinants of health.
This article was first published by HSJ.
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