Health inequalities are not a new product of the pandemic. However, over the past two years the impact of COVID-19 on marginalised communities has given impetus to a coordinated, united effort to narrow the gap in access to, experience of and outcomes from healthcare services. With the levelling up white paper committing to narrowing the gap in healthy life expectancy between the most and least affluent areas, and the forthcoming health disparities white paper committed to levers to improve people's health, a range of policy drivers are being put in place to support national action on health inequalities.
But what does this mean for trusts? We carried out a survey of trust leaders, to better understand the opportunities, challenges and lessons of the past two years on health inequalities. It shows that trust leaders are determined to fulfil their vital role in narrowing the health equity gap, but the scale of the challenge is still substantial.
Two thirds of respondents (65%) said they are confident that their board has effective leadership commitment and governance in place to address health inequalities.
Two thirds of respondents (65%) said they are confident that their board has effective leadership commitment and governance in place to address health inequalities, but only around half (45%) of trusts say they have a very or fairly well-developed response to health inequalities, including being embedded in the work led by integrated care systems (ICSs).
Trusts named a range of barriers to robust action on health inequalities, with around half saying that data and analytics remains a challenge (48%). Trusts describe the importance of having complete data to ensure analysis is accurate. The story the data tells is a key enabler of productive, ambitious conversations at board level about how to challenge unjustifiable differences in access, experience and outcomes, and embed effective board assurance to address them. They are keen to develop a shared understanding of 'what good looks like' for people from marginalised communities, and how best to ensure a culture of equity is built into services, supported by diverse leadership and engagement with communities.
Two thirds (65%) also said that wider system pressures and operational challenges present a barrier to meeting their objectives on health inequalities. Trust leaders are emphatic that health inequalities form a clear priority among the array of asks set out by national leaders. But they are concerned about the risk of health inequalities being sidelined when debates about tackling immediate operational pressures and care backlogs with stretched resources and workforce shortages become more pressing. In practice, their ability to meet demand, improve outcomes, and support staff will be most successful when health inequalities is embedded as 'core business', and as a fundamental pillar of good quality, responsive care.
Systems of accountability for progressing health inequalities are still emerging and developing in response to new national priorities and legal duties due to be implemented this year as part of the Health and Care Bill.
Despite this, two fifths (42%) say that unclear accountabilities and conflicting priorities from national regulators are still/remain a barrier. Systems of accountability for progressing health inequalities are still emerging and developing in response to new national priorities and legal duties due to be implemented this year as part of the Health and Care Bill. There is still work to do to ensure this translates clearly for trusts and systems, so the raft of asks from the centre are aligned with local objectives, the reality of delivering equitable services for diverse populations, and the complexity of measuring outcomes.
It is clear from this research that trust leaders are united against health inequalities, but they know they cannot tackle them alone. The wider determinants of health play a critical role in creating avoidable and unfair differences in people's health and life expectancy – from the housing people live in, to the green spaces and physical activity they have access to, and the impact of educational and employment opportunities on their financial wellbeing. As anchor institutions, and in place-based partnerships, trusts can go beyond their role as providers of care, and contribute to social and economic development in the places they serve. But trusts say that they need an honest debate about the impact of these wider pressures, and cross-government action on the link between socioeconomic inequality and population health, will be key.
Trusts understand the unique contribution they can make to reducing health inequalities, and share the vision of embedding health inequalities and the wider determinants of health within local systems. They are determined to maintain momentum and, with the right support, take concerted action to achieve real change.
This blog was first published by HSJ.