Health inequalities are unjust and avoidable differences in people’s health 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 health outcomes were laid bare. Data available within the healthcare system demonstrate stark inequalities for those from more deprived groups, from ethnic minorities, and for those with severe mental illness or learning disabilities, among others. Yet progress to reduce disparities has been slow in some areas and the role of NHS trusts in taking concerted action to reduce inequalities has not been clearly articulated. Though willing, NHS trust leaders may struggle to identify where to start as the nature of the topic itself covers so many elements and needs vary in different local areas.

The causes of health inequalities are complex, but research has shown that the main drivers of health inequalities are social determinants; the environments people live in, access to employment, the kind of start they had in life (Bibby, 2018). Inequalities are also driven by the ways in which health services are designed, delivered, funded, and by the quality of clinical care received. The NHS plays a role in both mitigating against the impact of the wider determinants and in reducing healthcare-based inequalities. Addressing health inequalities will improve the quality of clinical care, patient outcomes and safety.

NHS services can address health inequalities by:

  1. Ensuring fair access, experience and outcomes across different groups in the population.
  2. Acting as an anchor institution to support work on the wider determinants of health (NHS Providers, 2023a)

As well as a moral and social responsibility, NHS trusts have a legal duty to consider health inequalities. They 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, 2022a). They must also describe the extent to which they have exercised their functions consistently with NHSE’s views set out in the statement on information on inequalities (NHS England, 2023a). NHSE’s leadership and competency framework for board members states that “promoting equality and inclusion, and reducing health and workforce inequalities” is one of six key leadership domains for trust boards (NHS England, 2024a).

Tackling inequalities in health and care is embedded in the Care Quality Commission’s (CQC) 2021 strategy (CQC, 2021). Alongside the strategy, the CQC have published five equality objectives to support their role in addressing health inequalities (CQC, 2022). As an independent regulator, the CQC have stated they will take action if they identify examples of care not being good enough for people most likely to have difficulty in accessing care and people with poorer experiences of care. They encourage providers to actively seek out, listen and respond to these groups of people and will include this in their assessment frameworks.

There has been an increasing level of national government support and encouragement for the health sector to reduce health inequalities. The Department of Health and Social Care (DHSC) published the Major Conditions Strategy case for change and strategic framework in 2023, which outlines addressing health inequalities as an overarching aim across each of the priority areas (DHSC, 2023).

There is also an economic argument for addressing inequalities. In 2010 it was estimated that inequalities cost the NHS £5.5 billion annually and NHS treatment costs would be 15% lower if health inequalities were removed (Frontier Economics, 2010) – given the worsening inequalities over the intervening decade, we could realistically expect the financial cost to be even greater now. Tackling health inequalities leads to productivity and efficiency benefits for trusts, contributing to broader priorities such as reducing Did Not Attend (DNA) rates and high intensity use of emergency departments, as well as promoting inclusive elective recovery.


Health inequalities policy and guidance

In recent years, there has been a growth in guidance on the role of the NHS in addressing health inequalities, from NHSE and external organisations. Some of these provide statutory actions that trusts must take, while others are recommendations of good practice. As it is not always easy to keep on top of the various guidance documents pertaining to health inequalities, this guide aims to draw the various aspects together in one place. In the resources section we have provided a brief overview of each of these policy and guidance documents.