While they are coming to the health equalities agenda from different starting points and operational contexts, and recognising one size does not fit all, trusts are united on the need to make addressing inequalities in both access and outcomes more of a priority.

However, while our survey has shown clear board-level commitment and ambition on reducing health inequalities, many trusts are having to manage complex and challenging operational environments while they put in place their plans to deliver changes. The biggest enablers for change are also the ones which, by their absence, many trusts describe as being the greatest barriers to progress. For example, while trusts see data and analytics as being an enabler of high quality conversations and fundamental to assurance, challenge and behavioural change within their organisations, trust leaders’ confidence in their access to, and ability to interrogate, high quality data is varied.

Perceptions of conflicting priorities remain, highlighting the need to better align health inequalities and the wider work of system partners and COVID-19 recovery. Many trust boards are now viewing health inequalities as a lens through which to view the quality of the services they offer. However there remains a challenge to embed this into the core business of the trust and make it front and centre of conversations that can often be dominated by finance, operational pressures and workforce challenges. Trusts would welcome support from national bodies to facilitate the sharing of good practice, summarising the evidence base and guidance showcasing what good looks like to help them navigate this complex environment.

National leaders will ultimately need to consolidate and test insights from trusts, develop a clearer narrative for trusts’ role, and provide meaningful support. If efforts to tackle health inequalities are to succeed, this will require sustained focus and prioritisation over many years, however challenging the operational context trusts are working within.

How is NHS Providers responding?

NHS Providers is also responding to this opportunity to prioritise health inequalities as a core focus going forward. As part of our four-year strategy, we have made a commitment to prioritising this agenda, and contribute to a long-term, sustained effort towards long-lasting improvements.

In light of feedback from trust leaders about the challenges and opportunities surrounding health inequalities, we are developing a programme of support and peer learning for trusts to draw on in their efforts to reduce the health inequalities gap. This will be underpinned by work to ensure health inequalities is a central theme of our voice and influence. 

The insights from this survey, alongside engagement with trust leaders, will inform this work and, as an organisation, we look forward to being part of lasting change.