Our survey results show that 'lack of funding for health inequalities initiatives' is a key barrier preventing trusts making progress in reducing health inequalities, selected by over half of respondents (51%). This factor is further compounded by broader financial pressures facing trusts – representing a barrier to taking action for 53% of trusts (Figure 2). In considering the solutions for enabling more work on inequalities, 72% of respondents said that 'improved funding streams to deliver health inequalities initiatives' would drive action (Figure 11). During our calls with executive leads, lack of funding and resource was raised by nearly all as the main barrier to making progress.
"All projects have generally be done by re-allocating exiting resource or non-recurrent funds."
"Addressing health inequality and inequity is a long term challenge, on top of an already challenged day-to-day health service. Whilst benefits, including financial, will be delivered, they are years away. Funding for this work has not found its way to our Trust, and if/when it does it will be subject to the usual short termism. We need specific long term recurring investment in this area to support plans that can be developed and funded over strategic timescales."
Funding that trusts do receive for health inequalities was described as short-term, last minute, one-off, and typically externally funded (e.g. via third sector grants and research grants). This is a stark contrast to the nature of health inequalities, which are a long-term, complicated problem. The level of funding currently available does not match the scale of the challenge. In comparison, trusts would welcome permanent, protected, long-term funding streams. Despite NHSE providing an additional £200 million of ringfenced health inequalities funding for ICBs in 2022/23, which has now been made recurrent for 2023/24, we are aware that some systems have used this funding to support their bottom-line due to scale of their financial challenge, rather being in a position to protect it for specific health inequalities projects (Bagnall et al, 2024).
"Core20plus5 money for the place was absorbed to fill budget deficits within the ICB."
Where funding has been made available the processes for accessing it was noted as complex and time-consuming. Trusts are often expected to bring together multiple funding pots to piece together enough money to deliver a work programme. Collaborating with VCSE partners on health inequalities was also raised as a challenge, as partner organisations often have different funding and finance flows.
Some trusts are looking internally at how they can demonstrate an in-year return on investment for the inequalities work they deliver, to make the case for future investment.