Our guide for NHS trust board members - Reducing health inequalities - sets out a vision for what good looks like for addressing health inequalities, alongside a set of actions for trusts to take (NHS Providers, 2024a). Leadership and strategy are key components of effective health inequalities action. In practice, this means appointing an executive lead for health inequalities within the board – which is a requirement from NHSE (NHS England, 2021c). It also involves establishing robust accountability mechanisms, outlining commitments within strategy documents and providing a governance framework to monitor delivery. This could include establishing health inequalities working groups or committees that report their progress into the board.
It is encouraging to see that the majority of trusts have board commitments and established internal structures to oversee their health inequalities work (Figure 6). The commitment is demonstrated through high responses to 'we have identified a board-level executive lead for health inequalities' (85%) and 'health inequalities are embedded as a key element of our trust's organisational strategy and/or organisational priorities' (78%). Feedback from executive leads highlighted that good practice involved reviewing data to inform the strategy development. Others have worked in partnership at place and system level to develop their strategy with wider system partners. The challenge noted for trusts relates to transforming strategy into action and implementation. A number of trusts reported a sense of feeling "stuck" in strategic mode, which involves lengthy discussions on long-term vision and aspirations rather than focusing on practical actions to address immediate concerns. It is important that trusts are enabled to transform their strategy into delivery by addressing the barriers that are set out in this report.
There were particularly low responses to 'relevant clinical staff have received training in health inequalities' (16%) and 'we have developed a health equity impact assessment tool that is used by our board' (23%) – without which, the ability to embed a culture of addressing health inequalities as business as usual will be limited.
Executive leads highlighted the beneficial role of steering groups and committees to manage and oversee the action plans and projects of work targeted at reducing health inequalities, which then report their work into the board. This was seen to be particularly effective where trusts have appointed a health inequalities team and/or project manager dedicated to embedding health inequalities across the organisation. However, survey results show that while this may be best practice, these actions are not widespread across all trusts – with only 53% of respondents reporting to have 'a dedicated oversight group for health inequalities'.
“Health inequalities board reports 6 monthly to board.”
"Divisional areas of the business are developing local plans for reducing inequalities alongside organisational 10 priorities for tackling inequalities."