• Since our last United against health inequalities report in 2022 (NHS Providers, 2022a), NHS trusts have taken strides in addressing health inequalities. They have made strategic commitments to act and have identified an executive lead on their boards to champion the agenda. Other common actions have included undertaking data analysis to understand trends by deprivation and ethnicity, and addressing inequalities within the workforce. But there remains much more to do.
  • There is an opportunity for trusts to grow into a culture of business as usual in addressing health inequalities, by providing training in health inequalities, making more use of impact assessment tools, and utilising public health expertise in a more systematic way. There is also great potential for trusts to work closely with wider system partners and integrated care systems (ICSs) to develop and deliver on a shared vision for reducing health inequalities.
  • Trusts have identified the main barriers preventing further progress as wider system pressures, operational challenges, lack of resource and financial constraints. Compared to three years ago they are now less likely to report data availability as a barrier, but data sharing/interoperability, ethnicity coding and lack of informatics and data analysis skills continue to limit what trusts can do with the data available on health inequalities.
  • To shift the dial on health inequalities, trusts tell us they need both dedicated resource and investment and alignment on competing policy priorities. While NHSE policy and guidance relating to health inequalities is largely well known and applied among trusts, there is a lack of consistent messaging from the centre regarding the extent to which trusts should be prioritising this work. Trusts would welcome recurrent, protected, long-term funding streams for initiatives specific to improving health inequalities.
  • There is a high level of confidence among trusts about their role as anchor institutions, particularly in improving access to employment opportunities and preventing inequalities among their workforce. They recognise there is scope for them to act on a wider range of issues that will have a positive impact on the local economy, such as via social value procurement opportunities, and to address challenges such as climate change.
  • The NHS cannot resolve health inequalities alone. Only cross-government action to address the wider determinants of health will bring about real change. Shifting the dial requires action across all sectors that impact on the wider determinants of health – housing, education, local authorities, and the private sector. We need to build this into a model of care across government, making the NHS sustainable, and our national health and wealth prosper.