Is the spotlight dimming on tackling inequality?

The NHS Equality and Diversity Council's (EDC) working group believes so.

The council, co-chaired by Joan Saddler OBE, the NHS Confederation’s director of partnerships and equality, has welcomed national work on inequalities. This includes CORE20 PLUS 5, an approach to support the reduction of health inequalities at both national and system level, and guidance asking integrated care systems (ICSs) to create diverse leadership and employment opportunities for local people.

It has also welcomed the progress made in strengthening leadership to reduce inequalities, with all ICSs and providers identifying an executive lead for tackling health inequalities.

But having a lead is not the same as taking proactive, informed, co-produced action to understand and act on inequalities. While national approaches go some way, local systems understand their populations far better and need a flexible approach to set priorities with local communities.

Working in different ways

With this in mind, a recent EDC working group discussed three key areas:

• The opportunity the emerging new system landscape brings for the NHS to rethink its relationship with patients, along with the importance of co-production.
• A renewed focus on outcomes.
• Narrowing the gap in inequalities that stubbornly persists in terms of access and outcomes for people using a whole range of NHS services.

Tackling inequality has been the central focus for the EDC since its inception, where NHS system leaders, voluntary sector and workforce representatives emphasise the need to ensure strategic actions on reducing inequality. It is also a core focus of the NHS Confederation: we promote collaboration and partnership working as the key to improving population health, delivering high-quality care and reducing health inequalities.

A current core focus of the EDC is to assure support for emerging organisations working in different ways to make an impact on inequalities locally. In particular, it is keen to ensure that work is aligned with local authorities, the voluntary and community sector, local diverse communities and other key strategic partners.

The NHS Confederation has produced support and guidance for chairs and non-executive directors to help lead stronger NHS action on health inequalities.

The EDC and NHS Confederation are committed to further engaging with organisations and systems working nationally and locally to help support and drive these important initiatives.

Inequalities: asking the right questions

National work underway spans inequalities and workforce and patient equalities. But are you asking the right questions to ensure a bright light remains on tackling inequalities?

• CORE20 PLUS 5: an approach to reducing inequalities, an NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort (the ‘Core20’), adding additional inclusive health groups specific to ICS populations (the ‘PLUS’)  then identifying five focused clinical areas requiring accelerated improvement, including severe mental illness and respiratory disease. Every board should have a local health inequalities plan, particularly informed by what the NHS has learned about the impact of COVID-19. Have you seen yours? 
• Ensuring inclusive recruitment: the ICS people function guidance particularly asks ICSs to create a diverse leadership and employment opportunities for local people as a way of improving the lives of people living in the communities served by ICSs. A specific responsibility of integrated care boards is also to work with partners to create education, employment, volunteering and apprentice opportunities to widen participation in health and care – so addressing the wider social value agenda. Are you planning for diverse ICS leadership or working with your ICS?
• Supporting equality, diversity and inclusion (EDI) staff: EDI leads should be supported and celebrated if organisations are serious about tackling inequality. Such key roles require expertise for those working as EDI leads, who themselves have been instrumental in supporting provider organisations in their pandemic response. Are you aware of plans to develop effective career paths for EDI lead officers?
• Developing ICS guidance: NHSEI is currently revising guidance to reflect new legislative requirements. Under the currently debated Health and Social Care Bill, equalities and health inequalities and any key revisions to the Equality and Diversity System and associated assurance processes are being made. Does your organisation want to go further in reporting key responsibilities under the Equality Act 2010 along with your public sector equality duty?