Health Inequality Assurance Framework: a self-assessment improvement tool for integrated care boards

About this framework

This supportive tool helps integrated care boards (ICBs) to capture progress against strategic objectives and commissioning plans to tackle health inequalities and improve outcomes for all. By completing the assessment, and adding evidence for each theme and statement, a picture can be formed of the impact on tackling health inequalities across a system. Repeating the process at least once a year provides a record over time of progress being made. 

The evidence from the self-assessment will demonstrate where good practice and commissioning models are already making a difference and where more attention is required. This may be in terms of the governance, accountability and compliance measures in place; setting up the strategic commissioning landscape for success; and assuring that improvement processes, incentivised by strategic commissioning, are positively impacting access, experience and outcomes for all.

This tool is not mandatory but will inform and provide evidence for any future external assessments and oversight of an ICB’s work to tackle health inequality, as aligned to national and local strategic priorities and ICB strategic commissioning plans.

The ICB may decide to share the assessment with partners, patients and service users, healthcare providers and the wider population and/or to publish it, for example in an annual report. The tool may also be useful as a vehicle for a process of joint self-assessment with partners across the system, providing a ‘360’ view, and this may give new insights for the board on where and how they focus on health inequality improvement. 

ICBs are at different stages of development and maturity. It is for the ICB to decide how this assurance tool may best support and demonstrate their progress on health inequalities. Sharing the assessment outcomes within an ICB peer or regional group may also be a helpful aid to support future learning and innovation.

How to use the framework

The framework is divided into five sections:

1. Governance and accountability
2. Strategic commissioning
3. Compliance
4. Commissioning process
5. Evaluating and embedding

Within each section, assess the series of statements and rate each using one of the four descriptors:

1. Reactive: Practice or commissioning is unstructured, driven by immediate challenges or external pressures, and has limited alignment to long-term strategic goals.
2. Emergent: Initial progress has been made but this is limited to certain geographies and/or population groups or lacks consistency, integration and impact.
3. Growing: Clear practices and strategic commissioning plans exist aligned to long-term goals, allocated resources and outcome measures.
4. Consistent: Practice is consistent and the strategic goals are evident in all strategic commissioning plans and commissioning models, with evidence that providers/provider collaboratives across the system are tackling variation and inequality, consistently achieving improved outcomes for all.

Once each statement has been assessed, please enter a maturity assessment rating.

Please apply the most appropriate assessment level for each assessment statement. There is a free-text box to make any comments to assist the board self-assessment process and to embed links to evidence and relevant documents.

There are links to useful guidance and documents at the end of the framework, to support the self-assessment process. Some of these may be specific to particular sections, others will be helpful across the entire framework. Please review those most relevant to aid improvement for your ICB and inform next steps in action plans. This list of resources will be updated, with the latest version hosted on this web page.

We recommended informing and updating health inequality and population health improvement strategies and strategic commissioning plans in line with the self-assessment outcomes.