This section contains
Aims
Everyone who needs care should have:
- equitable access to services
- excellent experiences during their care
- the best possible outcomes.
Also, health and social care workers should be able to do their jobs in a supportive environment that is equal, diverse and inclusive.
To achieve these goals, integrated care systems (ICSs) need to:
- reduce the health inequalities experienced by their local population
- improve the workplace culture at system-wide and service level.
Context
What are health inequalities?
Health inequalities exist across England. For those who experience them, they can lead to reduced life expectancy, behavioural risks to health, and avoidable harm or death. They also increase pressure on the health and social care system.
Addressing health inequalities is one of the four main purposes of the integrated care system model. System leaders will need to work closely with partner organisations to achieve this.
The King's Fund defines health inequalities as "avoidable, unfair and systematic differences in health between different groups of people." This can be differences in:
- outcome, such as life expectancy
- access to services
- experience of care
- opportunities to live a healthy lifestyle.
How someone experiences those differences can depend on a combination of factors, including income, location, specific characteristics (such as those protected in law), or if they are part of a socially excluded group (for example, people experiencing homelessness).
People can experience multiple factors and inequalities at the same time. These overlaps (often called intersectionality) mean we should consider people's varying experiences and not see groups of people as homogenous. ICSs should develop policies that reflect this, using person-centred methods.
Reducing health inequalities in integrated care systems
Integrated care systems can use NHS England's Core20Plus5 framework to reduce inequalities in their local population. It helps identify:
- groups in their population who experience poor care
- ways to improve access, experience and outcomes for those groups.
Systems must ensure they meet the needs of groups with protected characteristics. Important groups to consider include:
- people with learning disabilities and autism
- people with serious mental illness
- socially excluded groups, for example, people experiencing homelessness or vulnerable migrants.
Addressing the social causes of health inequalities will improve the health and wellbeing of a system's local population. NHS England’s Equality and Health Inequalities Hub has lots of resources and information on this.
Access to good care should not depend on a person's financial situation or location.
For some, English may not be their first language. If they do not have an advocate, navigating the health and care system can be difficult. Access is also difficult for other groups of people, for example people with a learning disability or autism.
Digital innovations can improve access for some groups. But we also need to support groups marginalised by a Digital First approach. See more about this in Regulators' Pioneer Fund project: Regulatory recognition and sharing of innovative practice by NHS GP providers to reduce health inequalities.
A shortage of dental appointments has also widened existing health inequalities. In particular for regions with few NHS dentists. Known as "dental deserts", these areas present a serious risk to the dental health of millions of patients. Currently, oral cancer and type II diabetes cases are on the rise. Dentists could detect these diseases earlier if everyone had access to regular dental check-ups.
Evidence gathered from CQC inspections and stakeholders highlights areas of good practice, for example:
- have an up-to-date directory of services (DOS) for an area. It should be accessible by providers and people who use services.
- include inequality boards within governance structures, including UEC boards.
- create inequality and diversity champions in all parts of the system.
Improving workforce equality, diversion and inclusion
Partner organisations also need clear strategies to overcome disparities in workforce equality, diversity and inclusion. They can achieve this through positive culture change and support for their staff. People working in social care settings may not have the same terms and conditions as healthcare workers. They are also more likely to come from a lower socio-economic group and have other protected characteristics. See further details in the Department of Health and Social Care’s Adult social care workforce survey: December 2021 report.
Useful resources
Build Back Fairer: The COVID-19 Marmot Review
Royal College of Physicians (RCP), The NHS ‘Road to Recovery’: Ethical guidance for endemic COVID-19
Key suggestions
- Ensure directories of services (DOS) explicitly address people with protected characteristics.
- Develop and design services in coproduction with local communities. Create pathways that meet the needs of people at place and neighbourhood level.
- Irrespective of diversity demographics, consider the creation of:
- equality and diversity champions at operational levels
- diversity boards within governance structures.
- Create an inclusive workforce culture that supports diversity and equality in senior roles.
- Give people information in a suitable, easy-to-understand format.
- Increase education and training support across the whole system. This improves access to good quality training for all staff.
- Assess how the delivery of different models of care may worsen health inequalities, perhaps inadvertently. Take into account:
- various options for commissioning models and agreements at the integrated care board level.
- reduction of disparities between urban and rural areas.
- Recognise and understand how inequalities and deprivation affect different neighbourhoods and places within integrated care systems. Respond accordingly across the system.
Examples of good practice and innovation
Population health and health inequalities steering group
North East London Integrated Care Board (ICB)
North East London has high levels of deprivation and health inequalities. To face these challenges the ICB has set up a steering group that provides strategic leadership for:
- population health management
- reducing health inequalities.
Their successes include a reduction in vaccine inequality. This was achieved using data analysis, local interventions and outreach.
Tackling inequalities in health care access, experience and outcomes
NHS England
This guidance contains many useful case studies that highlight good practice in this field. See the full document tackling inequalities in health care access, experience and outcomes.