Addressing health inequalities as business as usual
Health inequalities peer learning event, held on 11 February 2025.
This event brought together trust and system leaders, alongside operational and equity leads, to discuss the barriers and enablers for addressing health inequalities as business as usual.
About the event
In March 2024, we published a guide for NHS trust board members on reducing health inequalities. Designed to support trust board members to address health inequalities as part of their core business, the guide includes a vision for what good looks like, a list of suggested objectives for board members and a self-assessment.
As we approach a year since publication of the guide, this peer learning event provided an opportunity to reflect on what has worked well in terms of local implementation of the guide, and what is needed to further encourage action to reduce health inequalities as business as usual.
Speakers during the event shared case studies from trusts and systems that have utilised the guide to enact positive change and interventions – including setting up local communities of practice and implementing health inequalities action plans.
Chair: Jenny Reindorp – director of development and engagement, NHS Providers
Speakers:
Rachael McKeown – policy advisor, NHS Providers
Professor Bola Owolabi – director, national healthcare inequalities improvement programme, NHS England
Christine Camacho – public health consultant, Northern Care Alliance
Jessica Berry – associate director, personalised care and head of health inequalities, NHS Hampshire and Isle of Wight integrated care board
Key themes from the event
This event offered an interactive discussion space for attendees to share learnings, challenges and opportunities experienced at their respective organisations. The event was not recorded, however, anonymised key themes from the event are summarised below.
Overall, it is clear that trusts are prioritising action on health inequalities, with many setting up working groups and developing priorities on specific areas to guide their work. Leadership around health inequalities emerged as a key theme for encouraging action at board level. However, barriers to progress remain, including funding and resource constraints and achieving cultural buy-in across organisations.
- Embedding health inequalities within the organisational strategy.
- Some trusts have developed specific action plans.
- Establishing a steering group / committee on health inequalities.
- This enables a focus on specific workstreams or action areas.
- These groups have been particularly effective where they feed into the board committee structure.
- It can be helpful to have a Terms of Reference (ToR) for health inequalities groups.
- Dedicated health inequalities roles or teams within the trust, which are able to operationalise health inequalities initiatives.
- Implementing training on health inequalities across the organisation, including awareness sessions for staff, and specific board development sessions on health inequalities.
- Working closely with communities and community partners to understand patient need.
- In one trust, board members have undertaken visits to understand patient experience of inequalities, which has provided inspiration to act as an advocate.
- Collaboration with wider system partners, such as integrated care boards (ICBs), the Voluntary, Community and Social Enterprise (VCSE) sector and local authorities.
- Some trusts are connected to their ICB level health inequalities working groups.
- One trust has developed a local toolkit for staff to learn about inequalities and understand their responsibility in tackling them.
- One trust commissioned an independent review of their approach to tackling health inequalities, with recommendations for the board. This helped them to develop a health equity plan and secure resources for delivery.
- Focusing on specific areas, such as:
- Digital inclusion
- Interpretation services
- Data and the development of health inequalities dashboards
- Learning disabilities
- High intensity use services in urgent care
- Sickle cell disease
- Did Not Attend (DNA) rates
- Smoking cessation
- Oral health
- Health literacy
- Bringing together the intersection between health inequalities and equality, diversity and inclusion (EDI).
- It takes time to embed activity on health inequalities within an organisation, many trusts still feel that they are in the infancy of their work.
- Demonstrating the impact of health inequalities initiatives is crucial, but challenging to provide the evidence of what is having an impact.
- Difficulties shifting the culture and getting buy-in from all staff.
- Awareness and understanding of the topic area can be limited in places.
- A number of trusts would like clinical services to take greater ownership for embedding health inequalities in their work.
- Limited resource and workforce capacity.
- Non-recurrent funding for initiatives is unsustainable and means that some initiatives are short-term.
- In particular, lack of resource within data and Business Intelligence (BI) teams limits the extent to which trusts can utilise their data to better understand the inequalities in their area and patient populations.
- Varying levels of system collaboration, with frustrations around lack of shared information on health inequalities at the broader system level in some places.
- Meaningful engagement with patients and communities is not always informing health inequalities initiatives.
Additional resources
- Event slides
- Association of Ambulance Chief Executives (AACE): health inequalities consensus statement
- NHS England: elective reform plan
- NHS Confederation: leadership framework for health inequalities improvement