Acute providers

• creating outreach programmes and health hubs
• creating workstreams and capturing health inequalities data on staff
• using a Health Equity Assessment Tool (HEAT) to show the difference capturing data has made and what processes may need to change for long-term outcomes
• developing a maturity matrix
• developing HEAT audits, particularly around addressing backlogs, to help highlight key messages and inform approaches for systematic and sustained reporting
• applying population-based indices
• wait time initiatives and prioritisation for those with learning disabilities
• having an engaged chief executive and Chair and good reporting activity
• looking at those that do not attend (DNAs) as part of the pack that goes to board.

Acute/community providers

• creating waiting room initiatives, prioritising those with learning disabilities and integrating the system for surgery waiting lists (e.g., ortho) to target patients that are more in need
• using this leadership framework to understand their performance reports through a health inequalities/equality lens
• launching a new strategy and placing health outcomes and inequalities right at the top of the agenda
• measuring measure activity versus outcomes
• aiming to ensure people use primary care more to work towards prevention and overuse of secondary care by that those facing inequalities in health
• seeking to improve special category data to identify improvement opportunities. The visualisation of the power BI dashboard was helpful as that potentially provides a means to identify areas for further exploration proactively.

Mental health/learning disability providers

• prioritising patient and community equity framework work with the black community
• looking at the trust alongside the community and community representatives
• using a model that includes staff, local community and local care representatives to deliver a productive model with shared objectives
• using power BI tools to help with board reporting and dashboards
• working with improvement colleagues and training the team to be health inequality champions.

Community providers

• working with experts and the Kings Fund to co-produce a health inequalities animation, this was shared with the trust and within the region
• embedding health inequalities and hitting all the targets
• measuring the number, type and quality of the reasonable adjustment
• undertaking an engagement piece looking at with patients that had reasonable adjustments and how their experience was
• using quality improvement approaches, including the use of power BI
• creating a health inequalities dashboard
• focusing on reasonable adjustments
• focusing on learning disabilities and autism as a standard.

ICBs

• supporting the Equality Delivery System framework as a template for providers to address health inequalities and looking at what those reports should look like to feed assurance to the board
• assurance can be improved through better reporting.

Acute/community providers

• Culture change is important, not just reporting.

Community providers

• The greatest challenge is how much people don’t want to change, but it is important to keep focus and don't give up, push through and support colleagues. Once they do first one or two becomes easier.

Acute providers

• There is a lot of enthusiasm for health inequalities, but culture change is easier said than done.

Community providers

• There is a strong focus by the system on place strategies, but this is less reflected in the provider with little data and little focus at board. Blank tables on performance reports come to board in relation to health inequalities and core metrics are not being captured.
• The board regularly asks for benchmarking on Accessible Information Standard (AIS) but this is not available.
• Guidance on demographic breakdown is needed.
• There needs to be more guidance on dashboards. Challenge around whether trusts should be developing individual dashboards or agreeing at a high level the top actions, and that these are streamlined and centralised.

Acute providers

• Health inequalities workstreams and data on staff is good, with lots of data coming to board where leaders are actively keeping an eye on metrics. However, the data on patients is less good – the problems are clear in the data, but this needs to be targeted to move the dial.
• There are challenges when trying to capture data on ethnicity. The data has helped prioritise clinical need – but there needs to be practical piece related. to board reporting to help demonstrate this impact.
• The measures of effectiveness need to be more process based as outcomes will be much further down the line. Data helps to evidence where process need to change and how this will impact outcomes but also that some measures are long-term.
• Sharing a board means that providers are at a bit of a standstill. Providers are being asked to think about an integrated performance scorecard. This is difficult when there are different levels of maturity across different trusts.
• The pack that goes to board monthly on ethnicity, ethnicity completion rates, waiting times for elective care and variations by ethnicity, deprivation, and gender is limited. A lot more data gets reported to board sub committees on regular basis, about quality and equity of care.
• There is no overview of the work being done collectively or measure of impact on metrics related to health inequalities more generally.
• There is no dashboard and the data is too broad.

Acute/community providers

• There is not enough being done to analyse the underlying position, meaning the board cannot know what is contributing positively or negatively to health inequalities. The board made the decision to push those with learning disabilities to the front of the waiting list to address one aspect of health inequalities for those individuals. However, there is not enough oversight on this to see if there is a positive or negative impact on health inequalities more broadly and this is not addressing other protected characteristics.
• There needs to be a better idea of how to move to firmer outcomes and benchmarks.
• There is a challenge around the effort and time that goes into presenting to the board versus spending that time and effort working at service delivery level. There seems to be a trade off at higher level discussions and how far it spreads across the organisation.
• Reporting is not going to the board – governance needs to be integrated.

Mental health/learning disability providers

• Consultants are requested by the ICB to submit quality assurance work, but this requires large amount of time that may or may not go towards positive/negative impact. This could assist towards the quality of data available towards improved assurance but challenges around direction and whether it is just a tick-box exercise, or is being actioned authentically.
• There is a need for simplicity and clarity in data, the data needs to be able to tell the story.

Acute providers

• There needs to be a focus on assurance around the quality of data.
• The role of communities in describing what assurance looks like needs to be explored. The community needs to be assured that what the boards are doing is right in this space. Trusts should explore - what does good look like to the community?
• It is hard to deliver metrics that allow the board to see what’s going on. Boards are having to learn to think about new kinds of risk now – they are used to having full control of the risk they are trying to manage.
• The role of the board assurance framework (BAF) risks needs to be considered. When health inequalities were recognised as a BAF risk, this has triggered a lot more activity and enthusiasm – having it separately captured in that way has supported a lot of necessary scrutiny to get things moving.

Acute/community providers

• There is a question on what the board wants assurance on. The board should also focus on how to upskill staff to understand system health inequalities issues and how they can help to address prevention in health inequalities, not just the board looking at data on population health metrics. Receiving outcomes is important but providers should take broader perspectives on patient care and health.

ICBs

• The board should be questioning themselves on what actions have they have made at each meeting that is gaining assurance in service of each of the four key focus areas of systems re population health. Framing the conversation always to lead back to health inequalities aims of the system.
• Plans for the ICB to address better assurance levels at provider level are unclear, but is the ICB in a position to do that without their house in order? Does that feel appropriate, or would that be the ICB parenting the provider?

Community providers

• The role of communities in describing assurance needs to be considered, even if it is hard to show metrics on progress. If it is not the experience of communities, then should Board really be assured?