A planning matrix has been developed to help NHS colleagues assess how their work is helping to reduce health inequalities and ensure high quality healthcare for all.

The Healthcare Inequalities Improvement Planning Matrix outlines key areas for consideration when services are designed, implemented, and evaluated. The matrix is being used by national NHS programme and workstreams leads, and service leads at a regional, system and provider level. It helps to ensure that programmes do not widen healthcare inequalities and covers the seven key areas described below.

1. Equitable access

Some groups or communities may be disproportionately affected by barriers to accessing healthcare. Using the same approach for all groups will be inadequate to fully address inequalities.

Consideration should be given to:

• the accessibility of information; access to services and support and digital inclusion
• the impact of a policy or service on different groups that may experience barriers to accessing support.

Groups that may be disproportionately affected by barriers to access include those living in the most deprived areas and socially excluded groups. This is the focus of, Core20PLUS5, NHS England’s approach to narrow health inequalities at a national and system level. The approach identifies a target population group of the Core 20% most deprived populations nationally and those which experience poorer than average health access, experience and/or outcomes across their communities. Target groups will often include inclusion health groups such as people experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups. Other target groups may include coastal communities, people with multi-morbidities, and groups that share protected characteristics.

2. Data and modelling

• Data and modelling should inform a targeted, proactive approach to narrowing healthcare inequalities.
• Data collection, analysis, presentation and reporting should be conducted in ways that reveal potential inequalities.
• Service models should be designed to support equitable access, especially for underserved people and communities.
• Models should have in-built agility so they can be reconfigured rapidly in response to any emerging inequalities in access, experience and/or outcomes.

The Healthcare Inequalities Improvement Dashboard brings together healthcare inequalities indicators across NHS England programmes to help users understand where healthcare inequalities exist, what is driving them, and how improvements can be made. A range of other data resources are also available to inform action.

Programmes are also encouraged to use data gathered from patient surveys and staff feedback to deliver services that are safe, effective, and continuously improving.

3. Co-produced delivery models

Engaging people with lived experiences when designing a service or policy helps to make sure services reflect the diverse needs of different populations. Legal duties and principles for public involvement should guide engagement approaches.

4. Community participatory research

Co-designing and co-producing research with people from diverse backgrounds will help to strengthen the useful insight. Recruitment methods should actively engage diverse groups and must not exclude any population groups.

5. Culturally competent communication

Communications on a national, regional, system, and local scale must be culturally competent and sensitive. When communicating to different audiences, programmes should:

• ensure the message is delivered in an authentic, relatable way from credible and relatable voices
• make sure messages are culturally appropriate and is in the right tone and/or language
• consider whether translation and/or interpretation services are needed
• engage with groups that know the target audience and work with them to co-create messages and content, for example community organisations, religious groups, voluntary groups and charities.

6. Multi-agency support

Partnership working between the voluntary sector, local government, and the NHS is important to improve care for people and communities. Programmes can refer to The Health and Wellbeing Alliance for more information on relevant networks to engage with around this.

7. Health Equity Audits

Health Equity Audits (HEAs) can be used to identify healthcare inequalities in different population groups. HEAs should be undertaken at the beginning of a project or policy design process to ensure the findings support targeted action to reduce healthcare inequalities in certain populations. The Equality and Health Inequalities Impact Assessment (EHIA) assists decision makers to make informed decisions on if their policy, proposition, programme, proposal or initiative meets the necessary equality duties.

Information on the legal duties on equality and health inequalities is available here.

The National Healthcare Inequalities Improvement Programme can provide further support and advice; please email england.healthinequalities@nhs.net

Healthcare professionals who are registered members of the Equality and Health Inequalities Network Future NHS platform can see the matrix in full at Healthcare Inequalities Improvement Planning Matrix – Equality and Health Inequalities Network – FutureNHS Collaboration Platform