Our approach to reducing healthcare inequalities

The NHS Long Term Plan placed tackling health inequalities at the heart of NHS goals for this decade. The big population health improvement goals can only be met through far better engagement with those least likely to present at NHS services now.

Furthermore, COVID-19 has shone a harsh light on some of the health and wider inequalities that persist in our society.  Guidance issued by NHS England in response to the COVID-19 pandemic, set out eight urgent actions for tackling health inequalities. This was later refined to five key priority areas which underpin the work of the National Healthcare Inequalities Improvement Programme (HiQiP).  These include:

  • restoring NHS services inclusively
  • mitigating against digital exclusion
  • ensuring datasets are complete and timely
  • accelerating preventative programmes
  • strengthening leadership and accountability.

Our approach is to work as a super-matrix across all NHS England programmes and policy areas, and the NHS more broadly, to hardwire healthcare inequalities improvement into our strategies, policies, initiatives and programmes.

The programme’s vision is exceptional quality healthcare for all ensuring equitable access, excellent experience and optimal outcomes.

Our most intensive work to date has been working with COVID-19 Vaccine Equalities team to drive equitable uptake of the COVID-19 vaccines and with the Elective Recovery team to create the conditions for an inclusive restoration of our elective waiting list.

From a clinical perspective, we are driving forward the evidence based Core20PLUS5 framework which defines key population groups and clinical focus areas for accelerated improvement in healthcare inequalities.

A number of initiatives are in development to support a social movement ethos including the introduction of Core20PLUS ambassadors and Core20PLUSConnectors.

We have also developed the Health Inequalities Improvement Dashboard  which brings together key strategic indicators in one place, enabling NHS services to take targeted action to reduce inequalities.

Most of the fundamental factors driving inequalities in health are beyond the responsibility of the health care system, for example our education system; economic and community development in our most deprived neighbourhoods; employment levels; pay and conditions; and availability and quality of housing.

The NHS contributes to tackling inequalities in health in three distinct ways.

  1. Influencing multi-agency action to address social determinants of health
    The role of integrated care systems (ICSs) working with local authorities and local communities is particularly critical here. Nationally NHS England will continue to work alongside the Government and the Office for Health Improvement and Disparities. We can also forge new international partnerships such as that between the NHS Race and Health Observatory and the US Centre for Disease Control.
  2. The NHS is a significant economic actor in its own right
    The choices we make as an employer, a purchaser and a local ‘anchor institution’ can help moderate inequalities.
  3. Tackling inequalities in healthcare provision
    This is our direct responsibility and must be the prime focus of our action. The enduring mission of the NHS is high quality care for all. That means tackling the relative disparities in access to services, patient experience and healthcare outcomes.

Great work is happening across a number of organisations to address healthcare inequalities and we are committed to working with our partners to further enhance and accelerate this.