As I approach the end of my first year as NHS England’s Director of Health Inequalities, I reflect upon the many people I have connected with on this journey so far. My priority above all else during my first months in post was to listen and understand the perspectives of the people in and outside of the NHS, experts by experience, and community trailblazers, unified by a determination to tackle the unfair and unjust health inequalities that persist in our society.

It is out of these conversations that the Health Inequalities Improvement team vision grew:

Exceptional quality healthcare for all through equitable access, excellent experience, and optimal outcomes.

Our vision is not new, rather it is a remembering of the very principles upon which our health service was founded. For this reason, I know that this vision is one which unites all of us who work for, and believe in, the NHS.

However, I also know that the scale of our task to eliminate health inequalities can feel daunting, particularly in the wake of the COVID-19 pandemic and given the exacerbation of the wider determinants of health; employment, household income, education etc. When I speak to colleagues in integrated care systems (ICSs), perhaps the biggest obstacle in the way of tackling health inequalities is the challenge of knowing where to begin. Against the vast expanse of the health inequalities landscape, the task is to focus and gain traction, leading to real, tangible impacts on reducing health inequalities.

The Core20PLUS5 approach is being developed specifically to meet this need. In a nutshell, it asks for focus on the target population of the 20% most deprived population by the Index of Multiple Deprivation – the ‘Core 20’ of the national population, ‘PLUS’ ICS-determined groups experiencing poorer than average access, experience or outcomes from healthcare and ‘5’ clinical focus areas with the greatest opportunities to narrow the current gap in life expectancy due to health inequalities.

It is hoped that the Core20PLUS5 approach will support ICSs to prioritise energy, attention and resources in a way that enables the biggest possible impact. Like our team vision, it is not a new set of priorities, but instead it distils our NHS Long Term Plan commitments on tackling health inequalities into clear and focused areas which have the biggest opportunities to narrow the health inequality gap.

Core20PLUS5 represents one element of the wider NHS contribution to an established body of efforts by local authorities, communities and the voluntary, community and social enterprise (VCSE) sectors to tackle health inequalities. It asks ICSs to work in partnership with these agencies and people in their communities to build from the learning gained during the COVID-19 pandemic, which harnessed community collaboration, system networks, partnerships and relationships to ensure the equitable deployment of the COVID-19 vaccine.

I am proud to say that the Core20PLUS5 approach has been developed collaboratively through an extensive programme of engagement which began with those early conversations, advanced with bespoke events for key stakeholders, and now continues with a new online survey; enabling us to engage with as many people as possible on the approach.

Where we are now with Core20PLUS5 represents the collective wisdom of the people we have engaged in the process so far; many of whom have been working tirelessly to make a difference in this space. Their input has been so important and valuable, and I am excited to see how we can further improve the approach, its implementation and our future engagement plans on the back of the survey responses.

I urge you to share your views with us on Core20PLUS5 by completing our survey so that we can continue to work collaboratively to ensure exceptional quality healthcare for all through equitable access, excellent experience, and optimal outcomes. Our survey is open until Friday 19 November 2021.

Download a PDF of the above Core20PLUS5 infographic