Tackling health inequalities in the NHS

My ambitions to reduce health inequalities comes from a personal place. At 17, living in Nigeria, I started university inspired to study medicine by a doctor who treated me when I was 9, she was kind and I wanted to be just like her.

But life had other plans, my father was made redundant, my mum became ill and all of a sudden everything was different. I watched my mother deteriorate and become a shadow of her beautiful self. Suddenly I had gone from being a teenager in a middle class, financially stable, healthy family with the world open wide, to a frightened medical student struggling to find the money to book a doctor’s appointment and the doors to my future closed shut.

With common insulin beyond our means, my mum’s condition declined. She was admitted to hospital, fell into a diabetic coma and died at 48 years old. Not because she had an incurable illness, but because we could not afford access to timely, quality medical help.

My story and that of my parents will not be like that of anyone born in the UK today, because out of the rubble of the second world war we agreed as nation that access to health, free and at the point of need was a basic right.

However, the issue of health inequality was soon identified as it became clear that there were disparities in access and outcomes for different groups from the same National Health Service.

When the pandemic struck, it cast a harsh light on these health and wider inequalities that persist in our communities. The virus itself has had a disproportionate effect on certain sections of the population; including ethnic minority communities, the most deprived, people with learning disabilities, those with severe mental illness and inclusion health groups.

COVID-19 has pushed health inequalities firmly up the priority list of health leaders and politicians alike. Now that we have their attention, we must take the specific measurable actions that we know can make a real difference to the life chances of many people who have been underserved for a long time.

I was delighted to be appointed NHS England and NHS Improvement’s Director, Health Inequalities at the end of 2020. This is an important signal of the NHS’ commitment to tackling this issue.

The Health Inequalities and Improvement Team will be working with other programmes and policy areas across NHSEI and partners in the wider system to deliver our team’s vision of exceptional quality healthcare; ensuring equitable access, excellent experience and optimal outcomes for all.

My team’s role is principally threefold; setting direction, creating a positive improvement culture and working with others to ensure that we deliver the commitments set out in the Long Term Plan and in the NHS response to the COVID-19 pandemic.

A central part of responding to COVID-19 and restoring services must be to increase the scale and pace of NHS action to tackle health inequalities to protect those at greatest risk.

A national advisory group of leaders from within and beyond the NHS identified eight urgent actions, building on the measures to implement the NHS Long Term Plan.

We are working to drive national and local action on, and support all systems and NHS organisations to implement, these eight actions. This will include working in close partnership with local government, other public services, the voluntary sector and with communities.

I have been leading this kind of community-engaged work recently in encouraging vaccine uptake with black, Asian and minority ethnic communities. I was humbled to be invited by the Prime Minister to discuss this work recently and be thanked for our efforts on behalf of the organisation.

Our health inequalities work does not stop with the COVID-19 response. Even before the pandemic, the issue of health inequality had already been identified as major issue to be addressed across the NHS and the Long Term Plan made tackling health inequalities a clear national priority. Black women in the UK are four times more likely to die in pregnancy or childbirth, the healthy life expectancy gap between the most and least deprived communities is 19.6 years and people with learning disability have a life expectancy gap of 15 years compared to the average population. Facts like these led to an NHS commitment to review funding allocations based on health inequalities and unmet need.

Underpinning all of our work is a strong focus on quality improvement with a real emphasis on data for improvement, strengths-based approaches and co-production with communities, patients and service users.

We need to ensure that interventions are driven by real-time, coherent and comprehensive data, enabling us to measure what is happening and the impact we’re having. We will be doing this through the creation of a Health Inequalities Improvement Dashboard. This quantitative data will be combined with effective community insight, and qualitative information that provide intelligence on people’s experience of healthcare; given the powerful impact that has on health outcomes and their future health seeking behaviour.

Clinical and professional leadership will be essential to taking this forward. We have already mandated all systems and each NHS organisation to have a named executive board-level lead for tackling inequalities. I am also bringing together leaders to shape our approach to strategy and delivery and bringing an evidence-based perspective as part of a National Health Inequalities Improvement Network.

This is a time of great opportunity and I am committed to working with colleagues across our organisation and beyond to generate dialogue where people are included, involved and inspired to tackle health inequalities and derive pride and joy in doing so.

Together, we can make a real difference.

Dr Bola Owolabi

Professor Bola Owolabi (MRCGP, MFPH Hon, FRSPH) is Director of the National Healthcare Inequalities Improvement Programme at NHS England. She works as a General Practitioner in the Midlands.

Bola has particular interest in reducing healthcare inequalities through integrated care models, service transformation, and using data insights for quality improvement. She has spearheaded NHS England’s Core20PLUS5 approach to narrowing healthcare inequalities.

Internationally, Bola was a member of the Danish Ambassador’s Tour De Health – a ten nation healthcare policy leaders’ summit. Additionally, she was the UK representative on the Commonwealth Fund/Academy Health Tour 2023, exploring equity in national health policy across the United States, Australia, New Zealand and Singapore.

She was previously National Speciality Advisor for Older People and Integrated Person-Centred Care at NHS England, where she led the Anticipatory Care workstream of the National Ageing Well Programme. She collaborated with teams across NHS England and the Department of Health and Social Care as part of the Covid-19 pandemic response.

Bola is an alumna of Ashridge Executive Education/Hult International Business School and holds a Masters degree with distinction in Leadership (Quality Improvement). She also received an NHS Leadership Academy Award in Executive Healthcare Leadership for Clinicians.

Bola is an Honorary Professor at the Institute of Applied Health Research, College of Medicine and Dentistry, University of Birmingham. She is also a Vice President of the Royal Society of Public Health (RSPH).