Supporting Health Inequalities Leads on NHS Boards

Background

In summer 2020, NHS England and NHS Improvement (2020a, b) asked all NHS organisations to take several urgent actions to make progress on health inequalities and prevention. This included identifying a ‘named executive boardlevel lead for tackling inequalities’ (referred to as HI leads hereafter) by October 2020. The NHS Race and Health Observatory commissioned this mixed-methods study in April 2021, to provide a basis for planning what support would enable HI leads to create impact through their roles.

Key reccomendations:

To support HI leads and their teams to create impact, we recommend that NHS England and NHS Improvement
put in place/continue to provide the following.

• • An induction offer including role guides, example activities and measures, and
    signposting to knowledge and support resources. These could be co-produced
    with HI leads based on their experience so far.
  • National and local action learning sets to develop capability and explore
    the specific challenges HI leads are facing. These could be developed into
    communities of practice or learning/improvement collaboratives, as the start of a
    social movement within the health and care system.
  • A repository of high-quality evidence, knowledge resources, methods and
    regularly updated case studies that reflect the progress that’s being made.
    These could be tailored to different professional groups and, in time, could be
    supplemented by facilitated reading or study groups and a non-mandatory
    qualification for those who wish to take their learning further.

Further, if addressing inequalities is one priority among many that board members are dealing with, these recommendations are likely to have more impact if there is a clear political and policy commitment to working on inequalities. We therefore also recommend the following.

• • A long-term policy focus and a cross-government strategy that places
    addressing inequalities at the heart of system development. This could include
    establishing HI leads as critical members of emerging integrated care system
    (ICS) structures, eg, within place-based partnerships.
  • An enabling accountability framework that puts inequalities on an equal footing
    with the most important performance metrics, and encourages innovation and
    experimentation to reflect the complex nature of inequalities. While potentially
    involving significant changes in local, regional and national approaches to
    managing performance, this may give more weight to the effort being made by
    those who are already more engaged, while also helping to overcome scepticism
    about the longevity of the current focus on inequalities.