Investigating strengthening system accountability for addressing health inequalities
Objective
Strengthened accountability is a key lever for driving effective system level action to address health inequalities. Since the passage of the Health and Care Act in 2022, NHS England have been considering how to best improve accountability mechanisms.
NHS England commissioned the University College London (UCL) Institute of Health Equity in November 2022 to write a report on health inequalities and accountability. The initial report findings did not provide the practical focus the national team were looking for.
As a result, we were commissioned by NHS England to build on the findings from the UCL report.
What we did
The project involved two main phases of work.
Literature Review
We carried out a targeted literature review to identify key examples of NHS and non-NHS system level accountability frameworks. Over 100 references were reviewed to answer three questions:
This included stakeholder mapping and the delivery of stakeholder roundtable discussions. A total of 31 attendees were interviewed including policy advisors, system leaders and regional SROs.
We conducted interviews with Voluntary and Community Sector Alliances and representatives from the Care Quality Commission (CQC), and Office for Health Improvement and Disparities (OHID). All discussions were thematically analysed to identify key findings and emerging themes.
Literature Review
We carried out a targeted literature review to identify key examples of NHS and non-NHS system level accountability frameworks. Over 100 references were reviewed to answer three questions:
- What steers have already been given to the system for action on health inequalities?
- How can we assess if the desired action has been taken across the system?
- How can we drive up accountability for healthcare inequalities improvement to make progress in narrowing the gap?
This included stakeholder mapping and the delivery of stakeholder roundtable discussions. A total of 31 attendees were interviewed including policy advisors, system leaders and regional SROs.
We conducted interviews with Voluntary and Community Sector Alliances and representatives from the Care Quality Commission (CQC), and Office for Health Improvement and Disparities (OHID). All discussions were thematically analysed to identify key findings and emerging themes.
Activity
Health improvement and inequalities
Assessing health inequalities and accountability frameworks
Communications and engagement
Stakeholder mapping and the delivery of stakeholder roundtable discussions and interviews
System transformation
We ensured support and buy-in across the system for the overarching principles we developed
Outcome
We produced a final report which aligned our recommendations to the Hewitt Review as to how to deliver improvements to system accountability.
NHS England valued how the desktop research and findings had been collated into one place, and particularly praised the practical focus of our work.
The expertise of the team was critical to delivering this project as we had a mix of experience, including those with master’s qualifications, academic experience and writing literature reviews.
NHS England valued how the desktop research and findings had been collated into one place, and particularly praised the practical focus of our work.
The expertise of the team was critical to delivering this project as we had a mix of experience, including those with master’s qualifications, academic experience and writing literature reviews.
