Reporting on health inequalities to NHS Trust Boards

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Reporting on health inequalities to NHS Trust boards

NHS England (NHSE) and ICBs have both statutory obligations and strategic imperatives to contribute to the reduction in health inequalities among the population.

A key strategic priority, ensuring the inclusive recovery of NHS services, sets out the need to improve board-level reporting on health inequalities.

NHSE asked for ICBs and Trusts to:

Use their data to plan the inclusive restoration of services, guided by local evidence
Publish board papers that include an analysis of waiting times disaggregated by ethnicity and deprivation
Demonstrate how the ICS’s senior responsible officer (SRO) for health inequalities will work with the board and partner organisations to use local population data to identify the needs of communities experiencing inequalities in access, experience and outcomes
Improve data collection and reporting will drive a better understanding of local health inequalities in access to, experience of and outcomes from healthcare services

NHSE commissioned us to produce a deep dive into board performance through a series of case studies with the aim of understanding the data challenges further, assessing whether trusts and systems feel they are currently reporting to a high standard, and identifying solutions that have been put in place.

Download the summary report (PDF)

Case studies

With support from the Provider Public Health Network, we conducted a series of interviews with eight Trusts from a range of different provider types – Acute, Community, and Ambulance.

Mid and South Essex NHS Trust has worked with its local partners to develop a digital tool to ensure Equality Health Impact Assessments (EHIAs) are completed in a more timely and accurate manner.

The tool is set to go live in October 2023, with testing completed in July 2023 showing its implementation will result in a number of quality improvements.

This includes:

driving forward compliance among staff with the EHIA process
increasing the proportion of EHIAs being actioned and impacts understood
increasing the robustness of reporting to provide reassurance to Boards that health inequalities are being appropriately considered in change plans.

Download the full case study PDF

Learnings

1

Trusts have used data to inform their decision-making and this has provided valuable insight as well as a fresh focus on health inequalities.

2

There is a lot of useful learning as organisations develop their thinking which provides a good opportunity for sharing information and building relationships or collaborations.

3

People are motivated to make real change and aren’t interested in going through the motions of tick-box exercises. They want practical, useful tools to help them take practical action to address health inequalities.

Overall, the eight case studies demonstrate that trusts are using a diverse range of approaches to report on the progress and impact of improvements in addressing health inequalities. It should be recognised the case studies are at various levels of maturity in the implementation of their approaches.

RFL started with a high-level, exploratory analysis to identify inequalities and then developed iterative methodologies to identify which of these inequalities was statistically significant and to identify the causes of these inequalities.

Senior leadership buy-in and support from Executive, the Medical Director being responsible for Health Inequalities reporting and Clinical Transformation and Communications team being fully committed have been key.

The strong leadership has been crucial to the support of the development and delivery of the reducing inequalities work to date. It is a real positive that leaders, as well as colleagues, fly the flag for equity.

Strong partnerships: system-wide working and linking with key stakeholders and establishing relationships across the region (Northeast) such as Health Care Public Health Network, Directors of Public Health network, Secondary care consultants can all support learning from and contribute to a system-wide approach.

Another key to improving equity is to seek out clinicians who are passionate about making change in their services. For example, a Consultant Endocrinologist was worried about a potential relationship between deprivation and lack of access to insulin pumps. Their theory that patients from more deprived postcodes were less likely to obtain an insulin pump was confirmed and the Trust were able to address the inequity.

Further resources

NHS Providers resources on health inequalities
NHS England‘s suite of inequalities-related case studies
Complementary work on inclusive elective care recovery carried out by The Strategy Unit
Provider Public Health Network: For any membership or other enquiries, please complete this form. The Provider Public Health Network is an independent forum, supported by the NHS England national Public Health Team.
NHS England - Making data count

Using data

Tackling health inequalities with effective data and insight (NHS Providers)
The Healthcare Inequalities Improvement Dashboard (NHS England)
OHID Acute Trust Catchment Populations Microsoft Power BI Dashboard

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