Health Inequalities: An NHS
England Perspective
Ruth Passman and Ray Avery
Equality and Health Inequalities
Team, NHS England
The NHS Constitution and Mandate
• Everyone counts . We maximise our resources for
the benefit of the whole community, and make
sure nobody is excluded, discriminated against or
left behind.
• An ambition for excellent care…for everyone
regardless of income, location, age, gender,
ethnicity or any other characteristic.
• Yet across these groups there are still too many
longstanding and unjustifiable variations in access
to services, in the quality of care, and in health
outcomes for patients.
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Legal duties – Health and Social Care Act
• NHS England and CCGs have duties to have regard to the need to reduce
inequalities in access to health services and the outcomes for patients.
• Secretary of State has a duty to have regard to the need to reduce
inequalities covering his NHS and public health functions for the whole
population.
• NHS England, CCGs and Monitor have further duties around integration of
health services, health-related services or social care services where they
consider this would reduce inequalities.
• The Act also contains duties around health inequalities on, variously, SofS,
NHS England and CCGs concerning planning, reporting and assessment.
• NHS England is required to meet the public sector Equality Duty of the
Equality Act 2010, and is supporting CCGs to do the same.
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Health Equity
• Health equity refers to the absence of disparities
in controllable or remediable aspects of health.
• Health inequity refers to unwarranted differences
in the quality of health and healthcare across
different populations
• Differences in the presence of disease, health
outcomes, or access to health care between
populations with a different race, ethnicity, sexual
orientation or socioeconomic status
• Vertical equity, the principle that individuals should
be treated differently according to their level of
need - distributional justice
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Working for Health Equity
• The role of health professionals in working for a fairer
distribution of health (Marmot)
• -influencing wider social and economic factors beyond
ensuring equity of access and treatment.
• initiate and develop services that take into account,
and attempt to improve, the wider social context for
patients and staff
• Recommendations for workforce, education and
training, working with individuals, communities and in
partnership, workforce as advocates
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What are the NHS England strategic
priorities for tackling Health
Inequalities?
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6 Equality Partners Presentation: Ruth Passman: June 2014
NHS England Strategic Priorities
• The 9 strategic priorities reflect the different roles of NHS
England and was approved by the Board in December 13
• NHS England’s role as a system leader
• NHS England as a commissioner
• NHS England as an employer
They include:
• Robust Data to measure equality and health inequalities,
determine priorities and drive improvement
• Resource allocation to support the duties around
7 inequalities
The Strategic Priorities (cont’d)
• Incentivise and prioritise improvements in primary care
towards communities and groups who experience
inequalities in healthcare and outcomes
• Embed equality and tackling health inequalities into NHS
England CCG assurance regime
• Remove derogations which permit geographic variations in
care standards
• Support the reduction of mental illness inequalities through
the parity of esteem programme
• Programme Board for Equality and Health Inequalities
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System data to measure equality and
health inequalities
• Expand and improve data available to measure equality and
health inequalities
• A National Equality and Health Inequalities data group has
been established to determine data collection, monitoring
and dissemination requirements and drive delivery within
NHS England and the wider system
• Information Standard proposal for the definition and
monitoring of protected characteristics/ disaggregation of
key data collections
Current priorities
• Provide expertise in the development, management and
delivery of operational process, policies, and strategies for
tackling health inequalities and promoting equality, ensuring
robust alignment with the activity of the organisation.
Current priorities
• Drive and refine current organisational arrangements for
meeting the health inequalities duties, working
collaboratively to devise improvements across a broad area
of activity to meet the needs of the organisation.
• Improving Access to, experience of and outcomes from
healthcare for ‘Inclusion Health Groups’.
• Patient, Public Voice and co-production
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Partnership working
• Department of Health
• Public Health England
• Clinical Commissioning Groups
• NHS Commissioning Assembly
• Local Government Association
• Academic Institutions for example
• Kings Fund
• Institute for Health Equity
• Kings College London
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Some current areas of influence
• Inclusion Health policy, models and challenges
• Inequalities lens- Information Sharing to Tackle
Violence
• Equality monitoring – coding, questions, practice
• Co-production and upward mentoring
• Commissioning to tackle Health Inequalities
• Workforce Race Equality Standard
• Wider equalities programme
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