NHSG strategic theme to improve health and reduce inequalities
Work in progress
Enabling a health improving and inequalities sensitive organisation
WHAT?
‘Enabling a health improving and inequalities sensitive organisation’ supports the
implementation of NHSG’s vision.1
OUTCOMES?
Global, UK, Scottish and local fiscal reductions, of unique scale in the modern era, are affecting all
agencies, their policies and services. The health needs of the population of Grampian are
increasing. All agencies require to do more with less. Targeting those most in need and
streamlining services demand an increasingly focused approach.
A health improving and inequalities sensitive organisation has the strategic capacity and
capability, as part of a wider partnership approach, to deliver long term solutions to have the
following outcomes:

Sustained and improved health outcomes;

Identified and reduced inequalities in access and use of services;

Identified and reduced gap in health outcomes between the advantaged and
disadvantaged.
OUTPUTS?
Agreed key milestones mark continuous improvement in NHSG’s journey as a ‘health improving
and inequalities sensitive’ organisation. Developing the ‘map’ together will allow us to agree
more refined milestones and measures, giving us confidence in the direction of travel.
Short term:
 NHSG Board, Executive team and other key players have built their own capacity and
capability to address health inequalities strategically and be better equipped to lead the
system.
 NHSG has the fundamental structural mechanisms to underpin its journey as a health
improving and inequalities sensitive organisation;
 Initial milestones are reflected in NHSG’s corporate objectives, implemented through
sector plans and monitored through sector scorecards.
 The substantive contributions of other NHSG programmes and workstreams, the specific
contribution of public sector partnerships and our corporate and sector relationships
with partners, are clear and consistent.
 An accessible, evolving, Public Health intelligence system informs, and supports
monitoring of progress.
Medium term (3-5 years):
 More refined performance measures benchmark progress;
1To
support the implementation of NHSG’s vision (2008) six programme boards and five strategic theme groups
were established. The cross-cutting strategic themes are : Improving the public’s health and reducing
inequalities; Delivering safe, effective and timely care in the right place; Involving patients, public, staff and
partners towards mutuality (including improving the patient’s experience);Developing the workforce and
empowering staff; Improving efficiency, productivity and sustainability. The Programme Boards are: Long Term
Conditions; Mental Health; Better care Without Delay; City Primary Care Redesign; Health Campus;
Intermediate Care.
LLB 1/12
NHSG strategic theme to improve health and reduce inequalities
Work in progress
 More refined decision-making frameworks take account of health inequalities;
 There is evidence of a mainstreamed, systematic, evidence-based approach, to
improving health and reducing inequalities in all NHSG’s policy making, planning,
programming, resource allocation, partnership working and practice.
 NHSG staff have increased capacity and capability, demonstrating the key
characteristics - behavioural, technical and cultural - which underpin an organisation
which is increasingly health improving and inequalities sensitive.
 Learning from local and national pathfinders on addressing inequality, including NHSG’s
response to Equally Well, is increasingly reflected in the Health and Care Framework and
is evident in organizational practices.
Long term (10-15 years):
 Improving health and reducing health inequalities is routine in high quality delivery of
healthcare.
 NHSG and public sector partners deliver distinctive, sustained and seamless
services which ensure improving health and reducing inequalities.
 There is evidence that, inter alia, the health of all of the population of Grampian, is
improving; longer life, with added quality, and inequalities as the exception, rather
than the rule.
WHO?
In delivering, or supporting the delivery, of quality healthcare NHSG staff in priority settings2 have a
clearly defined role to improve health and reduce inequalities.
HOW?
By harnessing expertise and commitment, routinely, to ensure longer life, with added quality, we
will ensure health inequalities are the exception, rather than the rule.
By targeting the needs of the most disadvantaged and threading our response(s) consistently
through our delivery of care and support systems - including our intelligence, corporate
objectives, policy making, planning, programming, outcome agreements, resource allocation,
partnership working and practice - we will improve the ways in which we support patients.
NHSG will play a lead role in systematically, through the Health and Care Framework, improving
health outcomes for the whole population, working across sectors to develop a coherent,
integrated approach as a health improving and inequalities sensitive organization, by:
 Reviewing and sharing current knowledge and existing relevant activity across
NHSG and with partners;
 Increasing understanding of opportunities and leverage within NHSG;
 Increasing understanding of opportunities and leverage with Community Planning
Partners (CPPs);
 Identifying priority settings and services;
 Continuously improving the quality (equity) of services;
 Improving and streamlining infrastructure for prevention, signposting and
referral within patient pathways;
 Implementing outcome planning;
 Influencing the North East Public Sector Group on common approaches to health;
 Identifying and implementing relevant performance measures;
2
Priority settings are those in which evidence on the patient group, the prevalence of presentations or the nature of the
service make a case for action which is likely to improve health outcomes, ensure improved and access to or more
appropriate use of, NHS or partners’ services.
LLB 1/12
NHSG strategic theme to improve health and reduce inequalities










Work in progress
Developing streamlined performance systems
Generating an improved, accessible Public Health evidence base3;
Piloting innovative approaches within re-design to address the needs of vulnerable
groups;
Implementing evidence-based interventions consistently across NHSG;
Strengthening individual, service and sector capacity and capability;
Equipping staff at all levels with needs-based guidance, training and tools;
Strengthening our communications across, as well as within, sectors;
Continuously improving our approach to mutuality;
Aligning our resources with strategic objectives.
Complementing the evolving Health and Well-Being Framework
Agreeing those components to address across the system, and those best addressed at sector
level, will result in clear actions to address known health inequalities ensuring local ownership,
strategic connection, and effective delivery.
WHERE?
Across all sectors, Managed Clinical Networks, services, corporate functions, programme boards
and strategic themes within NHSG, and in common cause with Community Planning Partners.
WITH WHAT?
Our key asset is our staff, bringing about the behavioural, cultural and technical change to
achieve long term solutions to reducing inequalities as integral to the provision of high quality
healthcare.
Building our own capacity, and the capacity of our patients, will support NHSG to tackle population,
as well as individual, health.
Assessing impacts on health, as well as healthcare, in the way we plan and deliver services, will
target resource with increasing effectiveness.
Agreeing a network of strategic and operational leads to support key pieces of work will
provide the visibility and the drive currently required to develop a systems approach which
is routed in practice.
Glossary
The goals of an inequalities sensitive health service are outlined in Equally Well4, as
adopted by NHS Greater Glasgow and Clyde. These include knowing and understanding a
diverse population, a diverse workforce, and the nature of inequality and discrimination;
reallocating available resources and managing performance to take explicit account of
these.
Health outcomes can be defined as ‘change in the health status of an individual, group or
population… attributable to a planned intervention or series of interventions, regardless of
3
NHSG’s evolving Data Directory is at:
https://web.nhs.net/owa/redir.aspx?C=56249242b25443d09dae08b1514e060d&URL=http%3a%2f%2fintranet.
grampian.scot.nhs.uk%2fccc_nhsg%2f14072.html
4
Equally Well Review 2010: Report by the Ministerial Task Force on implementing Equally Well, the Early Years
Framework and Achieving Our Potential
LLB 1/12
NHSG strategic theme to improve health and reduce inequalities
Work in progress
whether such an intervention was intended to change health
status.’http://www.who.int/entity/healthpromotion/about/HPR%20Glossary%201998.pdf
Advantaged and disadvantaged whether through socioeconomic factors and /or life
circumstances to frame ends of a spectrum (McIntyre, S et a 2010).
Health inequalities = Poorer health outcomes, access to and or use of services
associated with specific geographic location or specific characteristics such as
socioeconomic disadvantage, age, gender, disability, ethnicity, faith.
Dr Linda Leighton-Beck
Head of Social Inclusion
Public Health
LLB 1/12
NHSG strategic theme to improve health and reduce inequalities
LLB 1/12
Work in progress