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.

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.

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

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

What are the NHS England strategic priorities for tackling Health Inequalities? 2 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 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

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 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. 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

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

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