Addressing health inequalities matters Why addressing health inequalities Reducing health inequalities needs action to be taken to address all the factors that contribute to them. Harprit Hockley, Head of Equalities and Inclusion at NHS England and Improvement, outlines how we are working with our communities to take positive action As services become more integrated, our biggest opportunities to really deliver on improving population health and healthcare services are at the margins of our communities. Our vision is to ensure exceptional quality healthcare for all through equality of access, excellence in experience and optimal outcomes Dr Bola Owolabi, Director for Health Inequalities at NHS England and NHS Improvement, and keynote speaker at Leading for care integration the big collaboration last year H ealth disparities in our region are long-standing, stark and can undermine peoples ability to work and live long, healthy and independent lives1. These disparities create pressure on the NHS, social care and other public services, both in terms of population health and the impacts experienced by our own diverse workforce. By seeing our workforce and our communities through the same lens, we can improve the experiences of those accessing our services and those delivering them. Data from before the COVID-19 pandemic shows that the difference in healthy life expectancy for those born in the most deprived areas of the UK, compared with the least, amounts to almost two decades2 and the pandemic has exacerbated these health inequalities. Suggested reasons for this include housing, caring responsibilities, lack of financial safety nets and jobs that could not be moved to remote working3,4. The mortality rates from COVID-19 in the most deprived areas were more than double that of the least deprived areas5 and death rates from COVID-19 were highest among people of black and Asian ethnic groups5. As we recover from the pandemic and turn our attention to the backlog for treatment, those living in the most deprived areas are nearly twice as likely6 to wait more than a year for treatment compared with those living in the least deprived areas. I am delighted that reducing inequalities is a key part of the new strategy for Eastern AHSN and its been great seeing its work in action to partner with the NHS and the NIHR ARC, to pilot and evaluate innovations that are helping to reduce inequalities. Here are a few current examples from the past year of that commitment in practice: Leading the way in addressing health inequalities In September 2021, Eastern AHSN partnered with the East of England NHS Leadership Academy and our regions six integrated care systems (ICSs) to support the embedding of collaborative, compassionate and inclusive leadership within developing ICSs. I was delighted to be invited to lead a conversation with awardwinning journalist Afua Adom about how to talk about race and racism in a progressive way. I passionately believe that the NHS needs to continue to empower healthcare professionals to have difficult conversations and be allies and catalysts for change for underrepresented groups. We explored why people still feel uncomfortable talking about race and culture and the steps we can all take to 38% of attendees said they have made diversity and inclusion a priority following the Leading for care integration event become actively anti-racist. Dr Bola Owolabi also gave an inspiring keynote speech outlining a compelling case for the role of developing ICSs and the wider health system to address health inequalities. Read more about Leading for care integration the big collaboration here. Charlotte James, Director of Communications, Marketing and Engagement and Chair of Eastern AHSNs diversity and inclusion group Empowering patients E astern AHSNs close partnership with the East of England Citizens Senate is one of the ways it ensures citizens views are at the heart of the development of health services in our region. The integration of care will rely on a strong relationship between the healthcare system and patients and citizens with lived experience to understand the impact decisions may have on marginalised communities. Thats why the AHSN partnered with the NHS Leadership Academy to support Leading for Change, a fully funded four-day leadership programme delivered by the Citizens Senate for patient Pandemics expose fault lines in society Read Charlottes blog about our commitment to improving health equality and public voices in the NHS. The programme empowers participants by developing the skills, knowledge and behaviours to support collaborative and meaningful relationships with internal and external decision-makers. We trained 10 patient and public champions as part of the 2022 cohort. Kevin Minier, expert through lived experience: The Leading for Change programme taught me how to effectively engage in the planning and delivery of healthcare services. People like me have so much valuable experience, but so often dont know how to collaborate with clinicians and decision-makers. The programme gave me the confidence to be a critical friend and an equal partner on healthcare projects, offering a different perspective to develop better services. Strengthening inclusive leadership Eastern AHSN has been commissioned to support the design and delivery of a leadership programme for regional aspiring Chief Allied Health Professionals, with a particular focus on supporting those from ethnic minority backgrounds. As part of this programme, Eastern AHSN is developing the offer with This is a ground- breaking initiative, which has the potential to influence our approach to adaptation of innovations nationally as well as our understanding of health inequalities. staff through a series of co-design workshops. Helen Oliver, Deputy Chief Executive at Eastern AHSN, talking about the Cambridgeshire and Peterborough Adopting Innovation Hub Reducing inequalities through innovation Eastern AHSN is a partner in the set up and delivery of the new Cambridgeshire and Peterborough Adopting Innovation Hub, with its focus on implementing proven innovations to address the root causes of health inequalities facing certain communities in the county. You can read more about this programme here. Click here to read Tendais blog on how learning about different cultures can address inequalities in pregnancy Our pledges Across the AHSN Network, we have developed a set of diversity pledges that aim to deliver equality, diversity and inclusion in our leadership, our workforce and our work programmes. Locally, the Eastern AHSN diversity and inclusion working group is here to ensure everything we do is aligned to tackling health inequalities, from our recruitment practices to how we plan and deliver our programmes, how we assess innovations we come across and who we engage. Tendai Nzirawa, Maternity Clinical Improvement Lead and member of Eastern AHSNs diversity and inclusion working group. Assessing remote monitoring pathways in integrated care systems systems covering parts of Hertfordshire, Essex and Bedfordshire to explore how they support care pathways for hip and knee replacements, heart palpitations and Virtual wards and remote care solutions chronic diseases including asthma. have developed rapidly during the Eastern AHSN is supporting project COVID-19 pandemic to help clinicians governance, including project oversight, monitor peoples health at home and ensuring access to required data, reduce the need for hospital visits and establishing a lived experience advisory stays. However, with the introduction panel and leading stakeholder engagement, of technologies in healthcare there is a including the facilitation of site-specific risk of exacerbating existing inequalities steering groups and a large project related to digital literacy and access7. To oversight group. A key part of the work better understand where these inequalities will focus on understanding who is and arise and how they might affect patient is not well served by remote monitoring, outcomes, we have partnered with the and how patients are currently assessed, NIHR Applied Research Collaboration in triaged and supported. By understanding our region to assess the impact of remote how this impacts different groups, the monitoring technology on supporting findings will inform the future rollout of people with a wide range of conditions in remote monitoring to ensure inequalities the community. are accounted for and minimised so it is Remote monitoring systems are being only used where suitable. We look forward evaluated across four integrated care to sharing the results in spring 2023. Share this article Return to the contents page Supporting innovation If you have an innovation which could help us address health inequalities, get in touch Up next: Read how we are improving the prevention and management of heart conditions across the region References Williams, E., Buck, D., Babalola, G. (2020). What are health inequalities? Available: https://www.kingsfund.org.uk/publications/what-are-health-inequalities. Last accessed 19/04/22. 2 Census 2021. (2021). Health state life expectancies by national deprivation deciles, England: 2017 to 2019. Available: https://www.ons.gov.uk/ peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2017to2019. Last accessed 19/04/22. 3 Local Government Association. (2021). Health inequalities: Deprivation and poverty and COVID-19. Available: https://www.local.gov.uk/health-inequalities-deprivation-andpoverty-and-covid-19. Last accessed 19/04/22. 4 Stafford, M., Deeny, S. (2020). Inequalities and deaths involving COVID-19. Available: https://www.health.org.uk/news-and-comment/blogs/inequalities-and-deaths-involvingcovid-19. Last accessed 19/04/22. 5 Public Health England. (2020). Disparities in the risk and outcomes of COVID-19. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf. Last accessed 19/04/22. 6 Holmes, J., Jefferies, D. (2021). Tackling the elective backlog exploring the relationship between deprivation and waiting times. Available: https://www.kingsfund.org.uk/ blog/2021/09/elective-backlog-deprivation-waiting-times. Last accessed 19/04/22. 7 Litchfield, I., Shukla, D., Greenfield, S. (2021). Impact of COVID-19 on the digital divide: a rapid review. BMJ Open. 11 (10). 1