This research looks at how inequalities are addressed within a local area.
We commissioned RSM UK Consulting LLP along with Professor Rosalind Raine at University College London (UCL) and the University of Birmingham Library Services, to carry out this research, write the summary below, and the full report.
Purpose of this research
In March 2023, CQC commissioned research looking at information about how inequalities are addressed within a local area.
CQC have now been given new powers to regulate and inspect Integrated Care Systems (ICSs). ICSs being together local authorities, NHS organisations, and the voluntary and community sector. ICSs can take a view of the health and care needs of everyone in a particular area. This can help them to provide high quality care and reduce health inequalities.
RSM looked at good examples of how those responsible at an ICS area level are thinking about, supporting and meeting the needs of people who might not have equal access, experience, or outcomes from healthcare. By understanding what best practice looks like CQC can use it to inform their assessments of ICSs and consider how local systems can reduce health inequalities.
Findings from the review
Theme 1: What are effective ways of identifying local health inequalities or potential health inequalities?
Areas are complex and need different things. There are a number of different ways to use existing information to understand people’s experiences. While the research does not identify that there is one way to do it, the findings support examples of what needs to be considered to make a good decision:
- Have specific areas of health inequalities been identified?
- The use of wider determinants of health datasets
- The availability of data
Theme 2: What are the evidence-based approaches that work to address health inequalities within a local area?
Popular approaches identified from the research include:
- Asset-based or place-based approaches: these look at both physical community assets and voluntary and community organisations, and how they support communities through a range of programmes
- Proportionate universalism: this looks at allocating resources to services aimed at reducing inequalities, and increasing support based on need
- Engagement-based approaches: using people who already work closely with the local community to help produce and develop ways to engage people that are tailored to individuals or communities
Specific methods for addressing health inequalities identified from the literature focused on improving health outcomes more generally, such as by providing advice and guidance, or they looked at making changes to existing services to address barriers to access.
Making a decision on how best to meet the needs of the population and health inequalities was done whilst considering:
- Local area population
- Geographic coverage of the area
- Specifics of other interventions and existing services in the local area
Theme 3: What does successful engagement with local people and communities look like?
There are benefits of engaging local people and communities at every stage. Successful engagement includes bringing together lots of groups and hearing from a range of diverse voices to provide effective and inclusive ways of working to consider inequalities.
By including target communities and individuals in the design and development of approaches, they are shown to be more successful when implemented.
Learning for CQC
This research will help CQC with their development of assessment criteria for ICSs and how they address inequalities. To support this the research identified a list of useful themes to consider against the assessment criteria area:
Leadership
Considerations:
- Vision and understanding of the system
- Collective ownership
- Whole pathway framework
Integration
Considerations:
- Length and amount of funding
- Partnership / joint working
- Commissioning arrangements / contracting
- Wider determinants of health
- Community assets
- Population profile
Quality and safety
Considerations:
- Information governance and data sharing
- Use of data and data quality
- Co-production of services
- Engagement with communities
- Feedback from communities
- Engagement with populations at risk of inequality
Conclusions
The research has shown that there is no “one size fits all approach” identified in the literature, and that different methods are selected based on specific requirements of local areas and need. From what was available we know that tailoring the approach to different communities’ needs and perspectives are key, and that there are further areas of exploration needed to understand the long-term effectiveness of methods to address health inequalities.
Considerations for future research
Based on the evidence from the research there are some areas that could be interesting for further research. These include:
- Looking at a whole pathway framework: much of the evidence had a standalone focus, there is a gap in the evidence of looking at the links in addressing health inequalities across systems
- Improving the evaluation of interventions: looking at good practice in how to address challenges and provide robust evidence, by embedding and improving evaluation methods
- Sustainability: more research could be undertaken to focus on how successful methods can be embedded and scaled to other areas, communities, or needs
CQC could develop case studies with learning examples that can be shared with systems and others who are interested.