Addressing health inequalities through engagement with people and communities

A self-assessment and improvement framework for integrated care systems

Introduction

This self-assessment and improvement framework is designed to support integrated care systems (ICSs) to address health inequalities by improving their engagement with people and communities. It is a structured, flexible tool that helps ICSs to reflect on current practices, identify areas for improvement, and take strategic action to support their People and Communities Strategies and ensure compliance with the Public Sector Equality Duty.

The resource was co-designed and developed with:

• ICS leaders
• public health practitioners
• engagement experts
• voluntary, community and social enterprise (VCSE) partners
• people with lived experience.

The framework supports a whole-system approach to embedding meaningful engagement and reducing health inequalities.

ICSs can also use the learning from the process as evidence for internal or external assurance processes, where appropriate. Above all, this framework is designed to stimulate honest reflection, shared learning, and practical action planning.

Core principles

The ICS Health Inequalities Engagement Framework is underpinned by a set of core principles. These help to ensure that ICSs can apply it in a practical and meaningful way. The principles reflect the values and approaches needed to tackle health inequalities through effective, inclusive, and sustainable engagement practices.

• Co-design and co-ownership: Co-design ensures that the framework reflects real-world challenges and opportunities, while co-ownership encourages accountability and shared responsibility across all system partners. It empowers stakeholders to work collaboratively in addressing health inequalities.
• Lived experience: Meaningful engagement with people who with lived experience is essential to addressing health inequalities. This framework recognises and prioritises the unique insights of people and communities who are directly affected by health inequalities as critical to developing practical solutions that have an impact. Incorporating lived experience throughout the engagement process builds trust, fosters inclusion, and ensures that decisions are grounded in the realities of those most affected.
• Holistic engagement: Engagement goes beyond those conversations with people and communities that take place at designated meetings and events. The framework’s holistic approach emphasises the need to engage with people and communities at every stage of the decision-making process. This includes understanding community assets, barriers, and opportunities, as well as embedding engagement into strategic planning, service design, delivery, and evaluation. A holistic view ensures that engagement is not a one-off activity but a continuous and systemic practice.
• Flexibility and adaptability: Recognising the diversity of ICSs, this framework is designed to be flexible and adaptable to local contexts. It allows each ICS to tailor its approach to its unique priorities, resources, and challenges, ensuring it remains relevant and practical. The framework encourages continuous learning, improvement and innovation in addressing health inequalities.
• Equity and inclusion: The framework is based on equity and aims to reduce disparities by focusing on those most affected by health inequalities. It supports ICSs to take proactive steps to include marginalised and under-served communities, ensuring that everyone has a voice and a role in shaping services and outcomes. This principle challenges ICSs to embed equity into all levels of engagement and decision-making.
• Transparency and accountability: Transparency about engagement processes and their outcomes is vital to build trust and credibility. Clear communication about how decisions are made and how community input is used demonstrates transparency and accountability by valuing contributions and building confidence in shared goals.