Addressing health inequalities through engagement with people and communities

Aims and benefits

The self-assessment and improvement framework is designed to support improvement – not assurance. It supports your ICS to have honest conversations, discover learning, and develop practical actions to improve how you tackle health inequalities through partnership with people and communities. Although it is not primarily designed as an assurance tool, you may use outputs from assessments for both internal and external assurance purposes.

The framework is optional – it is not mandatory. It is designed to add value across your system, enabling you to address health inequalities effectively. You can adapt how you use it according to your needs and priorities.

Unlike other engagement tools, this framework is focused on health inequalities. It specifically supports ICSs to engage people and communities in reducing health inequalities, in line with the national Core20PLUS5 approach as well as their legal obligations under the Public Sector Equality Duty. Every decision and activity within an ICS can either address or worsen health inequalities, making this framework relevant across all system functions.

While primarily designed for strategic leadership, the framework can also be applied operationally at both system and place levels. The key is to define whether you are working at a strategic or operationallevel at each stage.

Use across the engagement cycle. You can use this framework at any stage of the engagement process, from planning and delivery to evaluation and learning. It is not only for retrospective review but for iterative improvement that reflects the dynamic and non-linear nature of engagement.

The framework is flexible and adaptable. You can develop how you use it to meet your system’s needs. Avoid viewing it as a rigid or prescriptive tool.

Owners, enablers and champions

Any ICS can use the framework as it’s designed to be flexible and applicable to a range of priorities, workstreams, and projects at all system levels.

Many system partners need to be involved in addressing health inequalities and delivering equitable outcomes. But the strategic use of the framework within a review and improvement process must be championed by leaders across the ICS, ensuring that addressing health inequalities remains a core priority.

Successful pilots of this framework were often led by staff in management and/or director level positions, characterised by an ability to foster strong relationships across the system. This included collaboration with leaders in the VCSE sector, people with lived experience, community representatives, and colleagues across health and care, including senior leadership, commissioners, and providers.

To ensure buy-in at a senior level and to drive system-wide culture change, it is essential to appoint an executive lead to oversee the implementation of the framework. This role champions the importance of meaningful engagement and health inequalities as system priorities, ensures alignment with ICS strategies, and provides clear accountability for progress.

A whole-system approach

This framework supports and requires a whole-system approach. It encourages collaboration between ICS leaders, providers, VCSE organisations, and communities by providing a shared structure for planning, reflection, and action, helping to align efforts to reduce health inequalities.

The target audience is not just engagement and health inequalities teams, but anyone with knowledge of, and capacity to address, health inequalities experienced in the communities served by the ICS. However, the ICS needs to enable the process of using the framework and the degree of involvement will vary across stakeholders.

To illustrate this, the following RACI (Responsible, Accountable, Consulted, and Informed) matrix shows examples of stakeholders in each category. (Note: this is not a full list and may not directly reflect roles and responsibilities within your system.)

Responsible: Who is responsible for getting the work done?

• Integrated care executive teams
• Community engagement teams
• Health inequalities teams
• Engagement practitioners
• Public health practitioners

Accountable: Who oversees the task?

• Integrated care board (ICB)
• Integrated care partnership (ICP)
• Finance teams
• Provider collaborative board
• Local authority board

Consulted: Who needs to assist to complete a task with additional information or support?

• Patients and people using services
• Families and carers 
• Healthcare providers
• Social care and support providers
• VCSE organisations 
• Healthwatch

Informed: Who needs to be kept up to date on the progress of a task or deliverable?

• Wider population
• Councillors
• Education providers
• Housing associations
• Faith leaders

Approaches to implementation

There is no prescribed way to use this framework. You can use it to reflect and prioritise actions, build on existing strengths and identify quick wins to improve engagement in the short term, while developing a long-term plan to address gaps in collaboration with partners, communities, and system leads.

During the pilot phase, ICS test sites adopted a range of effective approaches to implement it, as the following examples show.

• Purpose-established working group: One ICS formed a dedicated working group led by the ICB’s Associate Director for Community Involvement. This group initially focused on a specific engagement workstream, using the framework to assess current activities. This process helped identify gaps in engagement with certain communities and in applying engagement findings to service improvements. The group began action planning to address these gaps, aligning the framework with existing workstreams to strengthen integration.
• Pre-existing advisory groups and forums: Another ICS embedded the framework into existing advisory groups and engagement forums for people and communities, such as groups with lived experience and VCSE groups. These groups conducted both self-assessments and peer assessments using the framework. This process enabled learning and action planning, such as improving the collection and analysis of demographic engagement data to better serve marginalised communities. The ICS’s next steps include aligning the framework with its ICS People and Communities Strategy and securing senior leadership champions to drive action planning and review.
• Insights and engagement team ownership: In one test site, the Insights and Engagement team took ownership of the framework. They began by self-assessing several access and awareness projects from the past year. This highlighted opportunities to improve how to use insights in service improvement and provision, as well as how to measure the impact. The team’s long-term objective is to secure support from senior leaders for using the framework to develop a strategic approach that unites engagement, community involvement, and health inequalities functions with operational service planning and delivery.

Features of successful approaches

Successful approaches to implementing the framework share key characteristics:

• Combining existing expertise in engagement, health inequalities, lived experience, and system partnership working.
• Establishing and strengthening partnerships with new stakeholders.
• Ensuring alignment with ICS People and Communities Strategies to drive governance, action planning, and review.

At its core, successful use of the framework promotes meaningful reflection, avoids duplication of work, and supports sustainable use of resources.

Practical tips for using the framework

The framework is designed to support developing activity at any stage. You can begin at any of the 7 phases to match your current needs, priorities and capacity. It allows you to focus on specific areas where improvement is needed while maintaining a whole-system view. For example, you may wish to:

• use it retrospectively to review past projects and identify lessons learned;
• apply it prospectively to strategically plan future engagement activities;
• continuously capture evidence of your activities and include them in existing reporting processes or develop new ones as needed.

Your resources: If you have limited resources, start small by focusing on one phase or improvement area that aligns with your immediate priorities. Use the framework to identify existing assets and resources, so you can build on these sustainably over time rather than starting from scratch.

Involving communities: Pilots showed that VCSE organisations and community representatives bring invaluable insights. You can use simplified tools, such as checklists or discussion guides to involve communities in reviewing, planning, or implementing engagement activities.

Measuring success: You can measure how well your engagement aligns with addressing health inequalities. This includes improvements in identifying affected populations, amplifying community voices, and translating engagement into meaningful changes in services and outcomes.

How often to use the framework: The framework is designed for ongoing use as part of a continuous improvement cycle. You can apply it regularly at different stages of planning, delivery, and evaluation to ensure continuous progress in addressing health inequalities.

Supporting resources

An online resource hub will accompany the framework. This will provide practical examples, case studies, tools, and templates to help you get the most out of the framework for your ICS.