Ellie Carter, Shelford Senior Policy Fellow, writes about the work The Shelford Group is doing to reduce inequalities in clinical care, following on from a roundtable held with our Trusts in partnership with NHS England.
On 4 April the Shelford Group Medical Directors hosted a multidisciplinary roundtable with Prof Bola Owolabi, a GP and director of the national healthcare inequalities improvement programme at NHS England. Against a backdrop of Bola’s national vision to ensure ‘exceptional quality healthcare for all through equitable access, excellent experience and optimal outcomes’, colleagues from across Shelford trusts shared initiatives from within their own organisations to reduce inequalities in clinical care.
National approach to addressing healthcare inequalities
At the end of 2020, NHS England appointed Prof Bola Owolabi as their director of healthcare inequalities improvement. Driven by a vision of ‘exceptional quality healthcare for all through equitable access, excellent experience and optimal outcomes’ her healthcare inequalities improvement team have developed Core20PLUS5. Core20PLUS5 is NHS England’s approach to supporting the reduction of healthcare inequalities at both national and system level. It defines a target population cohort and identifies ‘5’ key clinical areas of inequalities requiring accelerated improvement for both adults, and children & young people.
A series of specific asks linked to tackling heath inequalities was set out in the NHS England 2023/4 priorities and operational planning guidance. This included a requirement to implement the five key priority areas which underpin the work of the programme. Significantly, funding has already been provided through core ICB allocations to support the delivery of system plans to improve health and reduce inequalities, and the £200m of additional funding allocated for health inequalities in 2022/23 is also being made recurrent in 2023/24.
The role of Shelford in addressing health inequalities and inequalities in clinical care
The Shelford Group is a collaboration between ten of the largest teaching and research NHS hospital trusts in England, providing a comprehensive range of services from community care for local populations, to highly specialised care for patients nationwide. Our ten trusts are also ‘anchor institutions’ for their regions. As anchors their role extends significantly beyond the diagnosis and treatment of ill health, to addressing population health and inequality by influencing the wider social determinants of health (the conditions in which we are born, grow, live and work).
Whilst these wider determinants are widely recognised as accounting for the majority of health outcomes there are also significant inequalities in access to, experience of (and outcomes from) healthcare which are directly within the NHS’s control. This is where our members have been focussing their efforts – introducing initiatives specifically targeted at tackling inequalities in clinical care.
Shelford showcase
Our roundtable in April was an opportunity for Shelford colleagues to share examples of three programmes of work already underway across member trusts to reduce inequalities in clinical care.
These case studies focussed on equity of access to clinical trials, prioritisation of waiting lists and the importance of making inequality everybody’s business.
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1. Addressing the under-representation of South Asian communities in genetic research
Manchester University NHS Foundation Trust
As leaders in life sciences and research, Shelford trusts and our academic and industry partners are at the forefront of genetic research. Researchers in Manchester are undertaking a programme of work aimed at advancing our understanding of health and disease in underrepresented communities through their contribution to the Genes and Health study. To read the case study click here.
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2. Data led prioritisation: preventing harm and reducing inequalities
Guy’s & St Thomas’ NHS Foundation Trust
In January 2023 7.21 million people were waiting for elective treatment nationally. Manual prioritisation of waiting lists to identify those most in need can be inconsistent and impractical given the constraints on clinical resource, the size of the lists, and the continued demand on services. Guy’s & St Thomas’ has therefore developed a data-driven approach to prioritisation to ensure patients are prioritised equitably, according to clinical need. To read the case study click here.
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3. Improving health and equity: everybody’s business
Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust have been analysing access, outcomes and experience at the trust which revealed a number of examples of inequities across services. To begin to tackle this, they have developed their health and equality framework to improve health, wealth, wellbeing and equity within the trust’s local communities and are using improvement approaches to drive action. To read the case study click here.
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Next steps
The Shelford Group is committed to continuing our work to reducing inequalities in clinical care. We outlined it as a key aspiration in our strategy ‘Improving health outcomes for all’ published in 2021 and it remains a priority programme of work led by the Shelford Group Chief Medical Officers.