How fair is your local NHS? Monitoring socioeconomic inequalities in health care within local clinical commissioning groups

Policy Briefing How fair is your local NHS (PDF , 187kb)

In England, socioeconomically advantaged people achieve better health care outcomes (e.g. surgical mortality, preventable hospitalisation), use more NHS preventive care, such as screening and vaccination services, are more likely to visit a medical specialist when ill, are more likely to receive a needed NHS hip or knee replacement, and have shorter NHS waiting times for heart bypass and angioplasty. 

The Health and Social Care Act 2012 gives local NHS Clinical Commissioning Groups the duty “to have regard to the need to (a) reduce inequalities between patients with respect to their ability to access health services, and (b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services”. 

The CHE equity group has developed prototype equity indicators to support this duty. These indicators could be used by the NHS to find out whether some CCGs are succeeding better than others at reducing socioeconomic inequalities in health care access and outcomes, and to monitor whether such inequalities are getting larger or smaller over time. This would enable CCGs to discharge the NHS inequalities duty in a more meaningful and evidence-informed manner, and to learn lessons about more effective ways of reducing health care inequalities. 

Our indicators measure social inequality gradients in health care within CCGs, and then compare this statistically with the national average inequality gradient. This enables us to identify whether a particular CCG is doing better or worse than England as a whole at reducing health care inequalities. This information could be used by the NHS to support quality improvement efforts, learn lessons about how to improve health care quality for all social groups, and share those lessons across the NHS. 

This is independent work-in-progress research funded from Jan 2013 to Dec 2015 by the NIHR Health Services and Delivery Research (HSDR) Programme (project number 11/2004/39), entitled “Developing indicators of change in NHS equity performance”. The core project team at the University of York comprises Richard Cookson (lead investigator), Miqdad Asaria and Shehzad Ali, and the co-investigators are Rosalind Raine (UCL), Mauro Laudicella (City), Maria Goddard (York), Brian Ferguson (PHE), Robert Fleetcroft (UEA), Peter Goldblatt (UCL). The findings from this work have not yet been published, though dissemination work is under way. Scientific papers are currently being written up and submitted for publication, a full draft report will be submitted to the NIHR in January 2016, and a final report will be published around July 2016. The opinions expressed in this Policy Briefing do not reflect those of NIHR, the NHS, or the Department of Health.