Reducing Health Inequalities in England

Professor Bola Owolabi

Director, Health Inequalities at NHS England and NHS Improvement

Professor Owolabi discusses her passion to tackle health inequalities and the work of NHS England’s Core20PLUS5 programme to make a real difference.

My ambition to reduce health inequalities comes from a personal place. At 17, living in Nigeria, I started university. I had been inspired to study medicine by a doctor who treated me when I was nine – she was kind and I wanted to be just like her.

But life had other plans, my father was made redundant, my mother became ill and all of a sudden, everything was different. I watched my mother deteriorate and become a shadow of her beautiful self. Suddenly, I had gone from being a teenager in a middle-class, financially stable, healthy family with the world open wide, to a frightened medical student struggling to find the money to book a doctor’s appointment, and the doors to my future closed shut.

With common insulin beyond our means, my mother’s condition declined. She was admitted to hospital, fell into a diabetic coma and died at 48 years old. This was not because she had an incurable illness, but because we could not afford access to timely, quality medical help.

My story, and that of my parents, will not be like the story of anyone who is born in the UK today. Out of the rubble of the second world war, we agreed, as a nation, that access to health – free and at the point of need – was a basic right.

However, the issue of health inequality was still soon identified, as it became clear that there were disparities in access and outcomes for different groups under the same National Health Service.

The impact of the pandemic

When the pandemic struck, it highlighted and exacerbated the health and wider inequalities that persist in our communities. The virus itself has had a disproportionate effect on certain sections of the population. This includes ethnic minority communities, the most deprived groups, people with learning disabilities, those with severe mental illness and inclusion health groups.

COVID-19 has firmly pushed health inequalities up the priority list of health leaders and politicians alike. Now that we have their attention, we must take the specific measurable actions that we know can make a real difference to the life chances of the many people who have been underserved for a long time.

Healthcare inequalities do not start and stop with the pandemic. Black women in the UK are four times more likely to die in pregnancy or childbirth, the healthy life expectancy gap between the most and least deprived communities is 19.6 years and people with a learning disability have a life expectancy gap of 15 years compared to the average population. Facts like these led to an NHS commitment to review funding allocations based on health inequalities and unmet needs.

I was delighted to be appointed as NHS England’s first Director for Healthcare Inequalities Improvement at the end of 2020. This is an important signal of the NHS’ commitment to tackling this issue.

Since then, my team and I have been working with other programmes and policy areas across the NHS and partners in the wider system to deliver our team’s vision of exceptional quality healthcare – ensuring equitable access, excellent experience and optimal outcomes for all.

My team’s role is principally threefold; setting direction, creating a positive improvement culture and working with others to ensure that we deliver the commitments set out in the long-term plan and in the NHS’ response to the COVID-19 pandemic.

Speaking to colleagues in integrated care systems (ICSs), one of the biggest obstacles that is in the way of tackling health inequalities is the challenge of knowing where to begin. Against the vast expanse of the health inequalities landscape, the task is to focus and gain traction, leading to real, tangible impacts on reducing health inequalities.

NHS England’s official approach to reducing health inequalities was specifically developed to meet this need. It is called Core20PLUS5. In a nutshell, it asks for a focus on the target population of the 20% most deprived population by the Index of Multiple Deprivation – the ‘Core 20’ of the national population, ‘PLUS’ ICS-determined groups experiencing poorer than average access, experience or outcomes from healthcare and the ‘5’ clinical focus areas with the greatest opportunities to narrow the current gap in life expectancy due to health inequalities; maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension.

Core20PLUS5 reducing health inequalities

Since launch, we have seen the national Core20PLUS5 approach to reducing healthcare inequalities gain traction across the NHS and beyond; and in 2023, we expect to see continued progress in the delivery and support to help systems implement the approach further. This includes a:

• Core20PLUS Connectors Programme, which seeks to recruit, mobilise and support influential community connectors to take practical action to improve health and reduce inequalities.

• Newly launched Core20PLUS Ambassadors Programme, which has recruited over 100 NHS staff to act as healthcare inequalities improvement ambassadors – helping to raise awareness and spread good practice.

• Core20PLUS Collaborative – a partnership between NHS England, the Institute for Healthcare Improvement (IHI) and the Health Foundation, which offers Integrated Care Systems the opportunity to become healthcare inequalities accelerator sites.

The Core20PLUS5 approach has also been recently adapted for use in children and young people’s services and will focus on clinical areas including asthma, diabetes, epilepsy, oral health and mental health.

Underpinning all our work is a strong focus on quality improvement, with a real emphasis on data for improvement, strengths-based approaches and co-production with communities, patients and service users.

We need to ensure that interventions are driven by real-time, coherent and comprehensive data – enabling us to measure what is happening and the impact we are having. Therefore, we have created a Healthcare Inequalities Improvement Dashboard. The dashboard measures, monitors and informs actionable insights to make improvements to narrowing health inequalities. It covers the five priority areas for narrowing healthcare inequalities in the 2021-22 planning guidance. It also covers data relating to the five clinical areas in our Core20PLUS5 approach.

By providing data cut by ethnicity and deprivation, the dashboard will enable the NHS to take concerted action to improve health inequalities.

Work to reduce healthcare inequalities is also being demonstrated to support other NHS pressures, such as elective care recovery and pressures on A&E. It can also boost wider economic growth and increase productivity.

Time of great opportunity

This is a time of great opportunity, and I am committed to working with colleagues across our organisation and beyond. This includes parliamentarians, whom I am pleased we have been working with across several All-Party Parliamentary Groups, including those for Sickle Cell and Women’s Health.

I want to generate a dialogue where people are included, involved and inspired to take action on reducing health inequalities. I look forward to continuing to engage with all levels of the Government on health inequalities and the crucial role that they can play in improving the health of the nation.

Together, we can make a real difference.

Curia’s Levelling Up and NHS Innovation and Life Sciences Commissions

Following the work of policy institute Curia’s NHS Innovation and Life Sciences Commission and Levelling Up Commission in 2022, the programmes will expand in 2023 to prioritise tackling inequalities working with the public, private and independent sector to make recommendations to improve outcomes.

To find out more, contact: team@curiauk.com

Chamber Winter Journal

Professor Owolabi’s exclusive feature appears in the December edition of the 2022 Chamber journal. To download your free copy, visit here.