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Supporting Health Inequalities Leads on NHS Boards

Over the past few years, we’ve seen an increasing reliance in the NHS on the ‘named lead’ – a policy exercise whereby an individual, usually at board level, is nominated to lead on a priority area of work. The theory is that making an individual responsible for change will create a sense of more focused attention and provide committed leadership.


In summer 2020, NHS England and NHS Improvement (2020a, b) asked all NHS organisations to take several urgent actions to make progress on health inequalities and prevention. This included identifying a ‘named executive boardlevel lead for tackling inequalities’ (referred to as HI leads hereafter) by October 2020. The NHS Race and Health Observatory commissioned this mixed-methods study in April 2021, to provide a basis for planning what support would enable HI leads to create impact through their roles.

Key reccomendations:

To support HI leads and their teams to create impact, we recommend that NHS England and NHS Improvement
put in place/continue to provide the following.

    • An induction offer including role guides, example activities and measures, and
      signposting to knowledge and support resources. These could be co-produced
      with HI leads based on their experience so far.
    • National and local action learning sets to develop capability and explore
      the specific challenges HI leads are facing. These could be developed into
      communities of practice or learning/improvement collaboratives, as the start of a
      social movement within the health and care system.
    • A repository of high-quality evidence, knowledge resources, methods and
      regularly updated case studies that reflect the progress that’s being made.
      These could be tailored to different professional groups and, in time, could be
      supplemented by facilitated reading or study groups and a non-mandatory
      qualification for those who wish to take their learning further.

Further, if addressing inequalities is one priority among many that board members are dealing with, these recommendations are likely to have more impact if there is a clear political and policy commitment to working on inequalities. We therefore also recommend the following.

    • A long-term policy focus and a cross-government strategy that places
      addressing inequalities at the heart of system development. This could include
      establishing HI leads as critical members of emerging integrated care system
      (ICS) structures, eg, within place-based partnerships.
    • An enabling accountability framework that puts inequalities on an equal footing
      with the most important performance metrics, and encourages innovation and
      experimentation to reflect the complex nature of inequalities. While potentially
      involving significant changes in local, regional and national approaches to
      managing performance, this may give more weight to the effort being made by
      those who are already more engaged, while also helping to overcome scepticism
      about the longevity of the current focus on inequalities.

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