Tackling inequalities

Services and systems have an opportunity to learn from new ways of working that have been put in place during the first wave of the pandemic. It is important that new pathways and practices are developed in ways that reduce health inequalities and improve people’s lives. The fact that the impact of COVID has been felt more severely by those who were already likely to have poorer health outcomes, including people from Black and minority ethnic backgrounds, disabled people and people living in more deprived areas, makes the need for health and care services to be designed around people’s needs all the more critical.

People must have access to person-centred care that is based on individuals’ needs. Local systems need to work together to identify where there are differences in outcomes for different groups, what the causes are for these differences and how they relate to individual needs. Local systems and providers must then take action to make sure people have their needs met and gaps in outcomes reduced.

In writing to NHS trusts, GP practices and commissioners in July about the continuing response to COVID-19, the NHS chief executive and chief operating officer put a great emphasis on action to reduce inequalities. We agree that this needs to be a key feature of the months ahead.

We have seen some examples of promotion of equality already happening, mostly by anticipating where inequality might arise. For example, one NHS trust realised that people from South Asian communities might need targeted information, advice and support to encourage people to continue using healthcare services with a ‘no visitor’ policy. The trust organised a proactive campaign using community radio and TV and through voluntary organisations. They strengthened their bilingual support services to relatives and raised the profile of their chaplaincy provision, to provide a strong conduit between patients and their loved ones, particularly when patients were at the end of their life.

Occasionally improvements to equality have been as a result of unintended positive consequences, from changes brought in during the pandemic. These improvements will only have a lasting impact if services take time to assess these changes on equality and human rights for people.

For example, in one care home for people with multiple health conditions and disabilities, changes to the way professionals visit the service as a result of coronavirus have resulted in more free time for people living at the home, giving them more choice and control over their lives. The residents decided they would like to have at least one day a week where no visiting professionals come to the home, even once pandemic conditions have eased. The manager is planning to put this in place, and they expect this to have benefits beyond improving people’s choices around their leisure time. This includes being able to move staffing resources from dealing with visitors to providing direct care, and refocusing meetings with professionals to concentrate more on individual people’s needs.

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Part 4: Looking forward, the challenges and opportunities ahead