My Lords, I thank the noble Baroness, Lady Thornton, for introducing this group of amendments. My name is attached to her amendments, and I have some amendments in my name; I thank noble Lords who have added their names. I will speak in particular to Amendments 11 and 14 but what the noble Baroness, Lady Thornton, said applies to other amendments, and I agree with them and have added my name to them.
Covid-19 has exposed and exacerbated existing health inequalities in England, and the Government have committed to “levelling up” the country. Progress on national NHS commitments related to reducing health inequalities has been slow in recent years, and NHS England has urged local systems to accelerate action to tackle health inequalities after the pandemic. A step change is clearly needed, yet the Bill’s current provisions on health inequalities amount to no more than the same: transposing existing inequality duties from CCGs to the new NHS ICBs.
One area where there is clearly scope for improvement is strengthening reporting on health inequalities. There is currently no explicit requirement for NHS England to publish national guidance about which performance data and indicators relevant to health inequalities should be collected, analysed and reported on by NHS bodies. The NHS’s current system oversight framework, as a means to define national priorities and monitor the overall performance of local systems, also includes little in the way of concrete measures on health inequalities, with those that are included being focused primarily on shorter-term Covid-19-related equity impacts.
The amendment in the name of the noble Baroness, Lady Thornton, addresses this. It would require NHS England to publish guidance on collecting, analysing, reporting and publishing data on all factors or indicators relevant to health inequalities. I hope the Government will commit to considering this amendment in order to drive more action on inequalities and enable better tracking of progress across different areas.
The only thing I would add to this is the NHS Priorities and Operational Planning Guidance that was published by NHS England just before Christmas—in fact, on 24 December; it could not be much nearer to Christmas. On page 6 of this, as one of the priorities for 2022-23, NHS England asks local health systems to:
“Continue to develop our approach to population health management, prevent ill-health and address health inequalities—using data and analytics to redesign care pathways and measure outcomes with a focus on improving access and health equity for underserved communities.”
It also states that in delivering all the NHS’s priorities, it intends to maintain the
“focus on … tackling health inequalities by redoubling our efforts on the five priority areas”—
already mentioned by the noble Baroness—
“set out in guidance in March 2021.”
It reiterates that ICSs will take a lead role in tackling health inequalities and notes:
“Improved data collection and reporting will drive a better understanding of local health inequalities in access to, experience of and outcomes from healthcare services, by informing the development of action plans to narrow the health inequalities gap. ICBs, once established, and trust board performance packs are therefore expected to be disaggregated by deprivation and ethnicity.”
On page 29 onwards there are further details about this.
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Amendment 11, in the name of the noble Baroness, Lady Thornton, to which I have added my name, therefore goes with the grain of current policy and would help support these efforts and put this in the legislation. Arguably, it will not be possible to do this effectively without more consistent guidance and clarity around how to measure progress on inequalities, which is what the amendment seeks to do. I am led to believe that NHS England might be supportive of this and clearly thinks it is needed to spur action.
I turn very briefly to Amendment 14, which relates to the “triple aim”. I strongly support Amendment 14 —in the name of the noble Baroness, Lady Thornton, and others—which aims to extend this. To send a clearer signal about the importance of narrowing inequalities, the triple aim should be extended so that it explicitly references the need for organisations to consider the impact of their decisions on efforts to reduce inequalities.
The Government so far have argued that addressing inequalities is already implicit in the first aspect of the triple aim—the requirement to consider the effects of decisions on the health and well-being of the population. It has clearly not been obvious to many experts and charities scrutinising the Bill. However, if it is the Government’s intention to ensure that the reduction of inequalities is prioritised, they should make this explicit in the Bill.