Leeds Beckett research reveals how NHS health inequalities funding is used

The research was led by Professor Mark Gamsu and Professor Anne-Marie Bagnall at Leeds Beckett University, in collaboration with the NHS Confederation, Clarity and the Care Quality Commission. The project looked into how the £200million per year made available by NHS England for ICSs to tackle health inequalities is being used. The team explored examples of best practice, and areas that support and hinder positive change.

Professor Mark Gamsu in the School of Health at Leeds Beckett University explained: “In 2022/23, the £200million funding was specifically ring-fenced to be spent on health inequalities. In subsequent years, it has been built into the NHS funding allocation but is not ring-fenced. This research was instigated after my independent analysis of the three ICSs in Yorkshire showed significantly different approaches to how this funding was used in 2022/23. In a climate where the NHS is under tremendous pressure in terms of demand and funding, it is particularly important that this funding is still available to support work on addressing health inequalities.”

The researchers interviewed 20 of the 42 Integrated Care Board (ICB) health inequality leads in England. They were all determined to develop meaningful programmes of action to address health inequalities in their ICSs. They felt that strong leadership, and the development of trust and relationships within the ICS and the community, were more important than the funding being ring-fenced by NHS England.

The researchers found that almost all ICBs used all or some of the funding for its intended purpose - with half of the ICBs interviewed ringfencing it in its entirety. Seven put some of the allocation into health inequalities projects and some into the wider system budget, and three put all of the allocation into the wider system budget.

The interviews showed a wide variation in how the funding was used. In almost all cases ICBs used it to instigate a range of different actions:

• Setting out principles around what the money is for;
• Using it as a catalyst for innovation around quality improvement;
• Commissioning pilot programmes which, for some, resulted in further funding being secured;
• Employing more staff to support and monitor health inequalities actions;
• Building skills within the ICS – including creating academies to support staff and partners in the voluntary, community and social enterprise (VCSE) sector to learn about health inequalities and how they can help.

Professor Gamsu said: “It is important to recognise that ICBs are still very new organisations – they were established in July 2022 to replace clinical commissioning groups. Relationships are still being formed, and health inequality is a complicated issue that requires focussed strategic action over time. But, we did hear hopeful examples of action from those we interviewed.”

The ICB health inequality leads reported four key areas that are supporting them to progress:

• Strong and engaged leadership at the top of the organisation – This gives health inequality leads the ability to access the full funding and raise the profile of their work;
• Structure – Many ICBs created new structures – such as health inequalities committees and groups – to bring people together and raise awareness;
• Relationship building and shared learning – For example, one ICS is working with Barnardo’s and the Institute for Health Equity on the mental health and wellbeing of children, speaking with 300 young people to make sure that their experience informs the work.
• Catalytic funding - the ongoing commitment to the recurrent funding is needed and welcomed.

The biggest barrier felt by the health inequality leads was the gap between NHS England’s priorities and the core purpose of the ICBs. Some leads said they felt it was a fight to keep health inequalities as a priority against the focus given by NHS England on short-term operational issues. 

Professor Gamsu said: “These short-term issues, particularly when enforced through rapid ‘must do’ letters from NHS England, were felt to cut across and unbalance the ICB work to tackle health inequalities – which is one of their four core purposes.”

The report sets out a number of recommendations to government, national regulators such as the Care Quality Commission, NHS England and the ICSs. These include:

• Developing a cross-government strategy to reduce health inequalities;
• The Prime Minister leading a national mission for health improvement;
• Ensuring that central initiatives, such as NHS IMPACT, align with the four statutory purposes of ICSs, including tackling inequalities;
• Ensuring that ICSs access peer support forums and networks and support the sharing of good practice and progress.