In our 2021 report, we described how people living in more deprived areas have poorer access to planned hospital care than their more affluent counterparts. These deficits are widespread, substantial, and worsening. In this report, we move beyond describing and explaining the problem, providing practical support for those keen to address it. We start from the premise that inequities are not immutable. Tackling the issue will not be easy, but it is essential if the NHS is to be true to its founding principles. Efforts to date have clearly not been sufficient. Bolder action and more potent interventions are required.

The report is primarily aimed at integrated care board (ICB) members. Is addressing inequities in planned hospital care a priority for your organisation? If it is, then we hope this report will help. How much additional care, and of what type, would be required to ‘level-up’ access to planned hospital procedures? Is levelling-up the only solution? What interventions exist that might help reduce inequities? How might an ICB go about setting its strategy? And once set, how should the strategy be monitored? These are the questions addressed by this report.


Update 10th August 2022: 

To help ICBs and others in taking the insights from this report into action, we have commissioned some further perspectives on the possible strategies described. The first of these is a publication from colleagues at Hill Dickinson which provides an up-to-date overview of the legal duties placed upon ICB decision makers in relation to reducing inequalities and then considers the range of possible strategies proposed in our report from that legal perspective.

Briefing note for Integrated Care Boards on legal duties in respect of reducing inequalities


Update 10th November 2022: 

The second publication is an Ethics review produced by Angie Hobbs – the world’s first Professor in the Public Understanding of Philosophy – this paper examines the ethical questions raised by our report outlining strategies for reducing inequity.

Professor Hobbs looks at our suggested strategies with the eye of a professional philosopher, asking: what ethical tensions and issues might arise by following these strategies? How can they be overcome?

Her headline finding is that all the strategies suggested in our work are viable from an ethical perspective. And she goes further, outlining a process for decision making which – if followed with care, thoughtfulness and humility – should give Integrated Care Boards (ICBs) and hospital trusts confidence in making ethically thorny choices.

Reducing inequities in planned care: An Ethics Review for Integrated Care Boards