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What we do

  • Last modified date:
    23 November 2009


The Health Inequalities National Support Team (HINST) has provided support to Spearhead PCTs and local health partnerships since January 2007. Following the Secretary of State report ‘Health Inequalities: Progress and Next Steps’ (see link below), the team expanded to enable support to be offered to all Spearhead areas.

The HINST focuses on the National Public Health Service Agreements aimed at reducing the gap in life expectancy by 10% and mortality from the major killers between the quintile of local authorities with the greatest burden and the national average by 2010 (as outlined in relevant documents such as Choosing Health, Department of Health national priorities and the NHS Operating Framework for 2007/08). This quintile, identified as local authorities with a combination of factors including high levels of deprivation, relatively low life expectancy and high mortality rates for major killers such as heart disease and cancer, are known as the Spearhead communities.

The diagnostic work of the HINST seeks to identify the strengths within local health partnerships to form the basis of the recommendations from the visit, which will help the area to move forward in reducing inequalities in health.


In October 2009, the HINST began work on an Enhanced Support Programme (see link below). Core to this programme is the Priority Action List, drawn together initially on the basis of HINST experience from its many Spearhead visits. This list, in the light of experience, plausibility and a core of available evidence, encompasses actions which could be expected to make an impact on mortality in a short timescale

In 2009 the HINST have also begun to visit non-spearhead areas completing a number of visits to areas in the West Midlands.

Work is going on to tie the future work of the team into the Marmot review (see link below) and already workshops have been developed which look at approaches to wider determinants of health, which will impact on health inequalities in the medium and long term. Workshops include:

  • Low Income, Debt and Health
  • Employment
  • Housing and Health

Process overview

The team uses a diagnostic model to help local areas identify the key interventions they can implement in order to succeed.  The three categories of intervention are:

  • population
  • personal health; and
  • community health

The HINST team then helps local areas identify interventions that can improve service outcomes and how local populations can use and be supported to use those services.

You can find further information on this diagnostic model in the HINST Publication – Systematically Addressing Health Inequalities. (see link below).

The theoretical ‘Christmas Tree’ delivery framework outlines practical steps that can be taken to hit health inequalities targets and has been used by the HINST as the basis of its diagnostics. 

It has also been used to develop a series of detailed workbooks, which are the basis of half day workshops that are run during NST visits.  Current workbooks include:

  • Cardiovascular disease
  • Diabetes
  • Cancer
  • Tobacco control
  • Infant mortality
  • Seasonal excess deaths
  • Chronic obstructive pulmonary disease
  • Alcohol harm reduction
  • Low income, debt and health
  • Employment

During a visit to an area the HINST also holds a number of 1:1 discussions with key stakeholders and runs a Focus Group to explore approaches to and examples of Community Engagement.

The HINST also provides follow up support to areas through the provision of ongoing support, interim management, social marketing training and visioning events.

The HINST have engaged in a number of regional events to market and share learning with Government Office and Strategic Health Authority (SHA) colleagues, PCT and Local Authority Chief Executives and Directors of Public Health directly.

The HINST have produced a number of high impact change guides, communication tools and good practice publications to enable shared learning across England

The HINST approach

The HINST support visits focus equally on identifying strengths and good practice and making tailored recommendations on how to address gaps in planning and delivery. 

The HINST offers a consultancy style service in relation to delivery.  Our aim is to     demystify; we identify real problems and practical, pragmatic solutions.  We provide expert knowledge in relation to evidence of what works and signpost to examples of good or interesting practice from elsewhere. 

Our recommendations are bespoke and tailor made to fit the area.  The feedback reports that we produce are finalised and completed within the visit week, saving the area considerable time in identifying ways forward.  These reports are detailed and comprehensive and raise the profile of issues in the area particularly with senior management. 

The HINST aims to build self-esteem and self-belief that delivery is possible.

Achieving percentage change in population health

Programme characteristics will include being:

Evidence based:  concentrate on interventions where research findings and professional consensus are strongest

Outcomes orientated:  with measurements locally relevant and locally owned

Systematically applied: not depending on exceptional circumstances and exceptional champions

Scaled up appropriately:   “industrial scale” processes require different thinking to small “ bench experiments”

Appropriately resourced:  refocus on core budgets and services rather than short bursts of project funding

Persistent:  continue for the long haul, capitalising on, but not dependant on fads, fashion and policy priorities

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