3. Reducing inequalities

by Department of Health on 04 August 2010 | 6 comments

How can the proposed Outcomes Framework support equality across all groups and help reduce health inequalities?

The NHS Outcomes Framework should recognise the importance of reducing inequalities and promoting equality. For example, because of the social gradient in most health outcomes, the most potential health gain will often be available from the lower reaches of the gradient, from disadvantaged groups and areas.

Further information can be found in the consultation document on page 12, paragraph 2.17

Please add your comments below.


  1. Question 9: It is suggested that heart disease is measured as mortality, whereas cancer is measured as survivorship. Presumably this relates to the fact that it is known that heart disease can be prevented by appropriate lifestyle etc., whereas cancer cannot. Would it not be better to divide heart disease into incidence (reflecting our success in prevention) and survivorship (reflecting our success in treating established disease)

  2. HI, when I go to see any Health care professional I go to seek the best possible advice/treatment.I expect that I shall recieve the appropriate treatment. I do not accept that my socio-economic status is of any relevance t o this process as the NHs doesn’t have either the data nor the remit to concern itself with these issues. The NHS is there to treat people of their ailments ( whatever the causation) at point of need.
    It is making a gross assumption to state that issues of health care equality are important to me as a patient.I want good quality care and I do not want to be lectured about “lifestyle ” issues! Nor treated as mere statistical /sociological object.

  3. All interventions should be evidence based. It is no use implementing a policy to address disadvantage, if that policy has not been demonstrated to be effective. It is simply a waste of money. Inequalities often have a socio-ecomonic basis. Social policies may be a much more effective way of tackling health inequality than health policies.

  4. Above comments noted, but there are significant health-determining factors which have a socio-economic gradient – such as most drugs and smoking. Thus enacting (evidence-based) policies aimed at prevention and treatment of these factors (for all of society) will provide more benefit for the least advantaged, and hence reduce health inequalities.

    Furthermore, healthcare is often less accessible to more disadvantaged people – pushy educated middle-class people are more likely to be able to get themselves into any clinic, usually at the expense of a less articulate/self-confident/disenfranchised individual.

  5. Two points:
    1. Evidence based information is required as stated by others. To do this effectively requires a full understanding of the data items that need to be collected, a method of standardising that data to smooth the effect of variables related to demographics, location, etc. and a system in place to mandate the collection of the data and subsequent validation. Too often in the past decisions have been made on flawed data.
    2. Already the discussion has moved to reducing inequalities in disadvantaged groups, areas, etc. I’m all for that and applaud its socialist (with a small “s”) principles. Indeed, much work has been done by Public Health Observatories, SHAs and PCTs to identify these groups and areas (despite flawed and incomplete data) with a view to allocating resource based on need However, with “the patient” being at the centre of all that is done there will be many individuals who will expect to have an equal slice of the pie for their health care needs, regardless of the severity of their conditions, rather than see “their” money being diverted to the more needy. How will the expectations of the more selfish be managed?

  6. Some inequalities may occur in the vulnerable because poor care may be less easily discovered and corrected. This can be overcome by each patient being provided with a transparent outline of their care and the reasoning behind it so that there is a greater chance that someone else will be able to compare what is written with reality and detect any errors (see comment by Llewelyn on Principles, 11th October). This will also make writers of transparent summaries equally careful with the more vulnerable in society. If ‘transparent’ summaries are coded, various comparisons of markers of quality of care can be made between the summaries of vulnerable and non-vulnerable groups.