This report examines current and past mechanisms and levers that enable and hinder accountability for health inequalities and analyses whether these accountability processes are sufficient to reduce health inequalities. It provides proposals to improve accountability for health inequalities across Integrated Care Systems (ICSs).  

Views were gathered from senior managers in the NHS in England with experience and expertise in health inequalities. In addition, we reviewed policy documents and relevant grey and academic publications to inform our assessment of past and current accountability mechanisms. 

Existing NHS England tools and approaches are likely to increase actions on healthcare inequalities however, they are unlikely to increase accountabilities. Many local areas have taken the initiative and created their own actions to address inequalities, and whilst this leadership is admirable, leaving actions to local leadership is not sufficient, and can risk some areas not taking effective action.  

The report finds the NHS does not have all of the levers to address the causes of health inequalities, which are found outside the health system. Nonetheless, improving accountability mechanisms in the NHS to reduce inequalities is needed, in addition to other actions, such as increasing investment and policy implementation and implementing a broad, cross-sector approach – all of these actions will reduce inequalities in the social determinants of health.

Professor David Hunter of Newcastle University, an expert with copious experience and research knowledge about NHS structures, reflects in the blog on the findings from the Improving Accountability in the NHS report.