What Yorkshire Integrated Care Systems are doing with their inequalities funding
What do you do when you are allocated a tiny amount of funding to tackle a long standing and complex problem? There must be a temptation to spend it on other pressing challenges … on the basis that the funding would not make a great deal of difference anyway.
I think that this is one the dilemmas that integrated care systems faced when each received some funding specifically to address inequalities.
This spreadsheet shows the funding allocated to each integrated care system in England for 2022 – 2023, page two shows the specific funding allocated to address health inequalities.
The thinking behind this funding is set out in this document.
In Yorkshire the total funding to specifically tackle health inequalities was just over £22 million in 22/23. This sounds a lot – but equates to just under a quarter of one percent of total NHS spend.
Just to note I might have misinterpreted some figures – but I think my data is broadly correct – get in touch if you know better!
More positively this is recurrent funding with quite broad criteria with regard to how it is used, this could provide an opportunity to develop strategic levers for system change.
So, lets have a look at how each of the three Integrated care systems decided to use their allocation. I have had responses to a Freedom of information request from each ICB in Yorkshire.
The full response for each ICB can be read below, I recommend reading the West Yorkshire one in particular because it is the most considered and comprehensive.
I have tried to summarise these responses in the table below
Summary for each ICB
West Yorkshire
Have well established structures, active involvement of a range of stakeholders including the local NHS, Local Government and the VCSE. Their actions are consistent with the Core20plus5 NHSE model. They have a decentralised model which balances local actions with sub regional activity when this is more appropriate.
Humber and North Yorkshire
Half of the funding has been used to underpin their financial plan. I interpret this as contributing to addressing the financial security (deficits) within the system. While I do not agree with using this funding in this way – I do welcome their honesty in declaring this. The approach they are taking with the remaining funding is consistent with some of the priorities within Core20plus5 but is quite narrow.
South Yorkshire
As the table above shows, South Yorkshire ICB approach feels vague. They are not able to identify their spending plans for this year – and now have less than 3 months to commit. It is hard to see how they will get the money out of the door. From the response it looks as though they are more focussed on next year. Unlike the other two ICBs it is hard to see what specific structures they have in place to drive this work forward.
Actions
Read this
Given the significant variation in actions across the three ICB in Yorkshire it is very likely that this inconsistency is reflected across England as a whole. This muddled approach is consistent with the findings of a piece of work by Olivera et al which flags up that work in local health care systems on inequalities is characterised by vagueness, lack of clarity and lack of commitment to action. This report is a must read for NHSEI and for integrated care boards.
More accountablity
It is very concerning that Integrated Care Boards are able to use this funding to address wider system funding problems by in effect raiding a tiny fund which is specifically allocated to develop actions to improve the health of the most disadvantaged. This is precisely the sort of behaviour that creates and deepens inequality. NHSEI need to establish clearer requirements to ensure that ICBs are held to account for decisions they take both locally and nationally.
Theory of Change
As the Olivera paper notes there is a real lack of clarity about what actions will have the greatest strategic impact and indeed what is meant by health inequalities. It does feel as though there is a lack of rigour here. There should be a clear requirement for Integrated Care Boards to each develop a 5 year theory of change which should underpin their health inequalities strategies.
What do you think?
Do you have regional information on health spending per capita?
Regards
Hi John – its a good question – and I was considering looking at that – but I try to keep my blogs to less than 800 words. I think the data is all available – so I might return to it shortly
Hi Mark, an interesting article highlighting the vastly different approaches being taken in different areas. It would be great if you could share your FoI request and we can look at submitting it locally. You can contact me on mark@cambridgecvs.org.uk. Cheers
Hi there Mark – I have dropped you an email with the information – do get in touch if you don’t get it or need further information – all the best – Mark
Thanks, Mark. NHS and wider HSC provider approach to reducing inequal (and improving PH) has three key parts for me, whatever level you’re talking about. This needs specific funding but also reshaping everything you do. I think it’s the only sustainable way to manage need/demand 1. Invest in and increase services dedicated to addressing the drivers (tobacco and alcohol control, healthy diet and activity, sources of social and financial support) and make every contact count to making this accessible. 2. Target all core care and realted services to greatest need (informed by deprivation and protected characteristics … Core20PLUS covers this) … that means using IMD and inclusion grps (or, go one further by making a local household level version of IMD) to support everything right down to direct care … it means integrating that info into clinical and administrative systems to influence all care provided. 3. Become the best local health partner and anchor institution / network you can be (using the huge envelope of NHS and HSC provision to support partners, social mobility, local economy and climate / environment) and be an energetic advocate for health in all policy creating accountability yourself and across all sectors in local / regional socioeconomic development. Measure what you’re doing too … right down to the gap in care provision … and make those outcomes and gap measurements part of performance measurements.
Fascinating research Mark. Intuitively the findings are what we might expect around the degree of variation both in the actual allocation of funding within systems, but also the governance and transparency over how the funding was overseen. The issue of system accountability for ICS action on health inequalities is challenging, as NHSE should avoid micro-managing but at present there is very limited transparency on the ICS programmes and spending on health inequalities, and it’s relevant you had to submit FOIs to get this information. With the HI funding allocation becoming part of the baseline in the new financial year the risk of being diverted to other uses (especially in the current circumstances) becomes even more likely.
Thanks Andrew – really helpful comment. In fairness I didn’t ‘have to submit an FOI’ in the sense that I never asked for the information directly first. However, I am very confident that I would not have got it if I had. The advantage with the FOI is that both sides benefit – in the sense that FOI responses are monitored and a wise public body gains kudos from being able to show that it responded in a timely and honest manner. I do think that your point re transparency is important – interesting that the Hewitt review is looking this up – albeit in a lumbering and inaccessible way! I had not clocked your final point re incorporating the HI funding in the baseline – I agree that is concerning. All the best – Mark