Academic Highlight: The NHS and Child Health Equity

Brewster et al (2024) Understanding responsibility for health inequalities in children’s hospitals in England: a qualitative study with hospital staff

Since the Covid-19 pandemic, increased attention, within the NHS, has been directed to reducing health inequalities amongst communities, with a specific focus on children and young people, as seen through initiatives like NHS England’s ‘Core20PLUS5’ targeting the most deprived 20% of the national population and minoritised groups. Highlighting this, Brewster and colleagues sought to investigate how staff in children’s hospitals view their responsibility to reduce health inequalities for paediatric patients accessing their services.

Via interviews and focus groups, with 217 multi-rank staff (leadership, clinical and support), at nine participating hospitals, the qualitative study explored how NHS statutory duties regarding anti-discrimination and reduction of unequal access and outcomes, as per the Equality Act 2010 and various national strategies, interact with and manifest, in practice, in staff’s everyday activity.

Findings of this study in England revealed two concurrent themes, following dataset analysis using Rapid Research Evaluation and Appraisal (RREAL), conducive to timely service evaluation and learning. Concerning the first theme, the authors found that all nine children’s hospitals generally deemed the reduction of health inequalities an important component in daily paediatric healthcare delivery and as ‘everyone’s business’ in staff’s everyday activity. Several staff reported that there was a duty to intervene in order to prevent paediatric patients under their care from experiencing further disadvantage. Organisational function in reducing health inequalities pertaining to access and quality of care for paediatric patients was understood by senior leaders. Conversely, the second theme revealed that, due to the embedded and intersectional composition of child health inequalities, their reduction appeared to be perceived simultaneously by the children’s hospital staff as too complex and rather deemed as ‘no-one’s responsibility’.  

The qualitative dataset exposed underlying factors contributing to the above described discrepancy between NHS statutory duty and everyday practice by staff at these nine children’s hospitals. Some of these factors pertain to there being varied understanding and uncertainty amongst the children’s hospital staff regarding the boundaries of responsibility within and between health and social care bodies; a lack of definite guidance within national strategies on the management of inequalities in access and outcomes in the NHS and a lack of performance indicators to prioritise and evidence health inequalities related activity.

Given the scarcity of associated research in the UK, as noted by the authors, this first study offers valuable insights into how NHS staff in children’s hospitals view their responsibility to reduce health inequalities for paediatric patients. Through the study’s corresponding exploration of statutory duty and everyday practice, the authors rightly conclude that improved national policy is required to concretise health inequalities within children’s hospitals’ everyday work.