‘Dangerous’ to rely on ringfenced inequalities funding, NHSE director warns

Professor Bola Owolabi, director of NHSE’s health inequalities improvement programme and a GP in north Derbyshire, instead urged leaders to “embrace [their] own agency to act”.

Integrated care systems have received a share of a £200m health inequalities funding pot that was made recurrent by NHS England for 2023-24. Reports have emerged that some systems are using the funding to service their own deficits, or for other purposes. 

Speaking at HSJ’s Reducing Health Inequalities Forum in Birmingham this month, Professor Owolabi called on them to battle to protect health inequalities allocations locally, on behalf of “the marginalised and the voiceless”, but she said national ringfencing was unwise.

She said: “I think if we have to ringfence every single pot of money, you will very quickly get to a position where only the things that are ringfenced get done.”

She continued: “What the NHS Confederation found in their [March 2024] report is that the ringfencing wasn’t the most powerful thing, it was the leadership. It was the CEOs and the chairs who knew what their portion was, were prepared to go their board, and argue the toss if necessary.”

“I think it’s really important that we as leaders embrace our own agency to act. I think it’s dangerous for us to get into a position where we can only do something if we are told to do so.

“There’s something that comes with leadership, which is autonomy, which is responsibility, which is accountability, and self-direction.”

Complex data

Professor Owolabi also admitted ethnicity coding was “complex” and said she “hadn’t appreciated” the depth of concern when patients are asked to disclose their ethnic background.

NHSE tasked systems with five priority areas for how to address health inequalities in response to the pandemic, among them being to ensure datasets are “complete and timely”.

Although no national targets have been set around this, organisations were asked to improve ethnicity recording in areas such as primary care, A&E, mental health, and community services.

She said: “[The problem is] complex in that there is a trust issue. When people are asked for their ethnicity, we find that there is a problem. There’s almost the sense of, ‘why are you asking me that question?’”

“It’s not just from the side of the healthcare professionals. There is work to do in terms of public understanding and awareness that, if you are not in the data, you do not exist in the eyes of the system.

“I think it’s about the training of healthcare professionals to feel confident to ask the question, because a lot of our colleagues feel very uncomfortable asking people about their ethnicity. The public themselves feel uncomfortable about disclosing their ethnicity.”

During her keynote, Professor Owolabi spoke about the NHS’s work to listen to excluded and “left behind” groups during covid and what was needed to improve their health.

She said she was “worried, nervous [and] anxious” that lessons learned during covid were being forgotten.