Equality in healthcare is firmly on the agenda for trusts around the UK and has been for some time. But non-executive directors must go beyond the rhetoric and create local realities.

But what does this mean in the current, local context? And which services should be targeted?

Ronny Flynn is director of the Race Equality Foundation, which is particularly active in the areas of health and housing inequalities. He says: "One reason for this activity [on health and housing inequalities] is the fact that there are clearly good policies in race relations for these areas, but there is still a gap between those policies and their implementation."

The foundation maintains that, too often, decision makers do not fully engage with the evidence on inequalities or, if they do, are not clear on how it should translate into action. The same points might be made about health inequalities based on income, age, disability, family structure, and so on.

Collecting data

Gurch Randhawa is professor of diversity in public health at Bedfordshire University and chair of Luton Teaching primary care trust. He says the first step in levelling the playing field of local health is an obvious one. "It's absolutely imperative that PCT boards are familiar with their local population's health needs." This in turn should clarify existing health inequalities.

In fact, while "familiarisation" may sound like a simple idea, the reality can be quite complex. Race for Health national director Helen Hally says: "Meaningful community engagement can actually be quite troublesome. Developing networks, identifying each forum and key leader in the community takes time. And then that work is out of date because the communities have shifted again. It is work that continually needs to be refreshed."

As Ms Hally explains, non-executive directors can help to refresh their trust's planning in other ways, too. Under pressure to break even, some trusts are starting to see unplanned surpluses, she points out. "If they are really taking the equality agenda to heart, then that investment could be targeted to address urgent inequalities."

But as Professor Randhawa makes clear, not everything in the world of equality is about fresh thinking and improvisation. The first step is to do with knowledge of local communities and their needs. "The next step is to ensure that the PCT's three-year strategy is focused on reducing these inequalities," he says. "This means ensuring that commissioning priorities, local area agreements with local authorities, practice-based commissioning and so on are not only geared towards delivering national NHS targets. They also need to be aligned to reduce health inequalities."

In secondary healthcare, the delineation of roles can in itself be an important step in maximising local health equality. Robina Shah, chair of Stockport foundation trust, points out that, while every PCT will have a public health director on the board, this is not true elsewhere. "As a foundation trust, I believe we are rare in that we have always had a full-time consultant in public health. The role is pivotal in ensuring that research and evidence informs our policy direction in health equality."

Action points

So once non-executives know the up-to-date demographics of their local population, what should they do with that information? Ms Shah explains: "Health impact assessments can then help to match this profile with specific needs, and where patient flow comes from in relation to particular conditions. The response, as in Stockport, might involve community-based clinics targeting smokers, for example."

At another foundation trust, Guy's and St Thomas' in London, non-executive Jan Oliver says: "It is important that an equality impact assessment has been carried out, and the board is confident that it is taking account of this when making decisions, whether about a service redesign or a new staff policy."

For local knowledge, the trust's own equalities and diversity manager, as well as public health reports from local PCTs, can be good starting points, she adds.

While local information is essential, national organisations can also provide valuable insights. Joining the 21 trusts that are now part of the Race for Health programme can help focus minds, for instance, and the Race Equality Foundation offers briefing papers on specific topics, as well as an informative website.

Finally, Ms Hally at Race for Health draws a telling contrast: "The outlook of executive directors can, through no fault of their own, be blinkered after a while." On the other hand, she says: "There's something about the role of the non-executive that's more to do with the moral compass of the organisation."