Bristol primary care trust is using an enhanced equality impact assessment to reduce health inequalities by transforming the way it allocates funds

In Bristol, if you are unfortunate enough to be born in those areas with the worst health outcomes, your life will be around 10 years shorter than those born in more prosperous areas. As health secretary Alan Johnson quite rightly said in HSJ'shealth inequalities supplement: "It is unacceptable that the length of a person's life is still determined by where they were born."

As part of its commitment to eradicating health inequalities, Bristol primary care trust combined the equality impact assessment of its local delivery plan with a focus on inequalities. The objective was to ensure a systematic focus on reducing inequalities in the way the PCT allocates funds to improve health.

As a result of this enhanced equality impact assessment, the local delivery plan process will be redesigned in four ways:

Diverse providers

There will be a focus on encouraging and developing bids from charities and other organisations working with the communities with the worst health outcomes.


Each bid will be reviewed to understand whether it will treat all members of the community fairly.


The groups working on developing and reviewing bids will be adjusted where possible to better represent our community - for example, by increasing the proportion of lay representatives from groups experiencing poor health outcomes.


Explicit weighted criteria will be used to decide which bids to fund and an increased weighting will be given to those focusing on inequalities. A system for performance managing successful bids will be developed to ensure they deliver.

This process has been recognised as being of great value in ensuring that the commissioning function at Bristol PCT has an integrated focus on reducing inequalities. We have compiled three top qualities crucial to the work's success:


The equality impact assessment was simple in two key ways. First, it took a complex process and presented it in a simple and accessible format. This ensured that those we consulted on our process could understand and criticise it effectively. Second, the process itself was simple. There is a danger with legislated processes such as equality impact assessments of getting suffocated by obscure language and pointless procedure. To avoid this, a new and simplified process was developed: define the objective, present facts, consult, decide and act.


The consultation process the equality impact assessment went through was different from the typical procedural one where a dry document is left on a website for a few months. Instead, we presented the facts truthfully in a workshop with a collection of community leaders who knew far more about equality and inequalities than us and asked them what we should be doing better. They had brilliant ideas we would never have thought of which we listened to and will now act on.


Process is worthless without outcomes. We defined our objectives at the start of the project and whenever something was suggested for inclusion in the equality impact assessment, we asked: "Will this help deliver the target outcomes?" If it did not, we did not do it. Constantly ensuring that our work contributed to stipulated outcomes made the process easier, simpler and ultimately more effective.

Inequalities are an unacceptable feature of our health landscape. Equality impact assessments can be seen as boring processes that must be endured or as mechanisms for reflection and catalysts for improvement. By embracing the recommendations of its enhanced equality impact assessment, Bristol PCT will ensure that the elimination of inequalities is integral to its local delivery plan process.