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NHS adopts inequality monitoring system to reduce potentially avoidable A&E admissions

Posted on 22 August 2016

Indicators of how well the NHS is tackling health inequality across the country have now been adopted by the NHS.

The indicators are designed to help local NHS managers reduce potentially avoidable A&E admissions arising from social inequality, and were developed by researchers at the University of York.

The indicators focus on emergency hospitalisation for patients with long-term conditions such as dementia, diabetes, respiratory and cardiovascular diseases, which previous research has shown can be reduced by more effective primary care and outpatient care.

The indicators have just been rolled out as part of the NHS Clinical Commissioning Group Improvement and Assessment Framework.

They show large differences in inequality performance between different clinical commissioning groups across the country, and that between April 2015 and April 2016 there were 264,000 of these excess hospitalisations associated with socioeconomic inequality.

Online tool

The results show that this variation occurs regardless of the deprivation of the area. For example, Liverpool CCG, which is among the most unequal CCGs, and Tower Hamlets CCG and Portsmouth CCG which are amongst the most equal CCGs, each serve some of the most deprived neighbourhoods in the country.

Similarly for more affluent areas of the country, South Cheshire is one of the most unequal CCGs with an indicator value of 1316 excess hospitalisations per 100,000 population, whilst East Surrey CCG is amongst the most equal CCGs.

Researchers at the University of York have developed an online tool to allow members of the public to explore inequalities within their CCGs for themselves, available at:

Legal duty

Lead investigator, Professor Richard Cookson from the Centre for Health Economics, said: “NHS policymakers and managers have a legal duty to consider reducing inequalities. However, reliable information on healthcare inequalities is currently scarce: national monitoring focuses on the average patient, and little attention is given to local monitoring of healthcare inequality.

“These indicators could be used to help managers learn quality improvement lessons, to help regulators and others hold the NHS to account, and to help inform the public about healthcare inequalities within their local area.”

Lead analyst, Miqdad Asaria from the Centre for Health Economics added: “There is a social gradient in preventable emergencies meaning everyone, not just the poorest, is affected.  The further down the gradient a person is, the greater the chances of suffering a preventable emergency hospitalisation.

“The NHS can now start producing our equity indicators on an up-to-date, annual basis to help improve the co-ordination of care and reduce preventable hospitalisation and mortality arising from social inequality.”

Local initiatives

Ruth Passman, Head of Equality and Heath Inequalities at NHS England said: “Social inequalities in potentially avoidable emergency hospitalisation impose large and rising costs on the NHS, as well as raising important concerns about social justice.

"For the first time, NHS managers can now find out how well their local CCG area is doing in tackling these inequalities, compared with similar CCG areas, and see how these inequalities are responding to local healthcare initiatives.  This will help NHS managers learn about the best ways of reducing costly health emergencies associated with social deprivation.”

Further information:

Funding declaration:

This study is Independent research funded by the National Institute for Health Research via the Health Services Research and Delivery Programme  (HS&DR - 11/2004/39) and Dr Richard Cookson's Senior Research Fellowship (SRF-2013-06-015). The funding body did not play any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. For further information, visit the NIHR website ( 

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