Health inequalities resources and references

The health inequalities self-audit tool

Download the health inequalities audit tool (Word)

An SLT must be able to provide personalised and equitable care to all service users who require it. Understanding an individual’s preferred language, culture, religion, family setup, attitudes toward their health status, beliefs on approaches to play, language or rehabilitation is imperative. Having well-planned, accessible, equitable, and appropriate care pathways, resources, assessment materials and workforce are all essential to mitigating health inequalities.

In addition, SLTs must avoid the risk of stereotyping or assuming that all service users from particular communities hold the same beliefs or share the same experiences. SLTs should also demonstrate inclusivity and allyship to those from under-served communities, which should be reflected in their approach and resources.

There will always be changes in how language, religion and/or culture impacts on communities and the individuals who live within them. This may be as a result of generational changes or other impacts. Therefore, SLTs must develop ‘cultural humility’ and commit to working reflexively across their careers. SLTs will need to constantly adapt their practices to best meet the communities that they work with.

Cultural humility can be defined as: “A lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities.” (Yeager and Bauer-Wu, 2013, p 251).

A crucial part of the speech and language therapist’s role is understanding not just the ‘norms’ of development and communication breakdown in English, but also the norms of development and communication breakdown in other languages and cultures – as well as thorough understanding of the implications of food modification for those with dysphagia.

As individuals ourselves, we all have different needs (eg which languages we wish to communicate in), values, and beliefs which we hope will be explored and respected. In providing personalised care, we should apply these principles to those we work with.

When working with our diverse caseloads, it is therefore essential that we move to a more flexible approach, applying the research we have where this exists. We have to be aware that much of our research may exclude some of the more vulnerable in our society – including monolingual English-speaking communities living in areas of deprivation, those who are from Black and minority ethnic backgrounds, those who may speak no English or have English as an additional language, or those who are LGBTQ+ or have disabilities. Thus, we also have a role in contributing to the evidence-base in these areas.

How you can use this tool

We would encourage you to use this tool in the context of your team environment as well as in clinical excellence networks (CENs) to consider in the light of particular clinical conditions. This could also be an activity to suggest to students on placement.

This tool can be used by SLTs in the NHS and in non-NHS settings, including in research and the higher education sector, and we would encourage you to adapt it to your own settings. It can also be used in different ways. You may simply want to use the questions to guide reflection or a team discussion, or you may wish to complete a full audit by answering all questions. This may be done by using a simple yes or no, or you may wish to assign a rating e.g., a score out of 5. We welcome you to use it creatively to suit the needs of you as a clinician, team, manager or service.

It provides you with space to note your reflections, and actions for next steps. You can also edit the template so if you wish to make rating scales or similar, you can do so. We have suggested some resources you can use and you can also refer to other tools in the resources hub.

This tool should be used alongside the other resources in this hub to help find information about your population. We have included a few key resources within the tool itself, which may provide solutions to identifying information you have not considered.

You might also find the AHP Health inequalities framework helpful. It provides ideas on how to view and consider health inequalities and suggests breaking each area down into how you can improve your awareness of health inequalities, what action you can take and how you can be an advocate.

We are looking for feedback about how your team, CEN or student on placement has done this to build a picture of best practice. Please contact info@rcslt.org to share your thoughts.

Using data to help address health inequalities

As described in the audit tool and throughout the guidance, SLTs can use data to help identify and understand potential health inequalities, as a first step towards addressing them.

One aspect of this may be looking at unmet needs. This involves bringing together and comparing information about who your service is supposed to serve and who it is actually serving.

To do this, we can bring together data about the general population or community that our service targets and data about who we see in our service and see if there are differences. The worksheet below can serve as guide to help you do this. The additional resources in this section will help you gather the data that you can use to complete the worksheet.

Download the Health inequality indicator worksheet

Unmet need is just one aspect of inequality that you may wish to look at in your service. Others may include looking at whether outcomes differ for different groups of patients i.e. whether there is ‘unwarranted’ variation. Following a pilot, the RCSLT Online Outcome Tool (ROOT) now includes additional data fields, designed to help services monitor health inequalities, to find out more about ROOT please see the outcome measurement pages or contact root@rcslt.org.

Gathering data about your patients

Your service may already be collecting or have access to data that will help you to monitor potential health inequalities e.g. ethnicity, language profile, pupil premium. If you work for an NHS Trust or Health Board, it is likely that there will be a central team of data analysts who you should be able to support your service with accessing existing data collected through electronic patient records.

In other cases, new processes may be needed to gather this data from service users. Collecting personal data can be complex and sometimes sensitive for patients, especially with regard to ethnicity, gender and sexual orientation. Below are some key principles to support this:

• Self-reporting is the most effective way of asking about an individual’s identity.
• Personal data should be collected in agreement and collaboration with the patient and if the identity, such as ethnicity, of a patient is unknown, it should not be assumed or inferred.
• It is important that services consult local policies and advice regarding obtaining this information.
• Your organisation or local area may have someone with responsibility for health inequalities, who you can approach for support. You may also find the RCSLT guidance on Information Governance useful.

It is important to think about why you are collecting data and how it will be recorded and used: data should not just be collected ‘in case’. We collect different types of information for different purposes.

As discussed throughout this guidance, SLTs need to ask service users and their families detailed questions to ensure they understand their experience and social factors that affect them and can provide personalised care. However, to produce information that is useful for data analysis purposes, it may be necessary to distil this more complex information into broader categories or codes.

For example, an SLT would want to collect a range of information about the language profile of a multilingual family for the purposes of quality care, but in terms of data analysis, the fact that the family require an interpreter to access services may be an adequate data item, enabling comparison between groups who do or do not require an interpreter.

Useful resources

• Information Commissioner’s Office
• LGBT Foundation Good Practice Guide
• Monitoring Equality and Health Inequalities: A Position Paper (NHS England)
• NHS England Sexual Orientation Monitoring Information Standard
• Stonewall guide for employers on capturing data on sexual orientation and gender identity globally

See also: External resources and organisations 

Finding data about your local population

Data about the population is collected by different organisations in different ways across the UK. We have gathered some key resources here to get you started but there is a lot of information available from different organisations. What is most useful to your service will vary depending on where you are based and what factors you are interested in.

Top tips:

• Think about what geographical area you are interested in e.g. Integrated Care Board, local authority, custom area
• Check the source of the data (e.g. Census) and how up-to-date it is.
• Ensure that you know who the data relates to e.g. households / adult population / children
• Consider the questions and categories used, especially if you are comparing different datasets e.g. NHS services may use slightly different categories to describe ethnicity from the ones used in the Census.

See also: Assessing needs of local population

UK-wide

Nomis
Uses multiple sources of information (including historic census data) to provide statistics relating to population, households and society. Labour market profiles include data for an area on population, employment, earnings etc from a range of sources. Some reports at a smaller area level are only available for England and Wales.

Office for National Statistics
Provides a range of statistics relating to economy, population and society at national, regional and local levels.

Open Geography Portal
Useful resource for boundary maps etc including of Integrated Care Boards / Local Health Boards.

England and Wales

Census 2021
Can use mapping to look at local authority districts, smaller areas within this or build a custom area profile (See this handy how to guide). You can also create a custom dataset with the area and variables you are interested in and download this as a spreadsheet.

A huge range of data is available (being released in phases) including:

• how people identify themselves including ethnicity, religion, language, sexual orientation
• information about Education, Work and Housing that may act as indicators for poverty and other factors that can impact on people’s health and inequality
• how people rate their general health and whether they have a disability.

England

Local Authority Health Profiles
Part of Fingertips, a large public health data collection.
Interactive maps and charts providing an overview of health for each local authority in England. Pull together existing information in one place on a range of indicators for local populations e.g. life expectancy, ill health, behavioural risk factors, infant mortality. Intended as ‘conversation starters’ to help local government and health services make plans to improve the health of their local population and reduce health inequalities.
Check specific data sources e.g. if using 2011 census data, may be able to access 2021 data elsewhere.

Wider Determinants of Health Tool
Another Fingertips tool which aims to provide the public health system with intelligence regarding the wider determinants of health to help improve population health and reduce health inequalities.

Local Health
Small area mapping tool, to enable within-area comparisons.
Data sources are the same as for Fingertips but may present the data differently to ensure that small numbers are suppressed and will use the appropriate statistical method for indicators based on small numbers.

Analytics tools from Office for Health Improvement and Disparities

• Segment tool – information on life expectancy and causes of death at different local levels (e.g. local authority, integrated care board) and highlights inequality within and between different areas.
• Specific tools relating to impacts of COVID-19

English indices of deprivation 2019 (IMD 2019)
Measure of relative levels of deprivation in 32,844 small areas or neighbourhoods, called Lower-layer Super Output Areas.

• Mapping tools to look at deprivation (including individual domains) in neighbourhoods and local authority districts.
• Downloads of deprivation data for counties and local authority districts.

Local authority dashboard 
This tool from The Health Foundation brings together insights from a range of data sources to explore how a range of factors impact our health and how these vary across neighbourhoods.

Northern Ireland

Census 2021 – Area Explorer
A range of population data for different local government districts, such as language, ethnicity and housing.

Northern Ireland Multiple Deprivation Measure 2017 (NIMDM2017)
Provides a mechanism for ranking areas within Northern Ireland in the order of the most deprived to the least deprived. Includes interactive maps.

Health inequalities statistics
Examination of each indicator within the NI health and social care inequalities monitoring system (HSCIMS) at regional and sub-regional levels.

Northern Ireland Statistics and Research Agency
Range of other statistics and visualisations relating to population, health, education etc.

Scotland

Scotland’s Census
Search census data by a range of area types to find information about population identity, health, education and more.

Scottish Index of Multiple Deprivation 2020 (SIMD 2020v2)
Relative measure of deprivation across 6,976 small areas (called data zones)

• Mapping tools
• Population estimates including by NHS Board area 

Scotland’s Official Statistics
Explore a range of other datasets, including by different areas.

Wales

StatsWales
Brings together multiple data sources to provide a range of information relating to population, including:

• population numbers by age (2021 census)
• Welsh speakers
• information on housing, education, health and more.

Welsh Index of Multiple Deprivation (WIMD) 2019
Designed to identify the small areas of Wales that are the most deprived.

• Mapping tools

Case studies

We have brought together a collection of case studies showcasing good practice in meeting the needs of under-served groups and delivering quality care to service users who may be particularly vulnerable to health inequalities.

The case studies show how SLTs can support a service user/their families’ engagement with speech and language therapy and other health services and include examples of culturally sensitive care, use of trauma-informed approaches, service-level changes and the role of SLTs in wider health promotion.

Speech and language therapists should always take an evidence-based approach to practice (HCPC, 2014) and should always triangulate the findings from research, with clinical expertise and service user preferences.

The case studies illustrate successful examples of speech and language therapy practice, but it should be noted that each service user is an individual and it should not be considered that the care exemplified in case study is suitable for all people who meet the descriptions given.

We’ve developed a template with members to encourage SLTs to share their stories. Download the case study template to submit your case study.

RCSLT clinical and practice guidance

Members should refer to the following pieces of relevant RCSLT clinical guidance:

• Clinical guidance pages (particular attention should be paid to the statistics, or incidence and prevalence sections)
• Working with interpreters
• Assessing needs of local population
• Bilingualism
• Outcome measurement
• Measuring outcomes outside individualised care

Core20PLUS5 and SLTs

Core20PLUS5 is a national approach to inform action to reduce healthcare inequalities at both national and system level in England developed by NHS England’s healthcare inequalities improvement programme.

The approach defines a target population – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement in healthcare services, for both adults and children. Integrated Care Boards in England are focussed on addressing health inequalities in these target groups.

SLTs have a vital role to play in reducing health inequalities and we have produced two infographics to demonstrate how they contribute to these focus areas, which you can download below.

• SLTs role in reducing health inequalities – Core20PLUS5 infographic (adults)
• SLTs role in reducing health inequalities – Core20PLUS5 infographic (children and young people)

You can use these to highlight the role of SLT wherever it is appropriate, for example, discussing in team meetings or in the MDT or with students on placement.

Webinar and podcast

Watch our webinar to learn more about the guidance on these pages and hear from from SLTs about how they have used the resources.

Listen to our podcast, where we explored the complex topic of health inequalities and discussed the social and economic impacts as well as some ideas about how these inequalities can be addressed.

External resources and organisations

Please note: the resources on this page are not exhaustive and are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers.

Government agencies with responsibility for reducing health inequality in the UK

• Office for Health Improvement & Disparities (England)
• Public Health Agency (Northern Ireland)
• Public Health Scotland
• Public Health Wales

Useful organisations for exploring this topic

• Institute of Health Equity
• NHS Race and Health Observatory 
• Race Equality Foundation
• Stonewall
• The Kings Fund 
• The Health Foundation

External guidance and information

• Addressing health inequalities across allied health professional (AHP) services: a guide for AHP system leaders –  a guide for system leaders working across regions, integrated care systems (ICSs), local authorities and provider organisations, emphasising a population health approach.
• My role in tackling health inequalities: A framework for allied health professionals (The King’s Fund, 2021) – Practical suggestions for allied health professionals to tackle health inequalities in their practice.
• NICE and health inequalities (National Institute for Health and Care Excellence) – information on health inequalities and how these link to NICE guidance.
• Place-based approaches for reducing health inequalities (Public Health England, 2021) – This guidance explores the role of place in health inequalities and provides a framework for action.
• Tackling inequalities in healthcare access, experience, and outcomes: Actionable Insights (NHS England, 2022) – A guide commissioned by The Health Foundation and NHS England and co-written by the Yorkshire and Humber Academic Health Science Network with an expert reference group.

We are aware that the majority of these guides relate to the NHS in England and would welcome suggestions of resources from other areas that should be included. Get in touch at info@rcslt.org