We are pleased to announce that the Healthcare Inequalities Improvement Programme (HIIP) team at NHS England have commissioned the Strategy Unit to evaluate the national Core20PLUS5 approach for reducing healthcare inequalities. 

This evaluation will build on the legacy of applied health inequalities work produced by the Strategy Unit (see for example our range of health inequalities projects in the first few months of the pandemic). It will further our collective aim of generating better evidence to inform better decisions leading to better outcomes for those disadvantaged.

 

What is the Core20PLUS5 approach?

Health inequalities refer to the unfair and avoidable differences in health within society. They arise because some people are disadvantaged by the conditions in which they are born, grow, live, work and age. Reducing healthcare inequalities (how people access and experience health services) that lead to health inequalities is a priority for the NHS (see NHS England’s 2024/25 priorities and operational planning guidance and Lord Darzi’s Independent investigation of the NHS in England report). 

Core20PLUS5 is a national approach that has been designed collaboratively for healthcare systems to focus efforts on reducing inequalities. It provides a structured approach, targeting both adults (Figure 1) and children and young people (Figure 2) separately, to guide systems in addressing their most pronounced healthcare inequalities. 

The key elements of Core20PLUS5 are:

  • ‘Core20’: the most deprived 20% of the national population, as identified using the Index of Multiple Deprivation
  • ‘PLUS’: Iocally determined groups who might not be part of the Core20 population but experience poorer access or outcomes from healthcare. This includes for example people: who are ethnically minoritised; have disabilities; and, live in rural areas
  • ‘5’: is the five key priority clinical areas identified for accelerated improvement. The clinical focus areas are different for adults, children and young people (see Figures 1 and 2).

 

Figure 1. Overview of the Core20PLUS5 approach for adults

Reducing healthcare inequalities - Core20PLUS infographic

Figure 2. Overview of the Core20PLUS5 approach for children and young people

A poster with text and images Description automatically generated

How will the Core20PLUS5 approach be evaluated? 

The evaluation will begin with a process evaluation to explore how the Core20PLUS5 approach is adopted and how initiatives are implemented by healthcare systems. Year One of the process evaluation aims to provide a national account of the extent to which Integrated Care Systems (ICSs):

  • Engage with the Core20PLUS5 approach as part of their wider healthcare inequalities agenda
  • Make progress towards intended improvements in processes and short-term outcomes
  • Prioritise addressing healthcare inequalities in the face of other pressures (including financial).

In this first year, key evaluation activities will include: 

  • Case studies: A mixed method approach (combining qualitative and quantitative fieldwork and data analysis) will be used to provide an in-depth understanding of how a sample of 14 ICSs address their local healthcare inequalities
  • National staff survey: The Health and Care team at Ipsos will administer a national staff survey to gain a broader perspective from a range of staff working to address healthcare inequalities at all 42 ICSs. 

In future years, the evaluation will include assessing the broader outcomes and impact of delivering the Core20PLUS5 approach.  

Get in touch

If you’re interested in learning more about this evaluation or our other health inequalities work, please contact Dr Abeda Mulla at abeda.mulla@nhs.net