Health inequalities report - 2025/26

What steps have been taken to understand health needs and inequalities experienced by local ‘Core20’ and ‘PLUS’ population groups, for example, ethnic minority communities, people with a learning disability, autistic people, groups that share protected characteristics, inclusion health groups and coastal or rural communities, across a range of clinical domains?

The ‘Core20’ and PLUS population work undertaken by the Integrated Care Board (ICB) in the Herefordshire and Worcestershire area has identified areas of deprivation across both counties (Index of Multiple Deprivation (IMD) 1-2 populations), with plus groups for our region being identified as the GP unregistered population, and those living in areas of rurality that experience deprivation added to by geographical and digital challenges.  Other groups prioritised are those with severe mental illness, learning disabilities and autism, as well as the Gypsy Roma Traveller (GRT) community, the South-East Asian community, and digitally excluded people. 

From this, our work around Health Inequalities commenced with a Trust wide review to capture and share work happening in services to address inequities in access, experience and outcomes.  We established a Health Inequalities governance structure to include a Health Inequalities Implementation Group (HIIG), reporting to a Health Inequalities Sub Committee (HISC) and on to Trust Quality and Safety Committee, which reports to Trust Board. The aim of the groups was to develop a baseline understanding of Trust activity around the health inequalities agenda and engage with public health colleagues to gain a deeper understanding of the local population. 

This work has shown that the Trust has many areas of good practice in relation to the Core 20 Plus population groups.  For example, adult specialist mental health services have accessed and overlayed local population data with patient protected characteristic data to identify disparities, create a dashboard, and develop local solutions.  Work is at an early stage, so we cannot report on practice changes yet, but the services have each committed to working with an identified group and sharing learning.

Working with these communities is also about developing staff cultural curiosity to better understand community experiences and needs, and we want to support these services and all staff in the collection of protected characteristic data.  We know from staff engagement that they can find it hard to ask patients for this information, and that this may be due to previous patients responding poorly when asked or staff not feeling confident that they can explain why this information is required.  We also know as a Trust that we have work to do to improve our rates of collection.  For example, a 2023 NHSE audit of patient ethnicity data indicated that more than 1 in 5 of the Trust’s patient records do not have valid ethnicity information.  

According to caseload records as at 31 March 2026, this figure has now improved to fewer than 1 in 10 patient records with missing ethnicity data (9.6%).  Inpatient areas have higher rates of ethnicity data completeness and of those patients occupying a Community or Mental Health bed on the 31 March 2026, 94.6% had their ethnicity recorded. However, looking at marital status, 7 in 10 patient records do not have this information.  Several initiatives are underway to help staff feel more able and confident in asking for this information such as training, and dedicated communications initiatives to empower staff to in their curiosity and empathic approaches.

As a Trust that offers community services in Worcestershire and mental health services across Herefordshire and Worcestershire, we have undertaken a review of census data, as part of our Patient and Carer Race Equality Framework programme.  The work has enabled us to better understand who our local racialised and ethnic communities are, how the population percentages compare to Midlands and England and Wales levels, and where the communities cluster across the two counties.  This work has indicated that South-East Asian groups along with Gypsy or Irish Traveller groups comprise the largest numbers within our patch.  

Whilst it is at an early stage, work is taking place directly and via partners, to better understand the needs of these communities and establish connections.  In addition, we have invited presentations at the Trust HIIG to share work and disseminate learning from a patient safety review of end-of-life care with the GRT community, which prompted a request for support in developing a Trust wide plan to encourage professional cultural curiosity amongst staff. 

The Communications, Engagement, and Equality, Diversity and Inclusion Teams are working together to develop a campaign encouraging all staff to ask appropriate, empathic and sensitively curious questions of each other’s and our patient’s cultures and practices.  Work has been taking place too, through the Culture of Care programme in Older Adult Mental Health Services (OAMH). which closely links to PCREF priorities.  The work is about various initiatives and actions within OAMH services designed to make service provision more trauma, autism and race informed.

Trust Learning Disabilities (LD) Services have a programme of work aimed at supporting service users in accessing other healthcare services.  This work has significantly improved access to, and engagement with, health services for people with learning disabilities through sustained, collaborative, and community-based approaches.  A key outcome has been increased uptake of Annual Health Checks and Health Action Plans, exceeding national targets and gaining recognition as regional and national good practice.  Access to mental health services, vaccinations, and blood testing has also improved, supported by tailored interventions such as desensitisation and safe clinical holding, particularly benefiting individuals who previously struggled to engage.

Targeted pathway development in areas including respiratory health, epilepsy, bowel management, palliative care, cancer care, and dementia has led to earlier identification of need and improved continuity of care.  Notably, dementia assessment rates have risen significantly, alongside the implementation of a post-diagnostic pathway. Health promotion initiatives, including breast screening, dental care, and sexual health programmes, have demonstrated increased awareness and service uptake, with measurable gains in knowledge and safer health behaviours.

Efforts to address health inequalities have resulted in improved referral rates from underserved communities, including Black and Ethnic Minority and Traveller populations.  Community outreach—delivered in accessible settings such as schools, day centres, and residential services—has driven a 50% increase in referrals into community learning disability teams, reflecting both improved access and unmet need.  Additional outcomes include reduced missed appointments (DNAs), fewer hospital admissions through earlier intervention, and positive system-wide feedback from stakeholders.  Although much of the evaluation is qualitative, consistent feedback from service users, carers, and partners shows evidence of meaningful impact.  Overall, the work demonstrates that persistent, person-centred approaches can deliver substantial and lasting improvements in health access and outcomes for this population.

What actions have been taken to identify and improve the completeness and accuracy of coding and recording practices, including for ethnicity, other protected characteristics and socioeconomic factors such as housing status?

The latest published Data Quality Maturity Index scores for each of the national datasets submitted by the Trust, show an overall 86.8% score. A DQMI score of 86.8% is above average for mental health and community trusts and places the Trust in the upper middle to high performing range nationally.

To what extent have health inequalities across a range of population groups and clinical domains been identified as a driver of trends in performance, productivity and resource utilisation?

Much work has taken place around equitable resource allocation in Physical Health Neighbourhood Teams.  The work has involved reviewing service resource allocation against levels of deprivation, population health characteristics, prevalence of care homes, and geographic size in each area.  This has led to the development of a revised weighting system, and the work and resource allocation implications, is now being explored with ICB partners

Herefordshire and Worcestershire Talking Therapies undertook a detailed equity analysis of four years of service data (April 2020 to March 2024), with Public Health colleagues, examining the full pathway – referral, treatment initiation, completion, and recovery – across geography (Lower Super Output Area (LSOA)/district), deprivation (IMD), ethnicity, age, and presenting complaint.  The analysis revealed a clear pattern of inequality. Referrals were highest in more deprived areas, yet these cohorts were significantly less likely to commence treatment, complete, or recover. Fewer than 56% of referrals from the most deprived decile resulted in treatment initiation compared to around 65% in the least deprived areas, with recovery rates approximately 13–14% lower. LSOA-level analysis showed the highest referral rates were concentrated entirely within the most deprived areas, reinforcing a mismatch between need and outcomes.  

Triangulation with Census data, ICB comparators, and national Talking Therapies datasets indicates these inequalities are not solely an access issue; they are driven by delayed treatment initiation, higher rates of non-engagement or decline, lower completion in younger and more deprived cohorts, and data quality gaps, particularly missing ethnicity.  

Due to the recency of the report the service is due to embark on further analysis from 2024 to present to evaluate impact of recent quality improvement projects – such as workforce expansion, access remedial actions, and accessibility improvements. In addition, the service is underway with the development of a targeted outreach plan in priority LSOAs, a digital front door that demonstrates higher referral conversions than industry standards, improved demographic data capture, and focused work on disengagement. 

How is routine performance data – including elective and urgent and emergency care data – analysed and broken down by deprivation, ethnicity, age and sex, to better understand areas of inequality, and how have other triangulated sources of insight supported an understanding of the drivers of these including barriers to access or inequalities in patient experience?

As outlined, the Trust has developed a suite of inhouse operational dashboards that help services understand the demographics of patients accessing services. Included in these analytical tools are breakdowns of age, gender, ethnicity and IMD, allowing services to analyse referrals, caseloads, and patient activity by these characteristics and identify any underrepresented groups.  A dedicated Talking Therapies Outcomes Dashboard allows analysis of recovery and improvement rates by protected characteristics and has informed local understanding of recovery rates associated with ethnicity, age, gender and deprivation.

Feedback from the Patient Relations Service has shown that a significant number of complaints relate to the waiting times experienced when families want to access the Trust’s Children’s services, including Child and Adolescent Mental Health Services (CAMHS) and Community Paediatrics.  As a result, the Community Engagement Team has undertaken several pieces of engagement work with families currently being seen in Children’s services where the length of wait before being seen is raised as a main concern.

When looking at the demographics of families on the waiting lists there is a little variation between different levels of the Index of Mass Deprivation.  Overall, 56.8% of families wait more than one year for their first appointment. 58.5% of families in the most deprived areas of our region wait more than one year.  The table below shows that deprivation levels have very limited impact on the percentage of families having to wait more than a year to be seen. =

How is analysis being undertaken to identify those who frequently attend A&E, and understand the health inequalities they face, to inform proactive targeted support?

The Trust does not provide A&E services. However, we are working closely with Acute Trust colleagues and other system partners to understand our impact / role in this area.

How has local data been analysed to better understand areas of inequality in access to primary care, and how have other triangulated sources of insight supported an understanding of the drivers of these?

The Trust is not a primary care service.  However, we are working closely with system partners to understand our impact / role in this area.

How has qualitative information, such as patient reported outcomes measures (PROMs) and patient reported experience measures (PREMs) been collected and analysed to address healthcare inequalities? 

Each Trust service has its own arrangements for PROMs and PREMs.  From a primary care and community mental health service perspective, the completion rate for PROMs is reviewed through regular, established meetings and shared with managers for onward cascade. Good practice is disseminated across teams, and reporting processes are continually refined to support operational needs. The focus remains on ensuring that reporting is meaningful and useful for practitioners while also meeting required reporting requirements. 

PROMs / PREMs are well embedded in psychology services with each having their own process to capture information on clinical outcomes and patient experience on team plan templates.  Staff administer at initial and final assessments, and some also administer in between at six monthly intervals or at a mid-point review, with information stored and reviewed by the teams, to consider what improvements can be made. 

The Associate Director for Integrated Care has worked closely with Public Health colleagues to apply Index of Multiple Deprivation (IMD) weightings to the population served by community teams delivering care in people’s homes. This approach is helping to ensure that staffing models reflect the needs of communities who may be at greater risk of poor health outcomes.  Early analysis highlighted significant variation in staffing resource across the county, prompting a focused review to understand whether teams serving more disadvantaged areas were proportionately supported. By applying IMD weightings, the ICS is now better able to identify inequities, strengthen workforce planning, and ensure that community services are resourced in a way that promotes fair access and improved outcomes for those most likely to experience health inequalities.

Musculoskeletal (MSK) services have organised a series of community appointment days to support patients on the waiting list and improve outcomes. These events bring together multiple services in one convenient, accessible community setting, enabling patients to engage with dietitians, talking therapies, and MSK clinicians in a single “one‑stop‑shop” appointment. The events are held locally to the patient, supporting those who might not be able to travel across the county.  To further enhance timely care, the service will also offer rapid access clinics alongside patient initiated follow-up (PIFU) options, giving people greater control over when they seek support and helping ensure they receive the right care at the right time, aiming to intervene early in the patient’s journey.

The Trust now uses the Care Opinion platform to gather patient and carer feedback.  All feedback is thematically analysed and tagged as positive, negative or neutral according to CQC standards, one of which is health inequalities.  The findings are reported on to Trust Quality and Safety Committee and form part of the wider Quality reporting.  As more services become increasingly established with Care Opinion, and levels of feedback increase across the organisation, we will have more data and collective trends which will be useful to identify the inequalities that require addressing.  In addition, work is taking place to find a way to triangulate different sources of feedback to include Care Opinion stories, patient relations complaints and compliments, and PALS.   This will enable us to bring this data together and extract some overarching key themes across a range of sources.

How has information on health inequalities informed strategic commissioning decisions, pathway redesign or long-term strategies?

All Trust activity, which includes strategy and policy development or refresh, as well as service changes and developments, requires completion of an Equality Health Impact Assessment (EHIA).  EHIA are informed by engagement and those that pertain to service changes / developments or policies with direct patient impacts or those with negative impacts and no mitigations are presented to the Equality Advisory Group, which comprises a membership of people who identify with one or more the nine protected characteristics or another vulnerable group (including the homeless or those who live in deprived areas of both counties).  The group reviews and advises on the EHIA, ensuring additional engagement takes place where needed, or that health inequalities aspects are further considered, reviewed and acted upon. For service changes and developments, the EHIA are revisited as the work develops which provides the opportunity to consider how previous feedback has been used to inform developments.  The EHIA also form part of engagement activities to help inform patients, carers and the wider community as part of the engagement and feedback process.

A clinical/operational example is how population health needs were considered during the planning of resource allocation in physical health Neighbourhood Teams across Worcestershire, including population health characteristics and neighbourhood deprivation scores, which has been outlined earlier.  More generally, we are working closely with system partners to understand our population with the intention to design services and pathways to meet need.

How has information on health inequalities informed quality improvement approaches in service delivery, including in neighbourhood health models?

We have embedded a Quality Improvement (QI) approach throughout the organisation.  The Quality Improvement Team has worked closely with the Operations Manager for Adult Mental Health Specialist Community Teams to apply QI methods that drive preventive, proactive, and community-based improvements. Using inequality data to identify high‑risk groups has helped shape this service’s QI priorities and embed community‑led design to their chosen projects. This aligns with neighbourhood health models, which rely on local data, community assets, and existing relationships to target need effectively and reduce gaps in access, experience, and outcomes. Current projects include increasing engagement from areas of social deprivation within the perinatal mental health team and improving engagement among specific cohorts, such as male patients within the eating disorder service. This project will help inform how quality improvement supports services as they utilise health inequalities data to inform their service improvement and delivery. 

National and local reports about the experience of carers and highlighting poor carer health, have indicated the need to review our processes around the identification, support and involvement of carers.  A dedicated Carer Oversight Group within the Trust, comprising members of clinical, operational and corporate teams, along with colleagues from the voluntary and statutory sector have undertaken work to improve how we work with carers to ensure they receive carer advice and support information in a timely way, and that they are better involved and prepared around discharge discussions through the use of a prepared carer checklist.  We have undertaken work to support our Community and Inpatient mental health teams, to embed good practice approaches to improve the way those services work with carers.  

To what extent have inequalities in population health outcomes been used to inform decision making? Where trends exist, what ambitions have been set to target improvements?

The Patient, Carer, Race Equality Framework (PCREF) was the driving force behind us considering race inequity and experience in our reducing restrictive practices. We wanted to apply a lens of race and ethnicity to reporting and use national benchmarking data effectively. Previously we did not collect or interrogate seclusion data, so we commenced doing so in 2025.  Our initial work is at a basic level, and it looks at the number of seclusion episodes on our Psychiatric Intensive Care Unit (PICU) and the demographics of the patients who were secluded.  Our plan is to do the same with other restrictive practices such as restraint and have this information at our fingertips in a dashboard.  We aim to understand if these factors impact on use of restrictive practices and use a QI approach to focus improvement activity.

How is health inequalities data incorporated into performance reporting at board level, and what has been the impact of this on reducing health inequalities?

The activity of the Health Inequalities Implementation Group is reported through to the Health Inequalities Steering Group, which is a subcommittee of Quality and Safety Committee.   Quality and Safety committee then provide a summary and escalate as appropriate to Trust Board.  To date, reporting has focused on activity across the organisation to establish a baseline, and areas of challenge, from which we will better understand gaps, areas for future work, and support needs. 

The Data Quality Improvement Group (DQIG) plays a key role in improving the data completeness and quality of protected characteristics in patient data and is a subcommittee of Audit Committee. DQIG reports progress to Audit Committee at every committee meeting. The DQIG is responsible for giving assurance to Audit Committee that the Trust’s data is accurate, timely and complete. In 2025/26 DQIG established a Workstream dedicated to Protected Characteristics with a dedicated lead. Focus in 2025/26 was primarily ensuring that new functionality for recording protected characteristics within the Trust’s new electronic patient record system (EPR) was appropriately trained and used by staff to record data associated with promoting health equality. 

It is an ambition of the Trust to expand Committee and board reporting to include analysis of key metrics split by protected characteristics.

How have action plans to reduce inequalities in access and quality of care been developed and monitored across services and pathways?

It is our ambition to produce action plans following detailed understanding of the Trust’s baseline position.  Our work in the coming months will include the development of a Working with People and Communities Strategy which will incorporate health inequalities, our priorities in this regard, and clear implementation frameworks which will include the development and monitoring of action plans to improve access, experience and outcomes for people experiencing inequality.

It is our ambition to embed health inequalities reporting at every level in the organisation and publish our position regularly. However, we are at the beginning of our journey to understand and utilise patient data in the context of improving health inequalities and outcomes. As such, the data below does highlight data quality and completeness issues and improving our data capture regarding protected characteristics is a core area of focus going forwards.

Waiting times in Community Services

Across all Community Services provided to Adults and Children & Young People, for those patients with an ethnicity recorded, the median wait was 10 weeks for non-White British patients. The median wait for White British patients was 9 weeks.

More work is required to capture ethnicities for all patients, and this will more accurately inform whether services are easier to access to for White British patients, and to understand any barriers to open access to all ethnic types.

Waiting times in MIU split by age, ethnicity, gender and IMD 

The Trust has Minor Injury Units (MIU) at Malvern, Evesham, Bromsgrove, Tenbury In 2025/26 our Minor Injuries Units were attended 43,611 times. The median wait to be seen across all MIU sites and all attenders was 83 minutes. 

Analysis of attendances by index of multiple deprivation – an official measure of relative deprivation for neighbourhoods in England, that ranks areas based on seven distinct domains—including income, employment, education, and health – shows that those living in the most deprived areas waited on average between 2 and 7 minutes longer to been seen than patients living in other areas.

Further work is required to understand the reasons behind this, and to improve data quality for the cohort of patients where information on their home address was not captured or not available.

Inequalities in people achieving access and outcomes for NHS Talking Therapies

The Trust’s Talking Therapies service offers a range of psychological treatments that help people manage common mental health difficulties such as anxiety, depression, stress, trauma, and phobias.

During 2025/26, patients waited on average 19 days to access the service. 

The graph below shows the median wait by gender across all recorded gender categories. 

Please note that the notable outliers in terms of waiting times (Unwilling to divulge, Not Known and Not Specified) may indicate low levels of recording against these categories, rather than the norm.

Rates of restrictive intervention 2025/26:

From 1st December 2025, the Trust introduced recording the protected characteristics of patients involved in incidents. These are now mandatory fields for all patient safety incidents.

The table below shows the number of restrictive intervention which occurred in 2025-26 by ethnicity. In total, there were 873 incidents recorded where patients were restrained. Of these, 82.5% were White British or White Other. 15.3% were of Black or Asian ethnicity. 2.3% did not state their ethnicity. 

According to the 2021 census the population of Herefordshire and Worcestershire is between 93% and 97% White British/White Other. 

Further analysis work is required to understand inpatient admission rates by ethnicity to determine whether Admission rates and rates of restrictive intervention occur disproportionately within non-White patient groups.

The graph below shows restrictive interventions by gender in 2025-26. Incidents with females occurred over twice as frequently as incidents involving males. More analysis is required to understand the admission rates of males and females, the types of intervention involved, and the complexity and diagnoses of the patients involved.  

More work is required to improve data capture against gender category.