Tackling inequalities in access, experience and outcomes — how research evidence is informing our approach to integrated care system assessment

Care Quality Commission
4 min readDec 21, 2023

Joyce Frederick, Director of Policy and Strategy, reflects on research led by NHS Confederation, delivered by Leeds Beckett University, with support from CQC and Clarity. The research explores how integrated care systems are making decisions about how they allocate funding to address health inequalities. She considers how research evidence is informing our approach to integrated care system assessment.

Tackling inequalities in access, experience and outcomes is one of the key purposes of an integrated care system and represents an opportunity to make meaningful change to reduce the health inequity gaps experienced by many people and communities. But this opportunity is not without challenge. As acknowledged in our State of Care 2022/23 report, the needs of each local population varies, and Integrated Care systems (ICS) have to deliver tailored interventions suited to local need. ICSs need to make decisions about which health and care interventions to fund, against a backdrop of competing areas of need, the need to balance short term pressures and long-term goals, and considering both local and national priorities.

At CQC we have new responsibilities under the Health and Care Act 2022 to assess systems. Our aim is to assess leadership, integration, and quality and safety in ICSs and to understand how they are working to tackle health inequalities and improve health outcomes for people and populations. Reducing inequalities is a central focus in our assessment methodology. In developing our methodology, we undertook test and learn activities with two ICSs, and are currently learning with ICS pilot sites.

As we begin to roll out our systems assessment, it is important that we can demonstrate that our approach is based on evidence. That’s why we are investing in a programme of research, covering the themes of inequalities in care, systems working, as well as safety through learning, accelerating improvement and assessing quality. So far, through our research programme, we have undertaken projects to explore the characteristics of effective systems, and what works to address inequalities in a system setting. These research findings are published on our website and the evidence is being incorporated into our Single Assessment Framework. We are also embarking on new research to understand how systems can meaningfully involve people to make decisions about the care they provide and what impact we can have, and where we add value as a regulator undertaking assessments in a system setting. All of our research aims to better understand what makes high quality health and care, to enable us to be a smarter and more flexible regulator as well as to support providers and systems to improve outcomes.

We are pleased to be involved in NHS Confederation’s research, undertaken by Leeds Beckett University with support from the consultancy Clarity, to explore how ICSs are making decisions about the allocation of funding to address inequalities. This research gives us a specific opportunity to hear directly from inequalities leads in systems, as well as wider system stakeholders, and to look in more detail at the specific challenges they face when making these decisions, and importantly to identify and share best practice.

The emerging insights from the research so far have suggested the importance of leadership to set the tone for addressing health inequalities in a systematic way. This mirrors findings from our own research into effective systems, which highlights the role of leadership in setting a clear strategy and vision, as well as to engage and motivate the wider system towards clear goals. Governance, capacity and existing national frameworks, such as the NHS CORE20+5, are also coming up as playing a key role in systems’ ability to progress this agenda. We have attended workshops convened by NHS Confederation where it has been interesting to hear how the interim findings from Leeds Beckett University research resonates with various system stakeholders. We look forward to the final report from the research to understand these different approaches in more detail.

We want the insight from this research, along with findings from our wider research programme, to both inform our approach to system assessment as well as expand our understanding of how health and social care systems are tackling inequalities in access, outcomes and experience. We will use several of our regulatory levers to do this. We will reflect findings in our Single Assessment Framework, ensuring we are looking for the best possible evidence against the relevant quality statements. By sharing the findings of the research, we will also encourage systems to reflect on the learning to identify examples of best practice that might work for them, and support systems to learn from each other.

Findings from the NHS Confederation research will be available early in 2024. More information can be found about the project on the NHS Confederation website.

To learn more about CQC’s research programme, please visit our website.

Joyce Frederick is Director of Policy and Strategy at CQC.



Care Quality Commission

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.