Health equity programme

NHS North West London's health equity programme is working with partners and the communities of North West London to make real change in terms of improving inequalities in health and care.

You can read details of the full programme below and use the buttons to see more about the programme's achievements and our professional's academy.

Untitled design.pngThe programme

We know that some people in our communities in NW London are dying earlier than they should, with a range of factors including poverty, poor-quality housing, low-paid or unstable jobs impacting people’s physical and mental health.

Different communities also have very different experiences of health and care services.

By working together with our communities we can better understand different experiences and we can help to tackle these issues. Joint working has already improved care for many people in our communities.

The health equity programme focusses on putting people at the heart of what we do – reducing inequalities, improving people’s health outcomes and reducing the differences in healthy life expectancy. We work to tailor services to the level of need in our communities to achieve equity, not providing one-size-fits-all services.

You can read more about the inequalities we are working to improve in the case for change.

North West London is a richly diverse area, with around 2.4 million people from a wide range of backgrounds and a younger than average population.

In some of our communities people are dying earlier than they should, which is caused by a range of factors including: poverty, poor-quality housing and low-paid or unstable jobs impacting people’s physical and mental health. This is a long-standing issue and the inequalities gap in health and life expectancy has widened in recent years. 

When our communities don’t have the things they need, such as warm homes and healthy food, and are in low-paid or unstable jobs, it can lead to chronic stress, poor physical and mental health and lives being cut short. To create a society where everybody can thrive, we need all of the building blocks in place: stable jobs, good pay, quality housing and good education

People from our different communities also have very different experiences of the health and care services that we provide, including different levels of access, leading to very different health outcomes. 

The health equity programme includes partners from across all of NW London, to understand the issues people face and work with communities to address inequalities in health and care. Regular listening events and engagement sessions are held with partners across our communities, you can find details on the getting involved pages of this website.

The programme’s work is arranged around three pillars:

Pillar 1 - Identifying and tackling inequalities

This workstream looks at: identifying and addressing inequalities in access, experience and outcomes. It will do this by working with partners using the Core20Plus5 framework for both adults and young people and co-creating strategies and interventions to narrow the gap.

The workstream will:

  • Have a specific focus on hypertension, given current and increasing prevalence, priority within borough strategies and bad outcomes experienced by some groups. We will improve early detection and close the gap in monitoring.
  • Work with each of the ICB programmes to understand where there are inequalities gaps using data and support work to close these.
  • Develop a Core20Plus5 dashboard to track progress




This workstream looks at: highlighting and addressing the issues that different ethnicities face. This  includes hearing from our communities and staff groups and facilitating change. This work is governed through the race equality steering group.

Structural racism describes systemic and institutionalised disparities that disproportionately affect marginalized communities, which we see in the health outcome data in NW London. 

A key barrier to reducing inequalities is a high level of mistrust of public services within communities and amongst particular ethnicities, driven by structural racism.

The race steering group provides the ICS with a strategic platform to put the structural racism conversation and priority setting at the forefront of decision making.

This workstream will:

  • Work to understand ethnic differences in prevalence  of disease, access, experience and outcomes of services.
  • Identify key recommendations to address current barriers and lead on facilitating the change when required.
  • Ensure that the system has plans in place that are impactful in reducing disparities in health outcomes between groups, with a key priority area being cancer.



Pillar 2 - Population health management building blocks

This workstream looks at: building skills, knowledge and expertise across the system to successfully implement the locally developed methods to focus on reducing inequalities.

The workstream will:

  • Bring the NHS, local government, voluntary organisations and communities together to deliver healthcare earlier to groups of residents at greatest risk of poor health outcomes. 
  • Combine Information held by the NHS and local government to find out which residents are experiencing poor access to health and care, so health and care staff work together with those residents to develop and try out better places, better times, and better offers of care.
  • Challenge any discrimination in the way health and care services are delivered now and to improve equity of health access, experience, and outcome.
  • Make it easier and quicker for care to reach the people who need it most, so that fewer of those people are left to rely on emergency or reactive care.

Our population health management approach in North West London is delivered through the focus-on methodology and the population health management workstream builds capacity and capability across the system to successfully implement this approach.



Pillar 3 - Partnership working on wider determinants of health

This workstream looks at: working with partners to maximise the opportunities to increase healthy behaviours in our communities and embed a preventative approach, including better targeting and signposting, addressing gaps in service provision and improving staff skills in making every contact count

This workstream will:

  • Allow everyone to stay independent and in charge of their health as much as possible. THis includes easy access to culturally relevant local advice and practical support  which can make a big difference in staying well, and speeding up recovery from illness.
  • Encourage healthy behaviours in pregnancy and childhood can improve health outcomes in later life.
  • Improve health outcomes for residents experiencing low income, social exclusion and racial discrimination. Who have higher risks of preventable illness and premature death from obesity, from smoking tobacco and from vaccine-preventable infections.
  • Support residents to make informed choices and changes in their environment and lifestyle that can reduce the risk of illness to themselves and their families. Our ambition is to prevent ill health in higher risk communities, so that more residents stay healthy and independent longer.

This workstream looks at: developing volunteering across our communities, promoting the role volunteering plays in the health and wellbeing of both volunteers and those receiving support.

It also looks at supporting the third sector to be effective partners within the ICS, working with other grassroots organisations.

This workstream will:

  • Support the third sector to be an effective partner, with representation at ICB, ICP, BBP and neighbourhood level, to enable engagement in strategic planning and support to deliver on Anchor ambitions.
  • Promote volunteering as a key part of the workforce, as well as recognising and promoting the role volunteering plays in the health and wellbeing of both volunteers and those receiving support from volunteers.
  • Support inclusive access to volunteering: including SEND, refugees and asylum seekers, areas of high deprivation.

This workstream looks at: NW London Anchor Institution is working in partnership with the ICS to reduce health inequalities and improve wider determinants of health through influencing local social economic conditions by adapting the way we employ people, purchase goods and services, and use building and spaces.

The workstream will:image.png

  • Develop partners as anchor institutions, taking into account inequalities and wider determinants of health.
  • Reduce unemployment: building skills and providing local employment opportunities in health and social care to people from our most disadvantaged communities.
  • Increase local procurement, building in social value.
  • Support community groups with paid use of community venues for NHS partnership meetings.
  • Promoting the update of benefits to support families through the cost of living.
  • Provide a joint approach to improving housing conditions.

This workstream looks at: Working in partnership across the ICS to ensure no one gets left behind with the expansion of digital services in the NHS. It wil do this by building on existing support to equip residents with the skills, access and connectivity they need to engage with digital services, whilst also making NHS services more accessible and easy to use. 

This workstream will:  build on existing support to equip residents with the skills, access and connectivity they need to engage with digital services, whilst also making NHS services more accessible and easy to use.

On this page you will find detailed updates each month on work happening across the full programme:

September 2023

Details of the programme leads can be found in the table below.
You can also view the governance structure for the programme here and the terms of reference for the health equity programme board.


Key workstreams




Reducing inequalities

Addressing structural racism

June Farquharson


Specialist (e.g. sickle cell/haematology)

Reducing inequalities

Kate Langford

Kensington & Chelsea and Westminster

Elective care and diagnostics

Addressing structural racism

Gemma Duncan


Workforce and acute hospital care/UEC

Population health management

Matthew Harmer  


Local care

Healthy living / behaviours

Duncan Ambrose


Maternity and CYP

Third sector and volunteering

Chakshu Sharma

Hammersmith & Fulham

NW London ICS quality

Anchor institutions

Charlene Alfred


Mental health, learning disabilities and autism

Digital inclusion

Christina Cackett

Kensington & Chelsea and Westminster

Primary care and digital first

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