Appendix: methodology

Leeds Beckett University’s Centre for Health Promotion Research undertook a qualitative review based on 20 hour-long, semi-structured interviews with nominated ICB health inequalities leads from a purposive maximum variation sample of 20 systems. This report is based on analysis of the transcripts of these interviews, which took place from September to November 2023.

The research aimed to answer the following research questions:

1. On what theoretical, conceptual or other basis were decisions about allocation of the health inequalities funding made?

• What is the ambition behind them? 
  
  
• Was a theory of change or conceptual framework used?
  
  
• What was the evidence behind the decision?

2. What were the decision-making processes involved in the allocation of the health inequalities funding for 2022-24?

• What were/are the processes involved in decision making?
  
  
• Who was/is involved – to include social care and the VCS
  
  
• How transparent are these processes? How accountable?
  
  
• Are decisions made by individuals or boards? What is the role of the ICB/ICS in this process?
  
  
• How are the decisions then implemented? What is that process? How transparent etc.?
  
  
• What did you measure (including impact on health inequalities)?

3. What facilitating factors have enabled ICSs to progress action on health inequalities, what factors have held them back, and how have they overcome these barriers?

The research was approved by the Leeds Beckett University (LBU) research ethics coordinator.

Recruitment was coordinated via the NHS Confederation, which invited all ICS health inequalities leads or senior responsible officers to take part in an online or telephone interview with the LBU research team. Participant information sheets were distributed by email as part of this process. 

Representatives from 36 ICS (86 per cent) volunteered to take part, and a purposive maximum variation sample of 20 were selected for interview, using a sampling frame based on geographic region; population size; number of local authorities; Health Index Aggregated and Avoidable Mortality scores; inequalities ranking; NHS System Oversight Framework (SOF) ranking; and whether areas were urban, rural or coastal.

Semi-structured interview schedules were developed that aligned to the research questions. Selected ICS participants were contacted by the LBU researchers and informed consent collected. The LBU researcher read the existing Joint Forward Plan before carrying out the interviews. Semi-structured online interviews were carried out, recorded and transcribed using MS Teams. Transcripts were checked for accuracy by the research team, and thematic analysis (Braun and Clarke, 2006) was carried out using NVivo software. This involved line-by-line coding, generation and refinement of a coding framework and thematic categories by discussion. 

Interim findings were presented and discussed at four online workshops, with invitations extended to all ICBs. The workshops were used to test and broaden the initial findings from the interviews.

Acknowledgements

This report has been produced using research commissioned by the NHS Confederation, in partnership with the Care Quality Commission and Clarity Consulting, conducted by Leeds Beckett University in 2023.

We are grateful to all those who so generously shared their time and experiences with us as part of our interviews.

Special thanks also go to:

NHS Confederation

Ruth Lowe

Hashum Mahmood 

Caitlin Plunkett-Reilly

Frances Longley

Leeds Beckett University

Professor Mark Gamsu

Professor Anne-Marie Bagnall

Dr Joanne Trigwell

Susan Coan

Sarah Papadimos

Care Quality Commission

Alison Thwaites

Liadan Buggy

Joyce Frederick

Helen Rawlings

Lucy Wilkinson

Clarity Consulting

Andrew Moore

Karen Smith