Strategies to reduce inequities in access to planned care: an Ethics Review for Integrated Care Boards

Abstract

We are delighted to present a report on inequities in access to elective care for the Midlands Decision Support Network (MDSN). Produced by Angie Hobbs - the world’s first Professor in the Public Understanding of Philosophy – this paper examines the ethical questions raised by our report outlining strategies for reducing inequity. Professor Hobbs looks at our suggested strategies with the eye of a professional philosopher, asking: what ethical tensions and issues might arise by following these strategies? How can they be overcome? Her headline finding is that all the strategies suggested in our work are viable from an ethical perspective. And she goes further, outlining a process for decision-making which – if followed with care, thoughtfulness and humility – should give Integrated Care Boards (ICBs) and hospital trusts confidence in making ethically thorny choices. This ethics review is a further significant addition to the case for addressing inequities. It follows: Our May 2021 report outlining the nature and scale of the problem of inequities in access to elective care. Our May 2022 report suggesting strategies for addressing the problem. The legal review from Hill Dickinson examining these strategies from a legal perspective. Work by University Hospitals Coventry & Warwickshire NHS Trust, who have shown that it is practically possible to implement approaches to addressing inequities. Research by our partners Ipsos demonstrating that it is possible to engage people in the sophisticated and tricky choices involved. Analysis cannot change practice. This requires others – ICBs, hospital trusts, policy makers – to act. But analysis can guide action and reduce barriers to it; and we believe the work outlined above presents a compelling case with some clear routes forward. The NHS is committed to addressing health inequalities. We see our work as an important element in helping it to do so, with Professor Hobbs’ ethics review offering a unique contribution to this conversation.