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Health and Health Services

Doctor and patient

The Inverse Care Law describes the relationship between the need for health care and how it is used, acknowledging that often, people who are in most need of health care are the least likely to receive it. Throughout the COVID-19 pandemic it was noted that those living in more disadvantaged areas had worse outcomes, once again shining the spotlight on inequalities. 

When there is acute demand (e.g. hospital waiting lists following the pandemic) it can be difficult to allocate spend to prevention, but this is the only way to reduce further acute demand at a later time point. Tools such as Return on Investment and Social Return on Investment can be helpful. 

When planning and delivering healthcare services, there are many tools and techniques that can be applied to reduce inequalities. These include the use of health impact assessment, health needs assessment, and economic assessments

Decisions on services are based on data: information from the people in need (e.g. health needs assessment and epidemiological data), where it is best to spend resources (e.g. NICE guidelines or return on investment studies) and data on reducing inequalities (e.g. health impact assessment or integrated impact assessment). Investment is often driven by need and data but this is not always the case.  

Multi-criteria Decision Analysis and Programme Budgeting and Marginal Analysis

As a tax-funded system, the NHS is under constant strain as the demand for healthcare is close to infinite, whilst healthcare resources are finite. To create a balance between finite resources and infinite wants and needs, choices are necessary and consequently costs and benefits must be compared. Prioritisation is also required to assist this decision-making so resources are used in a way that maximises their benefit. 

Multi-criteria Decision Analysis (MCDA) and Programme Budgeting and Marginal Analysis (PBMA) are tools that aid decision-making and resource allocation so that benefits are maximised. They offer a framework to identify interventions that are cost-effective and address socio-economic equity, that improve productivity and keep people in work in Wales (e.g. addressing musculoskeletal issues and mental health). These frameworks require information on quantifiable indicators for interventions, for example how many people access services; what services cost; their reach; whether they are evidence-based and cost-effective; their benefits (e.g. how many people quit smoking as a result of the intervention). These frameworks can also assist in the development of key performance indicators prior to undertaking an evaluation.


Useful Resources

GUIDE

Driving Prosperity for All through Investing for Health and Well-being: An Evidence Informed Guide for Cross-sector Investment

This guide by Public Health Wales suggests policy options for priority investment in Wales, based on the best available Welsh and European evidence. The policy options address areas of high burden and costs, as well as demonstrating co-benefits (returns) to the economy, society and the environment, including investment in the health sector, a life-course approach to health and social care, and early access to mental health services. The guide can be used by policy- and decision-makers across national and local government, the health and social care service, and public bodies in all other sectors in Wales.

Driving Prosperity for All through Investing for Health and Well-being: An Evidence Informed Guide for Cross-sector Investment


GUIDE

How to Make the Case for Sustainable Investment in Well-being and Health Equity: A Practical Guide

This practical guide by Public Health Wales is a tool to improve governance, investment and accountability for health and equity. The guide is intended to help the development of evidence-informed, context-tailored advocacy reports and other relevant documents and tools, enabling healthy policy- and decision-making across different sectors, levels of government and country settings. It aims to prevent disinvestment in health, increase investment in prevention (public health), and mainstream cross-sectoral investment to address the wider determinants of health and equity.

How to Make the Case for Sustainable Investment in Well-being and Health Equity: A Practical Guide


REPORT COVID

Placing Health Equity at the Heart of the COVID-19 Sustainable Response and Recovery: Building Prosperous Lives For All in Wales

This report by Public Health Wales places health equity at the heart of a sustainable response and recovery to the COVID-19 pandemic. The report explores the impact of the pandemic on health services in Wales and the opportunities to adopt and accelerate new approaches and solutions to achieve healthier and more resilient people, societies and economies.

Placing Health Equity at the Heart of the COVID-19 Sustainable Response and Recovery: Building Prosperous Lives For All in Wales


REPORT

Making the Difference: Tackling Health Inequalities in Wales

This short paper by the Welsh NHS Confederation outlines ideas on ways of working that would ensure collective impact in addressing health inequalities, including an example of approaches to transform the way people access and rely on health and care by integrating community development initiatives with established services.

Making the Difference: Tackling Health Inequalities in Wales


REPORT

Reducing Health Inequalities Through New Models of Care: A Resource for New Care Models

This report by the Institute for Health Equity provides an analysis of the opportunities for new models of care and place-based health systems to improve health and reduce health inequalities in England. The report describes the opportunities for healthcare organisations to do more to improve population health and reduce inequalities in health. In particular, that healthcare services must integrate with other sectors to form place-based health systems that influence wider community, social and economic drivers of health, in addition to providing equitable access to treatments.

Reducing Health Inequalities Through New Models of Care: A Resource for New Care Models


STRATEGY

Health Systems Resilience During COVID-19: Lessons for Building Back Better

This health policy series book by the WHO European Observatory on Health Systems and Policies sets out that health systems resilience – defined as the ability to absorb, adapt, and transform to cope with shocks – is needed to ensure sustained performance of health system functions. The book identifies 20 key strategies, grouped according to the health systems functions that have been found as enhancing health systems resilience in the face of COVID-19. The strategies describe how to secure and (re)allocate financing while leaving no one behind, and emphasize the importance of governance and the need for more health workers who are fit for the job and well supported.

Health Systems Resilience During COVID-19: Lessons for Building Back Better


GUIDE

Improving the Quality of Health Services: Tools and Resources

This compendium by the World Health Organization describes tools and resources for WHO Member States aiming to improve the quality of service delivery. The compendium includes tools and resources on quality improvement and provides examples of how the tools and resources have been applied in country settings. It covers a range of technical areas from hospital management and emergency care to primary care and person-centered care.

Improving the Quality of Health Services: Tools and Resources


STATEMENT

The Path to Global Equity in Mental Health Care in the Context of COVID-19

This comment published in The Lancet suggests that efforts to achieve equity in mental health should address: involvement of people with lived experience; collection and integration of social determinants data to inform healthcare system responses; implementation of services responsive to population needs; leveraging care providers proportionate to population need; creating innovative and accessible services; incorporating equity objectives into global health policy activities and inter-sectoral programmes; and measuring cost-effectiveness.

The Path to Global Equity in Mental Health Care in the Context of COVID-19