FRAMING COMMUNICATION AUDITS

Framing Communication Audits

Abstract

Health equity audit (HEA), a pragmatic policy tool to ensure that services and resources are focused on issues that have the highest impact on health inequalities, has now become embedded in the national strategy to tackle these inequalities through a new mandatory requirement that primary care trusts (PCTs) conduct one such audit annually. This study aimed to assess their experience through a national baseline survey in 2004, all PCTs (n = 303) being electronically mailed a questionnaire with non-respondent follow-up. Replies were received from 132 PCTs (44%), a representative sample of PCT diversity, most of whom had completed only a few steps in the audit cycle. Audit topics (most frequently coronary heart disease, smoking cessation, and access issues) and dimensions of inequity (mainly area and deprivation) were agreed through only limited engagement with local strategic partnerships. Local public health networks and multiagency teams were infrequent partners in undertaking the HEA. Most PCTs wanted comparator data, good practice examples, and specific methodological expertise. While significant progress has been made, this survey shows only limited use of HEA as a tool for multisectoral use by PCTs in partnership with others and a focus on intra-PCT comparisons at the expense of those with a wider pool of 'look-a-likes'.

Framing Communication Audits

Executive Summary

The report discusses the concept of 'health equity audit' (HEA), a process for ensuring that services or other resources are distributed fairly in relation to the health needs of different groups, is relatively new. Its utilization in health policy was presaged by the Acheson Report1 recommendation in 1998 that an equity profile be produced for every local population with a triennial auditof progress. The Department of Health also introduced the 'equity profile' in the National Service Framework for coronary heart disease (CHD) in order to identify inequalities in heart health and in access to preventive and treatment services.

Introduction

It is only in the last two or three years that the concept has been more fully embedded in the national strategy to tackle health inequalities. Tackling Health Inequalities: A Programme for Action'3 identified HEA as a key tool to insert evidence on inequalities into mainstream NHS activity, such as informing decisions on investment, service planning, commissioning, and service delivery. This was supported in the Department of Health's Priorities and Planning Framework for 2003-2006,4 which required that the 'NHS... should narrow the health gap by... ensuring that service planning is informed by an equity auditand supported by an annual public health report by the Director of Public Health'.

In February 2004, the Department of Health asked primary care trusts (PCTs) to complete a self-assessment tool by the end of March 2004, so that they would be ready to use HEA effectively by the start of the next planning round in July 2004.5 This has since been reinforced in the latest planning guidance issued by the Department of Health covering the years 2005/6-2007/8.6 Also, the Commission for Health Improvement (CHI) (now Healthcare Commission)'s performance indicators for the 2004 star ratings included HEA, that is, ...