Health researchers from Imperial College London joined leaders from local government and NHS Trusts to discuss data and health inequalities in London.

Imperial Policy Forum partnered with the public services think tank Reform to deliver a roundtable discussion on the role that data can play in identifying and addressing health inequalities in London.

The featured speakers at the event were Professor Kevin Fenton, Public Health Regional Director for London at the Office for Health Improvement and Disparities, and Professor Paul Aylin, Professor of Epidemiology and Public Health at Imperial College London.

The event was attended by representatives from London's NHS Trusts, local government, community groups, and Imperial health researchers, including Dr Carinna Hockham, Postdoctoral Research Associate in Epidemiology at the George Institute for Global Health UK.

The discussion took place under the Chatham House Rule, so the summary below has been anonymised.

Potential for better use of data

There was clear agreement around the table that recent developments in the creation and use of public health data are enabling more sophisticated approaches to health service delivery. One example was the way in co-ordinating housing, utilities and health data could allow targeted support to those whose circumstances put them in the highest-risk categories for the effects of the cold winter and current cost-of-living crisis.

The discussion was tempered with the recognition that data is not a silver bullet for every issue facing health and care services at present. Participants recognised the need to make sure that digital and tech-oriented solutions do not exacerbate the inequalities experienced by individuals who do not have access to the devices and internet connections that these measures require.

The need for genuine engagement and collaboration with local communities was also a consistent point raised throughout the discussion. Participants agreed that one key element underpinning all attempts to harness the power of health data is public trust and confidence. It was agreed that, to maintain public trust, communities must be involved in the development of new approaches based on the use of their data, and also that the benefits to individuals and communities of sharing that data must be communicated back.

Data, tech and ‘differential’ interventions

Another development that advances in data and technology could deliver in future is by enabling ‘differential’ interventions. It is already possible to identify individuals and families whose circumstances and internet access make them ‘low-risk’ for particular health concerns. The use of technology-led solutions for that portion of the wider patient group would be both appropriate and beneficial.

The principal benefit is that the use of digital/tech-based support in these cases will free up human resources (for example, health worker appointment times) to invest in support for higher-risk categories and more complex cases. This differential approach presents a valuable opportunity to make sure everybody gets the care that they need, while making the most efficient use of available resources.

Whilst this remains an idea in its early stages, participants agreed that the ability to identify individuals according to risk and then to devote more health worker time to those at greatest risk, without sacrificing quality of service for lower-risk cases, is a promising development.

When to use data and when not to

As the discussion concluded, it was agreed that health services and other authorities must develop an approach of only collecting and using data ‘when you need it’. Rather than harvesting data at all opportunities and thinking of data as a first resort in service design and delivery, an approach that treats data as one available tool among many is key to maintaining public confidence and inclusive, effective services.

Questions of how to build trust within and between data-holding organisations (for example, NHS Trusts and local authorities) still remain to be resolved, and the group noted that this is unlikely to result from centrally-driven ‘one size fits all’ policies but rather from genuine, local-level collaborative relationships.

The meeting concluded with a recognition that, as the acute phase of the COVID-19 pandemic fades, there is a danger of ‘reversion to type’ rebuilding many of the obstacles to agile, collaborative use of health data that was necessitated by the public health emergency. With the cost of living crisis, and the dramatic rises in demand for services such as mental health, cancer and other non-communicable diseases, it was agreed that the UK cannot afford to turn the clock back.

Beyond service delivery itself, it was agreed that tackling the structural determinants that lead to health inequalities (such as access to housing, poverty, worklessness) remains the greater challenge, to which policymakers, health service administrators and academic researchers should focus their efforts.