Understanding responsibility for health inequalities in children's hospitals in England: a qualitative study with hospital staff

Objectives This study aimed to understand how staff in children's hospitals view their responsibility to reduce health inequalities for the children and young people who access their services. Design We conducted an exploratory qualitative study. Setting The study took place at nine children's hospitals in England. Participants 217 members of staff contributed via interviews and focus groups conducted January-June 2023. Staff were represented at all levels of the organisations, and all staff who volunteered to contribute were included in the study. Analysis Data were analysed using Rapid Research Evaluation and Appraisal (RREAL) methodology for rapid assessment procedures (RAP). Results All of the children's hospitals were taking some action to reduce health inequalities. Two key themes were identified. First, it was clear that reducing health inequalities was seen as something that was of vital import and should be part of staff's day-to-day activity, framed as 'everyone's business.' Many staff felt that there was an obligation to intervene to ensure that children and young people receiving hospital treatment were not further disadvantaged by, for example, food poverty. Second, however, the deeply entrenched and intersectional nature of health inequalities sometimes meant that these inequalities were complex to tackle, with no clear impetus to specific actions, and could be framed as 'no-one's responsibility'. Within a complex health and social care system, there were many potential actors who could take responsibility for reducing health inequalities, and staff often questioned whether it was the role of a children's hospital to lead these initiatives. Conclusions Broadly speaking, senior leaders were clear about their organisational role in reducing health inequalities where they impacted on access and quality of care, but there was some uncertainty about the perceived boundaries of responsibility. This led to fragility in the sustainability of activity, and a lack of joined-up intervention. Most hospitals were forging ahead with activity, considering that it was more important to work to overcome health inequalities rather than debate whose job it was.