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In this blog, Programme Director Catherine Dale explores how designing digital technology with a focus on health inequalities not only supports vulnerable communities but also enhances the likelihood of success by aligning with the goals of the NHS 10-Year Plan.

A great starting point for any innovator is: Am I building for everyone?  

Before COVID-19, health inequality wasn’t widely discussed, even though many people were already experiencing its effects. The pandemic, however, brought the issue into sharp focus. 

During the early months of the COVID-19 pandemic, a disturbing pattern emerged.  

Studies show that people from Black, Asian, and minority ethnic backgrounds were up to 50% more likely to die from the virus than white British people. And these weren’t necessarily people from low-income backgrounds. Often, they were highly educated doctors and nurses.  

At the same time, the murder of George Floyd reignited global conversations about racial justice. In the UK, this twin impact of COVID and racial reckoning forced the NHS and wider society to confront long-standing health inequalities that could no longer be ignored. 

When we talk about healthcare inequalities, we’re not just talking about the obvious gaps such as who can access care. We’re talking about outcomes including who gets sick more often, who dies earlier, who waits longer for help, and who gets left behind entirely. 

Inequity erodes trust in healthcare staff, providers and institutions​. 

If people have experienced discrimination within public services, they may start from a place of distrust. And if they’ve had poor experiences in the past, they’re less likely to access help in the future which creates a vicious cycle. 

There’s also an economic case to tackle this: when health outcomes are worse for certain groups, it costs individuals and the system more. The burden of poor health weighs heavily on society, especially when it could have been prevented. 

We are legally protected from discrimination by the Equality Act 2010 at work, in education, as a consumer and when using public services. The protected characteristics are: 

These legal categories form the foundation of anti-discrimination protections but when we talk about health inequalities we must go further. 

Some people face exclusion that isn’t fully captured by these protected characteristics.

Inclusion health is about deliberately reaching out to groups who are often overlooked in healthcare design and delivery.

These groups include: 

These individuals often fall through the cracks - not because they’re not protected in theory, but because services weren’t built with them in mind. That’s a critical failure, and one we can address as innovators. 

So how do we move from awareness to action? 

The NHS developed the Core20PLUS5 approach which is a targeted framework for reducing health inequalities. It’s practical, data-informed, and grounded in improvement methodology. 

In mental health, one key focus is ensuring annual physical health checks for people with severe mental illness. Others include maternity care, chronic respiratory disease, early cancer diagnosis, managing hypertension and a cross-cutting intervention on smoking cessation. 

This framework offers a way in for innovators because if your solution addresses one of these areas or groups, it’s immediately aligned with a system-wide priority. 

Much of our current understanding of health inequalities comes from the Marmot Review, which examined the social determinants of health - the conditions in which people are born, grow, live, work, and age. 

Published in 2010, and updated in 2020, it showed that not only were health inequalities growing, but for the first time in 100 years, life expectancy had stalled and even declined for the poorest women. 

Health is shaped by far more than just access to medicine. Poverty, insecure housing, adverse childhood experiences, stigma, and poor public service experiences all contribute. And while we may not control those factors, we do control the design and delivery of the services we create. 

It’s increasingly recognised that health inequalities are a patient safety issue. If someone is more likely to experience harm because of who they are or how they access services, then that’s not just a systems failure, it’s a safety failure. 

The Patient Safety and Healthcare Inequalities Reduction Framework helps reframe this problem: if inequalities lead to avoidable harm, they must be tackled as part of improving safety. 

Many PTSD treatments focus on ex-military personnel, often using exposure therapy to recreate past events. But civilian PTSD also requires tailored solutions.

One company addressing this gap is Propeer Solutions Ltd, which is developing an inclusive, low-cost VR app for use in community mental healthcare settings.

In collaboration with Paul Best at Queen’s University Belfast, they’ve created VR Photoscan, a tool that recreates trauma-related environments. One patient described it as offering a “more visceral exposure experience,” helping them prepare for real-life site visits after a city centre attack.

However, innovator Dominique Vyborna of Empress Immersive Ltd has found that exposure therapy isn’t effective for everyone, particularly young women and people from racially minoritised backgrounds.

To address this, she is co-creating a culturally relevant, affordable alternative by working with young women (16–24), neurodivergent individuals, and people from the global majority to design a solution that meets their needs - especially those facing long NHS waitlists.

These are brilliant examples of what’s possible when we rethink who our typical patient could be.

The 10-year Plan places tackling health inequalities at its core saying these 'persistent disparities’ will be tackled in both access and outcomes to give everyone, no matter who they are or where they come from, the means to engage with the NHS on their own terms.  

The government plans to: 

If you’re trying to develop an innovation that addresses health inequalities, don’t start from assumptions, start with data. 

There’s a clear message from the current government: we can’t talk about disparities without acknowledging injustice. Wes Streeting recently said, “These are not disparities that dropped from the sky - they are rooted in injustice, and we must attack the root causes.” 

That’s where we come in.  

As digital innovators we have an unprecedented opportunity to make a difference. And in doing so, we can make innovation not only smart but just. 

So, as you design your next tool, app, or intervention, ask yourself: 

This isn’t about ticking boxes - it’s about creating real impact. 

Catherine is the Programme Director for Patient Safety at the HIN.  

Catherine has 25 years’ experience in the NHS in London, with more than 20 years in quality improvement and transformation roles, including leading the national learning network for Covid Oximetry @home and virtual wards.  

Catherine has a master’s in business psychology, is a certified Institute for Healthcare Improvement Coach and an expert on co-designing improvements with patients and applying behavioural insights to healthcare.  

Catherine is also a Trustee at the Point of Care Foundation and has helped develop their Experience-Based Co-Design toolkit.  

In 2017 she taught on the IHI’s inaugural Co-design College in Boston, USA.  

Catherine is an active advocate for tackling health inequalities through improvement and organisational change. She co-led the HIN’s anti-racism programme - a journey to becoming an actively anti-racist organisation.  

Catherine was a Labour Councillor in the London Borough of Southwark from 2014–2018.