Using our advice
This resource helps healthcare professionals in taking actions to reduce medication safety inequalities across the system. Through sharing innovative practices, it aims to inspire healthcare professionals (HCPs), and supports the translation and replication of improvement initiatives across the system.
Patient harm
The safe use of medicines may be impacted by healthcare inequalities. Individuals with certain characteristics may have a greater risk of harm; we term these medication safety inequalities.
Healthcare inequalities are differences in access to healthcare, healthcare experiences and outcomes. Because of healthcare inequalities, some groups are more likely to experience poor health than the general population, and healthcare can be less safe for these groups.
Health inequalities are differences in health between different groups and communities in society. They are unfair and avoidable.
Patient safety healthcare inequalities reduction framework
NHS England’s patient safety healthcare inequalities reduction framework sets out five principles to reduce patient safety healthcare inequalities across the NHS. It should be used by all NHS providers to help foster a culture of inclusive and safe care.
Core20PLUS5
NHS England’s Core20PLUS5 approach aims to reduce healthcare inequalities at a national and system level.
This 20-minute video discusses Core20PLUS5 and how medication safety initiatives should consider this approach during planning and implementation.
Access to medicines
The NHS Business Services Authority ‘Healthcare Inequalities: Access to NHS prescribing and exemption schemes in England’ found on average:
- people in the Core20 population receive more NHS prescription items than those in the non-Core20 population
- people in the Core20 population are more likely to experience polypharmacy, potentially linked to multimorbidity
Key strategies to address medication safety inequalities
Reducing medicines-related harm due to inequity requires a collaborative, system-wide approach.
Reducing medication safety inequalities is everyone’s responsibility and requires cultural change within healthcare systems.
Given the scale of the issue, it may be useful to prioritise or focus on specific populations or settings when taking initial steps to address the medication safety inequalities. Several strategies can be used. These may be used alone, or in combination with one another.
Patient engagement
HCPs should engage and form trusting relationships with individuals and communities to reduce potential harms. This 17-minute video discusses the importance of building meaningful relationships with individuals and communities.
The NICE Guideline ‘Community engagement: improving health and wellbeing and reducing health inequalities’ covers community engagement approaches to reduce health inequalities.
Personalised care
Embedding NHS England’s personalised care approach helps to address individuals’ health priorities and needs. This can help to reduce medicines-related harm.
In this 13-minute video, originally from the SPS page 'Developing opioid safety across a system', personalised care is explored further.
The SPS page 'A person-centred approach to polypharmacy and medication review' discusses using a person-centred approach to undertake medicine reviews.
Making reasonable adjustments
HCPs must make reasonable adjustments to meet individuals’ needs.
NHS England provide information about reasonable adjustments, which can include providing:
- longer appointment times
- consultation appointments at a time suitable for the individual
- quiet environments for consultations
- information in languages other than English
- written information in ‘easy read’ formats
In this 16-minute video, the principles of reasonable adjustments and how they can be used to improve medicines safety are explored.
Reasonable Adjustment Digital Flag
The NHS Reasonable Adjustment Digital Flag, in the NHS Spine, helps HCPs record, share and view details of any reasonable adjustments individuals may require.
Training on how to use the Reasonable Adjustment Digital Flag is available on the NHS Learning Hub.
Reducing communication barriers
Utilisation of available resources within your organisation may support the safer use of medicines in individuals who may be affected by communication barriers. Organisational processes for identifying these individuals may support the safer use of medicines.
People for whom English is not their first language may suffer more from medication safety inequalities.
People without English as a first language, and those who are unable to read, may face challenges with written instructions for medicines which may increase the risk of medicines related harm.
Verbal communication barriers
NHS England’s ‘Improvement framework: community language translation and interpreting services’ should be used across the NHS, to support the provision of language translation and interpreting services.
In this podcast, the impact of language barriers on medication safety inequalities is explored.
This 7-minute video discusses examples of cross-system work to produce medicines information videos in languages other than English.
Written communication barriers
Using easy read formats or information in a more accessible language may support the safer use of medicines.
Some organisations provide information about healthcare and medicines in easy read formats. For example, Mencap have an Easy Read library which can be filtered for health resources.
Upskilling healthcare professionals
A greater understanding of healthcare inequalities and ways to address these can support HCPs in their own practice and can promote the success and sustainment of medication safety initiatives. Organisations should review available resources and identify where these can be used in practice to upskill their workforce.
The Office for Health Improvement and Disparities’ ‘All Our Health’ programme is a collection of educational resources that aims to help HCPs take action to reduce health inequalities.
There is a statutory requirement for regulated service providers to ensure health and care staff receive training about learning disabilities and autism. The Oliver McGowan Mandatory Training on Learning Disability and Autism aims to ensure HCPs have the skills and knowledge to provide safe, compassionate and informed care. The training is recommended by the government for health and care workers.
The Healthcare Inequalities Improvement Programme FutureNHS platform provides useful resources, including training materials, about healthcare inequalities. This 19-minute video discusses healthcare inequalities in people with a learning disability and autistic people.
Training resources about STOMP (Stopping Over-Medication of People with a learning disability, autism or both) and STAMP (Supporting Treatment and Appropriate Medication in Paediatrics) are available on the STOMP and STAMP FutureNHS platform. This 3-minute video talks about STOMP and STAMP.
Utilising electronic systems
Using shared care records can help to ensure records from different health and care organisations are accessible in a range of health settings.
Electronic tools or apps can help overcome communication barriers.
Introducing an intervention
Healthcare inequalities should be considered as part of every medication safety intervention.
Undertaking a system mapping exercise prior to implementing an intervention will allow you to see where it sits within the already established system. It will also support identification of any possible unintended consequences that may arise as a result of the intervention.
The Office for Health Improvement and Disparities’ Health Equity Assessment Tool is a framework that helps organisations identify and implement actions to address health inequalities into their workplan.
NHS England’s Health Inequalities Improvement Dashboard collates data for key indicators of healthcare inequalities. It aims to help the NHS take actions to improve health inequalities.
Prior to implementing an intervention, decide which outcomes will be measured. This will support the analysis of the effectiveness of the intervention.
Patient Safety Incident Response Framework
NHS England’s Patient Safety Incident Response Framework (PSIRF) sets out the NHS approach to developing and maintaining effective systems for responding to safety incidents.
Organisations should consider and address inequalities as part of their PSIRF response and patient safety plan.
Shared good practice
Sharing experiences with improvement interventions can help to prevent duplication, support efficient use of resources and promote standardised practice across the NHS. Useful resources, and a discussion board to network with peers, can be found on the MSATS FutureNHS workspace.
Full webinar recording
The SPS Medication Safety Across The System (MSATS) series of webinars are interactive sessions aimed at healthcare professionals working in any sector with a role within or passion for medication safety. The SPS article Developing Medication Safety Across The System (MSATS) explains more information about MSATS, and the webinars.
The recording of the full MSATS: medication safety inequalities webinar (September 2023) is available in the 1 hour 27 minute video below, this includes some of the presentations included during this page. Information presented during the webinar and associated resources was correct at time of recording. Current guidance should be followed.