Child Health Equity Readiness Tool

Child health equity readiness tool

Start

Top tip!

You can navigate to the different sections of the tool throughout

Navigation

Why use this tool?

ICS reflections

The policy context

Action plan

How to complete this tool

Resources

Let's get started

Contact us

Why use this tool?

This tool is designed to support Integrated Care Boards (ICBs) to reflect on their readiness to: 1. Address the social determinants of health 2. Reduce health inequalities among children and young people 3. Improve child health equity It is intended that the information you generate using this tool will support your ICB to make equity informed investment decisions about the health of babies, children and young people and their social determinants. To support this, you may wish to consider embedding it into your strategic commissioning frameworks.

The primary audience for this tool is ICBs, given their role as strategic commissioners. The language used throughout this tool reflects this. However, it will be useful for other organisations within the ICS interested in carrying out child health equity work, and they should apply the questions in the tool to their own structures.

This tool is based on our collective learning from the development of the Children and Young People's Health Equity Collaborative, a partnership between Barnardo's, the UCL Institute of Health Equity, and three Integrated Care Systems.

The CHEC developed the Child Health Equity Framework for the drivers of health and wellbeing among children and young people. This framework sets out the social determinants of health, which are the key drivers for health and wellbeing for children and young people. It demonstrates the intersectionality with their personal characteristics. The framework has been directly informed by children and young people.

Read the full report here ->

Hear directly from our Health Equity Champions in our CHEC videos.

The policy context for reducing health inequalities among children and young people is shaped by a growing recognition that the social determinants of health play a critical role in shaping health outcomes early in life.

The policy context

Core20PLUS5 Children and Young People is a national NHS England approach to support the reduction of health inequalities at both national and system level. It defines a target population cohort and identifies ‘5’ focus clinical areas requiring accelerated improvement.

Forthcoming: National Youth Strategy (later in 2025) – to prioritise better coordinated youth services at local, regional and national levels. Child Poverty Strategy (Autumn 2025) – to reduce the number of children in poverty by addressing the root causes and improving the life chances of children across the country.

The pledge to make this generation of children the healthiest ever originates from the Labour Party’s Child Health Action Plan. This plan is part of a broader mission to reform the NHS and improve child health outcomes across the UK.

The policy context

Children and young people feature prominently in the 10-year Health Plan for England and are particularly visible in the shifts to community care and prevention. The plan commits to the creation of a neighbourhood health service and within that, neighbourhood health centres. The neighbourhood model aims to bring services together to provide support for children in communities and to embed holistic support for them and their families.

The Neighbourhood Health Guidelines 2025/26 from NHS England outline a transformative approach to delivering health and care services in England, with a strong emphasis on integrated, community-based care. ICSs are expected to jointly plan neighbourhood health models.

As set out in the Model Integrated Care Board Blueprint, a key function of ICBs is to provide system leadership for population health, setting evidence based and long-term population health strategy. Their ability to build intelligence to guide future commissioning and resource allocation decisions as part of their health inequalities and inclusion expertise is highlighted.

The 2025/26 NHS Operational Planning Guidance sets out the national priorities for ICBs, NHS Trusts, and system partners. This includes Neighbourhood Health Services supporting the shift from hospital to community, sickness to prevention and analogue to digital.

This tool will help you to reflect on your readiness for child health equity work across seven domains:

• System buy-in and strategic leadership
• Prioritisation of children and young people
• The voice of children, young people, parents and carers
• Data and insight for equity
• Partnerships
• Commissioning for equity
• Workforce capability and skills

How to complete this tool

How to complete this tool

Each domain has a series of questions for you to consider. You can use your responses to these questions to determine which category you fit into for each domain.

The categories are:

Processes and relationships are being formed; beginning to align actions with child health equity goals. Child health equity work may be starting to be built into strategies and operations.

Child health equity is central, sustained, and driving systemic change; an equity mindset is normalised.

Early awareness or interest; some activity and/or recognition of the issue.

Emerging

Transforming

Developing

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Title

Title

Title

Write a brief description here

Write a brief description here

Write a brief description here

You may want to grab a pen and pad to jot down your reflections

Ready?

Let's get started

System buy-in and strategic leadership

Commitment to child health equity at a strategic and operational level.

Are child health equity principles embedded in board agendas, strategic plans, and/or performance frameworks?

Are there designated invividuals or groups accountable in your ICB for ensuring equity is built into governance structures?

Are there existing similar initiatives in your region (for example: are you a Marmot place)?

Does the leadership team in your ICB currently discuss and prioritise child health equity?

Which category are you?

Reminder

System buy-in and strategic leadership

Prioritisation of babies, children, and young people

How clearly and consistently babies, children, and young people are made a system-wide strategic priority.

Are babies, children and young people reflected as a priority in your local strategies, leadership structures, and system goals?

Are resources (time, funding, capacity) allocated to address the needs of babies, children, and young people across the system?

Do different sectors (health, education, care, VCSE) work together to deliver shared priorities for babies, children, and young people?

Does the system measure progress on outcomes for babies, children, and young people, and are targets set for this?

Are outcomes used to drive improvements?

Which category are you?

Reminder

Prioritisation of babies, children, and young people

The voice of children, young people, parents and carers

Embedding the voice of children, young people, parents and carers in child health equity work.

Are insights from children, young people, parents, and carers used to influence decisions, priorities and services?

Are there methods in place to ensure meaningful engagement across the 0-19 age range or up to age 25 for young people with SEND?

Are there methods in place to ensure meaningful engagement with underserved communities and groups?

Is there a designated lead for engagement with children, young people, parents and carers?

Are you using mechanisms to ensure that children, young people, parents and carers see the impact of their insights?

Which category are you?

Reminder

The voice of children, young people, parents, and carers

Data and insight for equity

Using data and insight to identify, monitor and address inequalities.

Do you currently collect data and insights relevant to child health equity data?

Is data and insight-sharing enabled between organisations within the ICS, including the VCSE sector?

Do you routinely disaggregate data by factors such as ethnicity, geography, disability, and deprivation?

Do you use data and insights to inform decisions or resource allocation?

Do you have an understanding of what data gaps exist, and are there plans in place to address them?

Which category are you?

Reminder

Data and insight for equity

Partnerships

Working across healthcare, education, local authority (including public health, environmental health and social care) and community partners.

Do joint initiatives, funding, or data-sharing arrangements in relation to child health equity exist?

Are partner organisations aligned on child health equity goals?

Are any gaps in collaboration being addressed?

Do you have cross-sector collaboration around child health equity?

Which category are you?

Reminder

Partnerships

Commissioning for health equity

Using commissioning and resource allocation to address health inequity.

Are children, young people, families, community organisations and inidividuals (e.g. youth and faith leaders) involved in shaping commissioning specifications?

Does equity feature in your commissioning priorities or decisions to enable you to meet the needs of the most underserved communities?

Do you assess the equity impact of commissioned services?

Are these equity in practice principles followed?

Does your ICB have dedicated and sustained funding specifically for child health equity work?

Which category are you?

Equity in practice principles

Proportionate universalism – interventions are available for all, but with a scale and intensity proportionate to the level of disadvantage

Building trust and long-term relationships – recognise that many communities have experienced systemic discrimination; interventions must build trust to be effective

Using equity metrics for continuous improvement – measure not only overall outcomes but also whether gaps between groups are narrowing

Centring the child and family voice – actively involve children, families and communities in decision-making about interventions that affect them

Embedding cultural competence – ensure interventions respect and integrate cultural values, avoid stigma and address historical inequities

Cross-sector collaborations – coordinate with education, housing, social services, and community groups because child health is shaped by multiple sectors

Intersectionality – ensure that interventions account for the fact that some groups experience mutiple forms of inequality and disadvantage due to their personal characteristics (e.g. gender, race)

Addressing upstream determinants – move beyond treating illness to addressing structural determinants (e.g. poverty, housing, education, food security)

Reminder

Commissioning for equity

Workforce capability and skills

Workforce capability and skills to carry out child health equity work.

Is there funding for staff training on child health equity, anti-racism, and/or culturally safe care?

Is the vision and strategy for child health equity incorporated into team and individual workplans and goals?

Is there strategic buy-in and leadership support for training, ongoing learning and implementation of learning?

Is there a designated lead with protected time to carry out child health equity work?

Are staff supported, both professionally and personally, to navigate the emotional, ethical, and systemic complexities of this work?

Which category are you?

Reminder

Workforce capability and skills

Readiness tool complete

ICS reflections

ICS relflections

Here are some insights from the three ICSs involved on their experience of being part of the Children and Young People's Health Equity Collaborative, and of doing child health equity work.

Nicola Ennis - South Yorkshire Children and Young People's Alliance Programme Director

Simon Clarke - Procurement Lead – Birmingham, Black Country and Solihull ICS

Dr. Liz Crabtree - Programme Director, Beyond Programme Cheshire and Merseyside ICS

Prof. Doug Simkiss -CHEC Lead in Birmingham and Solihull ICS

Now you've used this readiness tool to reflect on current practice...

What are the main barriers or constraints that exist currently?

What assets already exist that could support further progress?

What would moving to the next stage of readiness look like?

Who needs to be part of this conversation?

Action plan

Action plan

To support you in your next steps, we have developed an action plan template for you to download here The template is made up of a series of tables; one for each domain, with a reminder of the questions you have already reflected on as part of this tool. There will be four prompts under each domain for you to complete:

What enablers or assets already exist that could support further progress?

What are the key actions that need to be taken in the short, medium and long-term?

Who else needs to be part of this conversation?

What are the main barriers or constraints currently?

Resources

Resources

System buy-in and leadership

Prioritisation of babies, children and young people

Cheshire and Merseyside’s collaborative model to reduce health inequalities and improve population health - a case study of the Champs Public Health Collaborative, a model of collaborative leadership to tackle health inequalities, involving nince local authorities and the NHS. Reducing health inequalities in Luton, the first ‘Marmot Town’ - a case study of Luton's work to become the first 'Marmot Town'. Improving Health Equity: Guidance for Health Care Organizations - guidance from the Institute for Healthcare Improvement on how health care organisations can improve health equity. Health Inequalities Leadership Framework - Board assurance tool - tool based on the Care Quality Commission's well led domain eight key lines of enquiry measures and the five national priorities for tackling health inequalities (2021/22)

Cheshire and Merseyside’s collaborative model to reduce health inequalities and improve population health SHEU: The Schools and Students Health Education Unit - organisation that develops localised school surveys on the health and wellbeing of children and young people. The #BeeWell Survey - youth-centred programme led by the University of Manchester, The Gregson Family Foundation and Anna Freud. Uses co-created surveys delivered annually in schools to understand what affects young people's wellbeing and what can be done to improve it. The OxWell Student Survey - a collaboration between young people, schools, local authorities, the NHS and the OxWell research team at the University of Oxford's Department of Psychiatry. Delivers a large scale annual survey designed to measure the wellbeing (health and happiness) of children and young people aged 9-18 years.

Resources

The voice of children, young people, parents and carers

Barnardo's Children and Young People's Voice and Influence tool - a tool developed as part of the CHEC programme to support ICSs to review their current work to engage children and young people and plan staps to enhance their practice Child health inequalities and policy - a Royal College of Paediatrics and Child Health report on child health inequalities and poverty. Taking Decisions Together: An accessible participation plan to support children and young people to take part in strategic decision making - a participation plan from the Commissioner of Wales to support engagement with children and young people. Hear by Right Framework - a youth participation framework to support organisations to plan, develop and evaluate their participation practices to ensure youth voice remains front and centre. Lundy's Model of Participation ​- a framework that helps to ensure that children and young people are given the opportunity to express their views and that they are heard and taken seriously. A Fair And Equal Opportunity To Enjoy Good Health – A Young Person’s Toolkit - a young person's toolkit about how they can have a fair and equal opportunity to be healthy

Resources

Data and insight for equity

Partnerships

What good child health equity data looks like and how the VCSE sector can contribute report and the Child Health Equity Monitoring Framework North West London Health Equity Programme Driving health equity through Population Health Management in North West London - case study from North West London ICS on using a population health approach to improve health equity. NIHR Early Years Toolkit - a babies, children, and young people's toolkit providing practical tools, techniques, and shared experiences to support the development of services, enhance pathways, and improve child outcomes. Health Inequalities Leadership Framework - Board assurance tool SHEU: The Schools and Students Health Education Unit The #BeeWell Survey The OxWell Student Survey

Cross-sector collaboration to reduce health inequalities: a qualitative study of local collaboration between health care, social services, and other sectors under health system reforms in England - journal paper on cross-sector collaboration to reduce health inequalities in England. Cheshire and Merseyside’s collaborative model to reduce health inequalities and improve population health Reducing health inequalities in Luton, the first ‘Marmot Town’ North West London Population Health Management and Health Equity Academy - a training and development hub for health and care staff

Resources

Commisioning for equity

Workforce capability and skills

North West London Health Equity Programme Driving health equity through Population Health Management in North West London How to embed action on health inequalities into integrated care systems - A practical guide to inform spending on health inequalities - a practical guide for systems leaders to inform spending on health inequalities. New Commissioner Guide to Health Equity - a guide to support health and social care commissioners in address health inequalities of access. Extra Funding allocation Inequality Tool (eFIT) - a tool for ICBs to support equitable allocation of discretionary additional funds

North West London Population Health Management and Health Equity Academy E-Learning for Health cultural competency, embedding public health into clinical services, population health toolkit – e-learning modules for healthcare professionals. What works: Empowering health care staff to address health inequalities – an international evidence review of what is effective at empowering healthcare staff to address health inequalities.

We hope you've found this tool helpful. It's something we've developed to support your work, and we're committed to improving it over time. Your feedback is really valuable to us. If you have any thoughts, suggestions, or ideas, please use our form:

or

Visit the Barnardo's website for more Child Health Equity resources

Take me back to the start

ICS reflections

"The CHEC was a great opportunity to strengthen our commitment to the needs of children and young people through a focussed piece of work. The partnership with IHE and Barnardo’s provided a formality and structure to the delivery and the partnership working with other ICS colleagues enabled the development of strong, collaborative and supportive relationships that enabled us all to strengthen our collective approaches to addressing the wider determinants of child health". Dr. Liz Crabtree - Programme Director, Beyond Programme, Cheshire and Merseyside ICS

Commitment to child health equity at strategic and operational levels

• Does the leadership team in your ICB currently discuss and prioritise child health equity?
• Are there designated individuals or groups accountable in your ICB for ensuring equity is built into governance structures?
• Are child health equity principles embedded in board agendas, strategic plans, and/or performance frameworks?
• Are there existing similar initiatives in your region (e.g. are you a Marmot place)?

The primary audience for this tool is ICBs, given their role as strategic commissioners. The language used throughout this tool reflects this. However, it will be useful for other organisations within the Integrated Care System (ICS) interested in carrying out child health equity work, and they should apply the questions in the tool to their own structures.

Embedding the voice of children, young people, parents, and carers in child health equity work.

• Are insights from children, young people, parents and carers used to influence decisions, priorities and services?
• Are there methods in place to ensure meaningful engagement with underserved communities and groups?
• Are there methods in place to ensure meaningful engagement across the 0-19 age range or up to age 25 for young people with SEND?
• Is there a designated lead for engagement with children, young people, parents, and carers?
• Are you using mechanisms to ensure that children, young people, parents, and carers see the impact of their feedback?

ICS reflections

Nicola Ennis - South Yorkshire Children and Young People's Alliance Programme Director

Using data and insight to identify, monitor and address inequalities.

• Do you currently collect data and insights relevant to child health equity?
• Do you routinely disaggregate data by factors such as ethnicity, geography, disability, and deprivation?
• Is data and insight-sharing enabled between organisations within the ICS, including the VCSE sector?
• Do you use data and insights to inform decisions or resource allocation?
• What data gaps exist, and how are you addressing them?

How clearly and consistently children and young people are made a system-wide priority.

• Are babies, children and young people reflected as a priority in your local strategies, leadership structures, and system goals?
• Do different sectors (health, education, care, VCSE) work together to deliver shared priorities for babies, children, and young people?
• Are resources (time, funding, capacity) allocated to address the needs to babies, children, and young people across the system?
• Does the system measure progress on outcomes for babies, children, and young people, and are targets set for this?
• How are outcomes used to drive improvement?

ICS reflections

Prof. Doug Simkiss - Children and Young People's Health Equity Collaborative Lead, Birmingham and Solihull ICS

Workforce capability and skills to carry out child health equity work.

• Is there funding for staff training on child health equity, anti-racism, and/or culturally safe care?
• Is there strategic buy-in and leadership support for training, ongoing learning and implementation of learning?
• Is the vision and strategy for child health equity incorporated into team and individual workplans and goals?
• Is there a designated lead with protected time to carry out child health equity work?
• Are staff supported, both professionally and personally, to navigate the emotional, ethical, and systemic complexities of this work?

Working across healthcare, education, local authority (including public health, environmental health, social care) and community partners.

• Do you have cross-sector collaboration around child health equity?
• Are partner organisations aligned on child health equity goals?
• Do joint initiatives, funding or data-sharing arrangements in relation to child health equity exist?
• Are any gaps in collaboration being addressed?

Using commissioning and resource allocation to address health inequity.

• Does equity feature in your commissioning priorities or decisions to enable you to meet the needs of the most underserved community?
• Are children, young people, families. community organisations and individuals (e.g. youth and faith leaders) involved in shaping commissioning specifications?
• Do you assess the equity impact of commissioned services?
• Are you following the equity in practice principles?
• Does your ICB have dedicated and sustained funding specifically for child health equity work?

ICS reflections

"I have been extremely humbled to be a small part of the Children and Young People’s Health Equity Collaborative (CHEC). My experience has allowed me to understand how procurement can support with the mission of the collaborative to address disparities in health outcomes for children and young people, by focusing on the social determinants of health, early intervention, collaborative design, post-COVIID recovery and cost-of-living challenges. NHS procurement plays a critical role in enabling health equity by ensuring that the tools, services and technologies used across the NHS are inclusive, effective and accessible. It is a strategic enabler and ensures that equity-focused programmes like the CHEC are supported by the right infrastructure, tools and services to deliver on their promises." Simon Clarke - Procurement Lead, Birmingham, Black Country and Solihull ICS