The Black Country health and care system was one of four areas chosen to test a new national framework for working better with people and communities to reduce unfair differences in health. This framework was created by National Voices and the Point of Care Foundation for the Care Quality Commission. It helps health and care systems assess and improve how they involve local people in decisions that affect health and care.
What makes this framework different is that it focuses specifically on health inequality – the unfair and avoidable differences in health between different groups of people. It helps local health and care leaders involve communities in ways that make services more equal, as well as meeting their legal duty to treat people fairly.
Every decision made within the health and care system can either reduce or increase health inequality. That’s why this framework is designed for use across the whole system – from leadership teams to frontline services – and at both local and regional levels.
How we used the framework in the Black Country
As part of the pilot, we used the framework in two different projects. For one project, we looked back to see how things could have been done better. For the second, which was just getting started, we used the framework to plan how to involve people and communities from the very beginning.
The framework is designed to be flexible, so it can be used at any stage of a project, with whatever resources are available. It includes seven stages of involvement that can help shape a single project or guide long-term, system-wide change. It encourages fresh thinking and helps spot new opportunities to involve communities throughout a project’s life – not just at one point in time.
Although it’s not a required tool, we believe it shouldn’t be seen as optional. Real involvement, where people work together to design and deliver services, takes time – but it’s worth it.
What guides this work
This framework was created by people from many different organisations and backgrounds. That means it’s based on real-life challenges and is shaped by shared responsibility. It encourages everyone in the system to work together to reduce health inequalities.
To truly understand health inequality, we must listen to people who live with it every day. Their experiences offer vital insights into how things need to change. This framework places lived experience at the heart of how we plan, deliver and review our work.
Involvement isn’t just about meetings or consultation events. It should happen at every stage – from planning services to running them and reviewing how they’re working. This framework helps build long-term relationships, using what communities already know and have to offer.
Each local area is different. This framework can be shaped to fit local priorities, needs, and challenges. It helps teams learn, grow, and improve as they go.
This framework is based on fairness. It helps systems reach out to people who often miss out – including those who are overlooked or less likely to have their voices heard. It asks us to make sure everyone can take part in shaping services.
Trust is built when people can see how decisions are made and how their input is used. This framework encourages open communication and clear decision-making.
How we're using it in the Black Country
We use the framework to help plan projects with local people. It supports us to co-design and share decision-making from the very beginning, not just after key decisions are made.
We also use the framework to review past projects. It helps us and the people we serve understand what worked, what didn’t, and what we can do better next time.
Our goal is to make involvement part of everyday practice. We’re using this framework to set shared principles across the Black Country. This includes creating safe, welcoming spaces where people feel valued and able to shape services in a meaningful way.
