This page provides a set of resources to help you identify potential health inequalities in the provision of speech and language therapy services.
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This resource hub provides a collection of both RCSLT and external resources to help you in identifying and addressing health inequalities in the populations you serve.
- A health inequalities self audit tool to support you and your service to ensure you are meeting the needs of your diverse populations.
- Information on using data to help address health inequalities – including an indicator worksheet and data resources.
- A series of case studies illustrating good practice in delivering quality care to service users’ who may be particularly vulnerable to health inequalities (ie those from typically under-served groups)
- Related RCSLT guidance
- A range of external resources to give background and assist understanding about health inequalities
You may also be interested in the programme of learning from our profession wide event Anti-racism in speech and language therapy.
An SLT must be able to provide personalised and equitable care to all service users who require it. Understanding an individual’s preferred language, culture, religion, family setup, attitudes toward their health status, beliefs on approaches to play, language or rehabilitation is imperative. Having well-planned, accessible, equitable, and appropriate care pathways, resources, assessment materials and workforce are all essential to mitigating health inequalities.
In addition, SLTs must avoid the risk of stereotyping or assuming that all service users from particular communities hold the same beliefs or share the same experiences. SLTs should also demonstrate inclusivity and allyship to those from under-served communities, which should be reflected in their approach and resources.
There will always be changes in how language, religion and/or culture impacts on communities and the individuals who live within them. This may be as a result of generational changes or other impacts. Therefore, SLTs must develop ‘cultural humility’ and commit to working reflexively across their careers. SLTs will need to constantly adapt their practices to best meet the communities that they work with.
Cultural humility can be defined as: “A lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities.” (Yeager and Bauer-Wu, 2013, p 251).
A crucial part of the speech and language therapist’s role is understanding not just the ‘norms’ of development and communication breakdown in English, but also the norms of development and communication breakdown in other languages and cultures – as well as thorough understanding of the implications of food modification for those with dysphagia.
As individuals ourselves, we all have different needs (eg which languages we wish to communicate in), values, and beliefs which we hope will be explored and respected. In providing personalised care, we should apply these principles to those we work with.
When working with our diverse caseloads, it is therefore essential that we move to a more flexible approach, applying the research we have where this exists. We have to be aware that much of our research may exclude some of the more vulnerable in our society – including monolingual English-speaking communities living in areas of deprivation, those who are from Black and minority ethnic backgrounds, those who may speak no English or have English as an additional language, or those who are LGBTQ+ or have disabilities. Thus, we also have a role in contributing to the evidence-base in these areas.
How you can use this tool
We would encourage you to use this tool in the context of your team environment as well as in clinical excellence networks (CENs) to consider in the light of particular clinical conditions. This could also be an activity to suggest to students on placement.
This tool can be used by SLTs in the NHS and in non-NHS settings, including in research and the higher education sector, and we would encourage you to adapt it to your own settings. It can also be used in different ways. You may simply want to use the questions to guide reflection or a team discussion, or you may wish to complete a full audit by answering all questions. This may be done by using a simple yes or no, or you may wish to assign a rating e.g., a score out of 5. We welcome you to use it creatively to suit the needs of you as a clinician, team, manager or service.
It provides you with space to note your reflections, and actions for next steps. You can also edit the template so if you wish to make rating scales or similar, you can do so. We have suggested some resources you can use and you can also refer to other tools in the resources hub.
This tool should be used alongside the other resources in this hub to help find information about your population. We have included a few key resources within the tool itself, which may provide solutions to identifying information you have not considered.
You might also find the AHP Health inequalities framework helpful. It provides ideas on how to view and consider health inequalities and suggests breaking each area down into how you can improve your awareness of health inequalities, what action you can take and how you can be an advocate.
We are looking for feedback about how your team, CEN or student on placement has done this to build a picture of best practice. Please contact email@example.com to share your thoughts.
As described in the audit tool and throughout the guidance, SLTs can use data to help identify and understand potential health inequalities, as a first step towards addressing them.
One aspect of this may be looking at unmet needs. This involves bringing together and comparing information about who your service is supposed to serve and who it is actually serving.
To do this, we can bring together data about the general population or community that our service targets and data about who we see in our service and see if there are differences. The worksheet below can serve as guide to help you do this. The additional resources in this section will help you gather the data that you can use to complete the worksheet.
Unmet need is just one aspect of inequality that you may wish to look at in your service. Others may include looking at whether outcomes differ for different groups of patients i.e. whether there is ‘unwarranted’ variation. RCSLT is running a project to look at how the inclusion of additional data on the RCSLT Online Outcome Tool (ROOT) might help services address health inequalities, to find out more please contact firstname.lastname@example.org.
Gathering data about your patients
Your service may already be collecting or have access to data that will help you to monitor potential health inequalities e.g. ethnicity, language profile, pupil premium. If you work for an NHS Trust or Health Board, it is likely that there will be a central team of data analysts who you should be able to support your service with accessing existing data collected through electronic patient records.
In other cases, new processes may be needed to gather this data from service users. Collecting personal data can be complex and sometimes sensitive for patients, especially with regard to ethnicity, gender and sexual orientation. Below are some key principles to support this:
- Self-reporting is the most effective way of asking about an individual’s identity.
- Personal data should be collected in agreement and collaboration with the patient and if the identity, such as ethnicity, of a patient is unknown, it should not be assumed or inferred.
- It is important that services consult local policies and advice regarding obtaining this information.
- Your organisation or local area may have someone with responsibility for health inequalities, who you can approach for support. You may also find the RCSLT guidance on Information Governance useful.
It is important to think about why you are collecting data and how it will be recorded and used: data should not just be collected ‘in case’. We collect different types of information for different purposes.
As discussed throughout this guidance, SLTs need to ask service users and their families detailed questions to ensure they understand their experience and social factors that affect them and can provide personalised care. However, to produce information that is useful for data analysis purposes, it may be necessary to distil this more complex information into broader categories or codes.
For example, an SLT would want to collect a range of information about the language profile of a multilingual family for the purposes of quality care, but in terms of data analysis, the fact that the family require an interpreter to access services may be an adequate data item, enabling comparison between groups who do or do not require an interpreter.
- Information Commissioner’s Office
- LGBT Foundation Good Practice Guide
- Monitoring Equality and Health Inequalities: A Position Paper (NHS England)
- NHS England Sexual Orientation Monitoring Information Standard
- Stonewall guide for employers on capturing data on sexual orientation and gender identity globally
Finding data about your local population
Data about the population is collected by different organisations in different ways across the UK. We have gathered some key resources here to get you started but there is a lot of information available from different organisations. What is most useful to your service will vary depending on where you are based and what factors you are interested in.
- Think about what geographical area you are interested in e.g. Integrated Care Board, local authority, custom area
- Check the source of the data (e.g. Census) and how up-to-date it is.
- Ensure that you know who the data relates to e.g. households / adult population / children
- Consider the questions and categories used, especially if you are comparing different datasets e.g. NHS services may use slightly different categories to describe ethnicity from the ones used in the Census.
See also: Assessing needs of local population
Uses multiple sources of information (including historic census data) to provide statistics relating to population, households and society. Labour market profiles include data for an area on population, employment, earnings etc from a range of sources. Some reports at a smaller area level are only available for England and Wales.
Office for National Statistics
Provides a range of statistics relating to economy, population and society at national, regional and local levels.
Open Geography Portal
Useful resource for boundary maps etc including of Integrated Care Boards / Local Health Boards.
England and Wales
Can use mapping to look at local authority districts, smaller areas within this or build a custom area profile (See this handy how to guide). You can also create a custom dataset with the area and variables you are interested in and download this as a spreadsheet.
A huge range of data is available (being released in phases) including:
- how people identify themselves including ethnicity, religion, language, sexual orientation
- information about Education, Work and Housing that may act as indicators for poverty and other factors that can impact on people’s health and inequality
- how people rate their general health and whether they have a disability.
Local Authority Health Profiles
Interactive maps and charts providing an overview of health for each local authority in England. Pull together existing information in one place on a range of indicators for local populations e.g. life expectancy, ill health, behavioural risk factors, infant mortality. Intended as ‘conversation starters’ to help local government and health services make plans to improve the health of their local population and reduce health inequalities.
Check specific data sources e.g. if using 2011 census data, may be able to access 2021 data elsewhere.
Small area mapping tool, to enable within-area comparisons.
Data sources are the same as for Fingertips but may present the data differently to ensure that small numbers are suppressed and will use the appropriate statistical method for indicators based on small numbers.
- Segment tool – information on life expectancy and causes of death at different local levels (e.g. local authority, integrated care board) and highlights inequality within and between different areas.
- Specific tools relating to impacts of COVID-19
English indices of deprivation 2019 (IMD 2019)
Measure of relative levels of deprivation in 32,844 small areas or neighbourhoods, called Lower-layer Super Output Areas.
- Mapping tools to look at deprivation (including individual domains) in neighbourhoods and local authority districts.
- Downloads of deprivation data for counties and local authority districts.
Census 2021 – Area Explorer
A range of population data for different local government districts, such as language, ethnicity and housing.
Northern Ireland Multiple Deprivation Measure 2017 (NIMDM2017)
Provides a mechanism for ranking areas within Northern Ireland in the order of the most deprived to the least deprived. Includes interactive maps.
Health inequalities statistics
Examination of each indicator within the NI health and social care inequalities monitoring system (HSCIMS) at regional and sub-regional levels.
Northern Ireland Statistics and Research Agency
Range of other statistics and visualisations relating to population, health, education etc.
Scotland’s Census – Area overviews
Search by postcode, town or council to view information about population identity, health, education and more.
Scottish Index of Multiple Deprivation 2020 (SIMD 2020v2)
Relative measure of deprivation across 6,976 small areas (called data zones)
Scotland’s Official Statistics
Explore a range of other datasets, including by different areas.
Brings together multiple data sources to provide a range of information relating to population, including:
- population numbers by age (2021 census)
- Welsh speakers
- information on housing, education, health and more.
Welsh Index of Multiple Deprivation (WIMD) 2019
Designed to identify the small areas of Wales that are the most deprived.
We have brought together a collection of case studies showcasing good practice in meeting the needs of under-served groups and delivering quality care to service users who may be particularly vulnerable to health inequalities.
The case studies show how SLTs can support a service user/their families’ engagement with speech and language therapy and other health services and include examples of culturally sensitive care, use of trauma-informed approaches, service-level changes and the role of SLTs in wider health promotion.
Speech and language therapists should always take an evidence-based approach to practice (HCPC, 2014) and should always triangulate the findings from research, with clinical expertise and service user preferences.
The case studies illustrate successful examples of speech and language therapy practice, but it should be noted that each service user is an individual and it should not be considered that the care exemplified in case study is suitable for all people who meet the descriptions given.
We’ve developed a template with members to encourage SLTs to share their stories. Download the case study template to submit your case study.
Members should refer to the following pieces of relevant RCSLT clinical guidance:
- Clinical guidance pages (particular attention should be paid to the statistics, or incidence and prevalence sections)
- Working with interpreters
- Assessing needs of local population
- Outcome measurement
- Measuring outcomes outside individualised care
Additional supporting resources and background reading
The links below were accessed on 20 January 2023. If a link no longer works please do let us know at email@example.com.
- A matter of life and death: Explaining the wider determinants of health in the UK Recommendations for those working in public health on how to communicate about health inequalities, includes advice about how to frame data.
- A summary of Age UK’s Index of Wellbeing in Later Life 2017
- Data from 2011 Census shows people who cannot speak English well are more likely to be in poor health
- Ethnic disproportionality in the identification of speech, language and communication needs (SLCN) and autism spectrum disorders (ASD) (2012)
- Equity for all: Children’s Speech and Language Therapy Services in Scotland
- Institute for Public Policy Research: Health and Prosperity (2022) Looks at the impact of Covid-19 on population health and how improving health across the population will improve prosperity.
- Levelling Up Health: A practical evidence-based framework (2021) – Provides practical guidance on how to reduce health inequalities at local and regional level.
- Living longer: caring in later working life (2019)
- My role in tackling health inequalities: A framework for allied health professionals (2021) – Practical suggestions for allied health professionals to tackle health inequalities in their practice.
- NHS England: The Healthcare Inequalities Improvement Dashboard – A collection of strategic indicators relating to healthcare inequalities in one place. Login to the Future NHS platform is required to access resources.
- NHS England: Core20PLUS5 – An approach to reducing health inequalities for children and young people – This is a national NHS England approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort and identifies ‘5’ focus clinical areas requiring accelerated improvement. It has now been adapted to also apply to children and young people.
- NHS England: tackling inequalities in healthcare access, experience, and outcomes: Actionable Insights A guide commissioned by The Health Foundation and NHS England and co-written by the Yorkshire and Humber Academic Health Science Network with an expert reference group.
- NHS Race and Health Observatory: Ethnic health inequalities and the NHS (2021) – This paper explores how progress could be achieved in reducing the health inequalities experienced by people from Black and minority ethnic groups.
- NHS Race and Health Observatory Rapid evidence review (2022) -This report analyses the evidence of ethnic health inequality through the lens of racism.
- NHS Race and Health Observatory: Digital apps and reducing ethnic health inequalities (2023) – This report reviews how information gleaned from users of online health tools is used by health providers to analyse and improve patient health.
- NHS West Midlands Strategy Unit – This series of reports explores the legal and practical aspects of addressing inequalities, for Integrated Care Boards to consider.
- Public Health England Guidance: Place-based approaches for reducing health inequalities (2021) – This guidance explores the role of place in health inequalities.
- Department of Health and Social Care: The best start for life: a vision for the 1,001 critical days (2021) – This document outlines 6 areas for action to improve the health outcomes of all babies in England.
- The Kings Fund (2022) Equity and endurance: how can we tackle health inequalities this time? – This paper considers how health inequalities might be better tackled in future and learn the lessons from past attempts to do so.
- World Health Organisation: Global report on health equity for persons with disabilities – This reports calls for urgent action by WHO member states to advance health equity for persons with disabilities.
Organisations with an interest in health inequalities / sources of information
- The Kings Fund
- Race Equality Foundation
- Institute of Health Equity
- The NHS Race and Health Observatory
- The Health Foundation Evidence Hub
- FutureNHS Equality and Health Inequalities Network [login required]
- Office for Health Improvement & Disparities
In this section
What are health inequalities?