Review of the Mayor of London’s Health Inequalities Test

The Nuffield Trust was commissioned to undertake a review of the Mayor of London's health inequalities test – the first of six 'tests' expected to be met when considering major health care reconfigurations in the capital. This analysis reviews recent evidence of health care inequalities in the NHS in England and highlights ways the tests can acknowledge a changing understanding of the way inequalities arise within the NHS and health care more widely following the pandemic.


Published: 08/11/2022

Download the report [PDF 507.4KB]

The Greater London Authority sought a review of the 'health inequalities and prevention of ill health' test of the Mayor’s six tests, with a particular focus on: 

  • inequalities in access to, experience of, and outcomes from health services
  • the disproportionate impact of Covid-19 on particular groups in London
  • providing clarity to the NHS about what response and action the Mayor expects from the test.

The overarching aim of the review was to develop recommendations for the future of the test as it is applied to major health care reconfigurations in London, taking into account the remit the Mayor has with regards to the NHS and his interest in reducing health inequalities in the capital.

This report presents a review of recent evidence of health care inequalities in the NHS in England, as such inequalities form a major part of the problem the Health Inequalities Test has been devised to help address. It shows how inequalities are driven by obstacles that exist along the steps that patient takes to try to access health care: from the information services provide about themselves, through to the hidden indirect costs of attending clinics, and service flexibility and accommodation to different social needs.

It discusses some wider challenges which are relevant beyond London and consultations on NHS configuration, highlighting how health care inequalities have been viewed predominantly through the lens of the 2010 Equalities Act, some aspects of which exclude protections for groups experiencing disadvantage or exclusion as a result of economic deprivation.

We recommend a set of revisions to the current Health Inequalities Test, including to help embed the emphasis now seen in national policy on the structural drivers of inequalities, particularly as they relate to minoritised ethnic groups and people experiencing economic deprivation. Revisions are also needed to reflect the heightened ambition and urgency now found within the NHS to tackle health and health care inequalities, which is an ambition and urgency the Mayor shares.

Response from the Mayor of London

We are pleased that the Mayor has accepted our recommendations and has revised his Health Inequalities Test to reflect them. Read more about how the Mayor responded to our review – including how the Health Inequalities Test has been revised on the GLA website, and a blog by Tom Coffey, Mayoral Health Advisor, on where this work fits into the Mayor's agenda.

Suggested citation

Gainsbury S and Hutchings R (2022) Review of the Mayor of London's Health Inequalities Test. Research report, Nuffield Trust.