Map of the south west peninsula with pin pointing on Plymouth

Background and rationale 

It is well-established, both locally and more broadly, that more attention must be paid to addressing the persistent inequalities in health outcomes, healthcare access, and the social determinants of health. The Fair Shares Fund aims to target additional investment to populations (defined by demographic or geographic characteristics) which have historically been under-funded. The Fair Shares Fund originated in response to a recognition of historic underinvestment in the Western Locality as compared to the rest of Devon, together with significant deprivation and social challenges in the locality.
The Devon ICS has developed the Health Inequalities Game Changer strategy, part of which requires Local Care Partnerships (LCPs) to set out plans to demonstrate how we will take action to address the health inequalities experienced by our local populations by the end of March 2022. This framework serves as part of the Plymouth LCP plan to address health inequalities in the local area. 
The Fair Shares initiative has a dual aim: 
  • Reducing health inequalities
  • Improving baseline mental and physical health
Investments has been agreed for a set of programmes to address, for example, frailty, complex lives and homelessness, and general mental health and well being throughout Plymouth.
To maximise the impact of the Fair Shares funding, the Western Locality commissioned a researcher from the University of Plymouth to co-develop, alongside the CCG and provider organisations, a prospective evaluation framework to demonstrate the impact of the initiatives. By considering evaluation at the same time as intervention design and implementation, the aim is to ensure alignment with Devon’s long-term strategy and the stated aims of the funding of each constituent programme. 

Reducing Inequalities

The primary goal of this programme is to reduce health inequalities along multiple dimensions: 
  • Between different geographies and demographic groups in Plymouth 
  • Between the Plymouth locality and elsewhere in Devon 
  • Between Plymouth and the national average
Recognising that many health disparities stem from different social circumstances and access to resources and that to narrow these gaps requires not just more, but different service provision that responds to population needs. 

Improving Baseline Health

Living in complex and disadvantaged circumstances tends to have negative impacts on both physical and mental health. This means that the healthcare needs of the target populations for Fair Shares may be quite different to the population in general. 
The aim of this funding initiative is to not only narrow gaps in access, but also to improve the health of the population at large. These programmes, by opening up new avenues to provide targeted services, may also have knock-on effects on existing services in the area, shifting capacity to address wider concerns. 


Our ambition with this evaluation framework is to develop a flexible approach to identifying, monitoring, and responding to inequities in health outcomes and healthcare utilisation in the Western Locality. We take a Population Health Management (PHM) approach to identifying vulnerable populations and understanding their: 
  • Demographics,
  • Current service use, and
  • Needs, in order to respond to them most appropriately. 
In this way, the framework is aligned with the ICS’s broader ambition to move to a PHM approach to monitoring quality and performance. The framework is also designed to grow and change as programmes become embedded and understand the impact they are having, and new initiatives come on line. 
This study is supported by the NIHR ARC South West Peninsula (PenARC)