Self-harm and suicidal thoughts and behaviours are a significant public health concern. While individual risk factors have been widely studied, the role of social determinants in shaping these outcomes remains underexplored within policy contexts. This Rapid Realist Policy Review aims to investigate how macro level (national) policies in England address the impact of social determinants of self-harm and suicidal thoughts and behaviours.

This Rapid Realist Policy Review adapts the rapid realist review method to place policy documents at the centre of analysis. It will identify and extract relevant English policy documents (2002–2023) related to suicide, self-harm and mental health, using government and archival databases.

Policy documents will be mapped and categorised based on their pertinence to proximal and distal outcomes and social determinants. A predefined template will be used to extract and appraise data based on relevance, richness and rigour. Context-mechanism-outcome configurations will be developed, validated by content experts and synthesised into an initial programme theory. The review will follow Realist And Meta-narrative Evidence Syntheses: Evolving Standards for realist syntheses.

This review does not require ethical approval due to the use of secondary sources. Findings will be disseminated via an open-access, peer-reviewed journal article. A summary of key recommendations will be produced with the expert stakeholder group to inform policy and practice.

CRD420251057759.

This analysis aimed to explore how local health system strategies and plans seek to tackle health and care inequalities and address national policies. Specifically, the analysis considered alignment with five national priority areas: restoring services inclusively, mitigating digital exclusion, ensuring the completeness and timeliness of datasets, accelerating preventative programmes and strengthening leadership and accountability. In addition, the analysis explored the extent to which systems are engaging with the Core20PLUS5 approach, which targets the most deprived 20% of the population (‘Core 20’) and population groups experiencing disproportionately poor access, outcomes or experiences of care (‘PLUS’).

Integrated Care Systems (ICSs) are statutory partnerships that bring together healthcare, social care, local government and wider system organisations to collaboratively address the root causes of ill health and health inequalities. We conducted a document analysis of available ICS strategies, 5-year plans and health inequalities plans published in England between 1 January 2022 and 31 July 2023. A total of 43 strategy documents, 38 5-year plans and 7 health inequalities plans were analysed. A data extraction framework was used to guide reviewers and independent quality assurance was completed to ensure internal validity, intrarater reliability, and reproducibility of the project.

The analysis highlighted good alignment with national healthcare inequalities policies and local approaches to tackling healthcare inequalities, with the majority of systems citing the Core20PLUS5 framework. There was notable variation between systems on the adoption of the framework with the children and young people’s framework being less widely considered than the adult’s framework. Across systems, equity-focused tools were widely used, and numerous systems had developed outcome frameworks to monitor progress. Leadership for health inequalities was strengthened with senior leadership roles being established to hold integrated care boards accountable for improving access, experiences and outcomes. However, competing priorities, particularly concerning implementations of new organisational models and multiple national priorities, were evident within the plans which may challenge progress on reducing health and healthcare inequalities.

The review concluded that while progress has been made in adopting national healthcare inequalities policies and steers, significant variation exists between systems, possibly reflecting local population needs and varying levels of maturity of the systems across England. The review highlights the need for further evaluations at both national and local levels, allowing for further development of the systems. Additionally, consistent and sustainable funding and more robust training for health inequalities leadership roles is needed to ensure equitable access, experience and outcomes.