Learning and Action Network (LAN)

 

Image of senior leaders and sites from the launch of the Learning and Action Network on the 24th January 2024 in London. 

What?

The NHS Race and Health Observatory, in partnership with the Institute for Healthcare Improvement and supported by the Health Foundation, has established an innovative peer-to-peer Learning and Action Network (LAN). The LAN aims to address the inequalities seen in severe maternal morbidity, perinatal mortality and neonatal morbidity for people from Black, Asian and other ethnic minority backgrounds.

Ten teams, from eight Integrated Care Systems, in four regions are participating in an anti-racism focused quality improvement programme. The teams are focusing on four conditions where evidence highlights significant ethnic inequalities in health outcomes: post-partum haemorrhage; preterm birth; maternal mental health; and gestational diabetes.

Why?

Ethnic health inequalities are a long-standing challenge; Black women remain three times more likely to die during or soon after pregnancy compared to White women and the maternal death rate for women from Asian ethnic backgrounds remains two times higher than that of White women.  Babies from the Black ethnic group have the highest rates of stillbirths and infant deaths, with babies from the Asian ethnic group consistently the second highest.

In England, there are few large-scale maternal and neonatal health improvement initiatives aimed specifically at addressing ethnic health inequalities. There are also evidence gaps around organisation-level interventions targeting structural and institutional processes which perpetuate racism and ethnic health inequalities.

The RHO LAN pilot is based on the assumption that racism is one of the factors responsible for the persistence of ethnic health inequalities. Through this pilot, which views racism and racial bias as determinants of health, we aim to understand whether it is feasible, acceptable and possible to improve maternal and neonatal health outcomes for people from Black, Asian and other ethnic minority backgrounds through an anti-racism focused quality improvement approach.

How?

We are working with colleagues from the Institute for Healthcare Improvement and a group of experts drawn from the NHS RHO Maternal and Neonatal Health Advisory Group to develop and deliver an anti-racism focused Quality Improvement programme. By embedding the RHO Anti-Racism Principles in the programme, we aim to support teams to identify and address racism and racial bias in maternity services.

The RHO Anti-Racism Principles

  1. Name racism, engaging seriously and continuously with the ways in which racism impacts the lives of the patients and service users who are your focus.
  2. Agree a mutually accepted model of racism and health, which all partners will accept and ratify.
  3. Involve racially minoritised individuals in every stage of development, including ensuring that the improvement team themselves are racially diverse. ​
  4. Collect and publish data on race inequity in its entirety. Where data is not available, change policies to ensure that data is collected.​
  5. Identify racist bias in policies, decision making processes, and other areas within your organisation. ​
  6. Apply a race-critical lens to the adoption of interventions to be tested – did underlying research involve community participation? Who were the researchers?​
  7. Evaluate based on measures that recognise the role of racism as determinant of health.

Find out more:

We are looking for an evaluation partner to explore the feasibility and acceptability of an anti-racism focused improvement approach to address ethnic inequalities in maternal and neonatal health. Please see our Invitation to Tender for more information.

Teams participating in the first phase of the RHO LAN include:

 

  • Barts Health/ North East London ICS
  • Birmingham and Solihull Local Maternity and Neonatal System / Birmingham and Solihull ICS
  • Bristol, North Somerset & South Gloucestershire ICS
  • East London NHS Foundation Trust/ North-East London ICS
  • Imperial College Healthcare NHS Trust and King’s Health Partners/ North-West London ICS
  • Lancashire Teaching Hospitals NHS Foundation Trust / Lancashire and South Cumbria ICS
  • North Central London ICS
  • Northern Care Alliance NHS Foundation Trust/ Greater Manchester ICS
  • St Mary’s Hospital (Manchester University NHS Foundation Trust) / Greater Manchester ICS
  • University Hospitals of Leicester NHS Trust / Leicester, Leicestershire and Rutland ICS

The LAN programme includes: improvement coaching, anti-racism webinars, clinical webinars, online and in-person sessions during which teams share and develop their learning around quality improvement methodologies and implementing anti-racism improvement at System level.

  • The LAN pilot programme launch in January 2024 was attended by senior leaders from participating sites and key national stakeholders

This new network will help to accelerate local improvements in maternity and neonatal services, helping to ensure safer, more personalised and equitable maternity care for all women, babies and families.

Kate Brintworth - Chief Midwifery Officer for England

What next?

Through the initial phases of this pilot, we aim to assess feasibility, acceptability and effectiveness of applying an anti-racism focused Quality Improvement interventions and understand contextual and implementation factors important for scaling this approach. We are commissioning an evaluation to help us to understand these points and to design a strategy to scale and spread interventions of value for reducing maternal and neonatal ethnic health inequalities.

In later phases of this work, we will also seek to understand the applicability of this approach to other conditions and areas.

For further information, please contact: implementation@nhsrho.org