As the biggest employer of black and minority ethnic staff in Europe, the National Health Service needs to work more closely with local communities and other parts of the healthcare system to address long-standing ethnic health disparities and close the gap on future health inequalities.
The independent NHS Race and Health Observatory warns the disproportionate impact of the Covid-19 pandemic on black, and minority ethnic communities, and the subsequent recognition of enduring health inequalities, must act as a clear call to action.
In a new report by The King’s Fund, commissioned by the Observatory – Ethnic health inequalities and the NHS – Driving progress in a changing system – healthcare leaders are reminded of their statutory responsibilities for tackling ethnic health inequalities and the need for meaningful and sustained collaboration with local communities.
It calls for all NHS partners, including national government, neighbourhood teams, primary care networks, providers, and Integrated Care Systems to prioritise investigating, with renewed focus, a commitment to tackling ethnic health inequalities. This must become a key plan of action in developing organisational strategies.
Reducing ethnic and wider health inequalities has not been aligned with other pressures on the NHS system. Now, transformative, innovated approaches must be employed around performance management of ethnic health inequalities.
Marie Gabriel, Chair of the NHS Race and Health Observatory, said:
“The Report is rightly looking for a sustained approach across the NHS, an approach that enables all partners to work inclusively with patients and underserved communities to proactively address ethnic health inequalities. The Race and Health Observatory is committed to supporting the NHS with this approach through practical insights.
“People from black and minority ethnic backgrounds continue to face a range of unacceptable inequalities when utilising health services. We need to end this for future generations and rebuild health care systems inside out, based on a foundation of equity.”
Although laws including the Health and Social Care Act and Equality Act provide a strong framework for tackling inequalities, more sustained action needs to be taken by leaders across the NHS.
Richard Murray, Chief Executive of The King’s Fund, said:
“Despite warm words and good intentions, the NHS has not made progress in addressing ethnic health inequalities. This is because tackling health inequalities has not been given enough priority alongside issues such as waiting times and financial targets.
“The Covid-19 pandemic has taken a disproportionate toll on ethnic minority communities, pushing ethnic health inequalities into the limelight.
The NHS has an important role to play in tackling these inequalities – this work should be elevated to a ‘must do’ from a ‘nice to have’ as it has been in the past.
“The changes to NHS structures proposed as part of the government’s forthcoming Health and Care Bill provide an opportunity to embed this new focus, for example by integrating health inequalities within the new ‘triple aim’ that will set the priorities for NHS organisations.”
The report cites the implementation of the Integration and Innovation White paper, and the development of Integrated Care Systems (ICSs), as enablers to prioritise action on tackling health inequalities and calls for this to be embedded into the design of ICSs as they become statutory health bodies in 2022. To provide the required focus, the report also calls for tackling health inequalities to be integrated within the ‘triple aim’ that will frame the priorities for NHS organisations in forthcoming legislation.
To address some of the current disparities and limitations, the report calls for :
Support for NHS leaders and managers who should be held individually accountable for their role in addressing ethnic inequalities in access, experience and outcomes, via ongoing performance management conversations and through annual appraisals
- Practical action to establish more diverse and representative leadership
- Improvements in recording ethnicity data, the coverage and quality of which is currently poor
- Improving access to and experience of care for Black and minority ethnic people
- Better treatment and workplace experience for Black and minority ethnic staff
- Genuine, authentic engagement with all the diverse communities the NHS exists to serve.
Other urgent coordinated action national, regional and system leaders need to take across every level of the system to address ethnic health inequalities, include:
- Investing in measures that identify communities at higher risk of poor health. Culturally competent primary prevention activity efforts should target risk factors such as obesity, diet, exercise and smoking, based on what works for all communities.
- Ensuring actions to address ethnic inequalities in health sit within a broad approach to addressing the overlapping causes and dimensions of health inequalities – including intersectionality with other protected characteristics, socio-economic deprivation, and geography – and the role that structural racism and discrimination play in shaping and reinforcing ethnic inequalities in health.