Creating Equitable Environments

Despite many efforts to reduce them, racial inequalities are still ingrained in the institutions that constitute the health and care system, and in the systems that determine how people interact with it. The health and care landscape is a complex network of providers, commissioners, regulators, and various other umbrella bodies, some funded privately, some publicly, and all serving subtly different groups of stakeholders. As seen during the pandemic, this system can be agile and reactive, adapting quickly to respond to a crisis when needed. But this model can also lead to inefficiencies and duplication, and dispersed accountability can make it unclear who, exactly, is responsible for embedding racial equity in health and care.  

There are also outstanding inequalities within the health and care workforce. We know that Black and minority ethnic staff are concentrated at lower pay bands, and often have worse experiences of work than their White colleagues. We also know that our leaders are not representative of the workforces they lead, or the communities they serve. Having people working in health and care who are treated equitably, and can see themselves reflected in their leaders, is a vital prerequisite to delivering equitable health and care to patients and service users. Income is also an important determinant of health; if there are gaps in pay and income by race, this can exacerbate ethnic health inequalities. Ensuring equality and inclusion in the workplace is therefore an imperative area of focus and attention.  

As part of this workstream, we:  

  • Review how well the current system architecture serves ethnic minority communities, identifying areas for potential improvement and reform. This will especially focus on embedding considerations of ethnic inequalities in Integrated Care Systems.  
  • Work extensively and continuously with system leaders – including those with renewed responsibilities for health inequalities – to make ethnic equality in health and care impactful in the everyday lives of staff and service users.  
  • Scrutinise accountability structures, workplace environments, pay, and transformation processes across health and care to ensure that staff, as well as patients, experience equity.