NHS Race and Health Observatory response to the 10 Year Health Plan

After much anticipation and consultation, the government has released its 10 Year Health Plan to “fundamentally rewire” our NHS. Read our initial reflections.

A decade is a long time in the NHS. Ten years ago, we hadn’t imagined that a pandemic would stretch our healthcare service to its limits, nor that years of underfunding could push this treasured institution to the brink of collapse. Until the COVID-19 pandemic, we had also failed to truly confront the stark racial and ethnic inequities in the health of our nation.

It is positive, then, that the government recognises its plan for the NHS cannot simply be a strategy for maintenance or survival, but must be a vision of renewal and aspiration, looking towards a healthcare system of the future. For the Observatory, that means an NHS that serves all people in this country, properly accounting for their race or ethnicity, and providing an equitable level of dignity and care. It means ensuring that technological advances and innovation don’t leave any communities behind or exacerbate levels of mistrust. And it means working with those communities, as well as for them, to ensure that healthcare services are responding to the self-identified needs of the people, rather than expecting patients to navigate outdated systems and endure dangerous waiting times.

Race, ethnicity and racism

The Observatory was pleased to work with the government, and our diverse communities, in the development of the plan. It is right that the plan acknowledges the ‘intolerable injustice’ of healthcare inequalities, and points to some clear commitments related to race and ethnicity. The government has committed to:

• Supporting the NHS to recruit from the community it serves, publishing provider-level employment and recruitment data broken down by ethnicity.

• Working with the Social Partnership Forum to create staff standards with an aim to tackle racism in the workplace.

• Leveraging the power of the NHS App to provide more personalised care to ethnic minority patients.

• Improving access to HIV prevention interventions for under-represented communities.

These steps are welcome, and we hope for an even greater and more explicit focus on race, ethnicity, and their intersectionality with other characteristics, as part of the implementation of the plan. The Observatory’s evidence has shown, at every stage of life, a person’s expected health outcomes vary based on their race and ethnicity.

In implementing the plan, there are clear opportunities for the NHS to tackle long-standing barriers to health equity. The plan speaks about using patient data to enable better patient and population level decision making, meaning there’s a chance to improve the way ethnicity is recorded in patient data sets. The plan promotes the wide-reaching adoption of AI across the service, creating the opportunity to tackle the racial biases that are often ‘baked in’ to machine learning systems. The plan makes much of its new focus on prevention in reference to lifestyle factors such as smoking and healthy eating, and its implementation can go further by grappling with the more insidious structural determinants of health and poverty, including racism.

The commitment in the plan to review the Carr-Hill formula to shift NHS resources to the most deprived areas of the country is welcome. But we also have to acknowledge that minoritised ethnic communities do not only live in these deprived areas.

From maternity and neonatal care to mental health and genomics, we see inequity baked into clinical pathways, organisational policies, and the evidence base on which policy decisions are made. It’s not enough to think of inequity only in terms of deprivation; if the plan is truly to rewire the healthcare service, its implementation must also attend to these deeply entangled forms of racism and race inequity. If it doesn’t, we may look back in ten years and see that only some of our communities have benefited from these shifts.

Community participation

We welcome the focus on Neighbourhood Health Services, and the move away from acute care as a catch-all. We also celebrate the fact that so much of the plan aims to put patients at the centre of the new-look healthcare service.

For this plan to succeed, the NHS must first rebuild levels of trust between ethnic minority communities and their healthcare providers. Over the past few years, many people, especially the most marginalised in our society, have lost confidence in the NHS, no longer believing that the service is acting in their best interest. It will not be enough to simply land a neighbourhood health centre in a marginalised community and expect it to be used; the NHS will need to build relationships with communities that have been left behind.

The Observatory is working with the Department of Health and Social Care, the NHS, local communities, and other partners to build and rebuild the level of trust needed to tackle these issues – including work in East London on improving access to, and uptake of, healthcare services. Work in this area will form the critical foundations for the effective implementation of the plan.

This mission may be made harder by the abolition or downgrading of patient-focused organisations, as well as changes to funding for Integrated Care Boards, whose ability to respond to population health needs remains in question. In implementing the plan, therefore, it will be essential to demonstrate that people and patients, especially those disadvantaged by the current system, are not sidelined in pursuit of cost-savings and efficiencies – and the Observatory will support in this regard.

System collaboration and the workforce

If this plan is genuinely to deliver health equity, it will need to be delivered in collaboration. Not just at a local level where providers will need to work alongside local communities to understand and respond to their needs, but also nationally, where the infrastructure of our research, regulation, and education sectors will need to be aligned towards a shared goal of eliminating bias and racism.

Critically, if we are to achieve the ambitions set out in the plan, then we need an NHS workforce that is fully supported, engaged and representative of the populations served – and leadership that is truly representative of the workforce. The Observatory is working on these crucial areas, including on work to tackle the ethnicity pay and progression gap across the NHS workforce, to support leadership representation and development, and to tackle bullying and harassment across the system.

The Observatory stands ready to support the equitable implementation of the 10 Year Health Plan by the continued provision of high-quality evidence, resources, support and guidance for healthcare providers. Together, we can ensure the 10 Year Health Plan delivers true equity -– the very principle upon which the NHS was founded 77 years ago.