NHS Race and Health Observatory response to the Major Conditions Strategy: case for change and our strategic framework

The government’s published interim report on its upcoming major conditions strategy – styled as a ‘case for change’ – sets out a framework for onward development of its strategy, and insights gathered from many months of engagement. While the document provides some welcome steers around whole person care, early intervention, and quality treatment, there remains a lack of meaningful attention on ethnic health inequalities. This is particularly concerning in light of the clear evidence of racial inequalities in healthcare, laid bare in the aftermath of the COVID-19 pandemic, and widely reported across nearly all fields of health and care provision.

The major conditions strategy is the de facto replacement for the health disparities white paper, and we have long hoped that it would attempt to get to grips with the deeply ingrained health inequalities experienced by Black, Asian, and ethnic minority people in the UK. While this interim report does make a handful of references to ethnicity, it makes no mention of racism or discrimination, or the impacts that these forces have on the experiences and health outcomes of ethnic minority individuals.

The strategy does talk about the wider determinants of health with regard to deprivation and geography but, as we’ve argued before, identifying where inequalities exist is not enough – this strategy must also engage with the structural causes of these inequalities and should include consideration of racism among the wider determinants of health.

In terms of tangible action to reduce disparities and inequalities, the strategy points to the ongoing work of the Core20PLUS5 programme, which is empowering integrated care systems to use population data in reducing local inequalities. Valuable though the Core20PLUS5 programme is, we had hoped the major conditions strategy would do more to tackle the drivers of inequality that sit outside the immediate remit of the NHS, creating a cross-government consensus that takes an evidence-based approach to understanding structural inequality and its causes.

Finally, in addition to our concerns about the contents of this interim report, we are concerned also by how long it is taking to produce. The health disparities white paper was first announced in late 2021 before being quietly shelved in January 2023. This document indicates that the final strategy will not be ready until 2024, where it will likely soon be overtaken by new rhetoric and commitments in the run up to a general election. Health inequalities in this country cannot continue to be a secondary priority. Ethnic minority people are continuing to have worse experiences and health outcomes in the UK, and urgent cross-government action is needed sooner rather than later.

The Observatory was established to support and drive these changes and stands ready to work with the government and the NHS in delivering race equity and ensure that the NHS and broader healthcare system deliver on their promise of a universal offer.