A call to action on ethnic health inequalities: how can the NHS accelerate change?

Black women die during pregnancy or in the year after at a rate four times higher than white women. This is just one example of the health inequalities experienced by people from minority ethnic groups.

Understanding and addressing these inequalities – which are complex and have multiple overlapping causes – has (on paper at least) been a focus for the NHS for some time. Major policy documents like the NHS Long Term Plan identify this work as a priority, while legislation includes duties on NHS organisations to address health inequalities.

'But despite warm words and good intentions, the NHS has made little progress.'

But despite warm words and good intentions, the NHS has made little progress. Attention has been elsewhere – funding shortages and operational targets like waiting times have dominated system leaders’ thinking and national performance conversations. These are the ‘P45’ issues that chief executives know they need to address if they want to keep their jobs. Tackling ethnic health inequalities is not on that list.

Rather than diverting attention further, the Covid-19 pandemic pushed ethnic health inequalities into the limelight: in the first wave mortality rates were highest among Black groups and in the second among Pakistani and Bangladeshi groups. Close work with ethnic minority communities has been central to key elements of the pandemic response – such as local test and trace efforts and the vaccination program. The NHS has also been asked to use data on ethnicity and deprivation to help prioritise the waiting list backlog.

It is now time to build on that momentum and make tackling ethnic health inequalities part of the NHS’s business as usual.

At The King’s Fund, we have been working with the NHS Race and Health Observatory to consider the NHS’s role in tackling ethnic health inequalities and what needs to happen to accelerate change, as system-working develops and new NHS structures are implemented.

We found the NHS needs to address critical gaps in its capabilities to do this work. This includes by improving the quality of ethnicity data, accelerating action to diversify its senior leadership, investing more in community engagement activities and supporting the new executive health inequality leads (that were appointed across the NHS as part of pandemic recovery plans) to drive forward this work in their local areas.

'Work to address health inequalities should be elevated to a ‘must do’ and not just a ‘nice to have’ as in the past.'

Fundamental changes are also needed to the way the health system is ‘wired’ to make health inequalities, including ethnic health inequalities, a central focus for its performance, accountability and improvement infrastructure. Work to address health inequalities should be elevated to a ‘must do’ and not just a ‘nice to have’ as in the past. Ways of doing this include integrating health inequalities within the new ‘triple aim’ for NHS organisations; giving local systems and places the freedom to determine which actions can best make progress but being clear that making progress is essential; and implementing improvement support to help systems learn from one another and identify best practice.