We welcome the Health and Social Care Secretary’s recognition that our health and care system is still failing too many – especially those from Black, Asian and other minoritised communities. His commitment to tackling health inequalities, alongside wider systemic reforms, is a timely and necessary step in reversing decades of underinvestment, delayed diagnosis, and poorer outcomes for the most marginalised.
We are particularly encouraged by the announced review of the Carr-Hill formula. This is something the Race Equality Foundation has long called for, including when the NHS Long Term Plan was being developed. The current formula has consistently failed to account adequately for deprivation, systemic racism, language barriers and the higher levels of unmet need in many inner-city and ethnically diverse areas. As we have highlighted in previous analysis, urban areas like Hackney and Tower Hamlets have faced sharp funding shortfalls – even as their populations grow and their primary care systems struggle under the weight of complex need and workforce shortages. Not considering language needs has led to haphazard provision of interpreting services, with clarity on who pays for such services in primary care still not resolved.
Failure to address these longstanding imbalances has had tragic consequences. Delayed diagnosis – particularly in cancers and mental health – remains more common among Black and other racialised communities. The result is not just later stage presentations, but significantly worse experiences of care and, ultimately, worse outcomes. Our work with cancer charities and community organisations has repeatedly shown that these disparities are driven not by individual behaviours, but by systemic shortfalls: overstretched services accompanied by services not listening, not reaching out, not recording data accurately, and not adapting to linguistic needs.
We therefore support the Secretary of State’s intention to revise how NHS resources are allocated, so they align more closely with where the need is greatest. But this review must go beyond technical recalibration. It must embed equity as a central principle – including meaningful ethnicity weighting – and lead to real and sustained change on the ground. Without this, we risk yet another cycle of reviews without impact.
We also note the Secretary’s emphasis on early diagnosis and prevention. These must be tied to tangible improvements in workforce representation, service design that tackles racism, and a data infrastructure that allows us to see if change is taking place. Whether in maternity care, community mental health, or cancer pathways, people of Black, Asian and minortised ethnic communities continue to face structural disadvantages that no single funding formula can fix alone.
This moment offers a critical opportunity. The NHS has both a legal and moral duty to promote equality and reduce health inequalities. We stand ready to work with government, ICSs, NHS England and others to ensure that this duty is not only restated – but realised.
