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Another missed opportunity, an analysis of the Health and Care White Paper

Integration and Innovation: working together to improve health and social care for all

On 11th February, the Government announced a major reorganisation of the current health and care systems and published a White Paper detailing their proposed reforms. There is a large movement away from centralisation and towards collaboration between services, many of the measures due to be abolished were introduced in the 2012 Health and Social Care Act.

We have analysed the ways in which the White Paper plans on addressing both race equality specifically and health inequalities in general. The COVID-19 pandemic brought into sharp view the inequalities that have been allowed to persist and to grow in the UK. These are inequalities that have a detrimental impact on individuals, families and communities, as well as having an impact on the health and care system itself. 

The current set of proposals feels like a missed opportunity to address long standing issues that have led to poorer experiences and outcomes for Black, Asian and Minority Ethnic communities. We are calling on Government to come forward with revised proposals to address these inequalities. This paper examines NHS reorganisation proposals as detailed in the Integration and Innovation: working together to improve health and social care for all White Paper. It will summarise the key policies within the White Paper before examining some of the gaps with specific relation to race equality and broader health inequalities.

Read our full paper here.

We asked a few organisations within our network to give their thoughts and feedback on the paper

Jabeer Butt MBE Chief Executive, Race Equality Foundation

There is only one mention of ethnicity or race in the White Paper, at the beginning as a statement of intent to improve lives, “no matter where they are from, their ethnicity or social background.” There is no specific mention either in relation to the racial disproportionality in COVID-19 infections and deaths, nor in the other health conditions mentioned in the document that have a disproportionate impact on Black, Asian and Minority Ethnic communities such as diabetes, obesity, dementia, and mental health. There are significant lessons to be learned from COVID-19 and its disproportionate impact on groups including Black, Asian and Minority Ethnic people and people with a learning disability who had higher death rates, with Black, Asian and Minority Ethnic people with a learning disability having an even higher death rate from COVID-19. Understanding the causes through a robust inquiry would inform the design of systems and practices that tackle health inequalities, promote equality, and help restore the trust of those communities in public services and institutions. 

Clenton Farquharson MBE Community Navigator Services CIC

Gurch Randhawa Professor of Diversity in Public Health & Director, Institute for Health Research

The transition from Primary Care Trusts to Clinical Commissioning Groups was intended to yield greater clinical involvement but also created increased conflicts of interest. Alongside this we saw increased private sector provision within the NHS. The NHS White Paper championing integration is well intentioned but remains silent on handling the inevitable conflicts of interest that stakeholder organisations will have within the proposed ICS system. It is also unclear what the role of private sector will be within ICS. More importantly, the voice of patients and communities needs to be front and centre of the proposed ICS system if joined up care provision is truly the rationale for such reforms. Without this voice and public accountability, we risk health and social care inequalities widening.

Circle Steele Chief Executive Officer, Wai Yin Society

The Covid-19 pandemic has indeed uncovered the severe health inequalities affecting particularly the Black, Asian and Minority Ethnic (BAME) communities that were present before, including issues of higher rates of maternal deaths, delayed cancer and dementia diagnoses, and less engagement with public health interventions. Furthermore, with less face-to-face contact from health and social care services, language and cultural barriers have become more challenging. As increasing pressures on health and social care services are likely to worsen health inequalities, now more than ever is the time to address these urgent issues – they really are “life or death”.

Taskin Saleem Chief Executive, Subco Trust

Unfortunately there continues to be a colour blind approach. Systems and services need to be overhauled on the ground to tackle racism and disproportionality in the Health and Social Care Sectors. There is an urgency to work more concertedly with Voluntary, Community and Face sector organisations’ experiences to inform strategies, commissioning and delivery of services – with communities and by communities in the provision of services.