What has the COVID-19 crisis taught the NHS about reaching out to diverse communities? And what lessons are there for post-COVID policy making?

For the last few weeks I have been exploring how mass experience of the COVID-19 crisis may have brought about changes in what I call ‘the centre pf public opinion’ and have looked at how future policies might develop to address some of the issues about which that ‘centre’ are now more worried.

One of the main experiences of the infection crisis has been the reality of mass infection – no one is safe until everyone is safe. Whilst it is true that there has been more infection in some areas than others this is not a problem just for those areas but for the nation as a whole.

In my city (London) there have been times, for example in the autumn when the Government had said “travel to work” (how wise was that I wonder?), that commuter zones in north-east London and Essex developed the highest number of infections. And other times when outer London areas, such as Newham, did.

On both occasions it has not been possible for the rest of the city to ignore those areas and leave them to deteriorate. In a city any infection is a problem for everyone.

There is no drawbridge to pull up.

On Monday I explored the problems, created by decades of migration policy, in the relationship between government and many of those living in black and minority ethnic communities. For very many this mistrust is a direct result of past policies of creating a hostile environment. By creating such an environment a government cannot be surprised when hostility results. It is an intended – not an unintended consequence.

I talked about the problems such a hostile environment may create for vaccine take-up, but it goes much further than that. Mistrust created by hostility will blight everything.

However much the NHS may say that a Government policy of a creating a hostile environment has nothing to do with them (and such a stance is somewhat undermined since NHS has no choice but to follow the law that creates that hostility) – the NHS is a part of that state. In fact, one of the reasons the public love ‘our’ NHS is that it is a nationalised industry and is part of that greater whole – the state.

But if we – the NHS – want better (trusting) relationships with all communities (and if we believe in the principle of equal access for all we should) then we need to do something about building that trust.

This will involve the NHS reaching out to communities – and necessarily doing that through the communities themselves.

Given my point about the crisis demanding that everyone is included in policies to reduce infection, there are localities where that ‘reaching out’ has developed. One of the best examples being in the London Borough of Newham.

Here, early on in the national infection crisis, Newham was one of the places with the highest infections. Even before COVID-19 Newham Council had recognised that passively providing services to their hyper-diverse communities would not work, so they were already committed to reaching out to their public(s). As public health is now a local authority issue, their stance recognised the importance of reaching outwards.

The whole aim of Government policy and communication during this crisis has been to change human behaviour quite radically. We know that this is not at all easy. It is even harder if the main message is being communicated in a language and a culture that is different from the communities whose human behaviour you are trying to change. Harder still if you have previously created a hostile environment.

That was why Newham’s local authority and public health created COVID-19 champions. Respected people from the within the diverse communities in the borough who would develop messages and communicate to and from those communities.

You may have already read about these champions this on the media but if you haven’t I can recommend this article on the Kings Fund blog.

This is an especially important set of new relationships – created by a combination of local government and public health. But these relationships also teach the wider NHS lessons for a post-Covid world. If it wants to develop real equity in access the NHS is going to have to reach out to diverse communities in a similar way.

COVID-19 champions achieved two linked outcomes. It improved understanding of their diverse communities among public health professionals and it improved the understanding of public health within those communities.

Think for a moment of what that might achieve for the wider NHS. If an expanded primary care team could better understand the specific health and health care needs of every community, it would be able to shape its health care offer to better relate to those communities.

And if in turn those communities could better understand what the NHS had to offer they may understand how to create not only a better relationship with NHS services, but also more health inducing behaviour.

The NHS needs to develop its own community champions to create the better relationships it needs to improve health care outputs and health outcomes.

Any thoughts that staying inside our NHS health care buildings might achieve that are an illusion.