Increasing Public Involvement in NHS Long-term Planning – 3

(Much of the content of this post was inspired by an excellent lecture by Prof. Kevin Fenton (pictured) Director of Public Health for London at the NHS Confederation BME leaders’ group in September 2023)

In my previous two posts I’ve focused on the necessity of involving both patients and other civil society groups in the detailed development of the next long-term plan. This is not simply because it’s a nice thing to do to involve people. It will be necessary because we will need to change the covenant between the pubic and the NHS and social care and, for it to work, they must be involved in the planning of those changes. To change the NHS’ relationship with people we must listen to them.

This post continues this argument – but in a different way. The aims of the 2024/5 NHS and Social Care Plan will only be met if it really strengthens the relationship with people’s ability to develop their own health and social care. To reshape this relationship will be hard – and we need to do it for everyone, young and old and from every culture.

And that’s why this post gives priority to involving the black and minority ethnic community in the development and implementation of the plan. It’s not that the rest of us don’t matter – but if the plan is to gain the trust of everyone in developing a better relationship with the NHS, it must start by acknowledging that the current relationship is worse for some than for others. For its black and minority ethnic citizens, it has much further to go than for the rest of the population.

In 2024 we cannot afford the waste of health and life that structural racism creates. If in the next decade the NHS and social care do not play a much bigger role in reducing the impact of structural racism, there will not only have a moral cost for the country, but our nation will be literally economically poorer. As a country, we simply cannot afford the waste of human potential that structural racism creates,

Structural racism means that too many black and minority ethnic people are denied their full opportunity to contribute to our economic wealth. Covid showed us that black and minority ethnic people contracted long term conditions at an earlier age than others and this weakened their bodies. It was these weakened bodies that suffered much worse outcomes from Covid. And those fewer healthy life years limit the number of years people can work. This, combined with the impact of structural racism in other public services, costs the country more than it can afford.

One of the ways to start a conversation about changing the NHS and social care over the next decade is with the notion of ‘hard to reach’. For quite a while now the NHS has had the idea that certain groups of people are ‘hard to reach’. But let’s look at this another way. There is some truth in this idea but it’s not the communities that are hard to reach, it’s the NHS..

We learnt a lot about this during Covid. The pandemic hit the nation hard – but at least we have a universal health service. But for BME communities, where twice as many people died, this universality wasn’t that universal. Bodies weakened by more decades of long-term conditions couldn’t cope with the virus. That’s a health care issue.

We all remember the daily 10 Downing Street press conferences broadcasted to the country. How many black and minority ethnic people delivered those messages?

In terms of clinical trials – on drugs needed by us all – how many include people with very different racial characteristics. Vaccine hesitancy stemmed from the distance that those communities felt they were from the vaccine.

As Covid spread through the country, the NHS and public health had to reach out to those communities it had failed to reach before. Covid champions worked to provide a dialogue between those public service and ‘hard to reach’ communities. This had to be a dialogue, NOT one-way megaphone communication. The NHS and public health needed to learn what they were doing wrong. And when the vaccine came, they had to learn how to reach out a long way through vaccine champions.

What dialogue meant was learning from communities about how public service needed to operate differently if it was going to succeed. And that meant going beyond just ‘hearing what you say’ but changing what the NHS and public health actually did.

This should not be too difficult, since we have some things going for us on trust and communication. Nationally 24% of NHS staff are from black and minority ethnic communities (50% in London). Probably a slightly higher percentage in social care. Whilst the NHS as an institution might not be trusted the people who work within it, coming as they do from every community, would be.

Of course, it would be even better if 24% of very senior NHS managers were from those communities. At the moment it’s just over 10% (The State of Health and Social Care 2022/23 p78).

But dialogue with black and minority ethnic communities is not just useful during a pandemic. If the NHS is to live up to its universal principles it needs to be a construct that happens every day.

And for that to have an impact on how the NHS and social care will operate in 2034, black and ethnic communities must have an important role in helping to develop that 10-year plan.

It’s an historical fact that the NHS was created by white British people for white British people. Being of the same age the NHS and I grew up in a very white world.

That world is very different now and the NHS workforce has played a 50+ years role in leading that change to a richer, more diverse society.

To work for our population now the NHS and social care that we create over the next decade will need to finally recognise and celebrate this.