NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic.
In this blog, part of a series of comment pieces from NHS Confederation members and partners, Samira Ben Omar explores how the NHS and partners can work to address systemic inequalities facing underserved communities.
COVID-19 shed light on the impact of deep health inequalities on the everyday lives of people living in underserved communities. The history of health inequality in the UK paints a fascinating tapestry coloured by different understandings of poverty, deprivation and disregard .
For decades there has been multiple explorations and government initiatives on the correlation between health, inequalities and the social determining factors, and it is still questionable whether this agenda has sufficiently moved on or if indeed this is a watershed moment. After two Marmot Reviews, we are still asking how we can address the wider social determinants of health. There is a high level of national interest now and new openness to discuss race, communities, systems and inequalities in a way that has not been done before.
Community Voices is an approach that invites citizens (local residents, community activists, public sector staff, senior leaders) to have honest conversations that transform the way they connect with each other and the system to address systemic inequalities. Community Voices starts with the belief that if the challenges exist in communities then the solutions lie there too, and encourages people to find these by moving beyond their community, geographical and organisational boundaries. The approach is rooted in evidence of programmes like community champions and methodologies where connecting with communities on what matters to them demonstrates sustainable and self-sustaining progress.
Over the last three months, Community Voices listened to stories of black and minority ethnic (BME) individuals, frontline staff, patients and community activists. There is a sense of urgency that the time is ripe for a different conversation on race, racism and the wider inequality, sparked by Black Lives Matters movement. We listened as GPs, patients, carers and frontline staff shared their raw emotion of loss, their experience of bereavement, and what it was like to work through this difficult and challenging time.
COVID-19 is progressing but the impact of poor decisions regarding personal protective equipment, frontline staff redeployment, ignorance of cultural and religious practices continue. People in low paid or insecure work, those with existing health conditions, or who were already socially isolated found it difficult to cope with rent, bills, affordable food, and access to services they need . We hear stories that point to years of inadequate housing, and low pay for key workers.
We have a short window of opportunity as local councils and the NHS are developing recovery and risk plans to push for system-wide sustainable change. Our response has been to proactively share honestly and authentically what we have heard and learnt - and what our communities think can be done at every opportunity, whether in conversations with Senior Leaders in Local Authorities (Brent and Leicester) or with NHS Providers (Imperial NHS Trust Transformation Programmes) and not least with clinical commissioning group gold commands, and BME chairs networks.
We continue to collaborate and validate what we are hearing and seeing with grassroots organisations such as the BME Health Forum, The Abbey Community Centre, SOBUS, Healthwatch, and national organisations including National Voices.
The questions remain: how can BME frontline staff have a stronger say on issues that impact our communities? How can institutionalised racism and structural inequalities be tackled once and for all? What will encourage a radical rethink about communities, particularly BME, who feature across most of the indices of poverty?
This is an opportunity to have a voice and speak truth to power. It takes passion, courage and a different type of energy for change. It raises important dilemmas, paradoxes and contradictions that need to be carefully worked through. As Professor Donna Hall, chair of the New Local Government Network argues, it requires a new approach with different parts of the system working together with the communities they serve.
“We are aware that we are underserved” (Sharon Tomlin, Community Organiser)
Communities who are underserved worked together during COVID-19 to share their grief, loss, lack of access to support, friends and family, and connect at a deeper level. his approach is not unique to us and needs to be supported beyond the pandemic. BME communities play a vital role in crises, building a voice for change, and connecting with each other. This is the bedrock on which resilient communities thrive. As Kissu Denton-Savage a community champion states: “We are local people, that know the community, that are able to tune to the needs of our community.”
Finally, we have an ‘ask’ of you to join us in addressing system inequalities by connecting with communities and frontline staff through their experiences. We also ask that you work connect with communities in articulating what the question is and not just in discovering solutions.
Samira Ben Omar is assistant director of equalities for the North West London Collaboration of CCGs and co-founder of the Community Voices movement for change. Follow her and Community Voices on Twitter @benomsam @CommVoicesNWL
1 Department of Health, 1998. The Black Report, Our Healthier Nation: a Contract for Health
2 Royal College of Physicians, April 2020. COVID-19 and mitigating impact on health inequalities.
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