Every aspect of an integrated care system suffers from racism, ICS leaders have said, with efforts needed to tackle discrimination in both NHS and partner organisations.
ICB leaders must address racism in every organisation, beyond the Board, to improve staff experiences and should consider how to dismantle structural racism across ‘all four key aims’ rather than simply via the health inequalities brief.
Delegates from ICBs – who spoke under anonymity at the ICS Network conference, hosted by the NHS Confederation – assessed how to ensure ICSs become anti-racist systems.
One delegate highlighted that ICSs – linking local, national and non-NHS organisations – are uniquely positioned to tackle structural racism which is ‘not just an NHS challenge’.
They said: ‘If you look at structural racism, every component that forms the integrated care system suffers from it. Look at housing associations, charities, the voluntary sector, the police, and the local communities. And we have patients who say, ‘I don’t want a Black person touching me.’
They added: ‘At what point do we start to acknowledge that this is not just an NHS problem – and it is a huge issue in the NHS. We haven’t broken through ever. We might well have a few more Black non-executive directors – and that is really exciting – but we have one Black ICB chief executive.’
ICS leaders must ‘broaden the conversation’ to all aspects of the system, they added.
Another added: ‘We need to be thinking about the way in which we can dismantle structural racism: the way in which society is structured embeds [racist] practices that lead to worse outcomes for particular groups. That is for us really important as integrated care systems because we encompass housing, education, employment: all the wider determinants which lead to worse outcomes.’
Leaders also highlighted that the ICSs’ four ‘key aims demand of us to be anti-racist’.
They suggested that until now the NHS has been ‘data rich, but action poor’ on issues of racism, able to identify staff inequalities – through mechanisms such as the Workforce Race Equality Standard (WRES) survey – but often unable to tackle the root cause.
But the composition of ICSs allows for ‘coordinated action across clinical and social care, across organisations, across communities, and across regions’ to tackle structural inequalities across the system.
It comes as the NHS Confederation launched its new anti-racism strategy offer for members. The offer will support members to actively target, challenge and remove systemic barriers that enable racism, and recognise that this is a corporate responsibility.
In June, leading historian David Olusoga told senior NHS leaders that racism and discrimination are ‘still disfiguring’ the NHS, with limited opportunities available to staff from ethnic minority backgrounds.
And a recent survey found that Black and ethnic minority NHS leaders more commonly experience racism from managers within their organisation than from members of the public.