Reducing health inequalities in Black, Asian, and Minority Ethnic communities – our work on the Nottingham Health Inequalities Maturity Matrix

Donna Sherratt, Head of Programme, Small Steps Big Changes, discusses the use of the Nottingham health inequalities maturity matrix as a means of reducing health inequalities in Black, Asian and minority ethnic communities.

During the covid pandemic the discussion around health inequalities within Black and Minority Ethnic communities became more prevalent on an international scale.

As Small Steps Big Changes (SSBC) Head of Programme, I’ve celebrated the diversity of the communities we work in and aware of the importance of working in a way that is both inclusive and equitable within those communities; improving access to our services for ethnically diverse communities is something that we’ve been looking to strengthen at SSBC, and has come from an acknowledgement within the team that there are sections of our communities who we do not engage enough with. Since January 2021, Clive Foster and I have led the Race Health Inequalities Programme for the Nottingham Place-based Partnership (PBP) addressing three key objectives to reduce health inequalities within Black, Asian, and minority ethnic communities.

These three objectives, which have been co-produced with communities are:

1. Review commissioning processes to address structural racism, strengthening engagement with and involvement of Black, Asian and minority ethnic communities.
2. Understand the contribution of community organisations in the commissioning of services to meet the health and wellbeing needs of Black, Asian and minority ethnic communities.
3. Transform engagement and communications with Black, Asian and minority ethnic communities to improve access to and experience of using services.

Recognising the extent of these challenging and ambitious objectives, a group of senior PBP Leaders and senior representatives from Black, Asian and minority ethnic communities came together to develop and support this work. The initial approach was to understand and provide co-produced solutions which would help improve awareness amongst health and care providers of inequities around access to services for BAME* communities and the health implications of these.

This approach led to the open and respectful challenge of ideas, in the shared knowledge that addressing better health outcomes for Black, Asian and minority ethnic citizens is the primary objective.

These conversations allowed for an environment to be created within the meeting space. The areas which needed to be addressed to reduce health inequality and improve health outcomes for these communities could then be defined. It was quickly recognised that meeting online offered a neutral space to allow for such conversations to take place.

This co-production approach was able to remove the belief that one person, or one organisation has all the answers in addressing health inequalities and a whole system approach was required. The group also understood that a ‘one size fits all’ approach was not sustainable when seeking to address diverse and complex health inequality issues.

What was needed, was a sustainable and workable solution.

We needed a way for organisations to review their practice and gain an understanding of how they needed to develop, or what new ways of working they needed to implement to address issues specifically related to health inequalities within Black, Asian and minority ethnic communities. The group looked to Public Health England and their work around place-based Maturity Matrices to see how a similar approach could support this work; the eventual chosen approach favoured a bespoke Nottingham co-produced Maturity Matrix endorsed by the Place based Partnership which will create culturally competent organisations.

Bringing together the discussions and using recommendations from the NHS Race and Health Observatory, PBP and BAME* community partners were able to agree some content principles for the Maturity matrix including:

i. Equality Impact Assessments

ii. Community Engagement

iii. Representative workforce

iv. Accountable Leadership

v. Data & Evidence

vi. Financial investment

vii. Inclusive Decision Making

The maturity matrix seeks to improve cultural competence and responsiveness amongst health and care organisations working with communities, thus ensuring better health outcomes for Black, Asian and minority ethnic citizens of Nottingham.

At its core, systemic or structural racism stems from a historical power imbalance, using this maturity matrix tool is a means of delivering organisational transformation which, in turn, supports greater equity in access to health and care services across all communities. Future health and wellbeing have their foundations in early childhood, proactively addressing structural and systemic racism now, provides an opportunity to reduce inequalities for future generations.

It’s not an easy fix, however, the tool is a starting point which enables difficult conversations about inequality within structural organisations to be had from the

earliest onset; it provides a route for divergent voices to have culturally mature conversations which can support provision of health, care, and community services. Other enablers include greater strategic commitment and increased tools and resources to address health inequalities. Organisations using the matrix, however, need to be committed to change and a willingness to do better.

A three-month pilot phase with four organisations has been completed with a focus on testing the process and providing feedback to support implementation and inform guidance; the matrix has been refined and is now on target to being implemented across the system.

The potential impact of the Maturity Matrix is that:

• Commissioners can commission culturally competent services
• Providers should be commissioned to deliver and acknowledge the resources/focus/context for delivery
• Workforce will benefit from individual impact and behaviour change
• Communities will be better connected to services, have their voices heard and be able to influence services

For more information contact Donna Sherratt donna.sherratt@nhs.net or watch the shared learning session.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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Visit the A Better Start website to find out more.