NHS Scotland’s reform must tackle racism and inequality - Foysol Choudhury
Scotland’s NHS is about to undergo one of the biggest structural changes in its history. The Scottish Government has announced plans to radically reshape the way NHS Scotland is organised, including replacing the existing 14 territorial health boards with two strategic boards as part of a wider programme of public service reform.
The Government says the reforms will reduce bureaucracy, improve services and deliver better outcomes for patients. Those ambitions should be welcomed.
But there is a question that must not be lost amid the discussion about structures, savings and management: Where does tackling racism and health inequality fit into the future of our NHS?
A health service cannot truly be fair unless it works fairly for everyone. That includes the people who work in it.
Our NHS depends on people from every community. Thousands of staff from Black and minority ethnic backgrounds make an enormous contribution to Scotland’s health service every single day. They deserve to feel safe, respected and valued at work. Patients deserve the same.
And we should never accept a situation where someone is less likely to receive the care they need, less likely to be listened to, or less likely to feel comfortable speaking to a healthcare professional because of their ethnicity, religion or background.
Inequality has many causes, poverty, geography, disability, ethnicity, age and other circumstances, and our NHS must be equipped to understand and respond to them.
That is why the Government’s proposed NHS reforms must be about much more than moving responsibilities from one organisation to another.
If we are genuinely going to build a better NHS, we need to ask whether the reforms will improve the experience of the patient who currently struggles to access care.
Will they reduce health inequalities?
Will they improve outcomes for communities that have historically experienced poorer health?
Will they give staff the confidence to report racism and discrimination?
Will they ensure that equality and anti-racism are embedded in leadership, recruitment, training and accountability?
And importantly, will communities themselves have a meaningful voice in shaping the new NHS?
These questions are particularly important in Edinburgh and Lothian, where we have diverse communities with very different experiences of health and public services.
It should be judged by whether patients receive better care, whether staff feel safer and more valued, and whether the gap between those who experience the best health outcomes and those who experience the worst is finally narrowed.
The Government can make anti-racism and tackling health inequalities a central part of NHS reform rather than something added afterwards.