High quality healthcare commissioning: Obstacles and opportunities for progress on race equality

Author: Salway, Sarah, Turner, Daniel, Mir, Ghazala, Carter, Lynne, Skinner, John, Bostan, Bushara, Gerrish, Kate & Ellison, George

Corporate author: EEiC

Briefing series: Better Health 28

Publisher: Race Equality Foundation

Publication date: June 2013

High quality healthcare commissioning: Obstacles and opportunities for progress on race equality
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This paper draws on findings from the Evidence and Ethnicity in Commissioning (EEiC) project, together with practice experience and other research, to highlight obstacles and opportunities for healthcare commissioning to enhance access, experiences and outcomes for minority ethnic people. The aim of the paper is to describe typical elements of commissioning work and to point out a range of actions that clinical commissioners, commissioning managers and other stakeholders can and should take to improve healthcare commissioning for multi-ethnic populations. An earlier Better Health Briefing Paper (Salway et al., 2013) presents the case for why healthcare commissioning must make race equality a central concern.

Key messages:

  • Healthcare commissioning has the potential to tackle inequalities in access, experiences and outcomes between ethnic groups. However, organisational cultures and structures frequently fail to support attention to ethnic diversity and inequality, while individual commissioners often do not recognise their responsibility, and lack the skills and confidence, to engage in this work.
  • Sustained and meaningful dialogue with both service providers and minority ethnic patients, carers and members of the public, can help to improve understanding of problems and find creative, viable solutions.
  • Effective mobilisation of wider evidence is essential. While accessing, interpreting and applying evidence on ethnic inequalities in health and healthcare is often challenging, there are robust strategies to address these issues, and commissioners can do more to access relevant sources and drive improvements in data collection and use.
  • Looking across the whole commissioning cycle, there are many missed opportunities to integrate attention to ethnic diversity and inequality. A range of stakeholders should be encouraged and equipped to both challenge and support commissioning organisations to take effective action on ethnic inequalities.


  • Commissioning organisational structures, processes and culture
  • Partnership working and meaningful engagement
  • Mobilisation and use of evidence
  • Missed opportunities within the commissioning cycle