Leadership diversity 'can help close child mortality gap'

Habib Naqvi, chief executive of the NHS Race and Health Observatory, called for local organisations to be held to account for a lack of diversity in leadership.

At present, he said, it was contributing to racial and cultural bias, and in turn to NHS “policies and practices impacting patient experiences and outcomes, including those for ethnic minority mothers and babies”.

Mr Naqvi said: “Evidence clearly shows that a fully engaged and representative workforce at all levels leads to better care, safety, and optimal outcomes for all patients.

“NHS organisations should focus on evidence-based interventions that support the progression of ethnic minority staff across the workforce pipeline.”

He said interventions should target communities at high risk of premature births, including anti-racism approaches to quality improvement in maternity and neonatal services.

To implement such approaches, he said: “There needs to be leadership that represents the NHS workforce as a whole and the communities it serves.” He added: “At the moment, the NHS leadership does not have the diversity of thoughts needed to implement these policies.”

“There is a need for greater accountability on leaders and organisations for improvement in this area.”

Gap not closing

His comments come as new figures from the National Child Mortality Database show the sharp rise in death rates of children and infants of black or black British, and Asian or Asian British ethnicity, since the pandemic, has still not been corrected.

Mortality has long been higher among these groups – and, to a lesser degree, some other minority groups – but the gap became substantially wider in 2021 and 2022 (see charts).

In the year to March 2024, the gap remains very markedly higher than pre-covid for black or black British children. Among this group, the estimated death rate was 55.4 per 100,000. For Asian or Asian British children it was 46.8 — still nearly double that of White children (24.6, see chart left), among whom the increase has been small.

The pattern was similar for infants (under ones). Mortality among black or black British ethnicity was 6.8 per 1,000 live births; more than double the rate of white ethnicity (3.2 per 1,000 live births). The most common category for children who died under one year was a perinatal/neonatal event.

There is no clear evidence on why the gap has sharply widened in recent years. Problems are often related to late engagement with services during pregnancy, which may have been exacerbated by growing distrust of the NHS in some communities during covid, one expert said, speaking anonymously.

Overall, child (under 17) death rates in England fell slightly, while infant (under one) rates rose slightly, from the previous year. 

The Royal College of Paediatrics and Child Health president Steve Turner called the figures “unforgivable”. “This is a further sign of how we as a society are letting our children down.”

A Care Quality Commission report on maternity services last month observed that women and babies were still not receiving the high-quality maternity care they deserve, and women from black and ethnic minority backgrounds “continue to be more at risk of experiencing poor maternity care and outcomes”.

NHS England said disparities in care were “unacceptable” and acknowledged “more work” was needed.