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Tackling the structural racism which exists within the NHS has been high on the agenda since the coming of covid-19 and killing of George Floyd this year.

Although the subject is not a new one, new energy has been given to the movement towards equality. It is for this reason that readers may have been so shocked at HSJ’s report on one of the most multicultural regions of the country – Birmingham.

Despite its 40 per cent BAME population, none of the five trusts across Birmingham and Solihull Sustainability and Transformation Partnership have an executive director from a BAME background on their boards.

What does this mean in reality? Well those making the decisions about healthcare do not reflect the population for whom those decisions are being made.

For at least two of the trusts – Royal Orthopaedic and University Hospitals Birmingham – the lack of diversity is not new. Neither has had a non-white executive director for at least 20 years.

It would not be unfair to look at that figure and conclude that the absence of BAME decision makers has either been at worst wilful or at best a topic not on the trust leaders’ radars.

Lifting barriers

It is four years since NHS England brought down the curtain on the controversial programme, but renewed efforts are quietly being made to join up patient data across the country.

This time, the Local Health and Care Record Exemplar programme – run by NHSX – is attempting something similar but in a more softly softly catchee monkey manner.

While unsuccessfully tried to put NHS patients’ data into one giant repository, the LHCRE aims to help regions across England to create their own shared care records.

The programme has been running since 2018 with relatively little fanfare, but progress has been made – to varying levels - in each of the first five selected regions.

As you would expect, some barriers to implementation have cropped up, and some of the broadest issues are set out in an NHSX evaluation which has been shared with HSJ.

One major barrier is the mismatch between the patient flows and organisational relationships within a health economy compared to the geographical boundaries of the LHCRE regions, which were drawn up nationally when the programme launched.

As a result, NHSX now plans to allow more flexibility for the design of future LHCRE regions, a source involved in the programme told HSJ.

None of the other identified barriers are viewed nationally as insurmountable, though clarity over funding is needed at local level. More details on this are expected in the next few months.