“Healthcare commissioning has the potential to tackle inequalities” according to briefing

Four hands pointing
Chasm with one person on one side and lots on the other.

Bridging the gap between evidence and practice


This briefing has been prepared for clinical commissioners, commissioning managers, and everyone who works with multi-ethnic populations. It combines the findings from the Sheffield Hallam University project “Evidence and Ethnicity in Commissioning (EEiC) with other research, and practical experience. The aim of the Briefing is to demonstrate how health organisations can improve commissioning for their multi-ethnic populations.

The introduction includes a useful definition explaining what commissioning is, together with a set of four key messages:

  1. Individual commissioners do not understand their role in supporting different ethnic groups.
  2. Improving communication between service providers and patients from minority ethnic groups will make a difference.
  3. Making evidence about ethnic inequalities easily available is important to improving commissioning.
  4. Representatives from all the stakeholders should work together to support commissioning organisations.
Impossible with Im crossed out

Missed opportunities within the commissioning cycle

Obstacles and opportunities

The briefing summarises the evidence for several themes, highlighting the obstacles and opportunities and making suggestions for how organisations can overcome and build on these. Themes covered include:

  1. Commissioning organisational structures, processes and culture – this theme raises an important issue about “whether it is appropriate to focus on the needs of minority ethnic groups” rather than the population as a whole. But of course, by not addressing these groups, there is a risk of creating an unfair disadvantage to them.
  2. Partnership working and meaningful engagement – this section suggests that not only commissioners can contribute to the commissioning work, but that other areas, such as the Voluntary, Community and Faith (VCF) sector should be actively engaged with. This group will be more embedded in the population and will help commissioners understand the needs of minority groups.
  3. Mobilisation and use of evidence – here, the authors look at the difficulties of evidence-informed commissioning. There are many gaps in the research in this area, and if commissioners are not able to find the evidence, then commissioners will be less confident about investing in new initiatives.
  4. Missed opportunities within the commissioning cycle – this theme refers to the NHS Information Centre’s version of the commissioning cycle and identifies opportunities. It includes three “Promising practice” examples, where they show how commissioners have improved their service delivery in different areas, including Coventry, East London, Kent and Medway, and Sheffield. They detail the tools that organisations use, such as CQUIN (Commissioning for Quality and Innovation payment framework), service quality improvement tools, and Key Performance Indicators.

The briefing concludes that greater collaborative working between organisations who serve minority ethnic groups is required so that successes can be shared and lessons learned.

Magnifying glass with mix of colours

This briefing addresses the improved commissioning of services for minority ethnic groups


This Briefing is very important because it addresses the commissioning of quality health services for minority ethnic groups, which might be overlooked because they are in the minority. Not only does it provide the evidence, and practical examples of where interventions have been successful, but following the conclusions, there is a list of key actions, and a set of useful additional resources for supporting black and minority ethnic populations.

For commissioners working in areas where there are people from minority ethnic groups, think about which local groups you might engage with. This could be useful in terms of communicating messages and identifying relevant patient representatives. Also, where research is difficult to obtain, see if you have access to a medical library, as staff there can help find the evidence that you need, or monitor current awareness services, like the National Elf Service, which highlights evidence for a range of conditions and populations.


High quality healthcare commissioning: obstacles and opportunities for progress on race equality (PDF)
S Salway, D Turner, G Mir, L Carter, J Skinner, B Bostan, K Gerrish, G Ellison
Race Equality Foundation
June 2013

Supporting material

Evidence and Ethnicity in Commissioning (EEiC) – Sheffield Hallam University

High quality healthcare commissioning: Why race equality must be at its heart

Better Health: Using evidence to promote race equality in health

Engaging with BME communities: insights for impact (PDF)
NHS Confederation
June 2013

National Elf Service

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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