References

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Department of Health and Social Care. Press release-Government issues rallying cry to the nation to help fix NHS. 2024. https://www.gov.uk/government/news/government-issues-rallying-cry-to-the-nation-to-help-fix-nhs (accessed 4 December 2024)

The psychological safety of staff. NHS confederation presentation for equality, diversity and human rights week. 2023. https://www.nhsemployers.org/system/files/2023-05/The%20psychological%20safety%20of%20staff%20slides%20%281%29.pdf (accessed 4 December 2024)

The King's Fund. The health and care workforce: planning for a sustainable future. 2022. https://www.kingsfund.org.uk/insight-and-analysis/long-reads/health-and-care-workforce (accessed 4 December 2024)

NHS England. NHS people plan. 2020. https://www.england.nhs.uk/publication/we-are-the-nhs-people-plan-for-2020-21-action-for-us-all/ (accessed 4 December 2024)

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Leadership/management

Embedding diversity and inclusion in community nursing: insights from a unity in care event

02 January 2025
Editorial
02 January 2025
Volume 30 · Issue 1

Abstract

Trust within teams and between healthcare professionals and the communities they serve is central to effective and equitable care. Participants at the summit highlighted trust as critical for fostering collaboration, innovation and culturally competent practices. However, barriers persist, including a lingering blame culture in some teams, which undermines open communication and stifles progress on systemic challenges, particularly those related to equality, diversity and inclusion.

Community nursing operates at the intersection of health and social care, often serving populations facing significant barriers to health equity, including socioeconomic disadvantages, cultural differences and geographical isolation. The role of community nurses is pivotal, being uniquely positioned to build trust, deliver personalised care and advocate for systemic change.

The NHS People Plan (NHS England, 2020) emphasises the creation of compassionate and inclusive workplaces to support a diverse workforce capable of addressing contemporary care challenges. Similarly, Lord Darzi's report (2024) underscored the need to reduce health inequalities through proactive, person-centred approaches. Workforce diversity strengthens the profession by fostering innovation, wellbeing and psychological safety—essential qualities as the focus of care shifts from ‘hospital to community’ (Department of Health and Social Care, 2024).

The recent Unity in Care: a community nursing, health, diversity and inclusion summit hosted by NHS England North East and Yorkshire brought together 100 community nurses, leaders and students to explore diversity and inclusion in practice. Through presentations, workshops and networking opportunities, the summit created a space for sharing insights, challenges and successes, inspiring attendees to champion equity and inclusivity in their teams and communities. The discussions provided critical reflections on the systemic barriers facing community nursing and highlighted opportunities to address these challenges, identifying the themes of trust, culture and aspiration throughout the event.

Trust as the foundation for equity in care

Trust within teams and between healthcare professionals and the communities they serve is central to effective and equitable care. Participants at the summit highlighted trust as critical for fostering collaboration, innovation and culturally competent practices. However, barriers persist, including a lingering blame culture in some teams, which undermines open communication and stifles progress on systemic challenges, particularly those related to equality, diversity and inclusion. The need to transition to a one team ethos was emphasised, supported by transparent processes and psychologically safe environments where all voices are valued.

Initiatives such as allyship groups, as highlighted during the event, were identified as effective strategies to foster trust. These spaces build shared understanding, enhance cultural awareness and promote mutual respect among team members, particularly in diverse teams. For community nurses, trust is vital in bridging cultural divides, advocating for health equity and co-producing solutions with patients and families. Evidence supports this, linking psychologically safe workplaces to improved staff well-being, stronger team performance and better patient outcomes (Kalpaka, 2023).

Building inclusive cultures

Creating inclusive workplace cultures that reflect the diversity of the populations served is essential in community nursing. Summit participants identified persistent challenges, including underrepresentation of diverse groups in leadership roles and poor communication within teams. Addressing these issues requires organisational commitment to cultural transformation and investment in workforce development.

Reflective practice and health equality training were identified as valuable tools for fostering cultural inclusivity. By encouraging professionals to critically examine their biases and assumptions, these approaches deepen understanding of the cultural dynamics within communities. Research demonstrates that inclusive workplaces improve staff retention and enhance patient satisfaction (NHS England, 2023).

By prioritising inclusivity, community nursing teams can become drivers of health equity, addressing disparities and creating environments where both staff and patients feel empowered and respected.

Aspiration and professional development

Aspiration drives innovation and engagement within community nursing teams. The summit underscored the importance of creating career progression pathways, such as apprenticeships and targeted development programmes, to nurture talent from underrepresented groups. A key example shared was a diversity-focused leadership programme, aimed at improving broader representations in executive boards, having a significant positive impact on both individuals and organisational culture.

Providing opportunities for community nurses to influence strategic decision making was also seen as essential for amplifying their voices and driving systemic change. By investing in development programmes, the profession can ensure that diverse perspectives are represented at all levels of decision making, fostering more equitable and inclusive policies.

Key barriers

Despite its strengths, community nursing faces systemic challenges that can hinder progress in advancing equality, diversity and inclusion. The summit highlighted key barriers, including:

  • Workforce constraints. Limited capacity within community teams reduces opportunities for proactive, curiosity-driven care. These constraints disproportionately affect underserved populations, exacerbating health inequalities (The King's Fund, 2022).
  • Cultural competence. A lack of diversity in some nursing teams can hinder understanding of the communities served. Enhanced cultural competence training was suggested to bridge these gaps and support effective care delivery.
  • Fragmented IT systems. Poor integration between healthcare providers and voluntary sector partners limits coordinated, equitable care. Standardised IT frameworks were identified as critical for improving collaboration and reducing inefficiencies.
  • Reframing narratives. Participants emphasised the importance of shifting language from ‘hard-to-reach communities’ to ‘hard-to-reach services’, placing responsibility on healthcare systems to be more accessible and inclusive.

    • The summit also highlighted opportunities to embed equality and inclusion through innovative practices.

  • Integrated neighbourhood teams: working collaboratively with sectors such as pharmacy and optometry enhances inclusivity. Multidisciplinary approaches have been shown to improve patient outcomes, resource efficiency and staff satisfaction
  • Early intervention and prevention: prioritising early intervention, particularly for children and young people, was identified as a critical means of addressing inequalities at their roots, aligning with the shift from ‘sickness to prevention’
  • Community engagement: co-production, where patients and communities actively shape healthcare services, was recognised as a powerful approach to build trust and improve understanding around community need and to improve outcomes.

    • Conclusions

    The Unity in Care summit underscored the critical role of diversity and inclusion in addressing health inequalities and fostering resilient, collaborative community nursing teams. By addressing systemic barriers, investing in inclusive cultures and embracing multidisciplinary collaboration, community nurses can lead the transformation toward equitable, person-centred care.

    Aligned with key NHS policies, these insights provide a foundation for building a more inclusive future in community nursing. This is not only a professional obligation but also a moral imperative to uphold the dignity and humanity of all people. As community nursing evolves, let it do so with a commitment to unity, where every action taken strengthens the shared vision of equity in health and inclusion in care.

    Thank you and farewell

    The editorial board would like to offer its sincere thanks to Alison While for her long standing and significant contribution as consultant editor to the British Journal of Community Nursing. Alison's dedication and contributions over the years have been instrumental in shaping the journals' identity and success. We are deeply grateful for her commitment and the legacy she leaves behind and wish her every success in her next venture. We would also like to extend a very warm welcome to Professor Julie Green who will be consultant editor from January 2025 onwards.