Inclusive neighbourhood care: Systemic inequity and the role of tech
Transforming Care
23 February 2026
By Louisa
Interview with:
Ruby Osunsola
Operations Manager
Nilaari Mental Health Agency, VCSE Sector
Image credit: @jimpix
Health inequity remains one of the most persistent challenges facing our health and care system. Too often, the people who would benefit most from support face the greatest barriers to accessing it; whether because of geography, culture, trust, or the way services are designed. Integrated Neighbourhood Teams (INTs) offer a powerful opportunity to change this, by bringing care closer to home, embedding support within communities, and designing services around people’s lived realities.
But realising the promise of inclusive neighbourhood care requires more than structural change alone.
“Our team of mental health practitioners are uniquely placed to support our communities,” says Ruby Osunsola, Operations Manager at Nilaari. “Many of them have grown up in the communities they now serve, which brings trust, insight and a deep understanding of the realities people face when accessing care.”
“Our staff also come from racially marginalised backgrounds, which helps us offer culturally safe and relevant support,” Ruby adds. “That’s essential if care delivered closer to home is genuinely accessible and works for everyone.”
Nilaari is a Black-led mental health agency working across Bristol and the South West. The organisation focuses on mental health, wellbeing and community connection, alongside NIHR-funded research. Nilaari provides one-to-one talking therapies for adults and works in partnership with local agencies, including domestic violence charities. They also deliver B2B training and consultancy, to help organisations improve access, inclusion and equity. Alongside her role at Nilaarui, Ruby is mum to three wonderful daughters. She is also Neurodivergent and delivers CPD courses for Healthcare professionals, as a NDBirth Training Practitioner.
Challenges in integrating health and care services into neighbourhoods
Organisational culture as a barrier
Ruby identifies organisational culture as one of the most significant barriers to integrating health and care services into local communities. In particular, she points to a risk-focused mindset within parts of the system, especially in mental health, that can prioritise control and caution over strengths, relationships and community-led approaches.
“There’s often a heavy reliance on established ways of working, which can be quite limiting and lead to resistance to change,” Ruby explains.
This cultural challenge is compounded by uneven approaches to technology adoption across the system. Ruby highlights a disconnect between NHS organisations and the VCSE sector, where the pace, appetite and confidence around technology can vary widely.
“AI is a good example,” she says. “Some people fundamentally mistrust the technology, while others rely on it heavily, so we can’t take a blanket approach to community viewpoints.”
Trust and responsible data sharing
She describes how uncertainty around regulation, data hosting and accountability can undermine confidence in digital tools, making communities more cautious about engaging with services that rely on them.
“Data sharing in general is difficult because of the historical profiling of certain communities,” Ruby explains. “That creates real reservations about sharing sensitive information like ethnicity or religion, because of fears around identification and harm.”
Ruby warns that clumsily managed data sharing, such as new safeguarding officers picking up out-of-context notes, can shatter trust built over many decades. It can make individuals harder to reach, counteracting the goal of personalised care and multi-agency safeguarding.
In an environment where human error, data breaches and cyberattacks are increasing, the need for solid procedures to maintain trust and prevent health inequity becomes even more important.
“If people do not feel confident about how their data is used and protected, they may disengage from services altogether”, Ruby concludes.
The role of technology in tackling health inequity, not perpetuating it
Reframing health inequity
Addressing health inequity starts with the language we use. Ruby draws a clear distinction between health inequality and health inequity. A shift she believes is essential if real change is to happen.
“Inequality describes the uneven distribution of resources,” Ruby explains. “Inequity is about the unfair, avoidable systems and decisions that create those differences in the first place.” This distinction matters, because applying the same processes and principles to everyone does not produce the same outcomes.
“We need to move away from the idea that treating everyone the same is fair,” Ruby says. Instead, she argues, the focus must shift away from individuals who are labelled as “hard to reach” or “not engaging”, and towards the systems and structures that make access harder in the first place.
Too often, responsibility is placed on individuals, rather than on the policies, leadership decisions and cultural norms that perpetuate inequity; including racist, sexist and misogynistic practices.
Ruby advocates for extending the social model beyond disability, applying it equally to race, gender and other factors that shape people’s experiences of care.
“Rather than focusing on the experiences of affected groups,” she says, “we should be examining what our systems have allowed to keep happening to allow inequities to continue.”
She also cautions against focusing too narrowly on individual experiences, encouraging a shift towards population-level thinking. By stepping back and looking at patterns, trends and outcomes over time, inequity becomes visible as a systemic issue, not a series of isolated incidents.
“It’s not an accident that women’s health has been underfunded,” Ruby explains. “If it continues to be underfunded for the next five or ten years, we’ll see the same inequities play out, just in a different form.”
Technology as a tool for accountability
This is where Ruby sees technology and data playing a crucial role. Rather than simply reporting on disparities once they already exist, she argues that digital tools should be used to model, predict and expose the consequences of inaction.
“We should be using technology to understand what will happen if systemic issues like racism in healthcare aren’t addressed,” she says. “That shifts the conversation from being ‘pulled’ into action by communities, to being ‘pushed’ by the very real outcomes of doing nothing.”
Used thoughtfully, technology becomes a tool for accountability, helping health and care systems move from reacting to inequity, to preventing it.
Putting people at the heart of their care
Leadership responsibility
For Ruby, the success of neighbourhood teams (and equitable access to care) depends on taking a genuinely person-centred approach as a leadership responsibility.
“It’s your duty as a leader in health and care to make sure people are not coming to harm,” Ruby says. “And I don’t just mean physical harm. I mean people feeling unsafe, unheard or unrepresented when they engage with your service.”
Care that is difficult to access, culturally unsafe or digitally exclusionary can be just as damaging as care that isn’t available at all. Whether it’s maternity services or mental health support, Ruby is clear that these are not optional extras, they are core routes into the NHS. If people cannot access them safely and confidently, the system is failing at its most fundamental level.
To address this, Ruby explains a “tides of change” theory, an equitable adaptation of the ‘rising tides’ principle familiar in economics. The idea is simple but powerful: if our systems and new technologies are designed to work for those most affected by exclusion – whether digital, health or systemic – the benefits will be felt by everyone. “This may include unlearning, redesigning and reimagining”, Ruby outlines, “but the cost of ‘not’ doing so, is significant”.
Inclusive technology from the start
This principle extends beyond technology itself and into the ecosystem around it. Ruby highlights the vital role of local grassroots and VCSE organisations in inclusive neighbourhood care, stressing that they must be supported, not burdened, by digital transformation. That includes access to clear, practical training on data protection and GDPR; training that is freely available and not a financial barrier.
She also points to maternity care as a clear example of where systems continue to struggle following digitisation. Digitising services in isolation, without embedding accessibility from the outset, risks reinforcing the very inequities neighbourhood teams are meant to address.
“Inclusive technology can’t be something we tweak at the end,” Ruby says. “It has to be built from a place of accessibility from the start.”
Protection at the base
Drawing on her background in secure environments, domestic violence services and criminal justice, Ruby returns to a principle that underpins everything she advocates for: protection at the base.
Rather than reacting to harm once it occurs, systems should be designed on the assumption that everyone may be at risk; whether from domestic abuse, data misuse or cyber threats. She points to the tech sector as an example, where cybersecurity training is mandatory because risk is assumed, not exceptional.
“We don’t wait for a cyberattack to happen before we take security seriously,” she explains, “so why would we do that in health and care?”
Inclusive neighbourhood care
Looking ahead
Ruby is particularly excited by the potential for research into trust and AI; especially how trust is built or eroded across generations. She notes that the responsibility for understanding and navigating AI safety often falls to the “middle generation”, creating an additional, invisible burden that systems must acknowledge and address.
Ultimately, Ruby’s message is clear: neighbourhood health systems will only succeed if they are built on trust, protection and inclusion, with technology acting as an enabler, not a barrier.
By starting with those most at risk, health and care services have an opportunity not just to close gaps in access, but to create systems that work better for everyone.
Media Contact:
Louisa
Marketing & PR
hi@mayden.co.uk
01249 701100
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