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Action must be taken to reduce inequalities in care

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Joan Myers on how to improve care for BME patients

One of the key challenges of Lord Darzi’s Next Stage Review is tackling the significant variation in quality of care. Quality equals equality and equality leads to quality.

His final report set out a vision for high quality care for all in the NHS. He said that this could be achieved by giving patients more information and choice regarding their care.

However, this year’s National Patient Survey revealed that patients from black and minority ethnic backgrounds are less likely to report a positive experience than their white counterparts across all healthcare settings.

The response of BME patients was less positive about questions related to “access and waiting” and to “better information and more choice”. Patient experience is one of the important quality indicators used to demonstrate whether patients are receiving high quality care and these statistics show a lot more work needs to be done.

‘The challenge remains to embed equality and diversity legislation in policies to ensure positive outcomes
for BME staff and patients in the health service’

Central to the Next Stage Review are principles of fairness. Fair and equal access to services is a right of every NHS patient. Sometimes this means providing additional or different kinds of services, for example professional interpreters and patient advocates, to make sure all sectors of society are able to benefit from the NHS.

The NHS Constitution makes clear that the NHS has a wider social duty to promote equality through the services it provides and to pay particular attention to sections of society where improvement in health and life are less than the rest of the population.

As providers and commissioners of services and as employers, NHS organisations have a legal responsibility to promote race equality, eliminate unlawful discrimination and promote good relations.

This also includes reducing inequalities in health and personalising services. It is a challenge to design and deliver healthcare services to an increasingly complex and diverse population, but commissioners and providers can do it by working together to identify the gaps in provision and then putting a robust programme of work together to be managed at board level.
Organisations such as Race for Health and Pacesetters - commissioned to improve health outcomes for BME patients - have best practice guidance, showing where inequalities in outcomes have been tackled.

When the Department of Health set up the Mary Seacole Scholarship Awards in 1994, one of its objectives was to improve health outcomes for BME patients by sponsoring nurses, midwives and health visitors to research areas for improvement. Many of the projects have been used to inform and influence policy on how to improve access, communication and service provision for BME patients.

The first GP patient survey conducted in 2007 found that BME patients were less satisfied with primary care services than white people. This led to the report by Professor Lakhani, No Patient Left Behind, in 2008, which made recommendations, including:

  • Support for patient “choice and voice” within BME communities;
  • Stronger, equitable commissioning for diverse populations based on local needs assessment;
  • Better regulation;
  • Stronger leadership and commitment on BME issues;
  • Legislation to ensure routine ethnicity data collection and compliance.

The recommendation can be translated to include all NHS organisations, whether in A&E, other acute hospital settings or primary care.

The Healthcare Commission published Tackling The Challenge - Promoting Race Equality in the NHS in England in March 2009. It gives examples of how NHS organisations can challenge discrimination, promote equality and respect human rights.

The implementation of these recommendations will improve equity of service provision for all patients.

Legislation is in place to ensure that the health service is held accountable to the people it serves and allows them the opportunity to have a say. The challenge remains to embed equality and diversity legislation in policies to ensure positive outcomes for staff and patients.

The Audit Commission’s 2007 report Making Equality and Diversity a Reality said that the fact race inequalities still exist is due to the slow and sporadic progress being made by public services despite 27 years of race relations legislation.

The Race Relations Act now forms part of the new Equality Bill that in April this year harmonised the six equality strands into one. It is acknowledged that laws and wider action has led to some improvement but inequality and discrimination persists.
The data from the differing legislations and recommendations for improvement should lead to NHS organisations implementing processes, policies and procedures in their systems and structures to achieve high quality care for all patients regardless of who they are.

This can be achieved by NHS organisations working in partnership with external stakeholders, including communities, to implement changes for the benefit of all.

Joan Myers is professional officer for diversity at the Department of Health

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