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Care homes told to improve services to BME patients

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Only one-half of minority ethnic care home residents feel their needs are adequately considered. Helen Mooney analyses a critical report

‘Black and minority ethnic people should feel that their individual needs are being met, rather than providers making assumptions about their cultural requirements,’ Dame Denise Platt, chairperson of the Commission for Social Care Inspection, has warned.

Her comments accompanied a report published this month by the commission on how best to provide care services for BME people in England in nursing and care homes.

The report – Equality and Diversity Matters – and an accompanying snapshot poll found that only half of BME service users felt their needs were adequately considered by services.

‘People can only make choices if they are given the opportunity to direct their own care,’ said Dame Denise. ‘Providers can help people by asking about their cultural requirements and work with them to achieve this.’

The report followed the Department of Health’s 2005 Delivering Race Equality in Mental Health Care report, which outlined a five-year plan to achieve equality and tackle discrimination in mental health services in England for all BME people, including those of Irish or Mediterranean origin and eastern European migrants.

This earlier report also set out the government’s response to the inquiry into the case of David ‘Rocky’ Bennett, a 38-year-old black man who died 10 years ago in a medium-secure psychiatric unit in Norwich after being restrained by staff. Its programme of action was based on the three building blocks: more appropriate and responsive services; increased community engagement; and better-quality information that is used more intelligently.

The action points are not dissimilar from the commission’s recommendations. Its latest findings do not make positive reading.

One-quarter of 63 BME people interviewed for the report said they had faced prejudice or discrimination in care and nursing homes.

This included direct discrimination, such as verbal abuse, and also indirect discrimination, such as the failure of services to provide information in a person’s preferred language.

Only one-half felt that their needs as a BME person had been adequately considered. Just 37% of care providers told the commission that they had taken specific action to address equality for BME people.

The report warned that ‘personalised services cannot be achieved by just responding to individual needs as they arise. Services need to take a systematic approach to removing barriers that may prevent BME people receiving appropriate support. These barriers include organisational processes or assumptions and the behaviour of individual staff, which may amount
to either intentional or unwitting discrimination.’

The commission also warned that ‘despite race equality legislation being in place for 30 years, the experience of BME people using social care services is still very variable’.

One important issue highlighted was a need to develop staff training to work with BME people. The report found that more staff training was a frequent request by BME people and only 4% of providers mentioned training on race equality or diversity issues relating specifically to ethnicity.

Patients surveyed said they wanted ‘support from staff that have positive and respectful attitudes towards them’. Some people said they wanted staff from the same community and others wanted to choose the gender of staff or staff they thought had positive attitudes.

As a result, the commission has set out recommendations for those who run care and nursing homes (see box below).

However, the commission’s calls have not been seen as helpful by all those in the sector.

Frank Ursell, chief executive of the Registered Nursing Home Association, said that, while he welcomed the report, nursing homes did not always ‘need the obvious pointed out’.

‘What would be really helpful would be if the commission told us where best practice training could be accessed and what the most appropriate types of training are. We need more support on this,’ he said.

However, changes in the mix of care home staff mean that more of them could be expected to have an understanding of BME patients simply through having a similar ethnic background.

According to government statistics, the proportion of nurses from BME backgrounds in nursing and care homes
has increased.

In 1996, 9% of nurses were from a BME background, generally describing their ethnic background as West Indian. By 2006, 42% said they were from a BME background. Often they were younger than non-BME nurses, generally being in their 30s and 40s, and came from Africa, the Philippines and India.

Christabel Collison is manager of the Floron residential home and Abba day centre for older African and Caribbean people
in south London. She said it was important for organisations to have a strong equal opportunities and race equality policy in place.

‘In our organisations we have staff from BME backgrounds who are culturally orientated in terms of food and culture, and who are able to communicate better with our service users. They understand their needs and their language,’ she said.

While this is not possible for every care or nursing home, the issues raised by the commission must still be addressed.

Unfortunately, unlike a Healthcare Commission report on failing trust or hospital hygiene for example, this report has been largely ignored by the media and received no coverage in the national press.

But as Jane Ashcroft, vice-chairperson of the English Community Care Association, says, the promotion of ‘appropriate services’ for BME people is a necessity.

Recomendations for care home managers

  • Assess attitudes of potential staff to race equality as part of the recruitment process

  • Ensure all staff receive training that covers race equality on an ongoing basis

  • Review equality and harassment policies, career progression, and staff support and supervision to see how they are working for BME staff

  • Ensure regular, consistent messages on race equality are given to staff by managers

  • All staff should be expected to treat BME people fairly and without prejudice

  • Develop ways to gain the views of BME staff, including anonymous feedback

  • Consider establishing a BME staff forum

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