Embedding ethnic equality in
commissioning practice
Name, date, contact
1
What is ethnicity?
• Common physical and cultural characteristics, shared
values and history
• Affects health and healthcare via several routes:
- structural (exclusion; poor access to resources)
- cultural (risks; responses; healthcare experiences)
- biological/genetic factors
• Fluid and dynamic, complex identities, variation within
and between ethnic 'groups' (age, gender, generation,
class, religion), BUT important axis of difference and
disadvantage
Local ethnic profile
3
What is the issue?
• We live in a multi-ethnic society; ethnic diversity is
increasing; by 2020 1/4 local popn will be minority ethnic
• Ethnic identity impacts on health through varied routes
• Health services should mitigate wider disadvantage, but
can make things worse
• Inequalities in access, experience and outcomes
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Why does this matter?
• Commissioning has key role in addressing unmet
need and driving up standards of care. BUT, to-date,
impact on inequality very limited.
• Legal duty to proactively identify and reduce inequalities
(2010 Equality Act)
• Morally right thing to do
• Equity is core to the NHS constitution
• Closely linked to other key commissioning drivers:
► Quality
► Efficiency
► Health Inequalities
• YET, remains a side-lined concern with limited resource
and expertise
5
"Equality must be at the heart of the NHS. each of us
has a responsibility to ensure that care is high quality,
personal and fair"
Sir David Nicholson, Chief Executive of the NHS
"A better NHS that: is genuinely centred on patients
and carers; achieves quality and outcomes that are
among the best in the world; refuses to tolerate
unsafe and substandard care; eliminates
discrimination and reduces inequalities in care"
Equity and Excellence, White Paper (Our vision for the
NHS)
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Local examples : service access
Observed vs. expected revascularisation rate
Procedure rate per 100,000 M+F population
350
300
Male
Female
250
200
150
100
50
0
Gen pop observed rate
S Asian observed rate
S Asian expected rate
7
Local examples : service experience
“The GP will give more
time to White patients but
not to people from
Somalia and Bangladesh.
He treats them like shit”.
Local service user
"Never contact the doctors
at the hospital by phone,
always in writing..You can't
trust them. It is the way the
professionals talk to you or
deal with you because they
don't understand our culture
and our norms."
Local carer
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Local examples : health outcomes
9
Local examples: inefficiencies
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Local examples: a marginalised concern
"There’s a mind-set that says if we do anything for
BME communities that’s on top of what we already
do, rather than what we already do should
incorporate the needs of BME communities"
(Local commissioning manager)
Annual Quality Report, 2010/11, references to equality,
ethnicity, or ethnic inequality = 0
CQUINS with ethnicity focus/breakdown = 1/47
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What should healthcare
commissioners do?
• Ensure that existing services and interventions provide
equitable access, experiences and outcomes for all
service users and carers regardless of ethnicity.
• Ensure that any transformational work pays detailed
attention to the potential negative impact on particular
ethnic groups.
• Examine the fit between existing services and minority
ethnic health needs and respond to significant gaps.
• Shift spend towards prevention and early intervention.
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What are we already doing?
• ... TBC ....
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What more could we be doing?
• Mainstreamed attention across all our work.
• Using Quality resources and infra-structure to tackle
ethnic inequality.
• Investing in a BME user forum that gives meaningful and
consistent input to the commissioning process e.g.
Westminster
• ...... TBC ...............
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What would be the benefits?
•
•
•
•
•
•
Legal compliance
More efficient use of resource
Progress towards key targets
Reduced risk of serious incidents
Reduced risk of challenge from local communities
More flexible and responsive
services
• Better health for all!
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Some key questions to consider
What factors obstruct such mainstreaming?
Who is responsible for leading on this agenda?
What role should other people be playing?
What resources/strengths can we build on?
What are we going to do next?
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