Table 3.11.5(j)
3.11 Race Relations (Amendment) Act 2000
3.11.6 All populations served by NHS bodies
should receive equal treatment according to their needs. Would
the Department explain what steps it has taken to ensure that
people from minority ethnic groups receive equal treatment from
NHS bodies? What evidence does the Department have to show that
people from minority ethnic groups receive equal treatment from
NHS bodies?
1. The Department of Health is committed
to reforming the NHS and Personal Social Services, tackling inequalities
and discrimination. This means addressing health inequalities
for minority ethnic communities and improving the working lives
of minority ethnic staff. A number of studies, including Sir Donald
Acheson's report Independent Inquiry into Inequalities in Health
(1998), have shown that there are significant health inequalities
among people from black and minority ethnic communities. These
inequalities relate to differences in disease prevalence, differential
access to services and differential delivery of services. These
findings were borne out by the 1999 Health Survey for England,
published in 2001 which contains a wealth of socio-economic data,
which is valuable in identifying and monitoring inequalities of
health.
2. The New NHS (1997) and a First Class
Service (1998) introduced a range of measures to raise quality
of service and decrease variations in service provision including
introducing National Service Frameworks (NSFs). The NHS Plan re-emphasised
the role of these Frameworks as drivers in delivering the modernisation
agenda. National Service Frameworks cover: cancer, mental health,
coronary heart disease, older people and diabetes. The Diabetes
National Service Framework delivery strategy to be published later
this year will be followed by Frameworks for renal services, services
for children and young people and for people with long term medical
conditions.
3. The following is an update on the position
of the NSFs:
(i) The Children's NSF is currently being
developed. As the External Working Groups consider their advice
on the production of standards for children's services, racial
and other inequalities will be a key area to be covered. As standards
are developed officials from the department intend to meet with
representatives from a range of ethnic groups to ensure that the
diverse needs of the different groups are taken into account.
(ii) The National Service Framework for Coronary
Heart Disease highlights the particularly high risk of CHD developing
in people of South Asian descent, and the importance of identifying
such high risk patients. South Asians will benefit from work being
taken forward to prevent CHD in the general population, as well
as from specific projects to reduce risk factors in this community,
and from progress in identifying and treating people at high risk
of these conditions. The Department is now drawing together a
strategy to tackle heart disease in this high risk group.
(iii) There is world-wide shortage of donated
organs. In the United Kingdom about 2,700 organs (hearts, kidneys,
livers, lungs, pancreas and bowel) are transplanted each year
but currently more than 6,000 people are awaiting transplants.
There is a particular need to increase organ donation from ethnic
minorities. There is a high rate of renal failure and a low rate
of organ donation in the South Asian communities and relatively
high rates of diabetes, coronary heart disease, hypertension and
kidney disease feed into high rates of end stage renal failure
and the consequent need for transplantation. There are similar
problems among people from African and African-Caribbean backgrounds.
One of the primary objectives of the Renal Services NSF is to
reduce inequalities. Renal disease tends to predominately affect
the older population and research has shown that certain minority
ethnic groups are particularly susceptible, in some cases being
3-4 times more likely to develop renal failure. The NSF will therefore
focus on individual patient need, and age and ethnicity will be
cross-cutting themes throughout the NSF. The External Reference
Group for this NSF will identify the key issues facing members
of ethnic communities with renal disease, the major modifiable
risk factors, and provide an evaluation of the effective prevention
and treatment strategies.
(iv) The Health Select Committee on NHS mental
health services met in 2000. One recommendation was the requirement
to include training on cultural and racial issues as part of the
health professionals' core curriculum. As part of their remit,
the Mental Health Care Group Workforce Team actively consider
equality issues, including race awareness in education and training
needs. An early action of the Group was to commission a strategy
paper on equality issues. The Mental Health Task Force has been
given a specific remit to look at black and minority ethnic mental
health and are developing a strategy that will address the provision
of mental health services to people from these groups. Another
HSC recommendation was to develop early intervention services
for minority ethnic groups following evidence of their late access
to services. In November 2001, the Department announced early
intervention, crisis resolution and assertive outreach services
which would benefit all users but especially minority ethnic people
whose experience of hospital care was acknowledged to be often
negative.
(v) The NSF for Long-Term Conditions will
promote equality in the provision of health and social care services
for people from black and minority ethnic groups with a long-term
condition. Services will be expected to be equitable and plan
to meet the needs of people of everyone with long-term conditions.
(vi) The NSF for Older People sets out action
to ensure there will be no age discrimination in the NHS or social
care services and that discrimination of any kind (whether on
the basis of age, race or gender) is unacceptable. The principle
is that NHS treatment should be based entirely on clinical need
and the ability to benefit.
(vii) One of the explicit objectives of the
Diabetes NSF is to provide services that are person-centred, enabling
people with diabetes to adopt a healthier lifestyle and to manage
their own diabetes through education and support that recognises
the importance of lifestyle, culture and religion, and also tackles
the adverse impact of material disadvantage and social exclusion.
Services should be equitable, planned to meet the need of the
population, including specific groups within the population, and
appropriate to individual need.
4. The complex combination of factors contributing
to health inequalities for black and minority ethnic communities
means attempts to tackle this issue must be made across Government
and across sectors from national to local level. For the first
time ever, the Secretary of State for Health announced national
health inequality targets in February 2001 in the areas of life
expectancy and infant mortality, and in Autumn 2001 the Department
conducted a public consultation on the action needed to deliver
these targets. In addressing health inequalities, the specific
needs of black and minority ethnic communities are an important
theme.
5. The Department's 2002 PSA target on health
inequalities is as follows:
By 2010 reduce inequalities in health outcomes
by 10 per cent as measured by infant mortality and life expectancy
at birth.
This single target is supported by the following
two specific targets:
— Starting with children under one
year, by 2010 to reduce the gap in mortality by at least 10 per
cent between "routine and manual" groups and the population
as a whole.
— Starting with Local Authorities,
by 2010 to reduce the gap by at least 10 per cent between the
fifth of areas with the lowest life expectancy at birth and the
population as a whole.
6. Building on the announcement of the national
health inequalities targets, the Government conducted a Cross-Cutting
Spending Review on health inequalities as part of the recent spending
round. This provided a unique opportunity for the Government as
a whole to focus on health inequalities and establish priority
areas for action and cross-Government working. Tackling health
inequalities experienced by people from black and minority ethnic
groups will be an important dimension of action to narrow the
health gap. A cross-Government delivery plan, drawing both on
the responses to the consultation and the outcome of this Spending
review, is expected to be published later this year.
The Evidence Base
7. The evidence shows that members of black
and minority ethnic groups are not a homogenous group for health
status, disease patterns or health behaviour. However, a number
of studies, including the Acheson Inquiry Report (the 1998 Independent
Inquiry into Inequalities in Health) and the 1999 Health Survey
for England (which included a "boosted" sample of
the ethnic minority population), have shown that there are significant
health inequalities among people from black and minority ethnic
communities. These inequalities relate to differences in disease
prevalence, differential access to services and differential delivery
and take-up of services. Many people from black and minority ethnic
communities also experience other social conditions which impact
on health status and risk-taking behaviour, including poverty,
poor housing and racism.
8. Additional evidence put to the Acheson
Inquiry suggested that members of ethnic minority groups are just
as likely as whites to consult with a GP, even after differences
in reported health have been taken into account. However, one
study showed that South Asians with CHD waited longer for referral
to specialist care than white patients, and in another study,
they were half as likely to receive bypass grafts for triple vessel
disease, despite having further progressed disease. None of these
studies was able to explore reasons for these possible differences
in quality of care. An Health Education Authority survey published
in 1994 showed that people from ethnic minorities were more likely
than whites to find physical access to their GP difficult, to
have longer waiting times in the surgery, to feel that the time
their GP spent with them was inadequate, and to be unhappy with
the outcome of the consultation. Part of this might be related
to communication problems, or cultural differences.
9. As noted, this is a complex area and
more can be done to develop the evidence base. One approach has
been to review current evidence. Recent reviews include those
on equity of access (University of York 1998), access to health
services in London (Universities or Warwick and De Montfort),
and access and uptake to cardiovascular and mental health services
(Queen Mary College, London).
10. In addition to the research evidence
indicated above, a range of statistical material provides analysis
by ethnic origin or other relevant factors. A convenient summary
is provided on the London Health Observatory website (http://www.lho.org.uk/hil/bme.htm).
Important further analyses and data that will be needed to establish
up-to-date and comparable local population bases will come from
the 2001 Census. The Department of Health is also mounting a project
under the auspices of the Neighbourhood Statistics initiative
to improve the recording of ethnic origin information in local
health information systems.
References:
Goddard M and Smith P (1998) Equity of Access
to Health Care. University of York
Atkinson M et al (2001) Systematic review
of ethnicity and health service access for London. University
of warwick and De Montfort University.
Report of the Independent Inquiry into Inequalities
in Health, (1998) The Stationery Office
Erens B et al (eds) (1999) Health Survey
for England: The Health of Minority Ethnic Groups. The Stationery
Office
Queen Mary University of London and Kensington
and ChelseaHealth Authority (2001) Systematic reviews of access
to and uptake of health services by ethnic groups: Cardiovascual
disease; Mental health .. http://www.smd.qmul.ac.uk/gp/communityhealth/
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