How to get better health outcomes in diverse groups

Next month NHS chief executive David Nicholson will chair a summit for NHS leaders where he will draw together demands from black and minority ethnic communities, legislation and regulatory authorities and policy makers for concrete improvements in the care and treatment of people from minority ethnic groups.

Evidence shows mortality and morbidity in BME groups is worse than for the indigenous population.

One factor is lack of appropriate leaders. While 30 per cent of nurses and doctors are from BME groups fewer than 10 per cent of senior managers and only 1 per cent of chief executives are from a similar background.

And in one of its last reports published in March the Healthcare Commission revealed that a sizeable minority of NHS organisations are failing in their legal obligations on race and equality (see below).

The summit is organised by Race for Health, an organisation funded by the Department of Health and based at NHS Manchester.

Race for Health director Helen Hally says: “This important summit will publicly pledge leadership commitment, set out what must be done and how to do it and make clear that measurable progress is required.”

Race for Health’s brief is to support and challenge its 21 member primary care trusts to find new and effective ways of improving the healthcare experience and the health of people from BME communities.

Professor Hally says the key to improvement is a focus on better outcomes.

“From that springs innovation to improve cultural competence and better access to appropriate services,” she says. “BME communities fare poorly in several condition categories, such as diabetes and heart disease. That’s why Race for Health’s PCTs pledge annually to improve outcomes - and are assessed on their success.”

Diverse workforce

NHS Employers head of equality and diversity Carol Baxter says success starts with employing a diverse workforce that reflects the ethnic make-up of your area and knowing as much as you can about your community.

“Make sure staff have the right knowledge and skills and that they make people from BME communities feel welcome. A negative experience is nothing to do with the technical side of things. It’s about listening to the views of the service user and acting on these perspectives.”

Bradford City Teaching PCT, a Race for Health member, has done that with its speech therapy service. It is impossible to provide proper care for a young child with language development problems whose first language is not English when the speech therapist speaks only English.

Now the PCT has bilingual therapists specialising in Punjabi, Urdu and Bengali and is developing eastern European languages; and 30 of the unit’s 43 staff, including managers, therapists and clerical workers, are learning Urdu.

As the local dialect of Punjabi does not have a written script, information about what speech therapy can offer is available on CD and cassette before the first session.

Analyse impact

The NHS has a duty to promote “community cohesion”. But a recent report by the Institute of Community Cohesion concludes that some people thought the work they were doing under the label of “equality and diversity” was contributing to community cohesion when this was not always true.

Cohesion can be achieved by tackling inequalities, but it is also about breaking down the barriers, “developing interaction and mutual understanding to avoid conflict”.

The institute says the NHS must use readily available data such as GP registration and annual school census to see how communities are changing.

It also says that while targeting funding to particular community groups can promote equality it can also “foster resentment, segregation and separate development and inhibit interaction between communities.”

Funding policies should still recognise particular needs, but they must be applied in different ways and be based on a clear analysis of their impacts.

Consultant in public health Angela Raffle at NHS Bristol, another Race for Health PCT, agrees. She says Bristol’s policy of having link workers across all ethnic groups and conditions stemmed from having just one link worker for its Asian mother and baby service.

When new consultant radiologist Suma Chakrabarthi arrived in Bristol she wanted to do something about the low uptake of breast screening at a practice with large numbers of Asian women. While it is only a mile from the screening centre the journey was complicated by the barrier of the M32 motorway and dual carriageways.

The link worker and Dr Chakrabarthi used focus groups to make sure women knew what screening is about. The route was well publicised and there were a number of led walks to make sure women were comfortable with the journey.

Dr Raffle says the results speak for themselves. “In 2006 38 per cent of all BME patients at the practice came for screening. In 2009 this has leapt to 50 per cent. And across all groups it’s gone from 47 per cent to 56 per cent. That can’t be credited to anything but this hands-on intervention.”