Race equality in healthcare - getting up to speed

Some 30 years after race equality became law, the NHS is still struggling to apply fully the principles of the Race Relations Act to employment practice and service provision.

At national level, it has made huge efforts, with a string of initiatives and schemes. But in 2006 the Healthcare Commission found that just 1 per cent of NHS trusts were complying fully with the statutory duties required of them by the amended act of 2000.

NHS Employers deputy director Sian Thomas says: 'The Race Relations Act is very complicated and full of jargon. But it has been around for a long time and we should be much further ahead than we are for all strands of diversity. There are no excuses any more.'

A briefing paper from the Race Equality Foundation in March this year found that far too many black and minority ethnic staff languish on the lower rungs of the NHS career ladder and suffer discrimination.

Race for Health, the initiative led by primary care trusts that aims to ensure the needs of BME people drive health service provision, says this is a shameful waste of available talent and ultimately makes no business sense.

BME Britons have higher rates than the UK average of heart disease, stroke, perinatal mortality and diabetes. A diverse and enabled workforce is crucial to provide culturally sensitive services to tackle these disparities, says its latest guidance on workforce development, published in June.

'The evidence shows that organisations which make diversity central to their strategic thinking are more innovative and more connected to their communities,' says Sian.

'They don't just tick boxes, but provide better care for patients.'

'But the chief executive and the board need to understand this and show that diversity is part and parcel of their vision for the organisation and not just parked off as a separate issue,' she adds.

Opening doors

Gateway Family Services has taken an innovative approach. Originally developed by South Birmingham PCT, it is now a community interest company, which aims to reduce inequalities in learning, employment, and health in Birmingham.

Commissioned by three PCTs and the local authority through the Birmingham Health and Wellbeing Partnership, it equips people with skills to help them get into work. Of the 80 staff it now employs, two-thirds are from BME communities.

It also provides accredited training for newly created posts, including long-term conditions support worker and pregnancy outreach worker, and then employs them to deliver those services.

'Because we train [them] and run the service, we really understand what is happening on the ground,' says Gateway chief executive Vicki Fitzgerald. She cites an example of the male life expectancy programme, which opportunistically targets men over 40 in community settings, particularly Bangladeshi men, many of whom smoke.

She recalls a group of men who did not realise they needed to take their medication permanently and make lifestyle changes. 'They thought their tablets were antibiotics,' she says.

Gateway students and workers come from disadvantaged backgrounds, and often have few traditional educational achievements, and other barriers to getting a job, such as long-term unemployment.

But they have experience of the problems and cultures of the communities they are working with, and training is tied in with the skills escalator, so they can progress to degree level if they wish. 'If workers come into their jobs through this route and go all the way, they are much more rounded professionals, with a much higher level of understanding,' says Vicki.

'At the moment, there is a gap between professional training and community needs. We aim to turn out a different kind of professional from among people traditionally regarded as the problem, and not part of the solution,' she says.

Facing fear

Public health nurse specialist Arlene Cardinez also finds herself in a new post for Berkshire East PCT. She screens new UK entrants for infectious diseases, such as TB and HIV, and helps them access mainstream healthcare.

Arlene feels cultural sensitivity and the ability to network with other agencies are the most important qualifications for the job. Few speak English well. Many have been traumatised by conflict and torture, and so are distrustful and fearful.

But she thinks her ethnicity helps. 'I grew up in Venezuela, lived in Trinidad, and my grandmother is from India, so I can speak some Punjabi. I do feel people can relate to me a bit more as a result. Trust is really important.'

The Race for Health guidance advises the NHS to work harder to recruit and retain BME staff by enabling them to progress. The NHS has an ageing workforce, particularly in primary care, while BME people will account for over half the growth in Britain's working-age population by the end of this decade.

Haringey PCT has made concerted efforts to promote its BME staff. But director of human resources and organisational development Clive Martinez says progress is slow.

'There's not a lot of evidence we are making real inroads. And it's not because of a lack of will on the part of senior people in organisations.'

Several possible factors are to blame, suggests Clive. These include timorous performance-management of black staff by white managers, and electronic recruitment, which widens the geographical net of applicants. A lack of systematic review of individual career aims, a large range of employers within the NHS family, and 'bitty initiatives' also play their part.

'BME staff may not be putting themselves forward for certain roles,' Clive says. 'We might not be good at recruiting. But perhaps people out there don't see [the NHS] as part of their life plans or have different expectations.'

As the young chair of Stockport foundation trust and a member of the Black Leadership Forum, Robina Shah has broken through several barriers. But she firmly believes that BME people need to be more proactive.

'They need to assess where they see themselves going, and whether the organisation can deliver for them as an individual and for the BME community,' Robina says. 'If it can't, they need to ask why not.'

'Good organisations look for opportunities to progress their staff. They don't make assumptions, and are flexible. Some people move sideways or diversify. It's not always about moving upwards.'

• A workshop on effective workforce planning to develop a workforce which represents the local patient population is part of the Achieving Race Equality in the NHS conference, which takes place on 6 December in London. Details at www.hsj-raceequality.co.uk.