We must not treat our duties to minority ethnic communities lightly, says Helen Hally
It is no wonder questions are being asked about racial equality and the NHS. The NHS is Britain's largest employer, and almost 14 per cent of staff come from black and minority ethnic groups. It is also an institution used by almost everyone that binds our society together.
The Commission for Racial Equality is looking into how effectively the Department of Health meets its duties under the 1976 Race Relations Act. Mindful of this, NHS chief executive David Nicholson recently warned the sector to examine practice and assess whether it is fully complying with the act.
Why does this matter? It matters because the NHS has a longstanding concern about differential health outcomes for some communities. We know, for example, that south Asian people are 50 per cent more likely to die prematurely from coronary heart disease than the general population. There is also concern about infant mortality rates among women from some BME communities.
NHS organisations are doing much good work to tackle some of these issues. But some may inadvertently have left themselves open to criticism by failing to pay sufficient attention to the legal requirements of the act, requirements that are neither difficult nor expensive to comply with.
The CRE is focusing on duties to publish plans to promote racial equality schemes, demonstrate ethnic monitoring of the workforce and conduct racial equality impact assessments of service changes. In August, the Healthcare Commission reported that 40 per cent of trusts had not published this information on their websites. Although 60 per cent had published a racial equality scheme, only 6 per cent had published employment monitoring statistics and 3 per cent had published the outcomes of racial equality impact assessments.
Take racial equality seriously
Some may consider such requirements an irritating, time-wasting piece of box-ticking. They may point to various unsung initiatives showing that our hearts are in the right place when it comes to racial equality. Yet these requirements should not be dismissed as the paper-shuffling demands of overbearing bureaucracy. The NHS must not only take racial equality seriously but also be seen to do so.
Setting out an organisation's objectives relating to ethnicity in the form of a racial equality scheme amounts to no more than identifying the dimensions of racial equality, assessing current performance against it, listing remedial actions required, identifying those accountable, and setting a timeframe for reaching targets. This is standard NHS planning procedure. Responsibility for the scheme must sit with the chair, the chief executive, the board and the executive team - it cannot be a marginal task delegated to junior staff.
As most NHS organisations recognise, getting started on the scheme is straightforward. Each then needs to make sure that the objectives are not hidden away in a dark corner but published, as required, on a website.
As for workforce requirements, many of the relevant figures are available in reports to NHS boards. Some are not being collected, of which more later, but it is relatively simple to pull out available statistics and post them on the equality section of the website.
A straightforward task
The Healthcare Commission also found that most NHS organisations are not publishing racial equality impact assessments of service changes. Yet, again, these are quite straightforward - and no more complex than doing a cost-benefit analysis, a health and safety audit or an infection control assessment.
Unfortunately, some NHS organisations lack confidence about impact assessments. They may also worry that they will be divisive. In fact the opposite is often true.
Take Wandsworth, for example. Last year, when the primary care trust was reconfiguring services after financial pressures, it did an impact assessment. Although this did not alter the proposals significantly, it did - amid the redundancies and upheaval - make staff feel listened to and supported.
It is also worth remembering that racial equality impact assessments can uncover positive effects of service changes on particular groups, as well as negative ones.
Perhaps the most challenging area for the NHS is collating and publishing the required workforce data. Most organisations have a simple ethnic breakdown of their workforces. But they are required to monitor job applicants ethnically as well as applicants for training. They must also monitor career progression and those involved in grievance and disciplinary proceedings.
Some organisations may lack elements of this data. Indeed, some may break down staff ethnically against salary rather than grade. Because BME people are relatively well represented among doctors and pharmacists, this can disguise their over-representation in lower-paid grades and create a false perception of how well the organisation is developing its workforce.
So there is important progress to be made in improving workplace data. But organisations should first be concerned about whether they are failing to publish data they already have. They can remedy this quickly, easily and at small cost. They should then tackle the issue of gathering better data and analysing it appropriately.
All of this is important not simply because it solves a bureaucratic problem but because many parts of the NHS are doing a good job thinking about ethnicity and health. Race for Health was established to promote and disseminate good practice among PCTs, beginning with our 13 pioneer PCTs.
For example, in South Birmingham PCT, outstanding work is being done to train BME staff, many without formal qualifications, to steer people around NHS services. In Ealing, three local trusts have built a vibrant BME staff network that embraces all local NHS organisations in the area.
In Bristol, workshops in Urdu, Punjabi, Gujarati and Hindi have made a significant impact in the treatment of diabetes, which disproportionately affects the south Asian population. In Lambeth PCT, research is under way that links clinical data on patients to ethnicity, language preference and religion. This could help more effective commissioning.
Change is not confined to inner cities. Shropshire County PCT recently studied the needs of more than 1,000 people of Chinese origin in its area.
There is clearly a great deal in which the NHS can take pride. But the Macpherson report into Stephen Lawrence's death has taught us that, unless organisations take a systematic approach to tackling racial inequalities, great injustice can go unchecked, despite individuals' good intentions. -
Professor Helen Hally is the national director of Race for Health, a programme sponsored by the Department of Health equality and human rights group, and hosted by Manchester PCT. Its purpose is to drive forward racial equality in the NHS.www.raceforhealth.org