How to commission for equality and diversity in the NHS

People from a black or minority ethnic background now make up 16 per cent (7.7 million) of the UK’s total population - more than double the proportion indicated by the 2001 census - according to the latest figures from the Office of National Statistics.

Yet a raft of recent reports has shown that the NHS is still struggling to comply with even minimum statutory race equality duties, as well as grappling with health inequalities through world class commissioning.

People from BME communities are up to five times more likely to develop diabetes than the general population

Infant mortality rates are twice as high for babies born to mothers of Pakistani origin

Young black men are six times more likely than white men to be sectioned under the Mental Health Act

African Caribbean men are three times more likely to be diagnosed with prostate cancer

Gypsies and Travellers experience significantly higher than average rates of bronchitis, anxiety and asthma

In its final report in March this year, the Healthcare Commission admonished primary care trusts for their failure to profile the ethnicity of their patients, which made it hard to analyse ethnic differences in access to services and health outcomes.

Even with conditions for which BME communities are known to be at increased risk, such as coronary heart disease and diabetes, ethnicity data is patchy, says Christina Gray, associate director of public health, equality and social inclusion at Bristol PCT.

“If we could address the collection of ethnicity data at GP level, it would allow us to track and target interventions much more effectively,” says Ms Gray.

Under directly enhanced services, GPs can receive extra money for ethnic monitoring of newly registered patients, but it is often seen as yet another task. Ms Gray thinks that commissioners need to be actively involved.

“If PCTs want to encourage GPs to do it, they have got to be able to demonstrate that it results in service change,” she says.

“Once trusts and practitioners can see that, they will start collecting it.”

“You have to know who you are commissioning for,” adds Race for Health national director Professor Helen Hally. A lot of useful information is already out there to be tapped, she says. Community healthcare professionals, voluntary sector organisations and BME staff are valuable sources and can have strong links with BME communities.

However, commissioners still stumble over community engagement, which lies at the heart of commissioning services that will reduce health inequalities.

The process is not just about alighting on a topic and taking that out to community leaders or getting feedback on a proposal.

“It’s about shared endeavour, mapping out where the communities are - and giving them real power,” she says.

It also often sits in the HR directorate rather than being an integral part of public health, operations or commissioning. It is rarely seen as “core business” or led from the top.

Carrying out the equality impact assessment (EIA), a key component of the commissioning cycle, is impossible without fully engaged communities.

“[EIA] is not hugely complex, but it is hugely important,” says Professor Hally. “Yet it’s perceived as another bureaucratic chore rather than part of an assurance mechanism for organisations to know that they have got it right.”