Race equality is a challenge the NHS must rise to

How staff are treated impacts on patient care, but the NHS has yet to tackle discrimination against black and minority ethnic staff like it does other patient care issues, writes Roger Kline. In this article, he discusses new proposals whereby NHS organisations will be encouraged to take race equality seriously for the sake of patients

Now is the time for radical action on racial health inequalities

A new report by the NHS Race and Health Observatory makes robust recommendations—we must act on them, write Mohammad S Razai and colleagues

Delivering effective NHS services to our multiethnic population: collection and application of ethnic monitoring within primary care

Government health policy has emphasised the importance of understanding and tackling ethnic disparities in health and healthcare for at least four decades. Yorkshire & the Humber includes areas with large, well-established minority ethnic populations. In addition, most cities in the region, including those that have in the past been dominated by the White British majority, are now experiencing rapid migration. Persistent patterns of health disadvantage among established minority ethnic communities are now compounded by the differing health needs of new migrant populations. NHS organisations in Yorkshire & the Humber have begun to respond more systematically to the needs of minority ethnic groups. However, there is still progress to be made on establishing basic requirements for effective commissioning, including effective ethnic monitoring systems that provide high quality intelligence to commissioners, service managers and health professionals. While there are examples of innovation and good practice, there is significant variation across the region and a lack of sharing and learning between organisations. Here we report on a workshop that was convened by the Strategic Health Authority in June 2009 as a first step towards addressing this recognised area of need. The Workshop Chair was John Chuter, Chair of NHS Bradford & Airedale. The aims of the workshop were to: • Highlight the policy context and imperatives for ethnic monitoring. • Raise awareness of the current position with regard to ethnic monitoring and use of data in Yorkshire & the Humber. • Share emerging good practice. • Identify ways to move forward to improved ethnic monitoring across the region

Racial and Ethnic Disparities in Time to Cure of Incontinence Present at Nursing Home Admission

Abstract As many as half of older people that are admitted to nursing homes (NHs) are incontinent of urine and/or feces. Not much is known about the rate of cure of incontinence present at NH admission, but available reports suggest the rate is low. There have been racial and ethnic disparities in incontinence treatment, but the role of disparities in the cure of incontinence is understudied. Using the Peters-Belson method and multilevel predictors, our findings showed that there were disparities in the time to cure of incontinence for Hispanic NH admissions. A significantly smaller proportion of older Hispanic admissions were observed to have their incontinence cured and cured later than expected had they been White non-Hispanic. Reducing disparities in incontinence cure will improve health outcomes of Hispanic NH admissions. Significant predictors in our model suggest strategies to reduce the disparity including attention to managing fecal incontinence and incontinence in those with cognitive impairment, improving residents’ functional status, and increasing resources to NHs admitting older Hispanics with incontinence to develop innovative and cost effective ways to provide equitable quality care

Ethnic Minorities and their Health Needs: Crisis of Perception and Behaviours

There is considerable evidence to suggest that racial and ethnic disparities exist in the provision of emergency and wider healthcare. The importance of collecting patient ethnic data has received attention in literature across the world and eliminating ethnic and racial health equalities is one of the primary aims of healthcare providers internationally. The poor health status of certain racial and ethnic groups has been well documented. The improvement of racial and ethnic disparities in healthcare is at the forefront of many public health agendas. This article addresses important policy, practice, and cultural issues confronted by the pre-hospital emergency care setup. This aspect of care plays a unique role in the healthcare safety net in providing a service to a very diverse population, including members of ethnic and racial minorities. Competent decision making by the emergency care practitioners requires patient-specific information and the health provider's prior medical knowledge and clinical training. The article reviews the current ethnicity trends in the UK along with international evidence linking ethnicity and health inequalities. The study argues that serious difficulties will arise between the health provider and the patient if they come from different backgrounds and therefore experience difficulties in cross-cultural communication. This adversely impacts on the quality of diagnostic and clinical decision making for minority patients. The article offers few strategies to address health inequalities in emergency care and concludes by arguing that much more needs to be done to ensure that we are hearing the voices of more diverse groups, groups who are often excluded from engagement through barriers such as language or mobility difficulties

Black Workers and BME networks organising against racism in the NHS workplace

This research, conducted against the backdrop of neoliberal NHS austerity cuts and the Health and Social Care Act 2012 accelerating privatisation and outsourcing of NHS services, investigates the political differences and similarities of two forms of Black and minority ethnic self-organisation challenging racism in the NHS workplace. Based on case studies of two organisations – a local NHS BME Network and a local UNISON Black Self-Organised Group – the research explores the hypothesis that BME Diversity Networks may be seen as more effective ‘collective voices’ than trade union Black Self-Organised Groups for promoting race equality in the NHS workplace. The research documents the local NHS BME Network’s affiliation to the independent NHS BME Network, capturing a moment in time - 2012 -2018 - when the activism and lobbying of NHS Black workers led to the implementation in 2015 of the NHS Workforce Race Equality Standard. As an empirical qualitative study of a relatively under-researched group of BME NHS support workers and Allied Health Professionals, along with BME nurses, the thesis makes a contribution to knowledge by foregrounding the voices, agency, and everyday lived experience of BME workers challenging racism in the NHS workplace. The research uses a Black Radical Tradition theoretical framework drawing on scholars applying Marxism to conceptualise modes of ‘resistance and accommodation’ in anti-racist Black politics. The concept ‘racial capitalism’ is also linked to race and class theories of Black self-organised resistance to racism in the UK context. The research makes a theoretical contribution by applying the concept of ‘common sense neoliberalism’ alongside the concept of ‘racial capitalism’ to consider the implications of forms of race equality which, in aligning with neoliberal corporate diversity management agendas, operate to privilege Black professional middle class identities whilst marginalising Black working class perspectives

Ethnicity and prehospital emergency care provided by ambulance services

Prehospital ambulance care is becoming more important as an increasingly complex health system seeks to prevent avoidable admissions to hospital. Inequalities in prehospital care for ethnic minority groups are underpinned by problems of cultural awareness in professionals; language and communication difficulties; and a limited understanding of how the healthcare system operates for some minority groups. These inequalities in the face of increasing diversity have elicited a range of legislative and policy responses promoting equality. Ambulance services can also employ a number of practical measures to improve prehospital care for minority ethnic patients, including the collection of patient ethnicity data; targeted interventions; improved cultural competency; and better interpreting services. Challenges in delivering these strategies still exist and providers should strive to embed and improve measures to meet the needs of diverse communities

Long-term yogurt consumption and risk of incident hypertension in adults

The Nurses' Health Study and Health Professionals Follow-up Study cohorts are supported by grants UM1 CA186107, UM1 CA176726, and UM1 CA167552 from the National Institutes of Health. The current analyses were supported by small grants from the National Dairy Council, the General Mills Bell Institute for Health and Nutrition, and the Boston Nutrition and Obesity Research Center. The Boston Nutrition Obesity Research Center is administratively based at Boston Medical Center and is funded by the National Institutes of Health (NIH/NIDDK) grant P30DK046200. (UM1 CA186107 - National Institutes of Health; UM1 CA176726 - National Institutes of Health; UM1 CA167552 - National Institutes of Health; small grants from the National Dairy Council; General Mills Bell Institute for Health and Nutrition; Boston Nutrition and Obesity Research Center; P30DK046200 - National Institutes of Health (NIH/NIDDK))Accepted manuscrip

The unavoidable costs of ethnicity : a review of evidence on health costs

This report was commissioned by the Advisory Committee on Resource Allocation (ACRA), and prepared by the Centre for Health Services Studies (CHESS) and the Centre for Research in Ethnic Relations (CRER) at the University of Warwick. The NHS Executive does not necessarily assent to the factual accuracy of the report, nor necessarily share the opinions and recommendations of the authors. The study reviews the evidence concerning the degree to which the presence of populations of minority ethnic origin was associated with ‘unavoidable additional costs’ in health service delivery. While local health authorities retail full autonomy in their use of funds allocated to them under the Hospital and Community Health Services formula, the size of that budget is governed by a set of weightings applied to their population, to allow for factors known to influence levels of need, and the costs of providing services. The study began by considering the definitions used in describing ‘ethnicity’ and ethnic groups in relevant medical and social policy literature. It is clear that no fixed set of terms can be adopted, and that flexibility is required to respond to social changes. The terms used in the 1991 Census, with additions to allow for local and contemporary developments, provide a suitable baseline but require additional information on religion language and migration history for clinical and health service delivery planning. There have been notable developments in health service strategy to meet the needs of black and minority ethnic groups which have been encouraged by good practice guidelines and local initiatives. Together with research into epidemiology and ethnic monitoring of services, these have enlarged understanding of the impact of diversity. A conceptual model is developed which explores the potential for such diversity to lead to variations in the cost of providing health services to a multi-ethnic population. The research team reviewed the existing published evidence relating to ethnic health and disease treatment in medical, social science, academic and practitioner literature, using conventional techniques. Additional evidence was located through trawls of ‘grey’ literature in specialist collections, and through contacting all English health districts with a request for information. A number of authorities and trusts provided written and oral evidence, and a bibliography of key materials is provided. Key issues considered include the need for and use of, interpreter and translation services, the incidence of ‘ethnically-specific’ disease, and variations in the prevalence and cost of treating ‘common’ conditions in minority ethnic populations. Sources of variation are discussed, and a ‘scoping’ approach adopted to explore the extent to which these variations could be adequately modelled. It is clear that while some additional costs can be identified, and seen to be unavoidable, there are other areas where the presence of minority populations may lead to lessened pressures on budgets, or where provision of ‘ethnic-specific’ facilities may be alternative to existing needs. The literature provides a range of estimates which can be used in a modelling exercise, but is deficient in many respects, particularly in terms of precise costs associated with procedure and conditions, or in associating precise and consistent categories of ethnic group with epidemiological and operational service provision data. Certain other activities require funding to set them up, and may not be directly related to population size. There is considerable variation in the approaches adopted by different health authorities, and many services are provided by agencies not funded by NHS budgets. The study was completed before the announcement of proposed changes in health service commissioning which may have other implications for ethnic diversity. The presence of minorities is associated with the need to provide additional services in respect of interpreting and translation, and the media of communication. In order to achieve clinical effectiveness, a range of advocacy support facilities or alternative models of provision seem to be desirable. Ethnic diversity requires adaptation and additional evidence in order to inform processes of consultation and commissioning. Minority populations do create demands for certain additional specific clinical services not required by the bulk of the majority population: it is not yet clear to what extent the reverse can be stated since research on ‘under-use’ is less well developed. Some variations in levels of need, particularly those relating to established clinical difference in susceptibility or deprivation, are already incorporated in funding formulae although it is not clear how far the indicators adequately reflect these factors. Costs are not necessarily simply related to the size of minority populations. The provision of services to meet minority needs is not always a reflection of their presence, but has frequently depended upon the provision of additional specific funds. There is a consensus that the NHS research and development strategy should accept the need for more work to establish the actual levels of need and usage of service by ethnic minority groups, and that effort should be made to use and improve the growing collection of relevant information through ethnic monitoring activities. A variety of modelling techniques are suggested, and can be shown to have the potential to provide practical guidance to future policy in the field. Current data availability at a national or regional scale is inadequate to provide estimates of the ‘additional costs of ethnicity’ but locally collected data and the existence of relevant policy initiatives suggest that a focused study in selected districts would provide sufficiently robust information to provide reliable estimates. The review has demonstrated that there are costs associated with the presence of minority ethnic groups in the population which can be shown to be unavoidable and additional, but that others are either ‘desirable’ or ‘alternative’. It would be wrong to assume that all cost pressures of this nature are in the same direction. Our study has drawn attention to deficiencies in data collection and budgeting which may hinder investigation of the effectiveness of the service in general. The process of drawing attention to ethnic minority needs itself leads to developments in services which are functional and desirable for the majority population

Patient and researcher perspectives on facilitating patient and public involvement in rheumatology research

No abstract available