Manchester PCT
Profile
Twenty-three per cent black and ethnic minority population (6 per cent Pakistani; 2.1per cent Black Caribbean; 2.6 per cent Black African; 2.2 per cent Indian; 1 per cent Bangladeshi; 2.2 per cent Chinese) / 441,000 people covered / The majority of the trust’s population live in the city’s most deprived wards, resulting in considerable health and economic disadvantages for these residents.Our BME population faces big issues…
Deprivation: The trust’s ethnic minority population mostly live in areas of deprivation, where there is poor housing and unemployment. So their health and wellbeing faces multiple challenges.Poor information: The PCT, as elsewhere in the country, faces a shortage of data on the needs of the ethnic minority population at the level of general practices. GPs are now remunerated for collecting information on the ethnicity of new patients, but not on their existing list. So the trust has real problems knowing the details of local needs, even though national statistics indicate numerous health disadvantage issues for the ethnic minority population.
Transience and Migration: Manchester has a rapidly changing population and a lack of understanding about our migrant population. The trust has to be mindful that our migrant population know how to access our services and that our services are accessible and responsive to change.
Our workforce needs…
More responsive workforce: The trust needs a workforce that can respond to the needs of the local communities and is creative in encouraging BME people to take up positions working as practitioners. There is concern that people may not be coming forward because they do not have the relevant qualifications or because ethnic minority staff recruited in the 60s have regrets about their own experiences and so may not encourage their own children to apply.More local recruitment of minority staff: The trust is working with external consultants to improve access to job vacancy information for local BME communities. All job vacancies are distributed via the BME network and BME applicants are supported in their applications through the consultants.
Training for BME staff: This issue is becoming more acute with the shift to patient-led commissioning. The reduction in NHS managers means that the opportunities for ethnic minority staff to advance could be reduced. The trust is working to ensure transparency in selection processes and is involved in local and national development programmes.
Commissioning raises issues…
Appropriate provision: We need, for example, to ensure that a patient, whose first language is not English, can communicate with a district nurse. Or a Muslim patient who attends an acute hospital can obtain halal food. Commissioners need to make sure that race equality considerations tackle such important details.Better quality data: .The PCT needs to ensure that its monitoring of patients is consistently good across all equality groups and that regular monitoring reports are produced. We want to encourage GPs, who are busy people, to develop patient profiling. We need to ensure that appropriate analysis is undertaken and that the information is used to inform commissioning decisions
One size fits all vs. Localism: Commissioning services at a local level to suit the individual needs of our communities means a shift in thinking for the PCT and one which presents challenges which need to be addressed. GP will be directly commissioning services at a local level for their registered population. To ensure that the needs of BME populations are equally supported, it is important that issues of equality and diversity are incorporated into any service specifications.
Information requirements from contractors: Ensuring that our commissioned services deliver the information that we need to effectively plan and commission services for people of the BME communities continues to be a priority for the PCT. In addition the PCT needs to ensure it is able to use the information collected from service users as to what they need/want and commission on the basis of this.
We’re proud of…
Community Development Workers: The trust has recruited 8 CDWs through a consortium of BME voluntary organisations. This process of recruiting to the CDW roles with the help of local BME organisations has resulted in the CDWs being representative of the communities we serve with a greater understanding of their needs. They have been recruited by the community, for the communityImpact Assessments: The Trust has developed an approach that involves the managers who will be responsible for conducting Equality Impact Assessments. The approach is from a service perspective and follows the patient’s journey. The training programme has been rolled out across both commissioning and provider functions.
NED Recruitment: Recognizing that we want a board that reflects community we serve, the Trust, in conjunction with our Thinking Partner has engaged in an approach that involved working with 6 local BME people who expressed an interest in becoming a NED. We’ve supported them through 3 workshops, providing the potential candidates with vital information about the PCT. The appointments Commission also attended the workshops and so candidates were able to learn more about the selection process.
Race for Health Key Performance Indicators: In driving forward the KPIs, the Trust has taken a programme management approach involving Finance, IM & T, Public Health, the Joint Health Unit and Primary Care. This has resulted in proactive matrix working, and ownership of KPIs across the PCT Board.
Commissioning: The PCT has a rigorous business case approval process that now has equality and diversity as part of the assessment criteria. Commissioners have to clearly demonstrate what they are doing in terms of reducing health inequalities as well as addressing issues for diverse communities.
Engagement of the third sector: This is vital for BME communities as well as other marginalised groups, improved commissioning of the third sector can result in providing services that are more responsive to diverse needs. Through collaborative working the trust has worked with BME voluntary organisations as they have skills and expertise around communities. We have developed an approach that has enabled a consortium of BME voluntary organisations to put forward a proposal that will support Practice Based Commissioners in having a greater understanding of the needs of local communities.
SALT project: In our Tasty not Salty Project, a Community Dietician is working with our BME communities to promote healthy diets and long term behaviour change.
Next steps…
Strengthen Leadership: We recognize that equality and diversity has to be part of every function of the organisation, therefore it needs to be championed at all levels.Performance Management: The trust needs to embed equality and diversity into our performance management systems. Manchester PCT has adopted the performance accelerator process and we are keen to use this to performance manage progress on equality and diversity
To improve the knowledge of health needs at a local level. This will require working through practice-based commissioning, and supporting GPs, many of them highly skilled around diversity, in building up ethnicity data and using this knowledge to inform commissioning contracts.
Act upon data from Race Impact Assessments: these are an excellent tool for supporting change. Where poor access to services has been identified, the PCT hopes to better target services at those in need.
Programme Lead
Claudette Webster, Associate Director of Access and Inclusionclaudette.webster@manchester.nhs.uk