Health Service must act to tackle race inequality

Written by Musmirah_Shahzada on Tuesday, November 21, 2006 11:27

says major NHS conference

The NHS is missing out on opportunities to save lives and cut ill-health because it fails to focus properly on the problems of black and minority ethnic communities, a major NHS conference will hear on Thursday.

The Race for Health National Conference in Manchester on Thursday November 23 will be told of major gains that could be made against heart disease, diabetes, infant mortality and poor dental health if imaginative approaches to BME communities were more widely adopted.

Niall Dickson, Chief Executive of the King's Fund and a keynote speaker, will tell the "Commissioning, Community, Cohesion' conference, hosted by Race for Health, at the City of Manchester Stadium:

"With the NHS under significant financial pressure, we need to look at cost-effective ways of improving care and health outcomes for black and minority ethnic groups. It is clear, looking at the poor outcomes for some groups in areas such coronary heart disease, diabetes and smoking prevention, that more imaginative ways for providing services to these people could have great benefits. It could extend lives, reduce ill-health and help the NHS to deliver more even in a time of financial constraints. It is time that we devoted real energy to establishing where we can make 'quick wins' and then reconfigure commissioning accordingly."

Professor Helen Hally, National Director of Race for Health, an NHS programme, will say:

"The issue is not necessarily one of direct race discrimination. It is the simple, observable fact that being sensitive to ethnicity leads to better diagnosis, treatment and care of people and results in better outcomes for them, for society and an NHS charged with improving the well-being of our citizens."

Professor Hally highlighted the following NHS statistics:

  1. Some 35 per cent of African Caribbean men smoke, compared with 39 per cent of white Irish men, 44 per cent of Bangladeshi men and 27 per cent of the general population. Infant mortality in England and Wales for children born to mothers from Pakistan is double the average.
  2. In Britain today, black and minority ethnic groups comprise 8 per cent of the population.
  3. Young Asian women are more than twice as likely to commit suicide as young white women.
  4. In 2004, people from black and minority ethnic groups comprised 39.1 per cent of hospital medical staff but only 22.1 per cent of consultants.
  5. Young black men are six times more likely than young white men to be sectioned for compulsory treatment under the Mental Health Act.
  6. South Asian people are 50 per cent more likely to die prematurely from coronary heart disease than the general population. 38 per cent of Bangladeshis are under 16, double the figure for the white population.
  7. Asian women aged 65 and over have the highest rate of limiting, long-term illness (64.5 per cent compared to 53 per cent for all women aged 65 and over).
  8. The prevalence of stroke among African Caribbean and South Asian men is 40 per cent to 70 per cent higher than for the general population
  9. In 2004, 7.5 per cent of NHS Executive Directors in England were from black and minority ethnic backgrounds - up from 3.0 per cent in March 2000.
  10. Men and women of Pakistani and Bangladeshi origin are more than six times as likely as the general population to have diabetes. Rates for Indian men and women are three times higher and are significantly higher for African Caribbeans.
  11. Ninety per cent of children in the UK have visited a dentist. This compares with approximately 40 per cent of Bangladeshi and 60 per cent of Pakistani children.


Examples:

The conference will highlight some examples, set out below, of how the NHS is already becoming more sensitive to ethnicity, in some of the 14 Primary Care Trusts that are pioneering the approach that Race for Health wants adopted more widely. The 14 PCTs are: Berkshire East

Bradford and Airedale, Bristol, Ealing, Haringey, Lambeth, Leicester City, Manchester, Shropshire County, South Birmingham, Wandsworth, Westminster, Wolverhampton City, Liverpool.

Hands on approach beats diabetes

Harjeet Panesar, a retired midwife, knows the limitations of the printed word. When she began her job dealing with diabetes in Bristol's South Asian community, she was straightforward. "I said I believe in more hands on, less pen and paper," explains Ms Panesar from Bristol PCT.

Hundreds of people - some with diabetes, some at risk - have attended workshops that she conducts with a colleague, Veena Bassi, in Urdu, Punjabi, Gujarati and Hindi. They both speak each language fluently. For sessions in Bengali they recruit an interpreter.

Awaz Utaoh, an organisation dealing with domestic violence victims, has invited them in for a session. So has Dhek Bhal, a carers' association, and Khaas, a community organisation for disabled people, as well as the Asian Day Centre.

"A lot of our people don't like to read," says Ms Panesar. "People don't have time for it. You have to go out and talk to them. We don't even use power points, just flip charts so we really hit them with the message, there and then."

As well as raising awareness of diabetes, the sessions actually identify new cases. Ms Panesar does glucose tests, checks blood pressures, and refers some people onto GPs.

The next step is to hold sessions in religious institutions - six temples and a mosque want a workshop. "We've also developed our 'Lose Weight, Feel Great' programme," she says. "We offer yoga or aerobics for an hour plus a talk from a health professional. Organisations do it after they have had the diabetes workshop so people are learning and then positively improving their physical activity. It really makes a difference when you get out there and talk to people."

Someone to hold a nervous hand for an HIV test

Rhian Williams, a health visitor, remembers the first time a GP asked her to make a home visit to a refugee family - a Somali woman with an epileptic child.

"When I got there, I found a shared house with five women all together from different parts of the world," she recalls. "Four of them were HIV positive. One was pregnant and one had a little girl who was also HIV positive. None of them were registered with GPs and two did not speak any English. Two needed immediate hospitalization.

"That was my first case and I realised that this was a hidden population. We didn't know that people were out there because they were not on any local authority housing registers."

Since then, as part of a team from Wandsworth PCT, supporting the health care of homeless people and asylum seekers, Ms Williams has focused on understanding how they fare in the NHS. She trains GPs and health professionals - they often have little idea about their situation - and guides refugees and asylum seekers through the system.

She recalls an 85 year old Somali gentleman who was destitute. His daughter had not managed to get him registered with a GP. His health had become so bad that he was virtually bed bound. The simple act of finding him a GP and applying for an HC2 Exemption Certificate, securing him free dental care, eye tests and prescriptions, made a huge difference.

Refugees and asylum seekers, she says, often need more time than GPs can offer. "Take someone who is worried whether they will gain asylum. They may be living with grief and possibly trauma. There may be no-one to go with them for an HIV test, and a positive result could tip them into a suicidal state. We are there for them."

Number crunching gets to grips with psychosis

Wouldn't it be wonderful if commissioning agencies knew precisely which service modfications are effective in tackling ethnic health inequalities in, for example, diabetes and heart disease? You would know, for example, that one style of management was more effective than another, say, in cutting hypertension among African Caribbean men.

Lambeth PCT hopes to achieve just such knowledge with a sophisticated research project that ties together clinical data on patients with knowledge about self-ascribed ethnicity, language preference and religious affiliation.

Datanet recruits local practices and helps them to improve their collection of data on ethnicity, language and religion. It also helps clean up their clinical data. This data is then tied together for research. The Datanet project is based on a partnership of Lambeth PCT with the Department of General Practice at Guy's, King's and Thomas's and the South London Primary Care Research Network. Funds come from the St Thomas and Guy's charity. So far more than two dozen practices within the PCT have joined up.

"The first project is called 'Identifying and reducing ethnic inequalities in the management of people with psychosis'," says Dr Richard Williams, a local GP, and a project leader. "Datanet will be used to examine the difference in prevalence of psychosis between the African Caribbean and general populations. It will look at issues of access to services and develop service modifications to address these. In the long run, we should be able to do equity audits on a large number of health care activities. In time, lots of small modifications to services could make a big difference to health outcomes."

Oriental flavour in quintessential England

You might imagine that Shropshire, with its rolling landscapes and country market towns, is solidly white British. However, Shropshire County PCT became the first trust to commission the Chinese National Healthy Living Centre to take a closer look. There are in fact more than 1,000 people of Chinese origin served by the trust, according to the 2001 census (which found 247,403 Chinese people in the UK). The centre was commissioned to assess their health needs.

"Most Chinese people in Shropshire are Cantonese speaking and involved in the takeaway business," explains Lucy Tran, the centre's evaluation and research officer. "However, many in Telford are Mandarin-speaking from Taiwan or the mainland and in other businesses.

"The main issue is language. There are people aged 40 or 50 who don't speak English. They may rely on family and friends to interpret when they visit a doctor, so there are access issues. Those in the takeaway business say that GP opening hours are unsatisfactory. They find it difficult to book appointments. However, once people are in the system they are happy with the care."

College students in boarding schools comprise 50 per cent of the county's ethnically Chinese people - often from Malaysia, Singapore and Indonesia. The colleges worry about students bringing Chinese medicine from home and self medicating.

The study is expected to suggest translation of information leaflets into Cantonese and Mandarin - little is available - and better publicity for the existing interpreting service. "It's good the PCT realises that the community in Shropshire is so diverse," says Lucy Tran.

Lost in the NHS a long way from home

It's all very well having a great health service, but lots of people who need the NHS don't use it or don't know how to use it. That's particularly true in some ethnic minority communities. Worse still, people in these communities are more likely to have long-term conditions, such as coronary heart disease, that need regular care.

That's why South Birmingham PCT has developed an innovative course to train people to support people with long-term conditions in their own homes. The recruits, many of them without formal qualifications, are taught listening and communication skills and how to steer people around the NHS services. They are supported as they acquire the literacy and numeracy skills for the job.

"We're particularly interested in training people from ethnic minority communities," says Grainne Behan, course coordinator. "We want a workforce that reflects the community and will be better able to communicate. Often patients are more open because they feel the person from their own community is receptive, someone in whom they can confide.

"The new staff will visit people at home. Perhaps a husband is looking after his wife who has a chronic condition. The worker may find that the couple have been trying to access healthcare services but have not had much luck. A lot people with chronic illnesses don't know where to go to for help. The same goes for their carers.

"The new workers will signpost them to the right places. Perhaps the couple have been told to eat healthier food, but don't know where to start. So the worker takes them shopping to show them what to buy. Success in this field is all about understanding and communicating at a right level."

Notes to Editors:

Race for Health supports Primary Care Trusts to make the NHS locally, regionally and nationally significantly fairer for black and minority ethnic (BME) communities, and aims to deliver measurable improvements in the health outcomes of BME people. RfH has developed a growing network of 14 PCTs across the country, working in partnership with local communities, local authorities and other stakeholders. Together they seek to deliver health services that respond effectively to the different needs of local communities and individuals, drawing on the great benefits of the NHS's diverse workforce. Our PCT-led programme of work is funded by the Department of Health and hosted by Manchester PCT.

Contacts

Press: Jack O'Sullivan 07779 655585 jack@raceforhealth.org

Administration: Anurita Mulchand 0161 958 4081

enquiries@raceforhealth.org

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