« Previous | Contents | Next »
Listen
Fair Enough?
Fair For All Progress Report:
Analysis of Race Equality Schemes and Fair For All Action Plans
Introduction
The NHS is central to improving the quality of life of people in Scotland. If access to services is inhibited, or if provision is inappropriate or inadequate, it can be, literally, a matter of life and death. Evidence to date is that black/minority ethnic people are less well served than the general population. Many arguments can be advanced for this - these are less important than what happens now, as long as mistakes of the past are not repeated and racism, where it exists, is not perpetuated.
Responsibility for delivering the black/minority ethnic health agenda rests with the Chief Executives of organisations. In recognition of the challenges involved in delivering this agenda, the Scottish Executive funded a National Resource Centre for Ethnic Minority Health ("NRCEMH") within the then Public Health Institute for Scotland. The NRCEMH is now within a new Board, called NHS Health Scotland, previously 2 organisations - the Health Education Board of Scotland (HEBS) and the Public Health Institute of Scotland (PHIS).
The key aims for the NRCEMH include;
- Supporting the development and management of a Scotland-wide network of professionals, managers and key individuals to take forward minority ethnic health issues.
- Developing as a "centre of excellence" in partnership with the field, minority ethnic communities, statutory, professional and voluntary bodies.
- Developing as a source of information, support and advice for Health Boards seeking information, advice and development support on minority ethnic health issues. Initial support to be offered to Health Boards to define parameters / working principles for Health Board appointees to take forward the issues at a local level.
- Functioning as a capacity building organisation, undertaking organisational, management development and training work with Health Boards and Trusts and other individuals and organisations committed to the development of the health of minority ethnic communities.
- Encouraging policy development with effective and efficient organisation around minority ethnic health across Scotland, particularly in information, training and human resources.
As part of the Centre's work in standardising and co-ordinating best practice, the issue of broadening out ethnicity to incorporate other areas of inequality is under consideration in order to move towards diversity and social inclusion within NHS Scotland.
ABOUT THIS REPORT
This report was commissioned jointly by the National Resource Centre for Ethnic Minority Health (NRCEMH) and the Commission for Racial Equality (CRE). It is the product of a desk-based analysis of Race Equality Schemes (RES) and Fair for All (FFA) Action Plans produced by Scottish Health Boards and Trusts in response to their new responsibilities.
The specific purpose of the project was to provide "a robust response on the extent to which NHS Boards and Trusts in Scotland have been able to reflect the requirements of the Scotland Order (Specific Duty on Race Equality Schemes) and their preparation for Fair For All". Independent Consultants were asked to analyse and report on the extent to which National Health Service (NHS) Boards and Trusts in Scotland had responded to the requirements of these two separate but complementary frameworks - Appendix G.
As well as commenting on their progress against these explicit requirements, the document considers practice and planning examples and gives recommendations. The report also identifies additional approaches and resources to assist Boards and Trusts in the future. The appendices include the National Assessment Framework ( Appendix D), developed for use in the analysis and as practical guidance for Boards and Trusts. In addition there is a starter glossary ( Appendix C) and sources of help including useful websites, articles and books ( Appendix E).
This report is being issued to all named public authorities in Scotland covered by the Race Relations (Amendment) Act 2000 (RRAA) ( Appendix A). A briefing is also being produced about this report, as is a summary for communities in different languages including Urdu, Punjabi, Cantonese, Arabic, Farsi, French, Kurdish, Russian, Somali, Swahili, Turkish, Hindi, Bengali and English. The full report, briefing and community summary will also be available on CD-rom and on the websites of NHS Health Scotland and the Scottish Executive. In addition, the CD-rom and websites will include the summary report of the findings for each Board and Trust that submitted a Scheme and/or Action Plan. These reflect the final versions seen by the independent consultants and are not directly comparable since some Boards and Trusts were able to take account of the comments made in the first phase of analysis, whilst others will do so in the preparation of year 2 Action Plans.
As this report was going to press, the CRE announced publication of its survey (of public authorities in England and Wales) into compliance with RRAA, "Towards Racial Equality". The findings in this report are broadly comparable with the national survey, with similar variation in arrangements to meet the specific duties, but with a more encouraging response overall.
The Race Relations Act 1976 (RRA)
The primary legal framework for racial equality is the RRA and details of this can be found at Appendix A.
The Race Relations (Amendment) Act 2000 (RRAA)
The RRAA was introduced into Parliament in 1999 as a response to the Macpherson report into the death of Stephen Lawrence. The Report concluded that all UK institutions were affected by institutional racism - that is "the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people".
The RRAA sets out a new positive duty, the General Duty, on named public authorities to "eliminate unlawful racial discrimination and to promote equality of opportunity and good relations between people of different racial groups". This legislation has recently been amended to require public authorities to also eliminate racial harassment.
Further specific duties, including ethnic monitoring of staff and production of a Race Equality Scheme (RES) with a realistic Action Plan, were placed on over 250 Scottish public authorities - including all NHS organisations. The Scheme, in essence, is the public statement of what each public authority is promising it will do in implementing the General Duty. Further details of the duties can be found at Appendix A.
Fair For All (FFA)
The FFA stock-take report (Fair For All, Scottish Executive, 2001) was commissioned by the Scottish Executive to assess the extent to which black/minority ethnic communities could fairly access NHS services. The resulting report, whilst identifying areas of good practice, was largely concerned with the inability of the NHS to take effective action to ensure their services were open and accessible to all.
The FFA report was subsequently complemented by a Scottish Executive Health Department Letter [HDL 2002 (51)] which is reproduced in part at Appendix B. The HDL set out five key areas for delivery for all Boards and Trusts in the area of race equality and cultural competence. It also established the NRCEMH as the primary resource for Boards and Trusts to assist them in the process of making health services more responsive to needs of black/minority ethnic communities and bringing them into compliance with the law.
Relationship between RRAA and FFA
At an early stage both the CRE and NRCEMH recognised that without explicit and complementary guidance, the requirements of the RRAA and FFA may confuse, rather than assist, Boards and Trusts in their new duties. To assist, the CRE and NRCEMH produced and disseminated a Joint Monitoring and Reporting Structure, which explicitly stated the required activities, evidential basis for monitoring progress and preliminary timescales and targets to be achieved. This document could not be circulated before October 2002, and was unlikely to have provided a great deal of assistance for the RES. It should, however, have influenced the FFA Action Plans which, in many ways, consolidated and built upon the RES.
Broader Policy Context
There are many other drivers for equality in NHS Scotland including
- The Sex Discrimination Act (1975)
- The Disability Discrimination Act (1995)
- The Human Rights Act (1998)
- The Data Protection Act (1998)
- The Scottish Executive's Equality Strategy
- Spiritual Care HDL 2002 (72)
- The NHS Reform Bill (based on Scotland's Health White Paper "Partnership in Care")
- The Patient Focus/Involving People Strategy
Support and Guidance
The NHS has been given assistance beyond that which many other sectors will receive.
- The HDLs on Fair For All ( Appendix B) and on Spiritual Care provide explicit guidance on several aspects.
- In addition to the CRE, which is funded through Westminster, the NRCEMH has been set up by the Scottish Executive to support implementation across the health sector, providing opportunities for discussion on cross-cutting themes, and central guidance on issues of strategic importance as well as support for individual Boards and Trusts through dialogue. It is to be hoped that organisations will seek assistance from NRCEMH, the CRE and other relevant organisations, which can offer expertise and support.
- Funding of this analysis has ensured that every Board and Trust has an opportunity to consider best practice through the National Assessment Framework, to learn from examples of practice and planning, and to be given specific comment on their own effort.
Two phases of review have ensured all Boards and Trusts had an opportunity to develop a better scheme and action plan, setting a solid foundation for the long term.
« Previous | Contents | Next »