« Previous | Contents | Next »
Listen
IMPROVING THE HEALTH OF THE SCOTTISH MINORITY ETHNIC COMMUNITIES
OVERVIEW
Responsibility for delivering the minority ethnic community health agenda rests with the Chief Executives of Boards. In recognition of the challenges involved in delivering this agenda, the Scottish Executive funded a National Resource Centre for Ethnic Minority Health.
NRCEMH is sponsored by the Health Planning and Quality Division of the Scottish Executive Health Department and new investment of 1.1 million has been agreed for the first three years (2002-2005). It is envisaged that funding will continue beyond then.
NRCEMH has a responsibility across the NHS in Scotland serving the needs of minority ethnic communities including:
People of South Asian, Chinese, African, and Caribbean origin
Gypsy/Travellers
Asylum seekers and Refugees
Other groups where research suggests that health outcomes or quality of care may be compromised due to membership of a faith or minority ethnic group.
The Director of NRCEMH is Dr Rafik Gardee who is seconded on a part-time basis from his position as Consultant in Public Health Medicine with Greater Glasgow Primary Care NHS Trust. He is responsible to the Scottish Executive Health Department.
The other staff of the NRCEMH are:
Joan Jamieson | Information Project Manager |
Vibha Pankaj | Training and Development Project Manager |
Eleanor McKnight | Policy Project Manager |
Maureen Dunn | Project Secretary |
Carrie McNeil | Project Secretary |
A Steering Group with expert membership from across Scotland guides NRCEMH. It is charged with the responsibility of submitting the Annual Report to the Scottish Executive Health Department.
This Annual Report sets out the work of NRCEMH in its first year, focusing on its mission, aims and core values, its mode of operation and ways in which it interacts with health organisations and the minority ethnic communities in Scotland.
MISSION, CORE PRINCIPLES, AIMS AND PARTNERSHIP OBJECTIVE VALUES OF NRCEMHThe Mission of NRCEMH:
The mission of the National Resource Centre for Ethnic Minority Health is to help to ensure a quality service that addresses the concerns of marginalized minority ethnic communities and facilitate the development of a sensitive and culturally competent service based on anti-discriminatory policy and practice.
NRCEMH has been established on the basis of a set of core principles and values.
Respect for Others: Understanding, caring, tolerance and responsiveness to the privacy, dignity, values, beliefs, religious concerns and circumstances of others.
Partnership: Constructive relationships with patients, carers, members of the public, community organizations, other statutory and voluntary agencies, administrative staff and professional colleagues, with rights and responsibilities on both sides.
Innovation: The generation of exciting ideas and imaginative ways of delivering better services.
Social Justice: A fair approach in developing culturally sensitive services with equitable distribution of opportunities and avoidance of unfair discrimination based on ethnicity.
Community Development: A commitment to encouraging more effective participation from, and engagement with, the minority ethnic community sector.
The key aims for 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 ethnic minority communities, and 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 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 organizations, 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.
At the heart of NRCEMH is partnership working. The partnership objectives include:
Identifying and working with all those individuals and organisations who will be instrumental in improving minority ethnic health. This will include local authorities, the voluntary sector and commercial organisations. Key stakeholders will be minority ethnic organisations and individuals with a strong personal/ professional commitment to increasing racial equality.
* Working through a Scotland-wide network, establishing strong relationships with the Scottish Executive and building the minority ethnic dimension into policy development.
REMIT AND STRUCTURESPending further discussion on reporting relationships following amalgamation of the Public Health Institute for Scotland and the Health Education Board for Scotland, The Director of NRCEMH is reporting to the Scottish Executive Health Department and liaises with the Steering Group.
Overall strategic direction for NRCEMH is provided by the Steering Group which is chaired by Professor Raj Bhopal. The terms of reference and membership of the Steering Group is attached as APPENDIX A.
As well as reviewing priorities for current and future work of NRCEMH, the Steering Group is tasked with reviewing the progress of NHS organisations in relation to ethnicity and health through an Annual Report. This report will be used by the Scottish Executive Health Department as part of the Performance Management Framework.
The working relationships of NRCEMH are illustrated graphically below and explained in the ensuing text, figure (1):
NRCEMH: Working Relationships
Figure 1: Diagrammatic Representation of the Integrated Working Relationships
SERVICESNRCEMH is providing a range of services, including:
Supporting the development of Scotland wide networks on minority ethnic (ME) health issues.
Capacity building for Health Boards in relation to minority ethnic health issues, including training and organisational development support.
Compiling a national and an international database of individuals, organisations, initiatives, funding streams and funders, research and good practice in relation to ethnic minority health.
Offering seminars, guidance and advice on ethnic minority health, including offering models of good management practice, guidance on minimum standards, and encouraging the take up of good practice initiatives.
Gathering information, commissioning, undertaking and disseminating research.
NETWORKSMuch of the work of NRCEMH is being delivered through networking bodies and individuals most involved in setting and delivering the agenda for change in relation to race equality in NHSScotland. Networks operate at three different levels:
1. An NHS Board Lead Network of lead persons for race equality around Scotland resolves difficulties encountered by NHS organisations in the implementation of the HDL (2002) 51 and RRAA 2000. The terms of reference and membership is attached as APPENDIX B.
2. The NRCEMH project managers are establishing specific networks dealing with training, information and policy to develop guidance and good practice.
3. Good practice and positive action models are being shared through a number of themed support networks set up and hosted by the NRCEMH. These include networks for asylum seekers and refugees, Gypsy/Travellers, chronic disease management and specific health issues.
The three levels of networks and the general programme of work of the policy, training and information managers are set out below.
POLICY DEVELOPMENTPolicy work in NRCEMH has assisted Boards and Trusts in developing their Race Equality Schemes and Fair For All Action Plans. The Joint Monitoring and Evaluation Implementation Framework was designed early on in partnership with the CRE to help integrate policy and legal requirements. Subsequently a Project Team was set up to oversee the National Review across Scotland.
A Policy Network will now be established to help ensure the implementation of this work through the production of national guidance and sharing of models of good practice. In addition, a number of themed networks have been or are being established.
A multi-agency approach is being taken to harness the necessary skills and expertise. Key stakeholders in the minority ethnic voluntary and community sectors working on health have been identified to ensure that service users have an effective voice in the future development and implementation of policy.
Developing the Evidence Base
The Policy Manager is representing NRCEMH on working groups which will develop the evidence base on the health needs of minority ethnic health service users to more effectively inform policy in Health Boards and Trusts. These groups include Mental Health, Advocacy and Community Development.
The Policy Manager has also been involved in an advisory capacity on a Fair For All planning group for NHS Health Scotland and is a member of the Scottish Executive Health Department's Diversity Task Group. The latter is considering a Diversity Strategy for NHSScotland which would enable organisations to address the need to ensure equality of opportunity for staff and service users.
Partnership working
As stated, NRCEMH promotes partnership working to share and stimulate best practice. More examples of this are:
a)
Regional partnerships: An interesting model is the Joint Racial Equality Health Forum comprising of four West of Scotland Health Boards and the Race Equality Council. NRCEMH facilitated an away-day to allow the consortium to reflect on work to date and develop a practical way forward. A briefing paper shares some of the lessons with other regions.
b)
Rurality and health: There is increasing diversity outside the central belt of Scotland with significant number of ethnic minority families choosing a rural life, often attracted by employment opportunities. Isolation on top of discrimination can create a situation where it becomes even harder to have confidence in public services such as health, or even to have access to them in the first place.
It is therefore important to recognise that when community planning becomes integrated in the development of the Community Health Care Partnerships as a consequence of the White Paper (2003) on health, consideration will have to be given to rural factors, such as sparse population, geographical distance, personnel shortages, scarce resources, physical, emotional and social isolation.
The NRCEMH recognises that in rural communities, community orientated planning and professional/client/community partnerships are critical elements for reform to be meaningful at the local level. It will facilitate regional collaboration with special reference to case management and community-orientated primary health care, both models which have been found to be particularly useful in rural environments.
c)
National Health Board partnership: The National Boards which have national Scottish-wide responsibilities may be less involved in direct service provision, but have issues and concerns at national strategic level. This will be supported through collaborative working and sharing of good practice.
Themed networks
Given the diversity of health needs which require a Scottish wide perspective, a number of themed networks have been set up or are being consolidated to facilitate the policy and implementation process. This work is being supported through secondments from Health Boards and Trusts which will also give the secondees an opportunity to gain a national perspective in their speciality area.
a)
Gypsy/Travellers:
A visit to a Traveller-led project in Dublin took place in August 2002. Five Scottish Gypsy/Traveller women shared experiences with community representatives in Ireland and identified good practice models which could be easily transferred.
In January this year the Policy Project Manager coordinated a national Gypsy/Traveller Roundtable to identify priorities and develop an action plan around the four key areas:
Extension of good practice models nationally, e.g. hand-held records
Community-led national health needs assessment
Production of health promotion materials in accessible formats
Employment of a community researcher to develop the action-based research.
A full report of the Roundtable discussion has been published. Two secondees from Health Trusts are leading on this work, and a multi-agency Steering Group is offering support and advice. This work should have strong ownership and direction from Gypsy/Traveller community representatives.
b)
Asylum Seekers and Refugees:
In October 2002, the Scottish Refugee Integration Forum issued for consultation a National Action Plan supporting the integration of asylum seekers and refugees in Scotland. This plan will be taken forward with the Fair For All Agenda. A conference, which took place in February 2003, brought together key players in the health and social care sectors to address implementation of the Action Plan and to share problems, solutions and emerging best practice.
Following the Conference, the Policy Project Manager has supported two seconded staff from local Trusts to take forward specific action points through the establishment of an additional network. The network will run workshops with focused topics in order to identify good practice models and develop on-line national guidance for practitioners.
c)
Community Development:
NRCEMH is keen to address community development and capacity building needs as soon as possible in its work programme. A joint working group is planned with representatives from Boards as well as both national and local minority ethnic voluntary organisations. The proposed outcomes are to produce a briefing paper addressing key values and principles, a database of existing organisations offering support and/or resources and a national Seminar to raise awareness among the minority ethnic sector as well as sharing good practice models among Boards and Trusts. This working group will also take forward the Patient Focus and Public Involvement (PFPI) agenda in collaboration with the SEHD's Patient Focus and Quality Unit.
d)
Mental Health and Well-being Substance Misuse:
Following a Seminar on Mental Health and minority ethnic communities to be hosted by NHS Health Scotland in September 2003, it is anticipated that a national network will be formed which will be facilitated by Salma Siddique. This work will involve clarifying the current position of mental health strategies in Health Boards and conducting a mapping exercise of existing support organisations and on-going working in this area. A series of seminars are planned throughout Scotland to share and stimulate good practice which could include language and communication through bilingual counselling and therapy services, theologically or spiritually based counselling services and alternative and complementary therapy as well as culturally relative psychologies of mental health. Partnership working will be developed with the Mental Welfare Commission which has highlighted culture and ethnicity as part of their own 2003-2004 work programme.
The network will also review the current provision of service support for individuals with substance misuse issues with particular emphasis on joint working between voluntary, statutory and community agencies.
e)
Cancer:
An initial seminar was called by the CRE in spring 2003 to explore the need for a specific cancer strategy within Scotland identifying the required improvements to service delivery and practice. NRCEMH subsequently facilitated a further meeting to address the following questions: Where are we currently? What should be happening? and What are the next steps? A multi-agency group has now been formed to take forward specific pieces of work which will address in particular community development and health promotion needs, partnership working and effective monitoring at all stages. Initial discussions have also begun with Macmillan Cancer Relief in order to develop a joint response to taking this forward and in particular to identifying practical solutions to existing issues and problems.
TRAINING AND DEVELOPMENTThe Project Manager is developing a strategy to improve the knowledge, culturally sensitive attitudes and skills of NHS staff to equip them to deliver culturally competent services. It aspires to promote a culture where ethnic minority issues become an integral part of health care. To achieve this main objective, a work programme has been developed of which the following elements have been initiated or are planned:
Establishment of a training and development network
A Training and Development Network comprising of nominated representatives from Health Boards (NHS stakeholders) has been established. The network will take forward the training and development agenda through a co-ordinated approach and dissemination of good practice, preventing duplication of effort.
Four subgroups have emerged from the main network:
training strategy and implementation;
marketing and dissemination of best practice;
evaluation and standardisation; and
curriculum development
Curriculum development
To highlight the different elements that could be included in training for staff, a curriculum outline was developed and circulated. It included nine modules in three broad categories:
knowledge and understanding (of ethnic minority groups, their health and race relations policies);
attitudes (valuing diversity and developing cultural sensitivity); and
skills (effective communication and use/collection of ethnic minority data).
Training needs assessment
The National Resource Centre for Ethnic Minority Health with the Scottish Executive is currently undertaking a national training needs assessment of NHS staff in Scotland to deliver both Patient Focus Public and Involvement and Fair For All agendas. The training needs assessment has the support of the Royal College of Physicians, Royal College of Nursing and NHS Education Scotland. The training needs assessment methodology comprises of representative focus groups and stakeholder interviews in the first phase followed by a national survey of all NHS staff. The final report and recommendations of this exercise will be available in October 2003 highlighting training and support needs of NHS professionals.
Framework for training implementation
A draft framework to support Health Boards to develop training strategies is being developed. The framework will provide guidelines on training and development issues such as: development of a training policy; conducting training needs assessment within an organisation; developing the curriculum; commissioning training programmes; training evaluation; and training impact assessment.
Survey to assess the current status of training
NHS organisations are at different stages of development of training within their organisations. A survey to assess the ongoing and planned training and development activities in various Health Boards and Trusts is being conducted to identify gaps as well as good practice.
Training and development bulletin
An e-bulletin to disseminate information on issues related to training has been initiated. The first issue focused on available training programmes and resources. Various training organisations and consultancies that provide training in race equality issues were invited to register interest and provide details of their activities which were then summarised in the bulletin.
Developing the concept of cultural competencies
A proposal for a project looking at the cultural competencies of NHS staff is being considered in collaboration with NHS Education Scotland. It is expected that this could be used as a measuring tool to assess long-term impact of training on culturally sensitive service provision.
Other important issues
Other issues include:
A greater awareness and understanding of race equality issues needs to be inculcated amongst those responsible for developing training programmes and those leading the culture change agenda.
Integration of training activities within the training plans of organisations for sustainability.
The Race Equality Schemes and Action Plans of Health Boards generally provide little detail of their training strategies. Discussions have indicated that some NHS organisations may require considerable support to help them develop their training strategies.
E-learning resources could be used to deliver some aspects of the knowledge based modules. These can provide pre-training learning to reduce time spent during formal training sessions. The possibility of developing e-learning resources is being considered.
Training programmes need to be of high quality to ensure participants' interest and to ensure long term impact. Issues related to standardisation and accreditation therefore, need to be considered.
INFORMATION MONITORING AND RESEARCH AND DEVELOPMENTThe Vision for Information on Ethnicity and Health in Scotland is that:
Inequalities in health in Scotland are identified and addressed, by the collection and sharing of comprehensive and consistent ethnicity information across all minority ethnic groups.
The health needs of minority ethnic groups are known and can be met effectively, through the collection and analysing of high quality readily available information.
In order to meet this Vision, it is proposed to implement an operational collection system of information on ethnicity across NHSScotland organisations in order to:
(a) assess the extent of health inequalities across all ethnic groups and monitor the impact of efforts to reduce them;
(b) establish the extent to which health service provision is culturally appropriate and monitor changes; and
(c) comply with RRAA legislation, FFA, Spirituality and other NHS policies.
This programme is being taken forward in a range of ways.
Information monitoring
The information project manager is working with identified information persons from the 23 NHSScotland Boards (Information Network) and other collaborators to collectively strive to implement ethnic information monitoring from the perspectives of NHSScotland staff, individual patients and public groups. The information derived from ethnic information monitoring will, over time, ensure that the health of Scotland's minority ethnic groups is available to inform both local and national health needs, assist in service planning and support the cultural competence of delivered services.
Fig. 2.
Figure 2: The Information Vision
For ethnic information monitoring we need first to achieve the following key objectives:
Formulate policy, standardise practice and recommend data items for a national patient ethnic data collection to support ethnic monitoring.
Formulate policy and practice on required information systems and technology to support recommended ethnic data collection for ethnic monitoring.
A draft proposal has been developed to deliver a formal programme of work across Scotland which will meet these aims. In the first instance, this programme will be required to be agreed by both the Scottish Executive Health Department and the Steering Group for NRCEMH. The programme of work covers a three year period.
This draft programme addresses all aspects of information related to the gathering, sharing and use of information on ethnicity in Scotland:
what information is required to be collected;
how is that information to be collected;
who is that information collected by;
who is that information collected from.
This draft programme if accepted and implemented will deliver a coordinated and consistent approach to the implementation of ethnic monitoring across Scotland, allowing comparison between different Health Board areas, and different minority ethnic groups. Collection of consistent individual based information will enable the development of methods for the delivery of appropriate culturally sensitive services to address these inequalities and to develop research into health inequalities.
It will address the cultural aspects of attitudes of staff within NHSScotland and the various minority ethnic groups within the public, and tackle issues of buy-in at all levels and within all organisations. It will also address the technical aspects of the use of computer systems to collect and share information.
This programme will be the first of its kind in the UK, and will be viewed as a 'demonstrator' project outwith Scotland. This programme has UK-wide implications, and could be seen to be a model for the further development of the various Equality Units.
Main challenges for the Information Network
A number of challenges have been identified for the Information Network, including:
To develop a commitment at all levels of the organisations within NHSScotland to developing and delivering the plans to implement ethnic information monitoring.
To develop a clarity as to how communication flows within NHS organisations and in particular how NHS Boards communicate and relate to their acute and primary care colleagues.
To develop clear, straightforward standards for the information to be gathered and achievable mechanisms, systems and protocols for the collection of that information.
Research and Development
Significant progress has been made in R&D.
Extracting information on the health of minority ethnic groups from routine health data in Scotland. This project is led by a team in the University of Edinburgh in partnership with National Resource Centre for Ethnic Minority Health, Information Services Division and General Register Office for Scotland.
Using Coronary Heart Disease as a specific example, the project aims to explore the potential for retrospective analysis by ethnic group of routine health data sources in Scotland to provide information about the health status of minority ethnic groups and trends in minority ethnic inequalities in health. If successful this project will help meet information needs pending implementation of ethnic information monitoring in Scotland.
Themed Networks
Significant progress has been made in setting up a Themed Network to review the Epidemiology of Diabetes amongst the minority ethnic groups in Scotland. This Network has worked with the Scottish Diabetes Group and a number of local and national minority ethnic groups to develop specification of requirements for the provision of culturally sensitive services.
A major event is planned for the end of 2003 to evaluate the recommendations and develop plans for implementation.
Communication
The key to the overall work of the National Resource Centre for Ethnic Minority Health is awareness and involvement. One mechanism to create this awareness and involvement is through the communication of its aims, and the provision of basic information. This is being supported by the provision of a website. This is currently under development.
The website will be to act as an electronic resource of useful information to support NHS staff in their commitment to addressing institutional racism, promoting racial equality and supporting community development models of health and social care.
Notice boards to share good practice ideas and submit questions for support.
Currently, NRCEMH information is hosted on
www.phis.org.uk , but will be replaced by the first draft NRCEMH website by the end of September 2003. It is anticipated that the user-friendly approach to the website, will encourage all staff and, e.g. community organisations, to use the website when it is released and to comment on its usefulness.
« Previous | Contents | Next »