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Race Equality Advisory Forum

Health and Social Care action plan

Vision

The Working Group has therefore developed a vision in which:

Health and Social Care services demonstrate and deliver a service which is accessible and accountable to all sections of the community. In order to do so, they need to uphold and demonstrate fundamental principles that operate from the basis of human rights and promote social justice.

The Minister for Health's Challenge to the Health Service in Scotland

The Scottish Executive has inherited a challenge from the then Minister for Health in the Scottish Office, Sam Galbraith. This challenge set in April 1998 to Health Boards and Trusts was to:

• address the health care needs of their minority ethnic population
• ensure that their cultural and spiritual needs are met.

Since this challenge was made several relevant pieces of work have been undertaken, led by the Scottish Executive's Health Department. This work has included the Ethnic Minority Health Stocktake, Clearing The Decks, the convening of a group to consider issues around spiritual care in the National Health Service in Scotland (NHSScotland), and the NHSScotland document Our National Health: A Plan for Action, A Plan for Change. The REAF Health and Social Care Working Group welcomes these developments and intends that the proposals contained in this action plan will complement and build on that work.

It is also the hope of this group that this action plan and its recommendations can help the Scottish Executive to deliver its own "vision of modern social care centred around the needs of individuals... that delivers quality care when and where families really need it"² and Sam Galbraith's desire for "every looked-after child to have the best possible start in life."³

Operating principles

The Working Group believe that the development and implementation of an effective race equality strategy and action plan needs to be based upon certain key operating principles:

• equality of access and of service provision for all service users irrespective of geographical location
• respect for diversity within communities as well as across communities
• accountability and transparency
• partnership with users and communities
• evidence-based approaches to service provision
• integral monitoring and evaluation
• the need for comprehensive training, development and awareness-raising.

In drawing up the action plan and priority action areas framework the REAF Health and Social Care Working Group have based their thinking on the following views of what these operating principles might mean in practice:

Equality of access and of service provision for all user groups, communities and individuals with no direct or indirect discrimination on the grounds of disability, age, gender, sexual orientation, race, colour, language, religion or national or ethnic or social origin, irrespective of geographical location.

Respect for diversity: service users should be provided with services which respect their individual qualities, abilities and diverse backgrounds and properly take into account their age, gender, sexual orientation and social, cultural and religious background.

Accountability and transparency: consisting of public reporting through annual reports and statements, the use of internal and external performance indicators and staff appraisals and the development of national race equality standards.

Partnership with users and communities: to support the commitment to health and social care services which are user-led there should be measures taken in support of consultation mechanisms and the use of lay involvement and advisory forums in the planning and reviewing of local race equality plans; also sustainable local race equality work through a funding and capacity building programme and development of an appropriate information strategy.

Evidence based services require planning tools, research and information strategies such as comprehensive ethnic monitoring systems to identify needs and assist planning decisions covering all aspects of employment practice and service provision across the sector. This should include admitted patient care, health priority areas and the Community Health Index.

Integral monitoring and evaluation as part of the planning cycle should involve an initial audit of services, policies and practice followed by the mainstreaming of race equality into all planning and the production of central guidance on mainstreaming and planning for race equality. Local NHS planning processes should include the development of programmes of action with resources identified and implementation reported on centrally and publicly.

Training, development and awareness-raising should be based on a service-wide review to establish core standards for the design and delivery of a training strategy with a focus on knowledge and skills, evaluation and impact assessment. The strategy should be designed to ensure consistency and effectiveness, and be developed in the context of continuous development and consideration of lay involvement with associated national guidelines.

Actions

To ensure that health and social care services in Scotland meet the needs of minority ethnic communities, address institutional racism and promote race equality, it is proposed that actions should be taken across a range of areas:

a) Leadership and Strategic Direction

1 The Minister for Health to affirm Ministerial commitment to race equality;

2 The Scottish Executive Health Department (SEHD) to appoint a named individual within the Department's senior management team to take lead responsibility for race equality in the health and social care services;

b) Planning and Commissioning of Services

SEHD, the Scottish Executive Education Department, NHSScotland, and all those responsible for commissioning and providing health and social care services:

1 to incorporate consideration of equality issues, including race equality, into all planning procedures and documents and the commissioning of all services;

2 to ensure that the specific needs of minority ethnic communities are being met through both research and consultation; where unmet needs are identified, services to be commissioned to meet those needs;

3 to ensure that all services provided are culture and faith sensitive and meet service users' cultural, dietary and spiritual requirements;

4 to make race equality a condition of funding for all new services;

c) Communication and Access

SEHD, the Scottish Executive Education Department, NHSScotland, and all those responsible for providing health and social care services:

1 to develop and implement strategies for increasing awareness amongst minority ethnic communities about the availability of different health and care services and their rights in accessing those services;

2 to develop and implement strategies around health promotion campaigns to ensure that such campaigns reach minority ethnic communities;

3 to ensure that interpreting services can be easily accessed by all staff and patients;

4 to ensure that all staff signpost interpreting services to service users and are trained in the use of interpreters;

5 in consultation with minority ethnic communities, to develop and implement a clear policy on the provision of appropriate information in community languages;

6 to develop a programme to promote the uptake of direct payments amongst minority ethnic service users;

d) Advocacy

1 Local authorities and Health Boards to fund the provision of independent advocacy services⁴ for minority ethnic communities including for disabled people within communities; those authorities and Health Boards with small minority ethnic populations to look to purchase advocacy expertise from areas of more dense population, possibly using the Internet and video and telephone conferencing;

e) Research, Information and Data Gathering

1 SEHD, liaising with the Central Statistics Unit, the Common Services Agency Information and Statistics Division, the General Register Office for Scotland and local health and social care providers, to design and implement a strategy to gather all data around service provision and use on an ethnically disaggregated basis; the provision of data in this way to become a requirement on all service providers, except in those instances where it can be demonstrated that there are sound reasons for not doing so;

2 Ethnic group data to replace or, if practicable, supplement country of birth data on death certificates and anywhere else it is routinely used;

3 SEHD to develop further the commitment to information systems to gather data such as health service use, health relevant behaviours, morbidity and mortality rates; this data to be disaggregated for urban and rural areas;

4 Where appropriate, SEHD to require that service providers also collect data on the linguistic, dietary and spiritual needs of service users; such data to contribute to the provision of more culturally and linguistically sensitive services;

5 SEHD to study the findings of the Scottish Executive Audit on Ethnic Minority Research and commission research to fill significant gaps in health and social care research identified in the Audit;

6 The Scottish Commission for Regulation of Care to ensure that data gathering as part of inspection incorporates monitoring of ethnicity of users and how linguistic, dietary and spiritual needs of service users are addressed;

f) Training and Education

1 All providers of training leading to careers in the health and social care professions and designers of curricula, including the General Medical Council, the General Dental Council, the General Chiropractic Council and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting and the Council for Professions Supplementary to Medicine, to ensure that their curricula incorporate issues of diversity, discrimination and promoting equality of opportunity as well as race equality;

2 The Scottish Social Services Council, the Central Council for Training and Education of Social Workers, the Training Organisation for Personal Social Services and the Scottish Qualifications Authority to ensure that their curricula incorporate issues of diversity, discrimination and promoting equality of opportunity as well as race equality;

3 All providers of training leading to careers in the medical and care professions, including medicine, nursing, dentistry and social work, to ethnically monitor both applications and selection onto these courses and develop positive strategies to address any under-representation of students from minority ethnic backgrounds;

4 All providers of health and social care services to ensure that all employees at all levels receive equality, including race equality, training, appropriate to their duties; such training to ensure that staff can provide a culturally-sensitive person-centred service;

5 SEHD to ensure that all NHSScotland public appointees receive equality, including race equality, training;

g) Employment and Representation

1 All providers of health and social care services to draw up, where one does not already exist, or review and if necessary revise, where one already exists, an equal opportunities policy and implementation plan that includes specific references to race equality;

2 All providers of health and social care services to undertake ethnic monitoring of their workforce, and of their recruitment and selection processes; where inequalities and/or under-representation are apparent, positive strategies to be developed to address them;

3 All training and development programmes to be ethnically monitored to ensure that all staff benefit from equal access to training and development opportunities; where inequalities and/or under-representation are apparent, positive strategies to be developed to address them;

4 SEHD to continue to work closely with colleagues in the Scottish Executive Public Appointments and Equality Units to ensure awareness of equality and diversity issues when making NHSScotland public appointments and to develop and implement positive strategies to address continuing under-representation. As part of this, the Health Department to ensure that:

• this is reflected in the material prepared for applicants and in the design and placement of advertisements;
• a wide range of minority ethnic and other relevant organisations are advised when appointments are being advertised;
• it provides opportunities for "work shadowing" existing public appointees;

h) Racial Harassment

1 SEHD to require that all providers of health and social care services ensure that policies and procedures are in place for dealing effectively with any instances or allegations of racial harassment; these policies and procedures to cover harassment of staff by other staff, staff by patients and patients by staff;

2 SEHD to require that all providers of health and social care services publish statistics on racial harassment as part of their annual reporting process;

i) Consultation

1 SEHD to require and support the development of consultation frameworks by unified Health Boards to support the implementation of the new duty on the public sector to promote race equality in the Race Relations (Amendment) Act 2000;

2 SEHD to require and support the convening by unified Health Boards of consultation exercises around users' and voluntary organisations' experience of the health and social care services and their views on needs in relation to service provision, design and delivery. These exercises should bring together the service providers, professional and trade union organisations, user groups and interests as well as academic and other external specialists;

3 SEHD to require and support the convening by unified Health Boards of consultation exercises around children and young people's experience of social care services and their views on needs in relation to service provision, design and delivery. This should bring together the service providers, professional and trade union organisations, user groups and interests as well as academic and other external specialists;

4 SEHD to ensure that Health Improvement Plans contain specific measures for engaging minority ethnic communities;

5 All providers of health and social care services to consult with minority ethnic service users, including children and young people, around the planning, commissioning and delivery of services; such consultation to be used in identifying the extent to which current provision of services is meeting the needs of minority ethnic communities and in identifying unmet needs;

To be effective such consultation must:

• recognise the diversity of minority ethnic service users, both across communities and within communities; as well as consulting with all relevant communities, service providers also to ensure that they consult with the young, the old and women within communities, as well as those like disabled people who suffer from multiple discrimination;
• use a variety of meaningful approaches which reflect the diversity of those being consulted; such approaches could include public meetings, focus groups, roadshows, interviews, user surveys and electronic consultation;
• consider the use of initiatives which help user groups to contribute confidently and effectively to consultation processes; such initiatives could include shadowing and mentoring.

j) Monitoring, Evaluation and Reporting

1 All providers of health and social care services to mainstream equality, including race equality, into their annual reporting processes;

2 All inspection units to adopt inspection mechanisms around the promotion of race equality; such mechanisms to be based on the Commission for Racial Equality's equality standards and guidance developed in support of the implementation of the Race Relations (Amendment) Act 2000;

3 SEHD, liaising with the Central Statistics Unit, the Common Services Agency Information and Statistics Division and the General Register Office for Scotland, to develop disaggregated frameworks for the monitoring of service users and staff by ethnicity;

k) Actions Specific to Rural Areas

Minority ethnic households and groups in rural areas face specific challenges based on their small size, diversity and dispersion. Furthermore, rural health and social care service providers have often ignored the specific needs of minority ethnic households in their service provision and delivery, sometimes arguing that race equality issues are not relevant to their circumstances or service users. Accordingly, the REAF Health and Social Care Working Group proposes the following actions.

Providers of health and social care services in rural areas, in conjunction with SEHD and other relevant organisations:

1 to ensure that race equality issues are mainstreamed into the development and implementation of all rural health and social care initiatives and projects;

2 in partnership with other agencies and minority ethnic groups, to develop innovative and practical strategies to provide interpreting and translation services in rural areas in ways that overcome the disadvantages arising from the small size and the diverse and dispersed nature of minority ethnic households;

3 to develop consultation strategies which overcome the disadvantages listed above and allow minority ethnic communities to participate fully; such consultation strategies to take into account the time and costs spent on travel which can limit the involvement of all rural service users in consultation exercises;

Actions Relating To Specific User Groups:

l) Gypsies/Travellers

1 SEHD to give early consideration to the feasibility of developing patient-held health records throughout Scotland;

2 Primary health and social care service providers to develop and implement strategies to improve their liaison with Gypsies/Travellers as part of wider communication and access strategies; as one aspect of these strategies, to consider providing a named contact, possibly a Health Visitor, to liaise with Gypsies/Travellers and with local Gypsy/Traveller sites;

3 Providers of health and social care services to ensure that all consultation strategies build in concern for the particular circumstances and needs of Gypsies/Travellers, both through direct engagement with Gypsies/Travellers and through the involvement of relevant organisations such as the Scottish Gypsy Traveller Association, the Scottish Traveller Consortium and the Save The Children Fund; care to be taken to ensure that the voices of young, elderly and disabled Gypsies/Travellers are heard;

4 In addition to the recommendations on training above, providers of primary care and social care services to ensure that relevant staff receive training in Gypsy/Traveller cultural values;

m) Asylum Seekers and Refugees

1 Health and social care providers to provide specific culturally-sensitive services which recognise gender, religious and cultural needs, over and above a need to appreciate the specific needs of this very vulnerable group who have been displaced and traumatised and who may require specialist mental health and primary care services. This service provision to recognise that many asylum-seekers have not accessed any health care over a period of time and that they may have health conditions which are specific to their home country;

2 Health and social care providers to recognise that current barriers to the use of health and social care services facing asylum-seekers mean that those who have recently received refugee status may have pressing health and social care needs which need to be met quickly, effectively and with services which are culturally and linguistically sensitive;

3 Health and social care providers to ensure that vulnerable refugees are identified at an early stage and that appropriate partnerships are developed to meet their needs;

4 SEHD to ensure that resources are available to support the development and provision of services by Health Boards and voluntary sector organisations which meet the mental health needs of refugees who may suffer from depression and/or mental illness as a result of the experiences which led them to leave their countries of birth;

n) Carers

1 The REAF Health and Social Care Working Group welcomes the publication of the Strategy for Carers in Scotland in November 1999 with its aim of improving service provision for all carers in Scotland. As this work is being carried forward, the Working Group would like to draw attention to the particular barriers facing some minority ethnic carers, including linguistic and cultural barriers, and to make the following recommendations:

2 SEHD, in conjunction with local authorities and Health Boards, to develop and implement positive strategies to facilitate the involvement of minority ethnic carers and those they care for in community care planning, provision and evaluation and in all consultation exercises around the provision of services for carers; these positive strategies to include capacity building and the development of improved consultation frameworks;

3 Local authorities and Health Boards to ensure that the services they provide for carers and those who are cared for, as well as information about those services and the distribution of that information, are culturally sensitive and accessible to service users for whom English is not their first language;

Actions Relating to Specific Parts of the Health and Social Care Sectors

o) Mental Health

1 SEHD to implement those recommendations within Chapter 18 of the Report on the Review of the Mental Health (Scotland) Act 1984, also referred to as the Millan Report, relating specifically to service users from minority ethnic communities.

p) Primary Care Organisations and Independent Contractors (including General Practitioners, Dentists and Pharmacists)

1 Primary Care Trusts, in conjunction with the Clinical Standards Board and the Royal College of General Practitioners, to ensure that the promotion of race equality and the effective accessing of interpreting services become important parts of the practice accreditation scheme currently under development;

2 Primary Care Trusts to ensure that independent contractors comply with the general duty to promote race equality under the Race Relations (Amendment) Act 2000, both as employers and as service providers; Primary Care Trusts to monitor and report on progress in the promotion of race equality in this area;

3 The General Medical Council, the General Dental Council and the Royal Pharmaceutical Society of Great Britain to ensure that their members do not discriminate on the grounds of race, ethnicity, culture or language, and actively promote race equality by providing services which are person-centred, culturally sensitive and supported by the use of interpreting and/or translation services where appropriate;

q) Establishment of a Centre of Excellence

1 SEHD to establish a centre of excellence to provide expert advice to health and social care professionals on the promotion of race equality and eradication of institutional racism; its duties to include the collating and disseminating of examples of good practice around consultation, interpreting, provision of information and of culture and faith-sensitive services.

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