Taking action to improve health and care experiences for people from ethnic minority backgrounds

NHS and care leaders in Devon have backed a series of recommendations to improve the experiences of people from ethnic minority communities in accessing and working in local health and care services.

The move follows the publication of a report commissioned by the Integrated Care System for Devon (ICSD) on the ‘Experiences of health and care in Devon for Black, Asian and Minority Ethnic communities and staff’. The report was researched and produced by independent specialists the Nous Group between September 2020 and February 2021.

The ICSD decided to commission the report as an initial step in tackling the issue following local engagement work in summer 2020 on the development of an ethical framework for Devon*, during which negative experiences were shared by people from ethnic minority communities about access to healthcare, while the Covid-19 pandemic placed a spotlight on health inequalities faced by people from ethnic minority communities.

The report includes first-hand feedback from staff and patients, as well as an analysis of NHS data. It demonstrates that change is needed by highlighting negative experiences, describes some of the ways in which this is already happening, and sets out the areas for improvement.

A total of 29 recommendations were made by the Nous Group and all of them have been approved by the ICSD Board and, on 27 May, the Governing Body of NHS Devon Clinical Commissioning Group.

Chair of the Health Inequalities Executive, Dr Lincoln Sargeant, said: “I am pleased that ICSD commissioned this work – it demonstrates a commitment to seek out and tackle these difficult issues.

“The findings will be disappointing but unsurprising for some of our communities, but they are really important for the people of Devon. We need to get things right; not just for our ethnic minority communities but for everyone. If we all take the time to respect and understand all of our colleagues and patients we can get our services right for everyone.”

Jane Milligan Chief Executive of the Integrated Care System for Devon (ICSD) and NHS Devon Clinical Commissioning Group, who joined the organisations in April 2021, said: “Commissioning this report was the right thing to do. We own these issues and we don’t shy away from the report’s findings. We’re pleased people felt able to speak up, and partners across the ICSD have not only accepted all he report’s recommendations, but are already acting on them.

“The vaccination outreach programme is a good example of this, and we have committed to further resources for important initiatives like the BAME staff network.”

The report recommendations focus on key areas including:  

  • Building stronger relationships with ethnic minority communities to make sure health services meet people’s needs
  • Developing Black, Asian and Minority Ethnic reference groups (staff and public), which will provide a platform for feedback to ensure NHS and care partners are listening to the voices of ethnic minority communities (staff and public)
  • Developing cultural awareness training in partnership with ethnic minority communities to support inclusion across the ICSD
  • Developing and improving translation services with communities to ensure everyone is able to access the healthcare they need
  • Building a more diverse workforce that represents local ethnic minority communities across the ICSD and ensuring equal access to progression opportunities.

The report is hard-hitting and provides a detailed insight into the current experiences of patients and staff. Its findings show that too often, people’s experiences are falling short of what is acceptable. Findings include:

  • Devon has a range of processes in place to address BAME inequalities, but their effectiveness is limited
  • There is limited understanding of how BAME communities, patients and service users are faring
  • People from BAME backgrounds perceive barriers to access and appropriate care as a result of their ethnicity
  • BAME staff experience substantial inequalities, with action to address this at an early stage of maturity
  • Devon must seize the twin opportunities of COVID-19 and the transition to ICS to embed accountabilities for BAME inequalities

Chair of the Devon wide BAME staff network, Sanita Simadree, said: “Our members have shared their experiences of working for the NHS in Devon. It is essential that they are listened to and that they are enabled to progress their careers and work in an environment free from harassment and abuse. However, I am absolutely delighted at the recognition of the importance of our staff networks and the valuable part they play in helping organisations and communities shape a better equitable future for all.”

In the executive summary, the report also states: “This project has identified significant appetite for change, and many pockets of good practice and emerging bright spots – including Devon’s roll-out of the vaccination programme, which has incorporated many of the principles of local community engagement and understanding discussed in this report. Devon has an opportunity to build on this momentum.”

As part of the vaccination programme, health and care teams worked with members of faith groups, including Overcomers Christian Fellowship in Plymouth and Exeter Mosque and Cultural Centre to understand concerns or barriers to having the Covid-19 vaccination. This led to a pop-up clinic at Exeter Mosque to support people to have their vaccination in a familiar setting. Some NHS ethnic minority staff have also volunteered to become vaccine ambassadors to support people’s choice to have the vaccine. Engagement work has also taken place with Gypsy, Roma and Traveller communities in Devon.

The report states that “NHS organisations in Devon have a mix of measures in place to support BAME staff and address inequalities, including BAME staff networks, mentoring and reverse mentoring programmes, and tailored support for career development. However these activities are not consistent across the system; and many, particularly staff networks, have only recently been introduced.”

It also highlights substantial variation across partner organisations in reported rates of harassment, bullying and abuse among BAME staff, saying a deterioration in some figures may be explained by increased reporting, “a positive sign”.

A development plan is in place to implement the report recommendations.  These include improving accountability through measuring and reporting on ethnic minority patients and staff experience, outcomes and employment, improving engagement with staff and communities and working with communities to create appropriate support for accessing healthcare.

* The ethical framework provides guidance to doctors making life-and-death decisions in challenging circumstances.

The Nous report was initially published as part of the papers for the 27 May meeting of NHS Devon CCG’s Governing Body.

A note regarding terminology – reproduced from page 6 of the report:

Terminology and the use of “BAME”

The term “Black, Asian and Minority Ethnic” (shortened to “BAME”) is commonly used within health and care to refer to people of non-White ethnicities, especially when making comparisons to the White population. The term is imperfect, and often inappropriately used. There are concerns that it groups together diverse ethnicities: potentially masking instances of inequality and/or racism; or homogenising the experience of individuals and communities who experience racism in different ways. People are more likely to identify as a particular ethnic group or race, than as “BAME”. An alternative consensus on the terminology is yet to form and for the purposes of this report the term provides a useful analytical framework to understand racial and ethnicity-based inequalities. This report should be read fully cognisant of the limitations highlighted above, and experiences of racism set out in the report should not be assumed as applicable to all non-White individuals.

For more information, call 01392 674801 or email D-CCG.Communications@nhs.net