Select Committee on Health Memoranda

Table 3.11.5(j)

3.11  Race Relations (Amendment) Act 2000

  3.11.6  All populations served by NHS bodies should receive equal treatment according to their needs. Would the Department explain what steps it has taken to ensure that people from minority ethnic groups receive equal treatment from NHS bodies? What evidence does the Department have to show that people from minority ethnic groups receive equal treatment from NHS bodies?

  1.  The Department of Health is committed to reforming the NHS and Personal Social Services, tackling inequalities and discrimination. This means addressing health inequalities for minority ethnic communities and improving the working lives of minority ethnic staff. A number of studies, including Sir Donald Acheson's report Independent Inquiry into Inequalities in Health (1998), have shown that there are significant health inequalities among people from black and minority ethnic communities. These inequalities relate to differences in disease prevalence, differential access to services and differential delivery of services. These findings were borne out by the 1999 Health Survey for England, published in 2001 which contains a wealth of socio-economic data, which is valuable in identifying and monitoring inequalities of health.

  2.  The New NHS (1997) and a First Class Service (1998) introduced a range of measures to raise quality of service and decrease variations in service provision including introducing National Service Frameworks (NSFs). The NHS Plan re-emphasised the role of these Frameworks as drivers in delivering the modernisation agenda. National Service Frameworks cover: cancer, mental health, coronary heart disease, older people and diabetes. The Diabetes National Service Framework delivery strategy to be published later this year will be followed by Frameworks for renal services, services for children and young people and for people with long term medical conditions.

  3.  The following is an update on the position of the NSFs:

    (i)  The Children's NSF is currently being developed. As the External Working Groups consider their advice on the production of standards for children's services, racial and other inequalities will be a key area to be covered. As standards are developed officials from the department intend to meet with representatives from a range of ethnic groups to ensure that the diverse needs of the different groups are taken into account.

    (ii)  The National Service Framework for Coronary Heart Disease highlights the particularly high risk of CHD developing in people of South Asian descent, and the importance of identifying such high risk patients. South Asians will benefit from work being taken forward to prevent CHD in the general population, as well as from specific projects to reduce risk factors in this community, and from progress in identifying and treating people at high risk of these conditions. The Department is now drawing together a strategy to tackle heart disease in this high risk group.

    (iii)  There is world-wide shortage of donated organs. In the United Kingdom about 2,700 organs (hearts, kidneys, livers, lungs, pancreas and bowel) are transplanted each year but currently more than 6,000 people are awaiting transplants. There is a particular need to increase organ donation from ethnic minorities. There is a high rate of renal failure and a low rate of organ donation in the South Asian communities and relatively high rates of diabetes, coronary heart disease, hypertension and kidney disease feed into high rates of end stage renal failure and the consequent need for transplantation. There are similar problems among people from African and African-Caribbean backgrounds. One of the primary objectives of the Renal Services NSF is to reduce inequalities. Renal disease tends to predominately affect the older population and research has shown that certain minority ethnic groups are particularly susceptible, in some cases being 3-4 times more likely to develop renal failure. The NSF will therefore focus on individual patient need, and age and ethnicity will be cross-cutting themes throughout the NSF. The External Reference Group for this NSF will identify the key issues facing members of ethnic communities with renal disease, the major modifiable risk factors, and provide an evaluation of the effective prevention and treatment strategies.

    (iv)  The Health Select Committee on NHS mental health services met in 2000. One recommendation was the requirement to include training on cultural and racial issues as part of the health professionals' core curriculum. As part of their remit, the Mental Health Care Group Workforce Team actively consider equality issues, including race awareness in education and training needs. An early action of the Group was to commission a strategy paper on equality issues. The Mental Health Task Force has been given a specific remit to look at black and minority ethnic mental health and are developing a strategy that will address the provision of mental health services to people from these groups. Another HSC recommendation was to develop early intervention services for minority ethnic groups following evidence of their late access to services. In November 2001, the Department announced early intervention, crisis resolution and assertive outreach services which would benefit all users but especially minority ethnic people whose experience of hospital care was acknowledged to be often negative.

    (v)  The NSF for Long-Term Conditions will promote equality in the provision of health and social care services for people from black and minority ethnic groups with a long-term condition. Services will be expected to be equitable and plan to meet the needs of people of everyone with long-term conditions.

    (vi)  The NSF for Older People sets out action to ensure there will be no age discrimination in the NHS or social care services and that discrimination of any kind (whether on the basis of age, race or gender) is unacceptable. The principle is that NHS treatment should be based entirely on clinical need and the ability to benefit.

    (vii)  One of the explicit objectives of the Diabetes NSF is to provide services that are person-centred, enabling people with diabetes to adopt a healthier lifestyle and to manage their own diabetes through education and support that recognises the importance of lifestyle, culture and religion, and also tackles the adverse impact of material disadvantage and social exclusion. Services should be equitable, planned to meet the need of the population, including specific groups within the population, and appropriate to individual need.

  4.  The complex combination of factors contributing to health inequalities for black and minority ethnic communities means attempts to tackle this issue must be made across Government and across sectors from national to local level. For the first time ever, the Secretary of State for Health announced national health inequality targets in February 2001 in the areas of life expectancy and infant mortality, and in Autumn 2001 the Department conducted a public consultation on the action needed to deliver these targets. In addressing health inequalities, the specific needs of black and minority ethnic communities are an important theme.

  5.  The Department's 2002 PSA target on health inequalities is as follows:

  By 2010 reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth.

  This single target is supported by the following two specific targets:

    —  Starting with children under one year, by 2010 to reduce the gap in mortality by at least 10 per cent between "routine and manual" groups and the population as a whole.

    —  Starting with Local Authorities, by 2010 to reduce the gap by at least 10 per cent between the fifth of areas with the lowest life expectancy at birth and the population as a whole.

  6.  Building on the announcement of the national health inequalities targets, the Government conducted a Cross-Cutting Spending Review on health inequalities as part of the recent spending round. This provided a unique opportunity for the Government as a whole to focus on health inequalities and establish priority areas for action and cross-Government working. Tackling health inequalities experienced by people from black and minority ethnic groups will be an important dimension of action to narrow the health gap. A cross-Government delivery plan, drawing both on the responses to the consultation and the outcome of this Spending review, is expected to be published later this year.

The Evidence Base

  7.  The evidence shows that members of black and minority ethnic groups are not a homogenous group for health status, disease patterns or health behaviour. However, a number of studies, including the Acheson Inquiry Report (the 1998 Independent Inquiry into Inequalities in Health) and the 1999 Health Survey for England (which included a "boosted" sample of the ethnic minority population), have shown that there are significant health inequalities among people from black and minority ethnic communities. These inequalities relate to differences in disease prevalence, differential access to services and differential delivery and take-up of services. Many people from black and minority ethnic communities also experience other social conditions which impact on health status and risk-taking behaviour, including poverty, poor housing and racism.

  8.  Additional evidence put to the Acheson Inquiry suggested that members of ethnic minority groups are just as likely as whites to consult with a GP, even after differences in reported health have been taken into account. However, one study showed that South Asians with CHD waited longer for referral to specialist care than white patients, and in another study, they were half as likely to receive bypass grafts for triple vessel disease, despite having further progressed disease. None of these studies was able to explore reasons for these possible differences in quality of care. An Health Education Authority survey published in 1994 showed that people from ethnic minorities were more likely than whites to find physical access to their GP difficult, to have longer waiting times in the surgery, to feel that the time their GP spent with them was inadequate, and to be unhappy with the outcome of the consultation. Part of this might be related to communication problems, or cultural differences.

  9.  As noted, this is a complex area and more can be done to develop the evidence base. One approach has been to review current evidence. Recent reviews include those on equity of access (University of York 1998), access to health services in London (Universities or Warwick and De Montfort), and access and uptake to cardiovascular and mental health services (Queen Mary College, London).

  10.  In addition to the research evidence indicated above, a range of statistical material provides analysis by ethnic origin or other relevant factors. A convenient summary is provided on the London Health Observatory website ( Important further analyses and data that will be needed to establish up-to-date and comparable local population bases will come from the 2001 Census. The Department of Health is also mounting a project under the auspices of the Neighbourhood Statistics initiative to improve the recording of ethnic origin information in local health information systems.


  Goddard M and Smith P (1998) Equity of Access to Health Care. University of York

  Atkinson M et al (2001) Systematic review of ethnicity and health service access for London. University of warwick and De Montfort University.

  Report of the Independent Inquiry into Inequalities in Health, (1998) The Stationery Office

  Erens B et al (eds) (1999) Health Survey for England: The Health of Minority Ethnic Groups. The Stationery Office

  Queen Mary University of London and Kensington and ChelseaHealth Authority (2001) Systematic reviews of access to and uptake of health services by ethnic groups: Cardiovascual disease; Mental health ..

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Prepared 17 February 2003