Engaging With BME Communities: Insights For Impact
BME Leadership ForumEngaging with BME communities:insights for impactPersonal views from NHS leaders
The BME Leadership ForumThe Black and Minority Ethnic (BME) Leadership Forumwas founded in 2003 to help ensure that national healthservices meet the needs of BME communities. It providesmembers with a strong collective voice and a platform toengage with policymakers and key opinion formers fromacross the healthcare sector.Our mission is to support, develop, inspire, and positivelypromote BME healthcare leaders of the future and toencourage all NHS leaders to improve the health of theircommunities through working on prevention and betterclinical interventions that take into account issues ofethnicity, race and faith.The forum is passionate about championing BME leaderswithin the NHS. We work closely with our partners at theNHS Employers organisation and the Royal College ofNursing to influence policy to ensure that the NHS bothunderstands and is responsive to the needs of BME staffand communities.For more information on our work,please contact:The NHS Confederation50 Broadway London SW1H 0DBTel 020 7799 hed by the NHS Confederation The NHS Confederation 2013You may copy or distribute this work, but you must give the author credit, you maynot use it for commercial purposes, and you may not alter, transform or build uponthis work.Registered Charity no: 1090329BOK60066We support initiatives across the NHS thatpromote equality, such as the Mary SeacoleAwards, which highlight worthy examples ofempowering NHS staff and communities to helpreduce health inequalities.We will continue to champion the efforts of BMEstaff who make a real difference to reducinghealth inequalities, such as organ donationnurses across the country who have managedto reach seldom heard communities to increaseawareness and understanding of organ donation,and encourage more people to join the NHS OrganDonor Register.www.nhsconfed.org/bmeforumFollow the NHS Confederation on Twitter@nhsconfed
ContentsForeword 2Key learning points 4Turning rhetoric into reality in Liverpool5Reducing health inequalities in South Devon8Engagement with impact in Sheffield 11
0204Engaging with BME communities: insights for impactForewordEquality and diversity are often seen asmandatory statutory considerations, ‘morallyright’ actions and activities, or exercises inpolitical correctness. In truth, the guidingprinciples of the NHS make it clear thatembracing and promoting equality anddiversity is crucial to delivering the highestquality service to the public we serve.Ultimately, it is our responsibility to deliverservices that adequately and appropriatelymeet the needs of our increasingly diversecommunities.As chair and vice chair of the Black andMinority Ethnic (BME) Leadership Forum,our vision for the NHS is a service thatproactively meets and anticipates thegrowing and increasingly complex needs ofdiverse communities, and one in which themyriad benefits of a diverse workforce andpatient population are actively promoted andembraced.The UK is set to overtake the USA as the mostdiverse society in the western world over thenext 35 years. While socially and culturally wehave made great strides in first accepting andthen celebrating our diversity, some parts ofour healthcare system have been slow to reactto the changing demographic landscape.Clearly, we must accept that there are significantbarriers to accessing healthcare for largesections of our society. Matters as fundamentalas language, for example – one of the keybarriers to accessing services for many Pakistaniand Bangladeshi people – are issues we mustaddress to tackle these barriers head on.We see many examples in the NHS ofwhere ‘barrier busting’ is happening, led byinspirational and dedicated leaders. Thispaper highlights just some of these examples,detailing ways in which providers andcommissioners have developed innovativesolutions and approaches to better cater forand engage with BME communities.Gideon Ben-Tovim OBE, former chair ofLiverpool Primary Care Trust and NHSMerseyside, Paula Vasco-Knight, chiefexecutive of South Devon Healthcare NHSFoundation Trust, and Clive Clarke, deputychief executive of Sheffield Health and SocialCare NHS Foundation Trust, provide personalreflections on how, why and with whatimpact their respective trusts have engagedwith and better met the needs of their BMEcommunities. All provide case studies ofinitiatives within their trusts.Such initiatives are proving increasinglyimportant as statistics reveal a worryingpicture of health inequalities in Englandtoday:* South Asian people are 50 per cent morelikely to die prematurely from coronary heartdisease than the national average. Young black men are six times more likelythan young white men to be sectioned forcompulsory treatment under the MentalHealth Act. Infant mortality in England and Wales forchildren born to mothers from Pakistan isdouble the national average.*www.raceforhealth.org
Engaging with BME communities: insights for impactThe landmark 2010 Marmot Review highlightedthe extent of health inequalities in England,providing evidence that the many people who dieprematurely as a result of inequalities each yearwould otherwise have enjoyed between 1.3 and2.5 million extra years of life.Indeed, much has been said about theimportance of having a population-wide healthperspective for tackling health inequalities, withcommentators highlighting both the long-termclinical and financial advantages of preventativehealthcare. The Marmot Review reckoned thatthe healthcare costs associated with inequalitywere in excess of 5.5 billion per year, and thatif no action was taken the cost of treating thevarious illnesses that result from inequalitywould rise significantly.Tackling inequality can only be done by reallyunderstanding the communities we serve, andvaluing one of the key tools at our disposal – acaring, skilled and diverse workforce. But, if weare to truly harness the benefits of a diverseworkforce, coherent action and more detailedresearch will be needed into why, accordingto research by Bradford University, BME NHSemployees are twice as likely to face disciplinaryprocedures than others.We believe that the NHS will benefit hugelyfrom the learning and examples shared inthis paper – and others – of how to identifyand better meet the needs of the diversecommunities we serve.Jagtar Singh OBEVice Chair, BME Leadership ForumMaxine JamesChair, BME Leadership ForumNola Ishmael OBEVice Chair, BME Leadership Forum0305
0406Engaging with BME communities: insights for impactKey learning pointsUnderstanding the specific needs of seldomheard communities should be key to the design,delivery and evaluation of healthcare provision.To achieve this, we must engage with all parts ofour communities by consulting with local peopleand involving the community in identifying gapsin service provision.Engaging with BME communities to bettermeet their healthcare needs is not simply amoral imperative or an exercise in politicalcorrectness. Intervening early and providing BMEcommunities with the right health and social carecould save the NHS money by reducing healthinequalities. These inequalities cost the NHSdearly as they put pressure on acute, prescribing,mental health and social care resources.Communicating a clearly defined equality visionto all staff, partner agencies and the community,with specific action plans focusing on addressingthe needs of those who suffer the greatestinequalities, is vital. To make sure this does notbecome a tick box exercise, organisational andgovernance structures should be put in placeto ensure that the equality strategy becomes acentral policy for the organisation.To meet the needs of BME communities, it isimportant to embed their voice and their uniqueperspective into the heart of decision-making.This can be done by recruiting non-executive andlay board members from diverse communities.To create the right services, we must betterunderstand the demographics of ourcommunities. This involves analysing dataregarding BME groups and putting the tools inplace to measure their healthcare experiencesand the challenges they face. It also meansworking with local government, community andthird sector groups, who have significant data andintelligence about seldom heard groups.Healthcare isn’t always the right ‘first’intervention to improve health outcomes.Collaboration and joint working with otheragencies, voluntary organisations and localauthorities will help the NHS understand andaddress challenges that seldom heard peopleface, like unemployment and housing. These areoften the underlying reasons for poor health.By using patient and staff surveys and patientservice reviews, we can determine what caredelivery looks like to those who experience it atthe sharp end. We should use this informationto shape services to better meet the needs ofthe whole community.Take time to listen to patients and staff storiesand ensure you never lose sight of the dailyrealities of healthcare. This should be a twoway and open-minded dialogue, to ensureinnovative and inspirational ideas regardingservice delivery are captured.A diverse workforce is well placed to build trustand confidence with service users, showinginclusiveness. This will help organisations tounderstand the local community and aid thedelivery of outstanding patient care.It is vital to embed a culture of respect in NHSorganisations, where colleagues, patientsand visitors are respected and valued fortheir diversity. This will show that the NHSis personal, fair and diverse, where everyonecounts.Populations are not static and the needsof communities will not stay the same. Weshould continually monitor data, communicatewith partner agencies and engage withseldom heard groups to understand whatcommunities need, to commission and providethe right services.For more information on the issues covered in this report, contact matthew.macnair-smith@nhsconfed.org.To find out more about the work of the BME Leadership Forum, contact christina.heap@nhsconfed.org
Engaging with BME communities: insights for impact0507Turning rhetoric into reality in LiverpoolGideon Ben-Tovim OBEFormer chair, Liverpool PrimaryCare Trust and NHS Merseyside, andJoint Chair of the NHS EmployersEquality and Diversity Strategic ForumGideon is an honorary senior fellow at theDepartment of Sociology, University of Liverpool,and author of various books, reports and articlesin the fields of race relations, regeneration,local government and education. As well asbeing former chair of Liverpool PCT and NHSMerseyside, he also chaired the PCT’s humanresources committee and equality and diversitysub-committee. A former chair of MerseysideRace Equality Council, Gideon is also chair ofRace for Health.Making a differenceMaking it happenFor more than a decade, Liverpool Primary CareTrust exemplified what can be achieved withinthe NHS when equality and diversity work ismade a strategic priority, given strong leadershipand implemented by committed staff.When Central, South and North Liverpool PCTsmerged in 2006 to form Liverpool PCT, wetook the critical decision to locate equality anddiversity within the commissioning arm of thetrust. This meant we were able to influenceservice specifications, advise on proportionateweighting within tenders, and monitorcontract management to ensure that fundingand resources could be more effectivelytargeted at reducing health inequalities.When we began this journey, we weredetermined to tailor health services to the needsof Liverpool’s culturally diverse communities,ensuring that health inequalities associated withethnicity across the city were addressed.We started by communicating a clearly definedequality vision to staff, partner agencies andthe community itself, setting out an explicitimplementation policy and action plans focusingon groups suffering the greatest inequalities –including members of black and minority ethnic(BME) groups.To ensure this would not become just a ‘boxticking’ exercise, we put in place organisationaland governance structures to ensure the equalitystrategy became an ongoing and central policyfor the trust.We were also determined to recruit nonexecutive and lay members from the city’sdiverse communities to our PCT board.Following a PR campaign, over 100 peopleapplied for the first non-executive posts andour board became acknowledged as a model ofBME diversity.These stakeholders gave us a uniqueperspective on the health needs of theircommunities that helped to shape servicecommissioning. They also provided us witha direct connection to the communities weserve.
0608Engaging with BME communities: insights for impactCommunity engagementAccess for allUnderstanding the needs of a specificcommunity is key to the effective design,delivery and evaluation of healthcare provision.Early on, we recognised the importanceof entering into an ongoing dialogue withour communities who, in turn, proved tobe valuable partners in tackling healthinequalities.By making neighbourhoods the focus of ourhealth improvement actions, we were able todevelop highly targeted wellbeing outreachand grassroots programmes that included veryeffective peer-led health initiatives.Over the years, our investment in communityengagement yielded valuable insights andknowledge about the needs and concernsof the city’s diverse communities whichwe otherwise would not have had accessto. Combined with data from patientprofiling and health needs assessments, thisknowledge informed our service planning andcommissioning.The trust worked closely with its BMEcommunities to change attitudes and bringtogether communities with NHS services. Thisincluded actively involving the community toidentify gaps in service provision and waysthese might be addressed, and working incollaboration with Liverpool City Council andother agencies to develop different ways ofworking.For example, consulting with local peopleabout our BME health service provision led tous commission a new, first-class interpretingand translation service to support ongoinghealth work across the city. The serviceprovided face-to-face interpreting, a 24/7language line telephone service that wasavailable to all GP practices, and a catalogueof over 80 healthcare resources based onthe needs of BME communities. The servicehandled requests for up to 54 differentlanguages, with the most requested beingArabic, Mandarin, Cantonese, Polish, Czech,Kurdish, Farsi and Somali.The trust’s community development workers(part of the social inclusion team) kicked off anumber of groundbreaking initiatives, including:‘Understanding the needs ofa specific community is key tothe effective design, deliveryand evaluation of healthcareprovision’Grassroots working BME Older Person’s Carers Network – tosupport and highlight the needs of BMEcarers. Dementia champions – this project targetedSomali and Chinese communities to raiseawareness, provide support to carersand those with dementia, and signpostappropriate health services, by employingdementia champions. Yemeni health days – one-day events for menand women from the Yemeni community toaccess free health and wellbeing activities,body ‘MOT’ tests and information on NHSservices. African women days – one-day events toincrease confidence in the city’s healthservices and awareness of screening forinherited blood disorders such as sickle cell,thalassaemia and G6PD deficiency.
Engaging with BME communities: insights for impact Prostate cancer awareness events – healthand awareness promotions to African andCaribbean communities. Hospital Communication Handbook andPatient Passport – communication aidsfor BME communities, including resourcesfor refugees and asylum seekers relating tochild health and immunisation. Khat research and education – researchon the use of khat (a herbal stimulant)in Somali and Yemeni communities, theprovision of advice to people who chewit, and advice and guidance to healthprofessionals on khat use.Our health link workers, together with othermembers of our social inclusion team, playeda key part in improving access to healthservices for BME communities in the city.Working with the Somali, Chinese, Yemeni,Indian, Bangladeshi and Kurdish/Iraqicommunities, they initially only providedinterpreting services, promoted healthmessages and encouraged participation inscreening programmes. But, over time, theybecame an important source of knowledge andadvice for health professionals about culturalfactors, health concerns and other importantissues affecting their respective communities.Final thoughtsAt Liverpool PCT, we showed how NHS leadersand frontline staff really can make a difference,delivering meaningful outcomes that benefit thecommunities we serve.We achieved this by embedding equality anddiversity at the heart of our decision-making andservice delivery, supporting structures that act asa voice for local communities, and tackling healthinequalities at a neighbourhood level.The BME Leadership Forum would like to thankMichelle Cox, Patient Experience Manager atNHS England – Merseyside, former Head ofEquality and Diversity, Liverpool PCT, for hercontribution to this case study.Case study: Enabling better access to NHS addiction servicesThe Liverpool BME Alcohol and Drugs Outreach Navigators (ADON) project was created to enablebetter access to services for BME individuals with drug or alcohol problems outside of mainstreamNHS and social care services. It is a specialist outreach service developed for anyone with ‘minority’status.Developed in conjunction with Mersey Care Addiction Service and the Sanctuary Centre, the servicehas recruited ‘navigators’ from minority communities across the city to engage with BME communitymembers and support them in accessing NHS addiction services. The service is designed to reach outto individuals who may have been reluctant or lacked confidence to do so in the past.The face-to-face work of the ADON navigators is complemented by a telephone support service.Information and guidance is also available to the family and friends of individuals with drug oralcohol dependency problems.0709
08010Engaging with BME communities: insights for impactReducing health inequalitiesin South DevonPaula Vasco-KnightChief executive,South Devon HealthcareNHS Foundation TrustPaula has been chief executive of South DevonHealthcare NHS Foundation Trust for five years,having previously held a variety of senior postsin different organisations, including deputy chiefexecutive, executive director of operations andservice improvement, and executive director ofnursing and midwifery. As a chief executive, shehas led her trust to a prestigious ‘Acute HealthcareOrganisation of the Year’ award, and has beennominated for an ‘NHS Leadership RecognitionAward for Inspiration’. Last year, she wasappointed as a national ambassador for the NHSequalities agenda, taking up the role of seniorresponsible officer for the NHS Equality DeliverySystem.The cost of caringAs commissioners and healthcare providers,we need detailed and accurate knowledgeand information about the communities weserve. This includes becoming familiar withevery deprived social group within the localpopulation, including those from a BMEbackground.In South Devon, we’ve committed to a strategyof reducing health inequalities for everyone– including the homeless, refugees andother marginalised groups in society, such asprisoners, rape victims or those with learningdisabilities.Our commitment to this strategy goes beyondbeing merely a moral imperative. Engagingwith BME communities – and all those whoexperience health inequalities – is not simplyan exercise in political correctness for us.There’s a powerful business case for pursuingfairer access for all.Studies show there’s a clear cost benefit toreducing health inequalities, since the poorhealth and shortened life expectanc
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