EQUALITIES & INEQUALITIES

Transcription

1 EQUALITIES & INEQUALITIES SAMIRA BEN OMAR ASSISTANT DIRECTOR PATIENT EXPERIENCE & EQUALITIES

2 Introduction The Equality Act 2010 The National Health Service Act 2006 as amended by the Health and Social Care Act 2012

3 Equality Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. Advance equality of opportunity between people who share a protected characteristic and those who do not. Foster good relations between people who share a protected characteristic and those who do not. Age Disability Gender Gender reassignment Pregnancy and maternity Race Religion or belief Sexual Orientation Marriage and Civil partnership

4 Equality Coverage The PSED applies to the exercise of functions by NHS organisations. This includes, for instance, any decision made, any policy developed, any programme implemented and any practices driving activity. It also applies to functions and services provided by others on behalf of the organisation. Both new policies and decisions and existing policies and decisions, when reviewed, come within the PSED Taking action without demonstrating how you have paid due regard to the PSED leaves the organisation open to legal challenge.

5 Discrimination defined Direct discrimination Indirect discrimination Harassment Victimisation Discrimination arising from disability Gender reassignment discrimination Pregnancy and maternity discrimination

6 Between 25-50% of adult [mental health] disorders are potentially preventable with treatment during childhood or adolescence (2). People with mental health problems have much higher rates of physical illness, with a range of factors contributing to greater prevalence of, and premature mortality from: coronary heart disease Stroke Diabetes Infections respiratory disease (3) Type 2 diabetes is 3.5 times more prevalent in South Asians than Europeans (11). However, a Diabetes UK survey of South Asian members found that only 16% of those responding had attended a course to help manage their diabetes (12). Just 3% of women aged 18 and over with learning disabilities/difficulties living within a family, and 17% of those in formal care have had [cervical] screening, compared to 85% for women aged nationally (7). Gypsies and Travellers are reported to be more likely to visit accident and emergency departments than a GP because of a lack of trust of some GP surgeries (13). Barriers to health care access were experienced, with several contributory causes, including reluctance of GPs to register Travellers or visit sites, practical problems of access whilst travelling, mismatch of expectations between Travellers and health staff, and attitudinal Barriers (14). 6

7 42% of gay men, 43% of lesbians and 49% of bisexual men and women have clinically recognised mental health problems compared with rates of 12% and 20% for predominantly heterosexual men and women (4). Lesbian, gay and bisexual people may, for example, be reluctant to disclose their sexual orientation to their GP, because they anticipate discrimination, and then fail to receive appropriate health care (5) % 43% 49% 12% Gay Men Lesbians Bisexual Hetero Men 20% Hetero Women Research commissioned by Leeds Partnership NHS Foundation Trust as part of the Pacesetters programme found that one third of lesbian, gay and bisexual people in Leeds encountered mental health challenges, with more than half reporting having had suicidal thoughts at some point in their lives. One third of participants also reported selfharming. Of those who reported self-harming, 24% had not accessed a mental health service. Similarly, 33% of those who reported having suicidal thoughts had not accessed a mental health service (6). Some health care professionals think that lesbians do not require cervical smear tests (8), yet 10% of lesbians have abnormal smears this includes 5% of lesbians who have never had penetrative sex with a man (9). Lesbian and bisexual women were up to 10 times less likely to have had a test in the past three years but lesbians and bisexual women have often been invisible patients within health services and their needs are poorly understood (10). 7

8 8 Patient Experience - GP Patient Survey results Patients very satisfied with the care from their GP or health centre by ethnicity: Irish 60%, British 56%, NOT SATISFIED VERY SATISFIED compared with Chinese 27%, Bangladeshi 28% and Pakistani 29%. NOT SATISFIED VERY SATISFIED According to the NHS In Patient Survey, Asian/Asian British patients were 20% less likely to give a positive response to the question Overall, did you feel you were treated with respect and dignity while you were in the hospital? when compared to the White British group (16). Similar patterns emerge from a question regarding Emergency Departments. For example, other than White Irish patients, all ethnic minority patients were less likely to give a positive response to the question Overall, did you feel you were treated with respect and dignity while you were in the Emergency Department?. Chinese/other patients were approximately 50% less likely to give a positive response when compared to White British patients (17). NOT SATISFIED VERY SATISFIED From the same In Patient Survey, all ethnic minority patients, in comparison to white British patients, were less likely to give a positive response to the question Did the doctor treat you with respect and dignity?, with Asian/Asian British patients being 50% less likely and Chinese/other patients being 66% less likely to give a positive response (18). A report by MIND found up to 36% of gay men, 26% of bisexual men, 42% of lesbians and 61% of bisexual women recounted negative or mixed reaction from mental health professionals when being open about their sexual orientation (19). NOT SATISFIED VERY SATISFIED People who are admitted to hospital over the age of 80 are twice as likely to become malnourished than those under the age of 50 (20). Becoming malnourished leads to serious consequences for us, including: the need to stay in hospital for longer, the need to take more medications, an increased risk of suffering from infections and even death (21). UNDER 50 OVER 80

9 Staff Experience In their research, West & Dawson (26) stated that the unfair treatment of BME staff: prevents patients from getting the best staff to care for them; results in racism, causing stress, creating poor teams dynamics therefore diverting resources and energy away from patient care; leads to staff illness and how staff are cared for impacts on care they provide; compromises innovation and teamwork Kline s 2014 research identified the following key factors: Only 1 in 40 chairs and no CEO in London is BME; 17 of 40 Trusts have all white Boards but over 40 per cent of workforce and patients are BME; There are no BME Exec Directors in Monitor, Care Quality Commission, NHS Trust Development Agency, NHS England, NHS Litigation Authority, or Health Education England; Decreases in BME Senior Managers and Nurse Managers in recent years White staff are 1.74 times more likely to be appointed once shortlisted than are shortlisted BME staff; BME staff twice as likely to enter disciplinary process and more likely to be disciplined for similar offences compared to White staff; BME nurses take 50% longer to be promoted and are less likely to access national training courses compared to White nurses. 9

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12 Death by Indifference Significant failures in safeguarding Serious service and system failures Avoidable deaths Poor practice & care Failure to adhere to legislation In short, indifference

13 Death By Indifference Case Studies Martin was admitted to hospital with a stroke when he was 43 years old. Whilst in hospital, Martin wasn t given the nutrition he needed. He went for 26 days without food before he died. Tom s parents found that the concerns they raised over Tom s expressions of pain weren t listened to. He was 20 years old when he died. Emma died of cancer in 2004, aged just 26. The hospital delayed treating her because they said she would not co-operate with treatment and therefore could not consent to it. Warren was 30 years old when he died. He died of aspiration pneumonia, paralytic ileus and peritonitis, following perforation of the appendix. His mother and father had repeatedly asked whether Warren had appendicitis or a blocked bowel when doctors visited Warren. They were told that Warren had a virus. Ted died in May The death certificate stated that this was due to a heart attack, but this was changed after the inquest to aspiration. He was 61 years old. He had been admitted to hospital a few weeks earlier due to problems with urine retention. He was discharged three weeks later, despite the fact that his care staff raised concerns about his health. The following day he collapsed and died. Mark had been admitted to hospital with a broken leg. After an operation in which he lost a lot of blood, mark was discharged and readmitted twice in two months, finally dying in intensive care eight and a half weeks after the operation. Tom died after a very delayed diagnosis of an ulcerated oesophagus.

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15 My Health My Say Co-Designing an FFT App in partnership with people with Learning Disabilities

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