7. Health and Social Care Activity to Support Race Equality
The Covid-19 pandemic has exposed and exacerbated health inequalities in Scotland and across the world. The disproportionate harm caused by Covid-19 to Minority Ethnic groups, people living in greatest deprivation, people with obesity, diabetes and respiratory disease, has highlighted new vulnerabilities and underscored widening health inequalities. As a result, improving equality in health care has been at the heart of work for Health and Social Care directorate of the Scottish Government since the pandemic began. We recognise that supporting individuals – both patients and staff - from all backgrounds is paramount in ensuring we deliver the best care for the people of Scotland.
To support an increased focus on tackling health inequalities, and the issues that exist around equality and culture, we have established teams in Population Health, Vaccination and Health Workforce with a strategic focus on embedding equity and strengthening coherence, leadership and coordination to health equality activities across the Health directorate. These teams will also play a pivotal role in addressing challenges set for us by groups like the Expert Reference Group on Covid-19 and Ethnicity (ERG) and the Sturrock Review (2019).
There is a clear recognition that the evidence and data we have access to in relation to ethnicity is insufficient. It is critical that this is addressed to enable us to fully understand the highly complex picture that exists in relation to health inequalities, including equity of service provision, barriers that prevent people from engaging with and accessing health services, and the implications for people’s health. Only by having access to this type of information, can we identify where the need for action is greatest, and take appropriate action. As such, improving both the collection and the use of ethnicity data will be a priority across the whole of Scottish Government, particularly Health & Social Care.
Our work will also focus on creating the conditions that will lead to more equitable policy design and delivery for those with protected characteristics in Scotland. This will involve supporting a more strategic approach to identifying priorities in relation to health equality and embedding these into work being undertaken across Scottish Government and Health Boards. Central to achieving this will be considering how we can best listen, work and collaborate with those experiencing disproportionately poorer health outcomes.
For our workforce, the key to improving the experiences of our minority ethnic staff is by improving organisational cultures. Not only is poor workplace culture commonly reported as a reason for staff raising complaints against or leaving organisations, it also keeps staff from feeling confident in divulging invaluable equality data – data that is crucial to understanding the impact of the pandemic and other aspects of workplace experiences on staff. It is imperative that we collectively consider these risks and opportunities as the NHS recovers and remobilises and in light of the continuing pressures staff will face post pandemic.
Equality, diversity and inclusion are part of an organisation’s culture. The pandemic and the Black Lives Matter movement have further highlighted racial, health and other inequalities, as well as a lack of diversity and inclusion, across public sector workforces. Based on the ERG’s recommendations the Scottish Government is leading on cross-cutting work to drive change and deliver long-term meaningful outcomes for everyone with protected characteristics, with a particular focus on race, gender, disability, age and LGBTI. This includes establishing the new National Minority Ethnic Forum for the NHS to work with Scottish Government and Health Boards to tackle systemic racism in the workplace and improve workforce data on ethnicity. We have also made sure staff experience surveys include vital demographics questions.
There is now an opportunity to consolidate and extend this good practice and learning, by adding a culture “lens” to our work, as the NHS recovers and remobilises. For social care it is a complex picture due to the current mix of local authority, private and third sector providers, so our work to date has primarily focussed on health.
Significant work streams relating to the development of a National Care Service are currently underway, in particular to develop a social covenant to ensure the new service is designed around the needs of care users and supports the needs of care workers. There is no equivalent work in the NHS. As the work on social care develops, we should be mindful of the potential for codified discrepancies to emerge between health and social care.
Work is ongoing to develop a National Leadership Development Programme for health and social care, with a focus on compassionate leadership, and a programme to prioritise wellbeing throughout health and social care.
It is our collective responsibility across the Services and within SG to be a demonstrator and facilitator of positive working cultures in all policy areas and in our relationships with health and social care stakeholders. We in SG have just launched our new vision and values 'In the service of Scotland', which fleshes out the “how” we deliver the National Performance Framework. The values here of acting with integrity, being inclusive, innovative, collaborative and kind are important drivers for our engagement and expectations with health and social care partners.