Long term conditions framework: consultation analysis

20. Question 18

Given that racism and discrimination are key drivers of inequalities, what specific actions are necessary to address racism and discrimination in healthcare?

The majority (73%) of respondents answered Question 18, and the main themes that emerged from responses were:

• theme 1: education and training
• theme 2: equitable access to treatment, care and support
• theme 3: governance and accountability mechanisms
• theme 4: community engagement and co-production
• theme 5: increasing workforce diversity
• theme 6: structural issues

Analysis of responses to this question confirmed that a multi-faceted approach would continue to be required to address racism and discrimination in healthcare.

Theme 1: Education and training

The majority of respondents, particularly individuals and service providers, identified education and training as vitally important to tackle racism and discrimination in healthcare. There was strong agreement that relevant workforce development and training should be mandatory, ongoing and embedded at all levels of the healthcare system – from senior leadership teams to frontline staff.

Some respondents felt current approaches to anti-racism and anti-discrimination training for healthcare professionals were not good enough and provision was also variable. There were calls for improvements in training (such as cultural competence training) that equipped healthcare professionals with the knowledge and understanding of the issues around culture and health, and how this might influence health care outcomes. In addition, this could develop a better understanding of the way to deliver health care and respond to the needs of Scotland’s diverse population.

Related points on education and training included:

• the importance of targeted public health campaigns to reduce stigma and to challenge discriminatory attitudes and behaviours
• that people with long term conditions and healthcare professionals both experienced racism and discrimination in healthcare – and that action was needed on several fronts

Respondent quotes that illustrate points raised in theme 1 are provided below.

“Diversity education is appalling. In a lot of cases. The tropes and stereotypes in these existing courses serve to reinforce negative perceptions and drive unconscious bias.” Individual respondent

“There is a need for more education on health conditions and how these may present differently in ethnic minority physiologies from recognition of skin conditions on different colours of skin, to menopause symptoms being earlier in South Asian women, and risk factors of cardiovascular conditions and type 2 diabetes also presenting in lower BMIs in Asian older people.” Age Scotland

Theme 2: Equitable access to treatment, care and support

Many respondents highlighted specific actions to support equitable access to treatment, care and support. These respondents said certain population groups (for example, people with protected characteristics) were at greater risk of racism and discrimination in healthcare – and this could result in differences in terms of their access to healthcare, treatment, care and support, as well as health outcomes.

These respondents called for: person-centred/whole-person approaches; culturally appropriate care, information and education materials, including greater access to interpreting and translation services; and greater flexibility in service delivery (for example, community-based provision, flexible appointments).

A respondent quote that illustrates points raised under theme 2 is provided below.

“Refugees and people seeking asylum repeatedly stress the importance of culturally sensitive health provision that acknowledges their specific health histories and current needs, including the provision of more interpreters and training for healthcare providers to better understand and respect cultural differences in health practices.” Scottish Refugee Council

Theme 3: Governance and accountability mechanisms

Many respondents identified robust governance and accountability mechanisms as key to addressing racism and discrimination in healthcare. This included calls for:

• more robust governance, leadership and accountability mechanisms (for example, whistleblowing) to address racism and discrimination in healthcare. These respondents emphasised the critical role of strong leadership in: setting the tone (for example, not dismissing instances of racism or discrimination as isolated incidents); shaping governance and accountability practices, including greater alignment with existing anti-racism and discrimination commitments (such as NHS principles and values); ensuring greater transparency; and building trust with the general public
• embedding equalities and equalities outcome monitoring in policies and strategies for improvements in the collection of appropriate data (metrics) and insights to better understand and tackle health inequalities and racism and discrimination in healthcare. Some felt that the availability of data was limited at a Scotland and local level, and that improvements were needed to ensure improvements in service delivery were evidence-based and consistently implemented (for example, Equality Impact Assessments)

Theme 4: Community engagement and co-production

Many respondents, particularly representative organisations/groups for health and social care staff, said that the genuine involvement and engagement of people with lived experience of managing long term conditions was key to:

• developing a better understanding of the barriers to accessing healthcare
• understanding different perspectives on racism and discrimination in healthcare
• informing all stages of healthcare including service planning, design, delivery, and improvement
• building trust
• ensuring culturally appropriate care

A respondent quote that illustrates theme 4 is provided below.

“In Lothian, the Minority Ethnic Health Inclusion Service ensures minority ethnic groups can voice their views, have equality of access to services and support, delivers health promotion programmes and facilitates health screening with minority ethnic groups… Partner organisations work with black and minority ethnic unpaid carers in Edinburgh and the Lothians to reduce health inequalities, using local knowledge about diverse population needs to improve outcomes.” Edinburgh Health and Social Care Partnership

Theme 5: Increasing workforce diversity

Some respondents said more could be done to continue to improve workforce diversity in healthcare which could help to reduce health inequalities and improve health outcomes. Inclusive recruitment and retention policies were highlighted as a way to help ensure the healthcare workforce better reflected diverse population demographics, as was continued investment in continuous professional development.

Theme 6: Wider structural issues

A small number of respondents said that racism and discrimination in healthcare could not be understood or addressed in isolation. They called for consideration of racism and discrimination through the lens of wider structural issues (for example, poverty, deprivation, and housing) as well as adopting an intersectional approach.