The NHS Future Forum has completed a new phase of consultation, gaining further feedback from patients, service users and professionals on four themes relating to the proposed reform of UK health services (information, integration, education and the role of the NHS in public health).
This page looks at the report on public health, and considers the implications its findings and recommendations may have on black and minority ethnic communities.
The full report is available from the Department of Health website.
- See Public health report (external website)
- Find out more about our work with the NHS Future Forum
- View this text as Word document.
Key issues for black and minority ethnic communities
- NHS commissioners and providers of NHS‐funded care should use partnerships with other local services to improve the health and wellbeing of communities that the NHS locally finds difficult to reach, providing training where appropriate
Our research into the health and social care experiences of black and minority ethnic communities over the last 20 years has frequently shown that the voluntary and community sector may be well placed to serve and understand their needs. Feedback at our series of health ‘informed conversations’ suggested that multi-agency commissioning, although initially more time-consuming, could make services representative, efficient and cost-effective in the long-term, whilst delegates at our recent In your own words event emphasised the need for quality assurance frameworks for the commissioning process to ensure providers fulfil and understand community needs.
- The NHS has a responsibility to support individuals, their carers and family to think and act more healthily wherever possible, and guide them to any further help they might need especially those who can find it difficult to access NHS services, such as the homeless, Gypsies and Travellers, and Roma communities
We welcome this preventative/inclusive approach to health outreach. Our report, The NHS Constitution: Perception, Use and Value in Black and Minority Ethnic Communities, highlighted the difficult relationships between NHS and some communities, not just because of cultural or racial factors, but also due to poverty, isolation, and the sense that they might be ‘left behind’ by online resources and consultations. Likewise, responses to the Health and Social Care Bill, and part 2 of the Future Forum listening exercise suggest that on-going face-to-face engagement remains a necessity in order to achieve inclusion.
Our Better Health (external website) and Better Housing (external website) papers have sought to highlight some of the problems experienced by different communities in accessing appropriate services, and provide health practitioners with good practice examples to tackle these barriers. See, for example:
- Health and access to health care of migrants in the UK (external website)
- Towards race equality in advocacy services: people with learning disabilities from black and minority ethnic communities (external website)
- The health of Gypsies and Travellers in the UK (external website)
- Linking black and minority ethnic organisations with mainstream homeless service providers (external website)
- Black, minority ethnic and refugee women, domestic violence and access to housing (external website)
- Around 10% of the NHS budget is spent on diabetes and the complications that arise from it, yet the risk of developing type two diabetes could be reduced by up to 80% by adopting a healthier lifestyle
Diabetes is among a number of conditions that present a particular risk to black and minority ethnic communities (and in particular, South Asian groups). We would therefore emphasise the need for culturally appropriate outreach to target lifestyle factors, such as menu planners/women’s only swimming groups. The research collated on Better Health (external website) gives examples of innovative approaches to healthcare, including projects which distribute health information through mosques, hairdressers and community centres.
- Healthcare professionals may need support to strengthen their communication skills, so they can engage with individuals and communities to understand the attitudes and behaviours that underpin their health and the influence of factors like family and culture
As Department of Health Strategic Partners, this flow of information between service users, the voluntary and community sector and the Department of Health is of key importance. For example, our informed conversations on the NHS Constitution brought together diverse individuals including children, service users and healthcare professionals and introduced ways to utilise the NHS Constitution to increase understanding of cultural and social factors. Our Better Health briefings, Effective communication with service users (external website) and User participation in health care services (external website), may also provide useful tips for health practitioners on engaging with black and minority communities in health settings.
- Newham University Hospital NHS Trust found a gap in their maternity service and approached commissioners to fund a new post leading on care for vulnerable women
We welcome outreach efforts such as these- maternity services have been seen as a key area for outreach with black and minority ethnic community, as seen in our Better Health briefing, Addressing ethnic inequalities in maternity service experiences and outcomes: responding to women’s needs and preferences (external website).
- The NHS should look as a matter of course to external services– for instance, a Citizens Advice Bureau offering debt advice as a way to improve someone’s depression or anxiety
The “wider determinants of health” have become a key issue for the Department of Health since the Marmot Report, and as DH Strategic Partners we have emphasised the link between health and ‘real life’ experiences such as socio-economic factors, poor housing and experiences of racism. Our Better Health (external website) and Better Housing (external website) briefing papers have sought to emphasise this link, in particular, our papers Long-term ill health, poverty and ethnicity (external website); Rural minority ethnic experiences: housing and health (external website) and our up and coming briefing paper on black and minority ethnic communities and supported housing (external website).
- NHS must first “put its own house in order”- NHS should see that they in turn will act as advocates both for their patients and in their own communities. Given the diversity of the NHS workforce across a range of cultural and social backgrounds, this could make a big impact on health inequalities
We welcome this recognition of both the diversity of the NHS workforce, and also of some of the difficulties which face it. Our briefings, Experiences of bullying and racial harassment among minority ethnic staff in the NHS (external website) and The recruitment and retention of black and minority ethnic staff in the National Health Service (external website) have highlighted the limited representation of black and minority ethnic communities in NHS management, and also ongoing problems with racism or cultural misunderstanding. As DH Strategic Partners, we have emphasised the focus on workforce rights and responsibilities alongside patient rights and responsibilities in the NHS Constitution. We believe this can bring about a wider understanding of what the NHS means to those who use and work for it, whilst our regional conversations focused on the potential for the diverse workforce to reduce health inequalities.
- Empowering Parents and Empowering Communities was a community‐based research programme, which aimed to improve childhood mental health in Southwark, London, by training 24 local parents to teach parenting skills to peers in vulnerable and minority communities
We welcome this recognition of the interaction between mental health and stable family relationships, with evidence that parenting programmes can have positive outcomes in terms of health, community interaction/cohesion, education, discipline and contact with the criminal justice system. Our Strengthening Families, Strengthening Communities programmes has enjoyed particular success with parents from black and minority ethnic or vulnerable backgrounds due to its emphasis upon the roles of culture and community in successful parenting. Many of our SFSC parents also go on to train as facilitators, highlighting the importance of peer learning in this sector.
- ‘Sexual health screening services may not seem the obvious thing to do in a dental practice’
The potential for ‘making every contact count’ has been acknowledged in an up-and-coming paper on oral health, which highlights the role that dentists can play in delivering sexual health advice, or encouraging patients to stop smoking/using chewing tobacco. Use of tobacco is high amongst some black and minority ethnic groups, and our recent paper on tobacco usage and cessation suggests that awareness of the link between oral health/cancer/chewing tobacco may be low, particularly among the Bangladeshi community.