Cre Training Material And Exercises

SECTION ONE: THE

CONTEXT

FOR

RACE

EQUALITY

MANAGEMENT

EXERCISE 1.1

Self Reflection Activity Before you read on please take some time to reflect on what you know about, or how you would define, the following.

Please write down your answers and use them to compare with the

discussions in the following section. You can use the pro forma in Appendix 1 to write on. You could also copy blank copies so you can update it when you have new understandings. Legislation and policy " " " " " " "

The Stephen Lawrence Inquiry The Race Relations Act 1976 Race Relations (Amendment) Act 2000 The Human Rights Act 1998 The Crime and Disorder Act 1998 European Directives of Article 13 of the Amsterdam treaty The Equality Standard

Terms and concepts " Race " Racial group " Direct racial discrimination " Positive action " Positive discrimination " Indirect racial discrimination " Institutional Racism " Managing Diversity

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The Stephen Lawrence Inquiry After the racist murder of Stephen Lawrence in 1993, Stephen’s family campaigned to get justice for their son. It was 1997 before an Inquiry was called by Jack Straw the Home Secretary in the newly elected Labour Government. The result of that inquiry was published on the 24th February 1999 and will have a lasting effect on race equality in Britain. The Inquiry report evidently deals specifically with the police and related criminal justice matters. However, many of the recommendations can be paralleled to all public services. Some of the broad headings of the report are initially considered below:

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Institutional racism

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Occupational culture

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Representation, Accountability

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Racial incidents

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Training and professional awareness

Some of the management issues they raise are then reflected in sections 2-7 for example Policy and planning, consultation, recruitment and selection.

EXERCISE 1.2

Self Reflection Activity It is worth noting, that the report and its implications are detailed and warrant a great deal more consideration than we can offer here. It is therefore suggested that you obtain a copy of the report and/or its recommendations, (You can access the report via the 1990 Trust website, www.blink.org.uk) and conduct a seminar, which considers the 70 recommendations. Every year the home secretary reviews progress on the recommendations of the Inquiry and again it would be worth you finding these updates on the Home Office website www.homeoffice.gov.uk.

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Institutional racism The inquiry concluded that there had been examples of institutional racism in the Metropolitan Police. The inquiry defined institutional racism as:

“The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage Black and Minority ethnic people”.

On the one hand, this definition has allowed many public sector professions including the Metropolitan Police Service, education (OFSTED 1999) and nursing to recognise how institutional racism applies to them. On the other hand, there are some organisations, like the 1990 Trust (a leading Black Non Governmental Organisation) who think that the statement is weak because of its emphasis on collective failure and unwitting prejudice which seems to suggest that institutional racism is never intended nor the responsibility of individuals.

In addition to the definition of this issue arrived at by the Inquiry, a number of interesting and informative definitions were offered by a number of leading Black and anti discriminatory organisations. In examining these definitions it is important to note that most authorities suffering from this problem are by their very nature unable to recognise that they have a problem.

Black Police Association ‘The term institutional racism should be understood to refer to the way the institution or organisation may systematically treat, or repeatedly treat people differentially because of their ‘race’… We would say the occupational culture within the police service, given the fact that

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the majority of police officers are white, tends to be the white experience, the white beliefs, the white values’. (The BPA goes on to talk about how this culture involves racist stereotyping and racist banter)

The 1990 Trust ‘Racism can be systemic and therefore institutional without being apparent in broad policy terms. Racism within the police can be both covert and overt, racism can be detected in how operational policing decisions are carried out and consequently implemented, and indeed how existing policy is ignored or individual officers’ discretion results in racist outcomes.’

Commission for Racial Equality ‘Institutional racism has been defined as those established laws, customs and practices which systematically reflect and produce racial inequalities in society.’

EXERCISE 1.3

Questions 1. What do you think about the Stephen Lawrence Inquiry definition? How do you think it applies to the NHS or nursing as a profession? 2. How do you think it is reflected in your place of work? 3. Does your organisation fail to provide an appropriate and professional service to

people

because of their colour, culture or ethnic origin? How would you know? 4. Are there processes, attitudes and behaviour which amount to discrimination through unwitting

prejudice,

ignorance,

thoughtlessness

and

racist

stereotyping

which

disadvantage Black and Minority ethnic people? How would you know? 5. What is your perception of racism, both on an individual and institutional level?

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The Commission for Racial Equality and other organisations, such as the 1990 Trust, have also suggested that the problem does not only affect the police. The inquiry report stated:

It is incumbent on every institution to examine their policies and the outcome of their policies and practices to guard against disadvantaging any section of our communities… there must be an unequivocal acceptance of the problem of institutional racism and its nature before it can be addressed, as it needs to be, in full partnership with members of Black and Minority ethnic communities.

The Stephen Lawrence Inquiry, Implications For Racial Equality, Commission for Racial Equality (March 1999)

Nursing was one of the first professions to admit to institutional racism. The question here is what does this mean for everyday management practice? The CRE stress that:

Institutional racism should not be used to label individuals negatively; it is a problem for the organisation as a whole … everyone in all organisations needs to ask some basic questions for example: Are we acting fairly? Does the service we provide reach all the communities it is meant for and does it meet their needs? Are we applying the same professional standards in every situation?

The Stephen Lawrence Inquiry, Implications For Racial Equality, Commission for Racial Equality (March 1999)

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We would add a further question. Namely, ‘How do we know when we are achieving these objectives’?

One way is through monitoring systems, which can yield quantitative and qualitative data. For management to be effective you need to know where the indications of discrimination are occurring and where improvements can be made.

The Equality Standard and the Race Relations

(Amendment) Act 2000 discussed below in this section offer templates for helping mangers to set targets and monitor. They are also very good instruments for helping to mainstream race equality. That is everything an organisation does, all its functions, policies and practices should be interrogated for their contribution to race equality.

Occupational Culture The report of the Stephen Lawrence Inquiry also discussed the concept of occupational culture and the need for this to change if institutional racism is to be tackled. This recognises that tackling institutional racism requires institutional reform. Piecemeal approaches such as one-off training events will not work as has been demonstrated by the singular failure of police training in race relations. Indeed, several officers giving evidence at the Lawrence Inquiry could not even remember having been on the training let alone passing on the knowledge to others. This therefore reinforces the importance of building a work environment capable of supporting a longitudinal and integrated race equality strategy.

The challenge is to create an occupational culture which values diversity and is capable of sustaining race equality strategies. This means ensuring that everything an organisation does or produces reflects this commitment. Internal environments should be those where all employees feel valued, and which also contribute to ensuring the application of diversity strategies in external environments.

To achieve this we have to:

(a) Overcome the generally poor levels of knowledge about other cultures. 10

(b) Change ‘symbols’ and organisational practices.

(a) Overcoming poor levels of knowledge about other cultures

EXERCISE 1.4

Self Assessment Activity Answer the questions in the attached document ‘A Question of Culture?’ (Appendix 2.) Were you surprised at how much or how little you knew?

Further Reading ?

‘Transcultural Communication and Nursing Practice’ by Husband C and Hoffman E

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‘The Ethnic Health Handbook’ by Ghada Karmi

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‘A Fact file for Health Care Professionals’ Blackwell Science 1996; and

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Mares, P. (1985) ‘Healthcare in Multi Racial Britain’

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Overcoming poor levels of knowledge about other cultures requires the greater involvement of people in the ownership of managing equality and diversity. In addition, training will be needed, not only on different cultures but also on the values involved in appreciating differences. That is: ? sensitivity and empathy, appreciating other people’s situations and points of view; ? a willingness to look beyond the personal or individual level and take account of cultural and structural factors; ? a rejection of stereotypes and dogmatism; ? a recognition of the role of power and the ways in which it can be misused and abused, together with a commitment to empowerment; ? the need to develop a collective, collaborative approach; ? an avoidance of simple answers to complex problems.

(Thompson 1998:200)

Training and education with regard to collaborative working is also important to the clinical governance paradigm. As Boden and Kelly (1999) comment:

The prime role for educational consortia, therefore, is to ensure that effective teaching and learning strategies are developed to support the acquisition of critical appraisal skills to foster the development of multidisciplinary and interprofessional collaboration.

(Boden and Kelly 1999:180)

(b)

Change ‘symbols’ and organisational practices:

For example: ? holiday policies to accommodate different cultural needs; ? prayer rooms and washing facilities; 12

? logo’s; ? promotional materials, photos etc.

EXERCISE 1.5

Further Reading ? Thompson, N. (1998), ‘The Organisational Context’ in Promoting Equality: challenging discrimination and oppression in the human services, London: Macmillan. Read the section on ‘Organisational Culture’, pp 187-189 (inclusive of bullet points)

? Chouhan, K and Jasper, L. (2000) ‘A Culture of Denial’ (especially chapter 5 on Institutional Racism) Published and available from the 1990 Trust, London. (020 7582 1990)

? O’Rawe, M. (1997) Chapter 1 ‘A representative police service - diversity and cultural awareness’ in Human Rights on Duty: The Committee on the Administration of Justice Ltd.

Question

What can we learn from this about changing the image and reality of an organisation?

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EXERCISE 1.6

Activity Read Section 7 now, on Marketing and Corporate Image

Now reflect on your own organisation and list: ? what changes are necessary; ? potential blocks; and ? ways forward.

Dealing With Racist Incidents Obviously, the Stephen Lawrence Inquiry Report concerns itself with reporting and dealing with racial incidents. Similarly, the management of any organisation must also consider how they will deal 14

with such incidents which may be particularly pertinent in nursing contexts. The report defines a racist incident as:

‘any incident which is perceived to be racist by the victim or any other person’

and suggests that definition should be universally adopted by the police, local government and any other relevant agencies. This means that if anyone, the victim, a witness, a nurse, or a patient perceives an incident as racist it should be recorded as such regardless of any dissenting views.

Where a victim of a racial attack is brought into a hospital, this will also call for skills and knowledge of dealing with victims. Nurses are trained to deal with families and patients on a number of issues relating to care or bereavement, it would also be useful to offer specific training relating to racial incidents.

Such training could include: ? the definitions of racial incidents; ? liaising with the police; ? liaising with families; ? talking with victims; ? an understanding of why racist attacks are deeply psychologically wounding as they question the basic right of humanity; and ? understanding of the Crime and Disorder Act 1998 and the new offences of racially aggravated crimes.

The Crime and Disorder Act 1998

The Crime and Disorder Act (1998) provides for nine new offences to strengthen powers against racial violence and harassment, including racially aggravated assaults, racially aggravated criminal damage, racially aggravated public order offences and racially aggravated harassment offences. Between April 1999 and September 1999, 11,000 of these offences were recorded by police.

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The Act requires Crime and Disorder Partnerships – The Audit Commission guidelines state:

The partnership should assess the effectiveness of current communication and involvement with the community. Many neighbourhoods will have some level of community activity and local resident groups. Some of these may already have formal or informal contact with partner organisations, but this may be ineffective and erratic. In addition, local groups may not include a cross section of the local community and have no community mandate or they may have no clear purpose beyond a ‘talking shop’.

The partnership can establish a ‘map’ of local groups and contacts and

determine a strategy for community development and support.

Multi Agency /Partnership Approaches The comments in the text box above are reflected in the Lawrence Inquiry which stressed the importance of multi-agency approaches and partnerships and consultation with Black and Minority ethnic communities. The inquiry also took evidence from several people regarding what they called consultative abuse. That is, several Black and Minority ethnic communities had been frequently researched, or called to consultation meetings, only to find that their opinions and views were ignored or misrepresented. However, the consulting organisation was able to say that they had undertaken consultation to legitimise their own agendas. It is not surprising that there is now reluctance on the part of Black and Minority ethnic communities to engage in consultation exercises, without firm frameworks regarding the use of information.

The Race Relations (Amendment) Act 2000 and the Equality Standard 2001both lay heavy emphasis on consultation, great care will need to be taken not to add to the consultation fatigue of many communities. There will need to be co-ordinated initiatives which are built on a premise of long term relationship building with community groups. Some principles for ethical consultation are included at appendix 4.

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Partnership is also a much-misused concept. For example if a large organisation seeks to work in partnership with the voluntary sector it comes to the table with vastly differing resource bases and decision making power. If it is to be a true partnership then there must be early agreements about the resource base being discussed and how to ensure equality of decision making regarding those resources and the work in question

Margaret O’Rawe (1997), in her book outlining principles for better policing in Northern Ireland, discusses the various levels of participation by the community in policing matters. Very low levels of participation effectively mean powerlessness. She uses a 'ladder' graph by Thoburn and Shemmings (1995, cited in Horgan, G. and Sinclair R. 1997) to demonstrate this.

High Power: Controls Helps design service Partner Participant Involved Consulted Informed Placated Manipulated Low Power: Powerless. (O’Rawe 1997)

Levels of consultation by statutory agencies including local authorities have tended to be at the lower end of this ladder, however the aim now should be to work towards the top by involving people in the design and management of services.

Multi agency/multidisciplinary/partnership and consultation are all progressive sounding phrases but they can actually hamper efficiency, productivity and relationships if, they simply result in ‘talking shops’ which are unable (or unwilling) to implement their policies or ideas. This can, of course, be the

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result of the ‘web of bureaucracy’ which is often created when several agencies or organisations begin to work together.

In addition, as Bowling (1998) observes, there are often conflicting conceptualisations of the agenda and so disproportionate amounts of time spent on establishing a clear picture. As a consequence, Black groups have been critical of some partnerships and multi agency fora claiming that they are nothing less than ‘smokescreens for action’

Organisations will require policy guidelines on reporting and dealing with racial incidents. These will need to deal with issues of confidentiality - for example if a patient was to tell a nurse that they had been injured in a fight against some ‘paki’s’ what would he or she do about this? Conversely if someone had been the victim of a racial attack but was too frightened to report it to the police but told a nurse what would s/he do?

In addition grievance and disciplinary procedures should contain sections which are specific to racial harassment at work.

Racial Harassment And The NHS In March 1999 a circular was sent to all NHS Employers titled the National Plan for Action to Tackle Racial Harassment. Its publication was based on the recognition that although the NHS has had a history as the largest employer of Black and Minority ethnic staff in the country that the organisation had come to a point where the number of new recruits from these communities were severely decreasing and that one factor contributing to this was the need to tackle racial harassment effectively. Following dissemination of the circular the Department of Health set up five national strategic groups around the country to monitor and review progress on the implementation of recommendations in five key areas:

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Raising public awareness of racial harassment

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Report and Recording its incidence 18

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Evidence of staff of all races working together

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Effective leadership and management action

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Education and training

Seven learning networks of NHS employers, primarily Trusts were then set up to support the work of these groups. A study was undertaken covering trusts across the country to understand the role of racial harassment in the recruitment and retention of staff. The study: Tackling Racial Harassment in the NHS: Evaluating Black and Minority ethnic Staff’s Attitudes and Experiences (Department of Health, 2000) grew from the recognition that a major barrier to effective action in this area was the lack of comprehensive information on the extent and nature of harassment. Fieldwork for the study began in November 1999 and finished in May 2000. In this period focus groups of nearly 500 Black and Minority ethnic staff were held in 52 trusts to discuss racial harassment and abuse of:

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Staff by patients

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Staff by patients, relatives or members of the public

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Staff by colleagues

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Staff by managers

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Black and Minority ethnic patients or members of the public by white patients, members of the public or staff.

In the context of the study racial harassment was defined as

‘Targeted unacceptable behaviour motivated by racial intolerance’

The Key findings from the study in terms of incidence of harassment are outlined in the box below:

Over a 12 month period: ? 46.2 % of participants had experienced racial harassment. ? 37.9 % had witnessed racial harassment 19 ? Overall 57.7% had either experienced or witnessed some form of racial harassment. ? Staff in front line jobs e.g. Ancillary, General Support, Medical, Dental and Nursing

The study’s findings told the Department of Health much about the various forms racial harassment can take, both covert and open. When asked about examples of harassment by patients most came in the form of overt verbal abuse or refusing care. However, many staff seemed to feel, as did colleagues and managers that the latter was an acceptable exercise of patient’s choice. Most participants agreed that harassment from colleagues had become less overt over recent years but the most common form once again was verbal abuse or being excluded from work place conversations and social activities.

Strikingly the most common form of harassment by managers was being passed over for training, development or promotion together with unfair allocation of work. Participants also felt that complaints of racial harassment had resulted in little or no action in the past and this may in part be explained by a lack of senior Black managers.

A snap shot of some

testimonies of harassment revealed in the focus groups is provided below:

RACIAL HARASSMENT- PERSONAL TESTIMONIES ?

‘I have worked in the NHS for over 20 years and it is very common to hear people calling us Black bastards. You deal with it as it arises. It is an everyday thing.’

?

‘I am a community midwife. I have had patients say that they don’t want Black midwives. The Trust will put a white midwife in place.’ 20

?

‘I have listened to colleagues verbally abusing Black people and Black music and h h l f l d h h d

Clearly racial harassment has a number of implications both on an individual and organisational level for the NHS as an employer. Its often-covert nature can lead to the isolation and lack of retention of individual staff, whilst severely undermining cohesion between people who are delivering frontline services. This evidently has implications for the effectiveness of the services delivered. As the last quotation indicates if harassment is not tackled effectively it also has a longer term knock on effect of associating the whole organisation as tolerating and sustaining a culture of racism and thus limiting future recruitment from Black and Minority ethnic communities.

EXERCISE 1.7

Exercises in Dealing with Racism and Racial Incidents

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Situation 1

You notice that a junior Black colleague is looking rather down. You ask what is wrong and he mentions to you that has had to give up doing his masters degree because it was too much for him doing it after late shifts at work. This has also left him out of pocket by a significant sum. You asked him why he didn’t ask his manager for study leave. He said he had, but had been told in no uncertain terms that this was out of the question and that he had to do it in his own time and that his shifts could not be changed. This is not the first time that you have heard negative comments/complaints from staff, white and Black, about this particular manager. What is more, you know for a fact that several other colleagues in this manager’s department (who now that you think of it just all happen to be white) applied and were granted study leave successfully. You also know that the approach and action of this particular manager goes against the latest NHS human resource policies to encourage flexible working and staff development particularly from Black and Minority ethnic colleagues. You are responsible for implementing the NHS race equality targets in your Trust and are on the working party looking at developing an action plan to tackle racial harassment at work. meeting with this man’s manager:

22 You have a scheduled

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Situation 2 Examine the following statements which refer to incidents that could conceivably take place within a hospital or general practice setting.

1. A woman with a gynecological complaint says that she will only see a woman doctor. Only a male doctor is presently available. 2. A man who thinks he is suffering from malaria asks to see an African doctor. Apparently a friend some years ago almost died at this hospital because his symptoms were trivialised and not recognised in time by European medical staff. 3. A Bengali mother insists on thorough explanations in her language before consenting to an operation on her child 4. A young mentally ill Black patient refuses to be referred to the consultant psychiatrist because he thinks that a “white man doesn’t know where a Black person is coming from!” 5. An elderly white patient doesn’t want to see any Asian doctor because “they all speak with those funny accents anyway” 6. An elderly diabetic Caribbean patient complains that the diet sheet he got from “that English” health professional to help manage his condition was “no good.”

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Which of the examples do you think are an acceptable expression of ‘patients choice’?

?

What do you think could be the background /cultural reasons for these incidents?

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Which of them confirm racist and/or sexist stereotypes?

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Which of them result from cultural misunderstanding?

?

How could these be changed so that they represent gender sensitive, culturally appropriate health service delivery?

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Situation 3

You are a white health professional attending to a patient with a Black colleague. The patient is refusing care or treatment from your colleague, he has thrown a beaker at her saying that he doesn’t want to be touched by an “f****** monkey” or a “Black b****

?

What would you say to the patient?

?

What would you say to your colleague?

?

Would you report the incident to your health manager? Yes/No? Give your reasons

Representation, Accountability Any organisation which desires public involvement/approval will need to demonstrate that attempts to ensure representation in staffing and on management boards etc., do not amount to tokenistic gestures.

The Metropolitan Police Service was founded on principles of policing by consent and was subject to criticism from the Stephen Lawrence Inquiry about how seriously they took this maxim. Consequently, they were questioned about:

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Levels of employee representation at different levels of the service;

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The consultation mechanisms in place;

?

The way in which complaints were handled which resulted in recommendations for an independent police complaints authority

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?

Disciplinary and grievance procedures, which have now been overhauled to make it clear that any from of racism is a disciplinary offence.

?

Levels of accountability e.g. greater representation from Black and Minority ethnic communities on bodies which oversee their work such as police authorities. One of the calls for this accountability was for training to take place in civilian institutions that is via universities just as nurse and teacher training. (1990 Trust cited in Home Office Select Committee on Police Training, 1999)

All of these proposals, except for the location of training, are equally relevant to nursing and other healthcare professions. It is therefore important that attention is paid to:

? Recruitment at all levels in order to ensure representation of Black and Minority ethnic people; and ? Clear policy documents outlining the lines of accountability of staff to others in the organisation, and of the organisation and individuals within it, to the public. ? The level of staff awareness regarding ethnic monitoring and its uses

In section 6 on Employment, further attention is given to issues of recruitment and retention. Also the Statutory Order 2001 which accompanies the Race Relations (Amendment) Act

outline specific

Employment duties for organisations with over 150 staff. Please see below in this section re Race Relations Amendment Act.

Accountability is also addressed though the Equality Standard and the Statutory Order 2001 which accompanies the Race Relations (Amendment) Act. Basically accountability means ensuring that all actions of an authority are open to scrutiny (with some exceptions for security reasons). This is achieved by publishing monitoring data, results of consultations and assessments, action plans, policies etc.

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Legislation And Policy Human Rights Act 1998 The Human Rights Act came into force in October 2000. It represents the translation into domestic law of the European Convention on Human Rights. For the first time Britain has a legislative framework with defined standards of what each person can expect rather than what they should not do. This Act will cover all infringements of human rights regardless of gender, disability, ethnic identity, sexuality or class. For as Husband remarks:

A minimal liberal human rights agenda for multi ethnic societies is almost everywhere a basis for reasonable expectations of existence that are not entirely or even minimally achieved in reality.

(Husband 1998:)

The rights included under the Act are as follows (full text can be found in Appendix 3).

? The right to life. ? Freedom from arbitrary arrest or detention. ? Freedom from slavery or compulsory labour. ? The right to liberty and security of person. ? The right to a fair hearing. ? The right to respect for private family life. ? The right to participate in free elections. ? The right to freedom of thought, conscience and religion. ? The right to own property. ? The right to marry and found a family. ? The right to freedom of expression, including freedom of the press. ? The right to freedom of association and peaceful assembly.

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? The right to freedom from capital punishment, torture, inhuman or degrading treatment or punishment. ? The right to freedom from unfair discrimination (including religious discrimination) in the enjoyment of these rights. ? The right to education (First Protocol).

The right concerning discrimination (Article 14 of the European Convention) reads

The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.

Several of the above rights could apply within a nursing context such as the freedom from arbitrary detention, freedom of religion or respect for private family life. The right to freedom from discrimination has to be used in conjunction with another right – a feature which several campaigning non-governmental organisations (NGO’s) were unhappy about.

The new additional Protocol 12 to the European Convention on Human Rights has recently been agreed in order to create a free standing no-discrimination right. This will be opened for signature on November4th 2000. We welcome this new protocol, which will strengthen the rights of racial and ethnic minorities. We regret that the UK government does not appear to support it and we would urge them to sign, ratify and incorporate it into our Human Rights Act in line with their manifesto commitment to eliminate all forms of unjustified discrimination.

(Joint submission by NGO’s to the UN Committee for the Elimination of all Forms of Racial Discrimination, (2000) published by The 1990 Trust and Liberty p5)

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The implementation of the Act is as yet unclear and case law will no doubt be needed to test the possibilities and the loopholes. However, it will be incumbent on public authorities to at least seek legal advice and training to make themselves aware of the provisions and scope of the Act.

The Government has not yet set up a human rights commission. Therefore while the HRA 1998 potentially extends current protection from racial discrimination there is no central body to assist with enforcing the Act, by provision of legal advice or with public education. (Joint submission by NGO’s to the UN Committee for the Elimination of all Forms of Racial Discrimination, (2000) published by The 1990 Trust and Liberty. pp5-6

Europe - Article 13 Of The Amsterdam Treaty Article 13 of the Amsterdam treaty has recently been agreed by the European Union. Member states will now have to ensure that the directives contained under the Article are implemented through domestic law. The article states:

Without prejudice to the other provisions of this Treaty, and within the limits of the powers conferred by it upon the Community, the Council, acting unanimously on a proposal from the Commission, and after consulting the European Parliament, may take appropriate action to combat discrimination based on sex, racial or ethnic origin, religion or belief, disability, age or sexual orientation.

The directives, which emerge out of this article, are:

The Race Directive This directive deals with discrimination on grounds of racial or ethnic origin in a wide number of areas from employment to social protection and access to goods and services. It covers both direct and indirect discrimination on grounds of ethnic or racial origin It also recognises harassment and

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instructions to discriminate as a form of discrimination. It operates as an instruction from the European Union to each Member State to put in place laws providing the minimum standards set out in the Directive. Member States have until July 19th 2003 to do this.

The Employment Directive This will prohibit discrimination in the areas of Religion and Belief, Sexual Orientation, Age and Disability but only in the field of employment and occupation, it is sometimes referred to as the Framework Employment Directive. The provisions on religion and belief and sexual orientation must be implemented by December 2nd 2003, and the provisions on age and disability by December 2nd 2006.

Like the Employment Directive, the Race Directive would require member states to make discrimination on grounds of racial or ethnic origin unlawful in employment and training. However, it goes further by also requiring member states to provide protection against discrimination in nonemployment areas such as education, access to social security and cultural benefits, and the provision of goods and services. For the first time, anyone working, or simply travelling, within the European Union would enjoy the same minimum level of protection from discrimination in all the member states.

The Equality Standard And CRE Standards In part the imminent domestic law which will arise from the European directives are influencing initiatives to have comparative and consistent guidelines for delivering on equality issues across the board.

In 2001 the Commission for Racial Equality, the Disability Rights Commission and the Equal Opportunities Commission together with the Employers organisation for local Government produced the Equality Standard which is intended to update the CRE standards for race equality (See Box below) and make the standards relevant to gender and disability. The added intention is that as the new European directives are brought in line with domestic law that procedures for tackling inequality

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in terms of race, gender and disability can be easily adapted for the issues of age, religion or belief and sexual orientation.

In 1995 The CRE published a framework for local authorities to measure their performance in race equality. This was entitled ‘Racial Equality means Quality – a standard for racial equality for local government in England and Wales’. The publication is more often referred to simply as ‘The Standards’. The CRE later produced similar standards for schools and for youth work. These standards covered the areas of: ? Policy and planning. ? Service delivery and customer care. ? Community development. ? Employment – both for recruitment and selection; and developing and retaining staff. ? Marketing and corporate image.

The Equality Standard has five levels

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Level 1 Commitment to a comprehensive equality policy

?

Level 2 Assessment and consultation

?

Level 3 Setting equality objectives and targets

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Level 4 Information systems and monitoring against targets

?

Level 5 Achieving and reviewing outcomes

Within each level there should be attention to four areas

?

Leadership and Corporate commitment

?

Consultation and community development and scrutiny

?

Service delivery and customer care

?

Employment and training

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The Equality Standard in turn can be directly related to the requirements of the Race Relations Amendment Act – particularly to Race Equality Schemes. From April 2002 progress on the standard became a Best value performance indicator. While the Standard applies to local government it could be applied across public authorities and it is probably wise to do this to achieve an integrated approach to equalities work especially as the new European directives come into force.

In addition the government are currently considering a Single Equalities Commission, which would eventually replace the separate commissions now in place for race, gender and disability. Many community groups have expressed disquiet about this. There are concerns about the dilution of the specific nature of the equality issues in terms of how they differ in history, operation, and effects.

EXERCISE 1.8

Activity

1. Get a copy of the Equality Standard and the accompanying guidance notes for local government and see how it could be applied in your organisation. E-mail: [email protected] or Telephone 020 7296 6600

2. Find out about the Single Equalities Commission – either by searching the Home Office website, contacting them or contacting the 1990 Trust.

3. List the advantages and disadvantages of a Single Equalities Commission

Race Relations Act 1976 and Amendments 2000 33

Several organisations such as the Commission for Racial Equality (CRE) have campaigned for many years to achieve a strengthening of the Race Relations Act 1976. The Stephen Lawrence Inquiry gave added impetus to this, particularly because it was felt to be an anathema to equity that the police in particular were not subject to the Act.

The Race Relations (Amendment) Act 2000 The Race Relations (Amendment) Act 2000 strengthens the 1976 Race Relations Act by making public authorities subject to the Act in relation to all of their functions, including law enforcement and regulation. It also requires them, in carrying out their various functions, to have due regard to the need to eliminate unlawful discrimination and to promote equality of opportunity and good relations between persons of different racial groups.

The Race

Relations Act 1976 (Statutory Duties) Order 2001 required the most major public authorities to publish a Race Equality Scheme by the 31st May 2002 with the list of relevant functions and policies in the Scheme being reviewed at least every three years. Race Equality Schemes are intended to ensure specific attention is given to mainstreaming and delivering race equality.

Section 71(1) of the amended Race Relations Act requires all scheduled public authorities in carrying out their functions to have due regard to the need:

‘To eliminate unlawful discrimination and To promote equality of opportunity and good relations between persons of different racial groups.’

Thus, it is unlawful for public authorities in carrying out any functions to commit any act, which constitutes discrimination. Further, a scheduled public authority, in carrying out its functions must have due regard to the need to eliminate unlawful racial discrimination, and to promote equality of opportunity and good race relations. 34

?

This new statutory duty is enforceable. It can be enforced by judicial review if in taking a relevant decision a public authority fails to have due regard to race equality. If the authority appears not to be taking necessary measures, the Commission for Racial Equality (CRE) will have the power to take enforcement action, ultimately through the courts. The CRE has issued a statutory Code of Practice on the Duty to Promote Race Equality (available on the CRE website: www. cre.gov.uk) providing practical guidance to public authorities on how to fulfil their general and specific duties. Public authorities are now expected to consider the implications for racial equality within everything they do. The full list of public authorities subject to the general duty can be obtained from the Commission for Racial Equality. They include:

?

A health authority established under section 8 of the National Health Service Act 1977

?

The Department of Health

?

A national health service trust established under section 5 of the National Health Service and Community Care Act 1990

?

A primary care trust established under section 16A of the national health service act 1977

The Race Relations Act 1976 (Statutory Duties) Order 2001 This order (“the Statutory Duties Order”) imposes a set of specific duties on scheduled public authorities to ensure their better performance of the general duty. The specific duties that are applicable to these authorities are to publish a Race Equality Scheme (article 2) and to monitor their employment functions (article 5). The health authorities which must produce a race equality scheme are

?

The Commission for Health Improvement

?

A health authority established under section 8 of the National Health service Act 1977

?

The Department of Health 35

?

A national health service trust established under section 5 of the National Health service and community care act 1990

?

A primary care trust established under section 16A of the national health service act 1977

The Statutory Duties Order required these authorities before 31 May 2002 to publish a Race Equality Scheme (“RES”) that is a scheme showing how it intends to fulfil its duty under section 71(1) (the general duty) and its duties under the Order.

The RES shall state:

1. Those of its functions and policies, or proposed policies, which have been assessed as relevant to its performance of the general duty; and 2. The arrangements for: a. Assessing and consulting on the likely impact of its proposed policies on the promotion of race equality; b. Monitoring its policies for any adverse impact on the promotion of race equality; c. Publishing the results of such assessments and consultation; d. Ensuring public access to information and services which it provides; and e. Training staff in connection with the duties imposed by the general duty and this Order. 3. The Scheme must also state how the authority intends to comply with the requirement in the Statutory Duties Order relating to their role as employer.

The duty to monitor the following (by reference to the racial groups to which they belong): The numbers of – ?

Staff in post

?

Applicants for employment

?

Applicants for training

?

Applicants for promotion

36

?

Those who receive training

?

Those who benefit or suffer detriment as a result of the performance assessment procedures, Those who are involved in grievance procedures,

?

Those who are the subject of disciplinary procedures;

?

Those who cease employment with the organisation.

?

The results of the monitoring should be published annually

EXERCISE 1.9

Activity

Find the race equality scheme which most affects you – for example your Primary Care Trust Scheme and ensure you have understood it.

?

Do you think members of the public will understand it?

?

See if you think it fulfils the requirements for race equality schemes.

?

Does it point to where all its functions and policies can be found and list prioritise those relevant to the general duty?

?

Does it say how it will assess and consult for adverse impact on any new policies?

?

Does it say how it will monitor for adverse impact?

?

Does it say what it will do if it finds adverse impact?

?

Does it say how it will ensure access to information and services?

?

Does it say that it will and how it will publish results of all assessments, consultation and monitoring

?

Does it say it will and how it will train staff for implementing the Race Relations

?

(Amendment) Act and the race equality Scheme

?

Does it say how it will fulfil its employment duties?

?

Does it have an action plan?

37

Some of the key concepts of the 1976 Act which have remained unchanged are: (see CRE website http://www.cre.gov.uk)

Direct discrimination:- which means less favourable treatment on racial grounds. In practice, either it must be obvious that the treatment is on racial grounds, for example racial harassment, or there must be evidence that a person of a different racial group in similar circumstances would not have received the same treatment.

Indirect discrimination: - which is concerned with the imposition of a condition or requirement (not necessarily formally adopted but customarily operational within an organisation) that does not refer to race, but which in its application operates to the disadvantage of a particular racial group, as members of that group are proportionately less able to comply with the condition or requirement.

? Indirect discrimination is unlawful if it cannot be justified on non-racial grounds. ? Indirect discrimination can have the effect of barring certain racial groups from desired outcomes such as admission to a school, or subjecting them to unwanted outcomes, such as selection for redundancy. As case law has illustrated, it is often impossible to draw a clear line between direct and indirect discrimination.

Positive discrimination/Positive action: - Positive discrimination is illegal (some exceptions) and would occur if, for example, you employ someone or accept them on a course because they are white or Black. The Race Relations Act does not allow positive discrimination or affirmative action - in other words, an employer cannot try to change the balance of the workforce by selecting someone mainly because she or he is from a particular racial group. This would be discrimination on racial grounds, and unlawful.

38

However, employers and others can take positive action to prevent discrimination, or as redress for past discrimination, by arranging training especially for people from a particular racial group, or by taking steps to encourage people from that group to apply for certain kinds of work. They can do this if nobody from a particular racial group, or only a small proportion of people from a particular racial group, has been doing that kind of work within the previous 12 months.

For example, an employer with no Black supervisors but a high proportion of Black assembly line workers can arrange training for Black workers seeking promotion, encourage Black workers to apply for vacancies at that grade when advertising vacancies, or print leaflets in relevant minority languages to encourage them to apply.

The aim of positive action is to ensure that people from previously excluded minority ethnic groups can compete on equal terms with other applicants. It is intended to make up for the accumulated effects of past discrimination. Selection itself must be based on merit and treat all applicants equally. The law does not compel employers to take positive action, but it allows them to do so.

Positive action can also be taken by trade unions, by any organisation, which provides training courses, and by education providers who can take positive action by providing for special educational or training needs, such as special classes in English as a second language.

‘Racial Grounds’: - Grounds of race, colour, nationality – including citizenship – or ethnic or national origin. Groups defined by reference to those grounds are referred to as racial groups.

Other Current Policy Initiatives On Race: The Modernising Government White paper ‘In Touch With People’ puts an emphasis on: 39

?

Strengthening links between local authorities and local communities

?

Raising standards

?

The spread of best practice

?

Tackling serious failure

Best Value is the working framework to deliver this agenda.

Audit Commission:

The Government has defined best value as ‘a duty to deliver services to clear standards covering both cost and quality - by the most economic, efficient and effective means available.’ This represents a challenging new performance framework for local authorities. Best value local authorities will be required to:

?

Publish annual best value performance plans that report on past and current performance and identify forward plans, priorities and

?

Targets for improvement; and

?

Review all of their functions over a five-year cycle.

Best value will require local authorities to ask themselves fundamental questions about the underlying objectives and priorities of their work and about their performance in relation to other organisations in the public, private and voluntary sectors. In addition, best value will require authorities to consult with local residents and the users of local services about their views and priorities.

The Government will also require local authorities, including parish councils with budgeted incomes over £500,000, to publish an annual best value performance plan (BVPP) by 31 March every year, covering the entire range of authorities' functions. The BVPP will be a key public 40

document that identifies each authority's assessment of its past and current performance against nationally and locally defined standards and targets, together with its vision of future priorities and targets for improvement. It will also set out a programme of best value reviews (see Q4) scrutinising all of the authority's functions over a period of five years. The BVPP will be the main instrument by which authorities will be held accountable by the local community for delivering best value.”

Don’t forget that since April 2002 progress on The Equality Standard will be a best value performance indicator. See also section 3

The Home Office Report On Race Equality In Public Services The first Home Office Report on Race Equality in Public Services (March, 2000) opens with the statement

“The government is committed to creating One Nation, a country ?

where every colour is a good colour

?

where every member of every part of society is able to fulfil their potential

?

where racism is unacceptable and counteracted

?

where everyone is treated according to their needs and rights

?

where everyone recognises their responsibilities and

?

where racial diversity is celebrated”

The major areas of service delivery covered by the document are health, housing, education, employment, the voluntary and community sectors, and law and order. Although there may not be

41

agreement with some of the expression, this statement and the document, which follows heads a ‘basket’ of policy and indicators around race equality from the Home Office.

The second Race Equality in Public Services was published in February 2001. As mentioned earlier Schedule 1(A) of the Race Relations Amendment Act 2000 places a duty on certain public authorities such as the police, local government and NHS Trusts to ensure that their functions are carried out with due regard to the need:

a) ‘to eliminate unlawful racial discrimination; and b) to promote equality of opportunity and good relations between persons of different racial groups.’

The aim of this annual publication of data is to systematically monitor the effects of changes from race equality legislation and policy, across the different services, both in terms of their delivery and access by different groups. The Race Relations (Amendment) Act 2000, places a duty upon certain public authorities to produce race equality schemes, this publication will in the future track changes in race equality practice resulting from the implementation of these schemes.

The document is divided into three parts which provide qualitative data on the attitudes of Black and Minority ethnic groups to public services, hard quantitative data which clearly demonstrates how discrimination effects access to services and information on the performance of the civil service with regard to recruitment from these groups. In order to get a broad picture of the experience of Black and Minority ethnic communities and good practice within race equality we would recommend that you download the reports from the Home Office website: www.homeoffice.gov.uk

Importantly the 2001 document contains information on people’s perceptions of racial prejudice. Using the British Crime Survey 2000 as a vehicle for research a survey was carried out between January and July 2000 asking a broad range of respondents across all ethnic groups about their attitudes toward the existence of racial prejudice, today, five years ago and their expectations five years into the future. Interestingly enough amongst white respondents the proportion expecting prejudice to increase was twice that of those expecting it to fall.

The same survey also examined

42

perceptions of service delivery within the public sector and perceptions of the public sector as an employer. Both surveys looked at whether respondents think that certain public services treat people of all races equally as members of the public and as employees.

In terms of perceptions of service delivery Black and Minority ethnic individuals tended to consistently expect worse treatment than white people, with Black people expecting worse treatment than Asian. With specific regard to hospitals 1.1% of white respondents as opposed to 4.4% Black and 3.3 % Asian expected worse treatment. With regard to employment the data showed again that fewer white people expect to be treated worse than other groups, by staff working within an organisation. However, strikingly three public sector organisations were most likely to be picked by Black and Asian respondents as those where they would expect worse treatment than their white counterparts: the Police Service, Prison service, and Civil service. This expectation was also applicable to the private sector. When asked about health services as an employer it is equally striking that 2.3% of white staff as opposed to 10.8% Black and 6.0 % Asian felt that they were likely to be treated worse as employees.

Also included in the 2001 Home Office report are key findings from a survey on health and Black and Minority ethnic communities, conducted in 1999 as part of the Health survey for England (June 2000). The research illustrates that the experience of Black and Minority ethnic communities with regard to health are shaped by the following:

? Variations in disease prevalence ? Differential access to services ? Differential delivery of Services ? A disproportionate experience of other social factors which interact with health inequality e.g., overcrowded housing, poverty, deprivation and unemployment.

This last point has also been emphasised within a report published by the government’s Social Exclusion Unit, Black and Minority ethnic Issues in Social Exclusion and Neighbourhood Renewal, (SEU, 2000) the report identifies that:

43

?

People from Black and Minority ethnic communities are disproportionately concentrated in deprived areas. Fifty-six per cent live in the 44 most deprived local authorities in the country. And those 44 most deprived areas contain proportionately four times as many people from Black and Minority ethnic groups as other areas.

?

That these groups are more likely than the rest of the population to be poor. Twentyeight per cent of people in England and Wales live in households that have incomes that are less than half the national average, but this applies to 34 per cent of Chinese people; over 40 per cent of African-Caribbean and Indian people; and over 80 per cent of Pakistani and Bangladeshi people

?

Pakistani and Bangladeshi men also have higher rates of unemployment than all other groups. In addition, those in employment have low wages.

In terms of health, the Social Exclusion Unit report also highlights that although Indian, African Asian and Chinese people have similar levels of self-reported health to white people, people from Pakistani and Bangladeshi communities are one and a half times more likely to suffer ill-health; with AfricanCaribbean people a third more likely. One indicator of this inequality is that infant mortality is 100 per cent higher for children of African-Caribbean and Pakistani mothers, compared to white mothers.

The report also identifies that although much of the difference in terms of health between and within different ethnic groups is related to socio-economic status that there is also evidence that this is in part explained by health services, which do not always reach people from Black and Minority ethnic communities or meet their needs. With significant evidence to suggest that language barriers have a major impact on primary care services. According to the Social Exclusion unit one third of Chinese people do not understand the language used by their doctors and over half of South Asian people who do not speak English as their first language attempt to see a GP who shares another language with them.

The SEU say:

44

“One of the reasons why policies and services have failed Black and Minority ethnic groups in the past is the lack of information available about them. Much information that is currently collected is not broken down by ethnic group. In addition, because people from Black and Minority ethnic communities make up a small proportion of the population, their representation in many surveys is so low as to make it difficult to use the results with confidence. The resulting lack of detailed, local and robust data that covers the whole country means that it is often difficult to adequately diagnose problems experienced by Black and Minority ethnic groups, better target policies or services at addressing their needs, and monitor and evaluate the impact on them”

‘Without Prejudice’ is a detailed analysis of London’s Black and Minority ethnic communities produced by the Greater London Authority. A parallel document for each Health Authority region would be useful. This should be assisted with the results of the 2001 Census.

EXERCISE 1.10

Activity

Find out all you can about local demographics, via census data or other local documentation Make a note of the different categories used for ethnicity and any points of particular interest.

If we return to The Health Survey for England (June 2000) the picture is also bleak amongst these communities with regard to prevalence of specific health conditions

45

Key Findings ?

Bangladeshi men and women and Pakistani women were over three times as likely to say their health was bad or very bad or very bad.

?

Black Caribbean men showed higher rates for stroke, but much lower rates of angina and heart attack

?

Among those with hypertension, men in the Black and Minority ethnic groups, except Bangladeshi men were more likely to be treated for high blood pressure (with Black Caribbean men being most likely to receive treatment)

?

Indian and Bangladeshi men reported higher rates of heart disease and stroke.

?

Higher rates of diabetes were reported by men from all Black and Minority ethnic groups, and by women from Black and Minority ethnic groups

?

Black Caribbean and Pakistani women were more likely to be obese

?

A much higher proportion of Bangladeshis may suffer from psychiatric illness

?

For GP consultations all minority groups had higher rates of consultations than found among the general populations, except Chinese men who had lower rates and Chinese women who had similar rates

?

Bangladeshi men were nearly twice as likely to smoke, as men in the general populations, while smoking rates were also higher among Black Caribbean men. Chinese men were less likely to smoke than men in general.

?

Among people who had ever smoked, those from Black Caribbean and South Asian groups were less likely than the general population to have successfully stopped smoking

?

Women from all Black and Minority ethnic groups were less likely to smoke than the general population, with smoking rates particularly low for women from South Asian communities 46 (Home Office, 2001:40)

EXERCISE 1.11

Group Activity

In a small group discuss some of the possible reasons for the following facts already outlined above: ?

South Asians living in the UK have a disproportionately high premature death rate from coronary heart disease: The rate is on average 46% higher for men and 51% for women.

?

Among people who had ever smoked, those from Black Caribbean and South Asian groups were less likely than the general population to have successfully stopped smoking.

?

Bangladeshi men and women and Pakistani women were over three times as likely to say their health was bad or very bad or very bad.

The NHS And Race Equality: Some Proposed Solutions The NHS plan was released in July 2000. The Plan recognises, as mentioned above that ethnicity 47

can be a key factor in health inequality, setting out new measures for improvements in the NHS as a service provider and employer over a ten-year period. The improvements included the publication of national standards known as National Service Frameworks for key conditions such as mental health, coronary heart disease and cancer. Both the National Service Frameworks for heart disease and mental health have included performance indicators, which focus on the race equality dimensions of service delivery. With regard to Coronary Heart disease (CHD) the NHS has begun to introduce the monitoring of access rates to revascularisation services by Black and Minority ethnic groups. This is particularly important if we consider from the statistics cited above that South Asians living in the UK have a disproportionately high premature death rate from CHD.

In terms of Mental Health, the National Service Framework for Mental Health, published in September 1999 states that mental health services must be planned and implemented with local communities to meet the needs of Black and Minority ethnic communities. The 2000 version of the document also suggested that proposed national indicators of national standards for Mental Health Services should include:

?

Levels of psychological health

?

The experience of service users and carers including those from Black and Minority ethnic communities

?

Direct mental health advice availability in the first language of callers.

In October 2002 a forum was also held focusing on the need to provide culturally specific services in order to produce learning materials for those who provide and commission services to Black and Minority ethnic communities. Ethnic monitoring has also been used by health departments to identify take up of services, together with extra support given to Black and Minority ethnic voluntary organisations to deliver services jointly with NHS providers. The Plan also prioritized an improvement in interpretation and translation services to increase awareness of existing services amongst Black and Minority ethnic groups, whilst placing a responsibility on NHS organisations to demonstrate a commitment to recruiting and retaining Black and Minority ethnic staff by:

?

Setting targets for increasing the representation of Black and Minority ethnic staff in areas

48

where they are under represented, in order to ensure that that the workforce reflects the communities that the NHS Serves.

One example of this was an initiative undertaken by the Bradford Community Health Trust. The Trust began with a workforce from which 10.2% were from Black and Minority ethnic communities, compared to 18.25% of the local working population as a whole. It used a ‘jobshop’ based in Manningham Clinic to tackle the issue. A full time Asian worker with knowledge of a number of Asian languages was employed with leaflets on NHS careers published in English, Urdu, Punjabi and Gujarati disseminated within the local area and within the centre. The centre also managed a database in which vacancies were matched to potential applicants and as a result there was a rise in the number of Black and Minority ethnic staff employed. (Department of Health (a), 2001: 15)

?

Supporting the development of support networks for Black and Minority ethnic staff.

?

Beginning joint agreements with higher education institutions to aim at increasing the number of Black and Minority ethnic students on professional healthcares courses, through identifying and removing barriers to students gaining places and monitoring their access and progression.

An example of this is that of the ‘Community Parents’ trained in the Sparkbrook area of Birmingham. Birmingham Health Authority, Birmingham Voluntary Services Council, a local education college and Southern Birmingham Community Health Trust worked in partnership to tackle the problem of peri-natal mortality in the area. Birmingham experiences twice the UK average in terms of peri-natal mortality with this particular area experiencing even more than this. The area in question also had a high Black and Minority ethnic population but a lack of Asian people entering into nursing as a profession. The partnership realized that addressing the problem of peri-natal mortality required an integrated approach that looked at associated problems such as regional poverty, ill health, access to services, and regeneration. The result being a training programme which enabled 40 women from Black and

49

Minority ethnic communities in the area to become ‘community parents’. These are basically outreach workers who work with local families to provide support and advice on accessing services. The women received financial support throughout the 12-month programme and of the first 19 women who entered the project three are now studying for a degree in nursing. The programme has had the advantage of recruiting more staff from the area, but also bringing users perspectives directly to service provision, whilst increasing the numbers of Black and Minority ethnic staff providing localized health services.

Further Reading ?

Home Office (March 2000) Race Equality in Public Services, pages 29-33 http://www.homeoffice.gov.uk/reu/repbsvs.pdf

?

Home

Office

(February

2001)

Race

Equality

in

Public

Services,

investment

(2000)

www.homeoffice.gov.uk/new_indexs/index_racial-equality ?

The Health Survey for England (1999)

?

The

NHS

Plan

–

A

plan

for

http://www.doh.gov.uk/nhsplan/contents.htm

50

EXERCISE 1.11

Group Activity In a small group discuss how you would a. Approach increasing the number of South Asian women who access a particular service, eg, breast screening. List all the considerations involved in providing an appropriate service. b. Plan a partnership approach to developing culturally specific mental health services which involve working with: ?

Individuals/the local community

?

Voluntary sector organisations

?

NHS Trusts

c. Who else would you approach? d. How do you see ‘culturally appropriate’ services? What does the phrase mean to you?

EXERCISE 1.12

Activity

51

The Clinical Governance Agenda

National Institute for Clinical Excellence NHS performance assessment

Patient and public involvement

Professional Self-

Clinical governance

Lifelong learning

Commission for health improvement NHS performance assessment framework N ti l ti t d

Clear standards of service

Dependable Local delivery

Monitored standards

(Boden and Kelly 1999: 179)

52

The above discussions on race equality management have very similar key features to those in the diagram above. That is:

?

Clear national standards (legislation and the CRE standards)

?

Public involvement (consultation, multi-agency and partnership approaches with Black and Minority ethnic communities)

?

Implementation which can only be judged by monitoring and accountability.

?

Educational support.

Indeed, the work of Boden and Kelly (1999) illustrates well the obvious parallels between clinical governance and equality management.

53

Extract from Boden and Kelly (1999) National standards of clinical quality and evidence base = Expectations (government, clinical, professions + public) + case law Available resources + professional capacity The building blocks of clinical governance are therefore: ? Clinical audit ? Clinical effectiveness ? Clinical risk management ? Quality assurance ? Organisational and staff development. In addition, a recent position statement on clinical audit (NHSE, 1999) requires that future processes make explicit: ? A clear patient focus; ? Greater evidence of multi-professional working; ? A cross sector approach where appropriate; ? Closer links with education providers; and ? Better integration of the available effectiveness data. (Boden and Kelly 1999: 178 & 181)

The key principles of ‘The New NHS’ (Department of Health, 1997) are worth re-emphasising, as they clearly illustrate the sentiments underpinning clinical governance. That is: ? to cut bureaucracy and focus on quality so that excellence becomes the norm; ? to drive efficiency by more rigorous assessments of performance; and ? to make national standards a matter of local responsibility. As nurses are involved in all aspects of healthcare, their contribution to ensuring that clinical governance improves the quality of healthcare (of which effectiveness of interventions is only one component) will require more than simply paying lip service to the concept. It is essential that they become involved in all stages of the initiative if they are to have an input into shaping the culture for care. The clinical governance approach differs in that it provides an opportunity for both nursing and multiprofessional research initiatives to emerge naturally from the identification of local needs. For example, the recorded incidents of clinical risk mentioned earlier. This is a strategy which we are currently pursuing in collaboration with the trust’s R&D directorate, which, in turn, is conducting a research training needs analysis for nurses, members of the professions allied to medicine, and medical staff (this is in line with the staff training emphasis within the clinical governance framework). The cylindrical nature of this combined effort is illustrated in Figure 1A below. (Boden and Kelly 1999:182-183 54

FIGURE 1A The cyclical framework of the clinical governance approach (Boden and Kelly 1999:179)

Modify practice and Monitor outcomes

Quality assurance Risk management Clinical audit User surveys Local priority-setting exercises Educational programmes

Review available evidence base

Identify local response: Act on evidence or initiate research

KEY POINTS ? It is imperative that nurses are aware of the concepts underlying clinical governance as they will play a key role in shaping the nature of healthcare research and future service developments. ? Clinical governance is an attempt to ensure that high quality care is spread throughout the service and that national standards are guaranteed. ? There is an opportunity for nursing research and practice development to play a key role in contributing to future clinical governance initiatives. ? Clinical governance offers the profession a chance to strengthen its standing in relation to health service research and policy-making. ? Attention should be focused on establishing pilot projects to monitor the impact of nursing research on improving the quality of healthcare. (Boden and Kelly 1999:188)

55

EXERCISE 1.13

Activity

From what you have read above note down parallels to delivering race equality.

56