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Embedding ethnic equality in commissioning practice

Name, date, contact

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Introduction

This is a tool (Version 1.0, June 2013) from the Evidence and Ethnicity in Commissioning project (www.eeic.org.uk). It is a flexible template, designed to be modified to present the case for considering minority ethnic health issues to colleagues and board members.

Findings from the EEiC project, plus other research and practice experience, tell us that many key actors within the commissioning arena do not view tackling ethnic inequalities as a top priority. These people may question the importance of the agenda, or see it as a luxury that can not be afforded. There is a tendency for some commissioners to view this area as the responsibility of provider organisations, or to question whether it is right to give 'special' attention to particular groups. Many commissioners also lack confidence, skills and knowledge to adequately describe, understand and address the causes of poor service access, experiences and outcomes. At the same time, individuals who are committed to addressing ethnic inequality, whether within or outside of commissioning organisations, can be isolated and struggle to influence the commissioning agenda.

Making progress towards better services for minority ethnic people requires a wide range of stakeholders to make a more consistent and convincing case for why this work is important, and how it can support other core commissioning priorities, including quality and efficiency, rather than complicate or undermine other work.

Individuals who are committed to this agenda need to identify opportunities to argue for why understanding and addressing ethnic inequalities should be part-and-parcel of commissioning work. These opportunities may arise in a variety of settings, both formal and informal.

This powerpoint template is designed to be adapted for your local context. It should help you make a strong case: for considering ethnicity when commissioning health services; bolstering attention in service redesign; securing funding for additional services; or even setting policy and guidance.

It will be helpful to identify contexts where such a presentation may be helpful and impactful. For instance, you might be able to book a slot on the agenda of senior team meetings or partnership boards, or request time to speak to a group of GPs at their practice, or a consortia of third sector organisations. It will be useful to discuss with like-minded colleagues what the objectives of the presentation should be.

Depending on the audience and your objective, you will then need to consider which parts of the presentation are important and where changes/improvements might be needed. You may want to alter some of the language and ensure that the presentation has a local focus.

Many resources can help you access local evidence and examples to customise the presentation: including Public Health analysis; data from your local Trusts; your JSNA; information from user satisfaction surveys; local research studies; insight work, and information collected by third sector organisations that work with minority ethnic communities. Examples from the EEiC project (www.eeic.org.uk) and other on-line resources such as (http://help.northwest.nhs.uk/library) can provide more general examples.

You may also find it useful to read through the list of 'nightmare questions' and possible answers available on the EEiC website, so that you are ready for issues that may be raised, and to change the title to make sure it links to local objectives and is 'jargon-free'.

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What is ethnicity?

Common physical and cultural characteristics, shared values and history�
Affects health and healthcare via several routes:��- structural (exclusion; poor access to resources)�- cultural (risks; responses; healthcare experiences)�- biological/genetic factors

Fluid and dynamic, complex identities, variation within and between ethnic 'groups' (age, gender, generation, class, religion), BUT important axis of difference and disadvantage

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What is the issue?

We live in a multi-ethnic society; ethnic diversity is increasing; 8.7% in 2011, 14.0% in 2011

Ethnic identity impacts on health through varied routes

Health services should mitigate wider disadvantage, but can make things worse

Inequalities in access, experience and outcomes

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Local ethnic profile

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Why does this matter?

Commissioning has key role in addressing unmet need and driving up standards of care. BUT, to-date, impact on inequality very limited.�
Legal duty to proactively identify and reduce inequalities (2010 Equality Act)
Morally right thing to do
Equity is core to the NHS constitution
Closely linked to other key commissioning drivers:�► Quality�► Efficiency�► Health Inequalities
YET, remains a side-lined concern with limited resource and expertise

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