Equality not valued in NHS’ Realising the Value
Posted on Thu 8 Dec 2016
Evidence shows that there are comparatively poorer health and care experiences and outcomes for black and minority ethnic people, as well other groups in Britain. At the same time, we know there are practices and policies that will make a real impact and which have been implemented effectively, such as a competent and confident diverse workforce. In this context the “Realising the Value” resources have been much anticipated. Those wishing to promote equality and better address health inequalities will welcome the emphasis on peer support in its resources. However, for the most part these resources pay little or no attention to promoting equality and addressing health inequalities.
Realising the Value was launched by NHS England two years ago with the aim to ‘empower people and communities to take more control of their health.’ The programme saw an investment of around £500,000 in developing tools to support this aim. Thus far, nine tools have been made available, but unfortunately, these have failed to value an approach based on promoting equality and tackling health inequalities. It is possible to conclude that, at best, the tools are superficial and at worst ignore the challenges faced by people who experience discrimination and disadvantage.
Analysis of resources
- At one point, we come across the value statements which include ‘We value equity, and the gains to be made by targeting and tailoring our approaches to people with greater need for our partnership.’ Thereafter, there is little mention of equity, equality or health inequalities in over 200 pages of documentation.
- There is no discussion of the geographic, social and economic differences that affect the local strength of the voluntary sector and/or the ability of people to care for each other or themselves. Nor is there much attention to the challenges of quantifying value in these conditions.
- The only reference to black and minority ethnic people, LGBT people, age, gender, and immigration status are made in a section that notes people from these groups can be peer supporters. Nowhere does it explore the issues, challenges, and gains to be made by promoting equality or addressing health inequalities faced by these groups.
- It is difficult to find any exploration of the different methods and approaches that would be needed by particular communities and people. Research on personal budgets, for example, has shown that there is unequal access to them from black and minority ethnic groups. Fully realising the potential of personal budgets requires tackling these inequalities in access.
- Workforce issues are explored in another of the tools. However, they do not look at how development of a more representative workforce can facilitate better care, nor the barriers and inequalities currently in the system. We know from the work behind the NHS Workforce Race Equality and Disability Standards that these are critical issues. We also know that we are still some way from effectively implementing these standards.
- Within the financial modelling for Realising the Value, the £36 billion cost of inequality calculated by the Marmot Review is absent. There is also mention of ‘the social gradient’ – but again, there is no exploration of why the social gradient is important, what the issues are, and how they should be addressed.
We had hoped that Realising the Value would provide direction on doing better for all people and communities who use health and care, including those who experience discrimination and disadvantage. Sadly the resources do not do so at present. Empowering people and communities to take more control of their health and care will only really be progressed if we develop resources that promote equality and address health inequalities.