The review titled “Ethnic Inequalities in Healthcare: A Rapid Evidence Review” (published 14 February 2022), highlights the vast failings in the healthcare systems affecting ethnic minority patients in the country.
The review was ordered by the NHS Race and Health Observatory, an independent organisation established in 2020 to investigate inequalities in healthcare. It found what was described as “overwhelming” evidence of less than desirable results for ethnic minorities.
The NHS Race and Health Observatory’s team of academics screened more than 13,000 research papers over a 10-year period, identifying 178 studies that were included in the final review.
The areas explored included:
- NHS employees
- Genomic medicine
- Maternal healthcare
- Neonatal healthcare
- Genetic testing
- Mental healthcare
- Digital access to health services
Within these areas, the review explored factors such as experiences, outcomes, and differences in access and noted differences between different ethnicities, where particular communities had relatively worse experiences across the board.
Key points of the review
The research identified key points:
- Inequality is deeply rooted across various branches of healthcare. Some of the largest inequalities were found in mental health and maternity care.
- Areas affected included maternity care, mental health, access to healthcare on digital platforms, medicine, and within the NHS staff.
- The highlighted variances included the experience when receiving healthcare and the subsequent outcomes.
- Recommendations to the NHS, calling for critical steps to be taken where the worst outcomes were highlighted.
- Immediate action is needed to curb the “vast and persistent” problem.
The report revealed that when it came to mental health:
- Patients from ethnic minorities were not as likely to be referred to General Practitioners for psychological treatment compared to white patients.
- Lack of access was replicated in younger patients as they faced the same barriers their parents did.
- There were higher occurrences of compulsory admissions among ethnic minorities highlighting clear evidence of inequality.
- While in the wards, black patients were far more likely to be restrained face down i.e. in the prone position.
With regard to maternal healthcare:
- There were cases of cultural insensitivity, racial discrimination stereotyping, and outright disrespect. This led to some women feeling alienated, “unwelcome, and poorly cared for”.
- A section of the review highlighted the over-representation of Asian children in neonatal units because of jaundice. The researchers said it was “worth noting” that a visual examination of jaundice is particularly unreliable for babies with darker skin tones, “raising the possibility that postnatal care may disadvantage non-white babies by delaying access to care”.
Leading experts called for radical actions to tackle the widespread inequality that was uncovered within the NHS by the damning study, stating that it was harming the health of “millions of patients”.
According to the review, the inherent racism, discrimination against certain ethnic groups, and shambolic collection of data have had a negative impact on the health of those in ethnic minorities in the country.
The review’s lead investigator, Dr Dharmi Kapadia, Lecturer in Sociology and member of The University of Manchester’s Centre on Dynamics of Ethnicity said:
“For too many years, the health of ethnic minority people has been negatively impacted by a lack of high-quality ethnic monitoring data recorded in NHS systems; lack of appropriate interpreting services for people who do not speak English confidently and delays in, or avoidance of, seeking help for health problems due to fear of racist treatment from NHS healthcare professionals.”
“The evidence on the poor healthcare outcomes for many ethnic minority groups across a range of services is overwhelming and convincing. The time for critical action on ethnic inequalities in healthcare is now.”
“Our review confirmed that all of these issues are still to be tackled by the NHS,”
In response, the NHS stated that it is already taking the necessary steps to improve access to health service, where a spokesperson for NHS England saying the following:
“The pandemic has shone a stark light on health inequalities across the country, and the NHS is already taking action to improve the experiences of patients and access to services.”
“The NHS has set out what local health services should be focusing on over the next year so they can make these improvements in their local communities, and is already working closely with the Race and Health Observatory to drive forward the recommendations set out in this report.”
Sarah Salway, a Professor of Public Health at the University of Sheffield spoke on the matter:
“We know that persistent inequalities in the healthcare and health outcomes between ethnic groups remain, despite past commitments to address the issue. The review recommendations published today provide the clear direction we need to truly make a concerted effort to address inequity, not only in areas such as mental health and maternity care, but also within the NHS workforce itself.”
On the NHS, Professor Salway commended:
“As a nation we are proud of our NHS. It is one of the few healthcare services worldwide that enjoys a reputation for quality care that is free at the point of access, so it can be difficult to discuss how things may be failing. This report however, gives us the opportunity to identify how we can do things better, for a healthier and fairer society. We can work towards an NHS that provides equitable services for all, where language is not a barrier, medical technologies meet the needs of our diverse population, and everyone feels cared for.”
The response from Dr. Rajesh Mohan, the Presidential Lead for Race and Equality at the Royal College of Psychiatrists reiterated the need for action.
Dr Mohan commented:
“The Race and Health Observatory’s findings are damning. It’s clear that the government and the NHS must do more if it’s to stop the healthcare system from failing ethnic minority people.”
Speaking further, Dr Rajesh called for an end to the “warm words” and called on the government to act.
Among the expected government actions was the strengthening of the Health and Care Bill. This is to ascertain that monitoring systems are put in place to help point out any access, experience, and outcome discrepancies for ethnic minorities. It would also ensure a cultural shift, with people from ethnic minorities being included in creating and commissioning health services.
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Links to the full report(166pp) and a summary (17pp) are below.
The report indicates that it is possible that race inequality and the impact of direct and indirect racial discrimination can lead to incidence of medical negligence;
- Asian babies overrepresented in neonatal units
- Failure to provide timely caesarean delivery
- Harsher treatment for African/Caribbean patient in mental healthcare
The suggested recommendations for Practice & Policy are welcomed however the comment (made above) by Dr Rajesh is repeated: he called for an end to the “warm words” and called on the Government act.