This week saw the publication of a damning review by the NHS Race & Health Observatory which shows that urgent action is needed to tackle “overwhelming” minority ethnic health inequalities in the NHS.
Doctors working in the NHS have, however, called for more action rather than reports. Responding to the report Dr Rajesh Mohan, Presidential Lead for Race and Equality at the Royal College of Psychiatrists, said: “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.”
He called for “warm words to end and for the government to act” including strengthening the Health and Care Bill to ensure data and monitoring systems are in place that enable the NHS to identify and address discrepancies in access, experience and outcomes for all minority groups plus a “systematic shift in culture and practice, including designing and commissioning services collaboratively with people from ethnic minority backgrounds.”
The review revealed vast inequalities across a range of health services that mean the health of Black, Asian and minority ethnic people across England have been “negatively impacted” for years.
The review looked at mental healthcare, maternal and neonatal healthcare, digital access, genetic testing, and at the workforce in the NHS.
Ethnic inequalities were found in each area, but some of the largest inequalities were found in mental healthcare. The review of academic research, spanning a 10-year period, found that ethnic minority groups experienced distinct inequalities in mental health support provision, and in gaining access to mental health ‘talking therapies’.
The review found that there was a distrust of both primary care and mental health care providers, as well as a fear of being discriminated against in healthcare, which produced a barrier to seeking help.
Once help was sought, GPs were less likely to refer ethnic minority patients to the Improving Access to Psychological Therapies (IAPT) programme, compared to White patients and overall, ethnic minority groups were less likely to refer themselves to IAPT. There was also evidence for inequalities in the receipt of cognitive behavioural therapy (CBT) with ethnic minority people with psychosis less likely to be referred for CBT, and less likely to attend as many sessions as their White counterparts.
There was strong evidence of clear, very large and persisting ethnic inequalities in compulsory admission to psychiatric wards, particularly affecting Black groups, but also Mixed Black & White groups and South Asian groups. There was also evidence of harsher treatment for Black groups in inpatient wards, for example they were more likely to be restrained in the prone position or put into seclusion.
Ethnic inequalities in mental healthcare for adult populations are now being reproduced in younger populations, according to evidence found by the review. Parents reported their children facing the same barriers to accessing services as reported for adult mental health services.
One study in the review showed that Black children were 10 times more likely to be referred to Child and Adolescent Mental Health Services (CAMHS) via social services rather than their GP service, in comparison to White British children.
A major barrier to the work carried out for the review was the lack of national datasets with high quality ethnic monitoring data that allowed for robust analysis to investigate ethnic inequalities. The authors noted that many recent reports from NHS Digital did not report differences in referral rates by ethnic group.
In maternal healthcare, the review found evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading to some ethnic minority women feeling ‘othered’, unwelcome, and poorly cared-for.
The impact of racism on careers and professional development was also explored in the review, and there was evidence of an ethnic pay gap affecting Black, Asian, Mixed and Other groups, and to a lesser extent, Chinese staff.
The review was carried out by teams at the University of Manchester, working in conjunction with the University of Sheffield and the University of Sussex. The academic team undertook a comprehensive stock-take of available UK research, screening over 13,000 research papers, identifying 178 studies that were included in the final review.
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