Room for improvement?
Experiences of health and social care
services among older people from
minority ethnic groups
Jo Moriarty
King’s College London
Outline
What are the issues?
These will be familiar!
Inequalities in old age
Evidence on services
Making improvements
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Age Concern Bristol/Brunelcare Research Forum
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Background
Race Equality Foundation promotes
race equality in social support and
social care http://www.reu.org.uk
Funded to develop a national resource
to help improve the quality of health and
housing provision to black and minority
ethnic communities
Includes series of briefing papers containing
research evidence, good practice tips,
resources, and key messages for practice
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Presentation uses….
Asked to do briefing paper on health
and social care experiences on black
and minority ethnic older people from
http://www.reu.org.uk/health/files/heal
th-brief9.pdf
Currently have 13 briefing papers on
health and 12 on housing
Presentation today is overview of
topic, not a single research project
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Presentation uses (2)
Evidence from ESRC project on social
support and quality of life among older
people from different ethnic groups
Work for the former Healthcare Commission
Asked to talk to BME communities as part of a
wider review of the National Service Framework
for Older People
Practice guide for Social Care Institute of
Excellence (SCIE) on user participation
Work with SCIE on depression and BME
people
Other literature
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Why this topic is important (1)
Increase in older population from minority
ethnic groups
Projections influenced by migration history and
patterns of settlement
Currently 30 per cent people aged 65 and over in
Brent and 20 per cent Lambeth and Hackney
(Evandrou, 2000) are from BME communities
And in Bristol?
Council’s Improving the Quality of Life of Older
People in Bristol Equalities Impact Assessment
BME community in Bristol lower than average overall
but very concentrated in certain areas
Currently younger than average but likely to change
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Why this topic is important (2)
UK (especially England) is becoming
increasingly ethnic diverse
Term ‘super diverse’ is increasingly used
Reflected in work for Healthcare
Commission (now CQC)
Focus groups with older people from
Yemeni, Somali, Bosnian, and
Vietnamese backgrounds
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Impact of ageing on ethnic
inequalities
Age accentuates health inequalities
British Household Panel Survey data show
that inequalities in self assessed health
INCREASE with age (Sacker et al 2005)
May experience ageing process at younger
age (Ebrahim et al, 1991)
Prevalence of limiting longstanding illness
Higher among Irish, Black Caribbean, Indian,
Pakistani and Bangladeshi communities
Lower among Chinese (Evandrou, 2000)
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Ageing and health inequalities
Prevalence (frequency) of some age
related health problems diseases
varies
Coronary heart disease
Diabetes
(Parliamentary Office of Science and
Technology, 2007)
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Inequalities in access to services
Inequalities in access to health care
Over represented in primary care
Under represented in secondary
services (Ascheson, 1997)
Inequalities in reports of treatment
Patient surveys suggest older people
from BME communities are more likely
to report receiving poor care (Healthcare
Commission, 2006)
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Recognised in policy documents
Legislation and policy guidance
recognises differences in treatment
Examples include
Race Relations Amendment Act 2000
National Service Framework for Older
People (2001)
New Single Equality Bill (2009)
Public Sector Equality Duty
Dementia strategy (2009)
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But why don’t we know more? (1)
Still neglected issue in mainstream
research
Just eight per cent of articles in two old
age psychiatry journals included people
form a minority ethnic group (Shah et al,
2008)
Presents methodological challenges
Complexities of separating out multiple
factors
e.g. socio-economic status and ageing
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But why don’t we know more? (2)
Studies of older people still have low
numbers of older people from minority
ethnic groups
e.g. English Longitudinal Study of
Ageing
Studies may fail to report differences
by age
e.g. studies of depression and ethnicity
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But we do know some things….
Differences in access to information
Knowledge and attitudes of staff
Provision of culturally sensitive
services
Need to put this into action!
'Let's move on': Black and minority
ethnic older people's views on research
findings (Butt and O’Neill, 2004)
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Differences in access to information
Access to information about health
and social care services is always
variable
Studies have shown that BME people
are more likely to report they lacked
information (Lindesay et al, 1997, Butt
and O’Neill 2004)
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Specific issues
Lack of access to materials in
translation
Content of leaflets may not be
relevant
Shortage of good quality interpreting
services
Reliance on other family members
(Manthorpe et al, 2009)
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Dementia
Research has
shown that
knowledge about
dementia is less
among Asian and
Black Caribbean
communities
(Adamson, 2001,
2005, Bowes and
Wilkinson, 2003)
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Image from Dementia Strategy
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Consequences are….
May contribute to poorer outcomes
Later access to dementia services
Prevents benefits of early intervention
Can lead to increased carer stress
(Bowes and Wilkinson, 2003)
Dementia strategy
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Improving access to information (1)
There are many ways in which
improvements can be made
Why reinvent the wheel?
Costs of preparing and translating
leaflets are high
But there are many resources that exist
already
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Resources may already exist
Alzheimer Scotland has a set of translated leaflets on dementia
which can be downloaded free from their website
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Improving access to information (2)
Different media formats may work
better
DVD may work better than leaflets for
some communities, especially if they are
not literate in their own language
Consider content – using simple
language and avoiding jargon
SCIE guide – use of ‘jargon busters’
from community groups
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Improving access to information (3)
Health and social care services are
making increasing use of advice lines
May actually INCREASE inequalities
“There is lack of information in Gujarati on
benefits, social and health care services to
this particular over-50s women’s group. The
women say that there is no system where
they can just pick up the phone and get help
from services.”
– (Manthorpe et al, 2009)
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Also remember that…
Access to information varies
History of migration meant many older
people worked in health and social care
Older Black Caribbean women had better
levels of knowledge (Moriarty and Butt,
2004)
Experience of member of advisory group at
Carers’ Group very negative
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What role do our expectations play?
Differing expectations may influence
help we seek/expect (Chahal and
Temple, 2005)
Existence of stigma?
Preferences for different types of
treatment?
Lack of cross cultural studies in this
area
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Attitudes of professionals
Professionals may also create
barriers to accessing and using
services
Stereotyped expectations about extent
of family support (Katbamna et al, 2004)
‘They look after their own’ classic phrase
Existence of racism (Butt and O’Neill,
2004)
Unspoken issue (Culley, 2006)
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Diversity among workforce
Workforce may not
share same
cultural
backgrounds
Image from Simon Rawle’s
photographs taken for
International Migrant
Workers’ day for UNISON
http://www.unison.org.uk/file/
MWphotoexhib.pdf
Katrzyna Lichwala
Poland
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Increasing professionals’
knowledge
Consider content of professional
qualifying programmes
Role of guidelines for measuring
‘cultural competence’ as in the US?
Training across the workforce
Access to training among (non
professionally qualified) care workforce
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Emphasising that it is an important
component of the work…
2006 Social Work
recruitment
campaign featured
older Black
Caribbean man
(But celebrity
culture in 2009!)
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Making services more accessible
‘Link workers’ can improve
experiences of GP services, hospital
appointments
Role of community groups providing
advocacy and outreach
(Moriarty & Butt, 2004, Manthorpe et al, 2009)
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However….
Relationships with ‘link’ people
and/interpreters may be ambivalent
(Chau, 2007)
Benefits of improving workforce
diversity
Importance of recruiting bilingual
workers
‘El Portal’
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Providing culturally specific services
Role of culturally
specific services?
Most often for day
care/lunch clubs
Sometimes for
home care
Image from Age
Concern Lewisham and
Southwark Black Elders
Mental Health Day
Centre
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However….
How can we bring culturally sensitive
services into the mainstream?
Issues about funding (Butt and Mirza,
1996)
Groups may be in competition with each
other (Bowes, 2006)
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Making mainstream services more
culturally sensitive
In addition to using knowledge of
workforce….
Learn from expertise of people using
services
Dietary advice from Black Caribbeans
(Brown et al. 2007)
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Increasing public engagement
Different methods
of consultation are
needed for
different
communities
Events versus
surveys may get
better response
Photograph from ‘Listening event’
for Healthcare Commission
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New challenges?
Increasing diversity
Presentation for Making Research Count
London borough high proportion of
bilingual/bicultural workers – challenges of
new languages
Effects of personalisation?
Will it improve services or increase
inequalities?
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Using evidence on the health needs of black and minority