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Minding the Gaps

One of the key findings of the Minding the Gaps report was that BME communities consider access to GPs to be the most significant health concern with regard to health services. As a result of this finding the BME Health Forum developed the Access to GPs project which resulted in the Primary Concern Report.

To view our Minding the Gaps report in PDF form, please click here.

This project aimed to:

Identify BME organisations who have not participated in public consultations and health activities.
Canvass the views of BME organisations that have participated in such activities about the value of participation.
Obtain the perceptions of BME organisations regarding the health issues that concern their communities.
Methodology

Two hundred groups and organisations in KCW were interviewed by specially trained volunteers nominated by BME organisations.

Main Findings:

Public Consultations

Our results showed that many organisations are confused by the word 'consultation'. While 101 organisations (50.5%) reported having taken part in a consultation it transpired that many were referring to workshops that provided information e.g. TB seminars rather than health policy/service consultations. Moreover, it appears that the PCTs and NHS Trusts, do not keep records of public consultations or make clear distinctions between what constitutes a consultation and what are information giving sessions. It is therefore not possible to assess the effectiveness of particular consultations from the perspective of the BME communities.

The conclusions and recommendations to the PCTs and NHS Trusts are:

• Tackle the confusion surrounding the term consultation, i.e. be clear about what constitutes a formal consultation and what constitutes information-giving or promotional events.
• When consulting, PCTs and NHS Trusts should state very clearly that they are seeking the public's views and what it is they are consulting about.
• Address the apparent lack of confidence in their intentions to listen to the views of BME communities.
• Develop proper structures for feeding back and demonstrate that participation in consultation influences policies and decision-making.
• Publicise consultations more effectively amongst BME communities and communicate information in the right format at the right time.
• Inform the community about the outcomes of consultations and the effect on local services.
• Keep records of consultations, including details about participation of BME communities so they can monitor the participation of various communities.

Engagement with the BME Health Forum

Out of 200 organisations, 84 (42%) indicated that they had participated in BME Health Forum activities. However, 175 organisations (87.5%) said that they would like to attend the Forum's meetings and events in the future.

The BME Health Forum has been successful in reaching out to BME communities in KCW. However, the feedback received highlights that there are some communities who have not been sufficiently involved in the Forum activities. The Forum now has appropriate data with which it can widen participation.

Health Activities in the community

Overall the vast majority of organisations in KCW (179 organisations, 89.5%) are involved in health activities. There are a variety of health related projects run by BME community organisations mainly around mental health and wellbeing, access to health services, physical activity, hospital and home visits for ill people, and healthy eating.

The PCTs' priorities and funding schemes influence these results. In particular, a large number of projects involving physical activity are funded by the PCTs. In contrast, projects around access and other essential support such as home and hospital visits are far less likely to be funded. Nonetheless, many groups clearly consider these activities to be a priority and a number of organisations are supporting people register with a GP, interpret for them and offer support through the system when things go wrong. The fact that these activities are continuing despite little or no funding indicates the level of real need and commitment in the community.

Conclusions and recommendations to NHS Trusts from this section are:

• The priorities of BME communities, especially regarding access to services, must be
properly catered for when designing and delivering health information and awareness sessions.

• Supplementary schools must be targeted in their campaigns and included in the Healthy Schools programmes.
• The NHS must work with BME organisations as partners and service providers, particularly in the light of the introduction of "Commissioning a Patient-Led NHS" and "Practice Based Commissioning". Community-based groups and organisations play a crucial role in improving the health of their communities and for many BME communities their community-based group is their gateway to accessing public services.

Interest in developing further projects

Out of a total of 200 organisations 179 (89.5%) would like to develop further health related activities. This shows that BME groups consider health as a key issue for their communities and are interested in addressing it by developing health activities and projects. BME organisations can therefore play a key role in improving the health of their communities if they are given the necessary support to develop their services.

Health Concerns

Access to services, GP practices in particular, is the single most important health concern reported by community organisations. Problems about accessing health services were mentioned by 110 organisations (55%). Arguably, the persistence of this issue over so many years indicates a fundamental flaw in the way PCTs have dealt with it so far. The steady increase in spending on interpreting and translation services in KCW over the last few years has been necessary, important and welcome. However, overcoming the language barrier cannot be dealt with in isolation of the other aspects of access to services, i.e. interaction with GPs and registration. The fact that access is still a major health issue to so many BME organisations shows that without adopting a holistic approach to this issue, real change will remain out of reach.

In terms of Health Conditions and Lifestyles, mental health and wellbeing is the most pressing health concern in BME communities. Other major health concerns included diabetes, sexual health and HIV, high blood pressure, substance misuse and heart disease.

The conclusions and recommendations from this section:

• The focus of the PCTs and NHS Trusts should be on addressing the gaps and weaknesses in services. This should include raising awareness of access issues and training provision amongst health professionals, especially GPs, practice managers and receptionists. While, patient education and developing the BME communities' understanding of health provision is important and should be catered for, the focus must remain on the need to examine all aspects of access to ensure that needs are met.
• Ethnicity data: collection of ethnicity data at primary and secondary care levels is essential to understanding inequalities in access to health services.

Unregulated Migrants

During our research, we found that many organisations provide a wide range of health related services to unregulated migrants (include failed asylum seekers, overstayers, and others who are in breach of UK immigration regulations). These services include counselling and support for mental wellbeing issues, support in accessing services, interpreting, and information on various health issues. These organisations talked of the very serious distress that unregulated migrants suffer which is related to immigration problems and the associated lack of access to NHS services.

This humanitarian issue needs to be addressed. From a pragmatic perspective, the lack of access to primary care services faced by unregulated migrants increases pressure on A&E and hospitals, because minor health problems that could be easily and cheaply dealt with at primary care level are allowed to develop into emergencies. Currently, the government accepts that unregulated migrants are entitled to emergency health care on a humanitarian basis but has limited their access to primary care. This undermines other efforts to make NHS services seamless and promote community based services. It is clear, that this situation cannot be allowed to continue and that the DH need to ensure that this group, has full access to NHS services.

Next Steps

To take this report forward the BME Health Forum will be working with the PCTs, GPs and stakeholders in order to develop policies and structures to address the health needs of BME communities and to ensure that these communities are properly involved in the planning and commissioning of health care in the area.

Furthermore, it will develop projects and task groups to address some of the findings of this project. Concern about access to GPs, which is one of the main findings of the report, will be addressed by a project that will be developed by the Forum in due course to improve access to GP services for people from BME communities.

Moreover, the Forum recognises that it has not been able to reach out to and involve some BME communities due to lack of capacity. Therefore, involving new communities in our work is one of our priorities for the next year and efforts will be made to engage with those who have not been involved in the past.