Making local healthcare equal: healthcare concerns in Black and Asian communities

Healthwatch Hertfordshire wanted to understand the experience of Black and Asian people in accessing and using health and social care services. They used a variety of methodologies to speak to local people and interviewed senior people in local NHS trusts and CCGs to understand their EDI policies.  They spoke to 156 people.

Although experiences differed, Black and Asian people typically felt that the healthcare system was not designed to deliver fair and culturally competent care. Respondents shared experiences of not being listened to and feeling discriminated against, which for many contributed to a significant lack of trust in the healthcare system to provide adequate and person-centred care.

Over two in five  respondents felt that their health is not equally protected by the NHS compared to the health of a White person. Mistrust in the NHS stems from many places, including their own, or their family and friends’ negative lived experience, the disproportionate impact of COVID-19 on Black and Asian communities, and the existence of ethnic health inequalities more broadly.

A similar proportion felt they had been discriminated against in a healthcare setting, with many believing this was because of their ethnicity. Experiences included the use of racial stereotypes and mistreatment from healthcare professionals. Respondents felt that as a result, they were not listened to and had their healthcare concerns dismissed in a way that their White counterparts would not, resulting in mistrust and a reluctance to engage with healthcare services.

Respondents felt that healthcare professionals do not always have an adequate understanding of conditions that primarily affect Black and Asian people, or how conditions may present on darker complexions. Respondents felt that this resulted in late or incorrect diagnoses.

A lack of cultural competency in care meant dietary, language, religious and cultural needs and preferences were not always respected or accommodated.

Although all Trusts and CCGs emphasised a strong commitment to tackling ethnic inequality, more work needs to be done to provide equal and fair care to all patients. NHS policies and strategies often do not address ethnicity specifically, and do not look at the specific needs of Black and Asian communities.

Training on cultural competency within the NHS is limited, and not offered to all staff. Language preferences are often not recorded and translation support is not always forthcoming from healthcare professionals.

Communications often homogenise all ethnic groups by using collective terminology, such as ‘BAME’. The recording and collection of patient ethnicity data by NHS services is inconsistent and is not often used to highlight where health disparities may exist for Black and Asian communities. NHS services do not directly engage with local Black and Asian communities, preventing services from understanding their needs and experiences.

The report makes 16 recommendations to providers and commissioners.