Hidden voices – understanding health inequalities in Bedford Borough – Denny review

Healthwatch Bedford Borough undertook research on health inequalities in Bedford Borough. To give a voice to residents from minority or disadvantaged communities in Bedford, Healthwatch Bedford Borough were commissioned by the Denny Review steering group to engage with the Gypsy and Traveller community in Bedford Borough and with women from ethnic minority groups living in areas of multiple deprivation in Bedford Borough.

Three overarching themes appeared repeatedly in the responses given by participants in each of the groups, across all the questions discussed:

• Interpreters: Women in each of the focus groups mentioned language difficulties when discussing what hadn’t gone well for them, self-care, and what they wanted from the NHS. All the women said that they could become overwhelmed with information. Only one of the women in the Bangladeshi group said that she was able to read or write in English, whilst only one woman in the Bulgarian group could speak, read, or write in English. All of the women in these two groups said that they needed support from an Interpreter. Most participants said that health professionals will sometimes use words they do not know.
• Literacy: Almost all of the Gypsies and Travellers who participated in this study described literacy as a barrier to meaningful communication about their health or social care. About half described it as the most important barrier, using terms such as struggle and embarrassment. One person describes their feeling of shame in not to be able to read or write. When reading and writing is not an issue, participants still said that they worried about the impact of this on rest of their community. Only two or three people out of nineteen interviewed felt that literacy was not a barrier for them.
• Understanding of culture: Participants describe negative experiences that have arisen due to a lack of cultural understanding and competency, leading to discrimination and unequal treatment. Institutional racism, arising from systems, structures or expectations established within organisations, is not isolated to discriminatory incidents but also manifests in practices which exclude sections of the community. This includes ‘habits of thought’ which are not examined deeply.

The report contains five recommendations.