Equality & Human Rights: Policy; Theory; Practice
Week 19
Dr Alya Khan
CQC Equality Objectives 2017-19
- This week we will explore the Care Quality Commission’s current ‘equality objectives’
- They aim to target inequalities in UK health & social care provision
- We will consider the relationship between theories we have studied, the design of the ‘equality objectives’, & the plan to roll them out
CQC ‘Equality Objectives’
- The Care Quality Commission published their ‘equality objectives’ on 23 March 2017 (new)
- Why were these created?
- These objectives address the CQC’s role in regulating the health & social care sector, to improve equality
- CQC (2017): “Despite progress on equality, people from some equality groups are still less likely to receive good quality health and social care.”
A need to improve was identified & the objectives were developed to address this.
What is the Strategy?
- The Equality Act (2010) legally REQUIRES the CQC to set objectives every 4 years
- Time-frame to roll out the equality objectives: 2 years (2017 -2019)
- CQC plan: to regularly inspect health & social care providers, to check how far the equality objectives are being met
- 5 equality objectives
The Equality Objectives
How were they Developed?
CQC (2017):
- reviewed evidence of inequality in health and social care and in the CQC workforce
- gathered ideas from CQC staff, external organisations and people who use services
- engaged with these groups to help set priorities, by considering the impact of the inequality, the unique ability of CQC to make a difference and whether the issue has been neglected
- made sure that they reflect the changes in regulation from April 2017 by helping inspectors to look at equality issues that are already known
- Used guidance from the Equality and Human Rights Commission about selecting and prioritising equality objectives and making them specific and measurable.
Why Focus on Equality & Human rights?
- Issues of equality & human rights are often viewed in practice as a PROBLEM
- But, could there be reasons for viewing them as SOLUTIONS?
- CQC claims that there are ethical, legal, business, & economic arguments for providers to attend to equality & human rights
- We have studied some theoretical approaches: let’s revisit some of these
Human Rights in Healthcare
- The “FREDA principles”:
Fairness
Respect
Equality
Dignity
Autonomy
Applying these principles is seen as ETHICAL (doing what is morally right), & it fits with the NHS constitution & foundations. It’s a matter of SOCIAL JUSTICE: organising the institutions of health & social care in the right way
Person-centred care
- Person-centred care (objective 1.) is a human rights approach to care.
- This is because it is based on respect and autonomy.
- Person-centred care approaches are said to also help achieve equality. This is because they aim to meet individual needs. This includes needs based on people’s equality characteristics such as disability, culture, language, gender, religion, sexual orientation. This might include tackling barriers to equality faced by individuals. Removing these barriers might also improve care for others.
- A focus on promoting human rights and providing equally good access, experiences of care, and outcomes aims to create good quality care for all. However, equity does not mean treating everyone the same – it means treating everyone according to their needs. The focus is on the role of providers but this is a dynamic.
- Person-centred care is one of the requirements in CQC regulations(reg. 9)
- B. an instrumental reason for person-centred care can be made too, i.e.
- It’s a means to achieve better outcomes/consequences.
Service level
Person-centredness focuses on individuals
But sometimes, inequality must be tackled at service level. Barriers to equality may need removing for whole groups, not just individuals.
Example: Lesbian, gay, bisexual, transgender and intersex (LGBT&I) people can face discrimination, prejudice, misunderstanding or ignorance when using adult social care services. This means they can be afraid to “come out” when needing adult social care. This can affect their wellbeing and whether person-centred care is possible for them
CQC (2017), equally outstanding: Equality and human rights – good practice resource, p.9
Empowering people and communities
- Why do some people have poorer experience and outcomes from care?
Robert’s story
Robert was interviewed when he was on his way back up. A few years earlier he had a complete breakdown in his mental health. In his case, this was a result of the childhood trauma of losing a parent to suicide. He ended up on the streets, frequently being arrested, sectioned, medicated and discharged.
Eventually he found actual help when he heard about a place for people who had a mental illness and who were African Caribbean. With a secure roof over his head, and an environment he found supportive, he could start working on his recovery, start working on putting back together a life that had been torn apart with his breakdown.
These were things that the police, NHS, and homelessness services had not done. (p. 37)
WHY do you think Robert may have had these experiences of care?
Some reasons why…
Comparatively poorer experience and poorer outcomes for black and minority ethnic communities who use health and care services has been explained by:
- Racism
- Lack of spread of better practice across all provision (often, local changes only)
- Uncertainty/disagreement on ‘what works’
Empowerment
- The Race Equality Foundation looked at examples of good and best practice in black mental health together with MHPF (now MHPA) in 2014. In particular, they found two keys to success:-
- 1 the inclusion of broader services beyond specific and medicalised mental health services. These services. These services provide a more accessible and culturally appropriate way into discussing and addressing mental health issues. Services that seek to support the broad needs of the individual and the community they are in, and support their right to involvement in both services and the community creates a far more positive and engaged process. It is also a process that strengthens the rights of the individual, and those in their community who may need these services in future.
- Service user involvement was also a common feature, but had important differences between providers. The focus on what individuals can do, and can do now, meant service users and former service users were involved in service design and delivery in some organisations. In other organisations, they became advocates within the community and/or were supported into representative roles on local boards and forums.
An example
Dhek Bhal, Bristol
Dhek Bhal, an organisation supporting South Asian people provides:
- a‘sit-in service to give a break to carers,
- Home care service for elderly, support around the home, washing, dressing, cooking, taking medication, cleaning, companionship, read the inspection report here.
- Day care service and very vibrant luncheon club, a range of activities, talks on health, diabetes, heart disease.
- Importantly, these services are an important gateway to addressing the key issue of mental health where it may otherwise be difficult.
(pp.38)
So equality & human rights can be a SOLUTION to improve health & social care
But it can’t be ignored that this can be difficult in times of financial constraint
The CQC does address how providers can try to minimise risks & balance budgets
Aim to prevent problems/issues in the first place (see pp. 28-33) – Is this ethical?
What about the workers?
- The ‘equality objectives’ address the conditions & treatment of health & social care workers, as well as the service-users
- e. Improving equality in the workforce Look at data on e.g. race equality, disability equality, gender equality, in the workforce; listen to views of staff re: equality; develop & implement effective interventions – examples? Problems? (E.g. gender pay gap)
Where are we now?
- 1 year in for the CQC ‘equality objectives’. ‘Transformational change projects’
Explore the current landscape; a lot of change
Consider how far services are meeting the theoretical ideals of equality & human rights
Concrete reality is non-ideal; how to negotiate this? Financial constraints – what are the limitations?
Where are we headed? From individual to more ‘population level’ models of care
Is this the right approach – morally, legally, financially..?
Further changes on the horizon: e.g. ACOs
References
Care Quality Commission, (2017), CQC’s Equality Objectives for 2017-19
Care Quality Commission, (2017), equally outstanding: Equality and human rights – good practice resource
Equality and Human Rights Commission, (2011, revised 2014), Objectives and the Equality Duty – a guide for public authorities.
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