This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information
Section three: Policy and planning
Equal opportunities policies and action plans are becoming more commonplace within the public sector, not least because of the impact of the Stephen Lawrence Inquiry. But are these policies making a difference? Do the policy and planning processes have equality and diversity considerations as a core aspect?
Whilst some of the successes should not be ignored, the overwhelming evidence is that most local and health authorities are experiencing major difficulties embedding these issues into their strategic policy and planning frameworks.
Embedding the issues into the organisation's policy and planning framework
There are three types of organisations: those who make things happen; those who watch things happen; and those who wonder what happened.
(Anonymous)
How would you describe the NHS's tackling of race and equality issues in relation to the above quote?
Whatever your response - what is clear is that much more needs to be done if the NHS is to tackle the major employment and service delivery issues concerning Britain's Black and Minority ethnic communities. Organisational policies are extremely important. They not only set a framework for the organisation's work and give guidance to employees, but they also send out a signal to the outside world about the culture of the organisation and the issues that are viewed as important. However, unless policies are put into practice, then the exercise is only a paper one.
A constant criticism of both health and local authorities is that whilst there has been a notable increase in (race) equality policy documents, the problem is that they do not link into the mainstream decision making processes and are often left 'on the shelf'. The planning process is therefore crucial to ensuring that race and equality become mainstream issues and that implementation takes place.
In addition, there are ongoing concerns about the need to raise awareness of race and equality issues within a primary care-led NHS. Some of the prevalent existing incorrect assumptions that are made about culture and religion continue to cause concern and it is important to ensure that plans around the configuration of services are consistent with the changing needs and demands of an increasingly multi-racial and multi-cultural society.
Management paradigms
The government has placed much emphasis on the need for new management paradigms that reflect the demands of its modernisation agenda. This approach demands that the Health sector places 'the needs of its customer' as its ultimate concern. The Best Value regulations introduced in 1999 provide a useful template for taking this work forward. This legislation commits local authorities, the NHS and other public bodies (including the police), to a robust and rigorous analysis of services along the following lines:
- Best Value as a duty to the public should enhance local democracy and accountability
- Best Value should be owned by local government. The framework for Best Value should balance motivation and regulation.
- The delivery of Best Value to the public must benefit from the shared experience of best practice in local government.
- To ensure Best Value, all local authority activities must be consistent with a local authority’s corporate aims and its core policy values, respond to the needs of local people, and respond quickly to evidence of failure.
- Best Value must be demonstrated to the public.
- Best Value must be shaped by the active involvement of citizens, employees, the private sector and other social partners.
A detailed examination of the above should lead to the conclusion that there is a great opportunity for race and diversity issues to be seen as the norm. In fact, it is difficult to see how an organisation can truly embrace the Best Value approach without addressing equality issues throughout.
This has been reinforced by the requirements of the Race Relations (Amendment) Act 2000 and the fact that from April 2002 a local authority’s progress on the Schemes and on the Equality Standard is a best value performance indicator. Although the Standard does not immediately apply to health authorities or PCT’s it could be adapted, easily, for use in Health organisations.
Chandra (1996), in arguing the need for mainstreaming race issues into NHS policy and planning processes, argued for a 'paradigm shift'. He contended that those health authorities that had made progress, whether as purchasers or providers, recognised that what was required was a significant cultural change in their organisation. He argued that in these cases
...'they embarked on the task of organisational transformation not just because of the ethnicity issue but from their commitment to making organisations responsive to the needs of all residents, and a desire to offer genuine choice for patients'.
Figure IV: Chandra's paradigm shift model is set out below
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The Policy development and strategic planning process
A traditional management approach to policy development and strategic planning is set out below:
Figure V: A traditional management approach to policy development
In developing a model to explore issues of race and equality within the Health sector, we have devised the following checklist / framework for managers.
Planning stage:
Corporate planning
- Ensure your departmental/management/team meetings discuss issues relating to race and equality. The more this happens, the more 'natural' it becomes.
- Ensure that your vision / mission statements recognise that your organisation serves a diverse and multi-cultural society. This does not mean that there should be an explicit statement - but then again, why not?
- Regularly revisit the issues. Analyse whether equal opportunities are apparent in organisational practices in relation to both employment and service delivery practices.
- Set up mechanisms for checking progress with staff (including Black and Minority ethnic staff) and external organisations that work on race issues.
Business planning
- Ensure business planning structures and mechanisms address the issues. Search for meaning - do not simply rely on the rhetoric. For example, if you have decided to consult with Black and Minority ethnic groups, be clear about the purpose, who you will speak to and what you intend to do upon completion of the process.
- Set targets. Identify key people and set aside appropriate resources to support the objectives.
- Ensure that when monitoring and reviewing outcomes, remedial action is agreed where targets are not being achieved. It is not acceptable to monitor just for the sake of it.
- Ensure that equality considerations are central to each business plan objective. Speak to the workers who have the interface with customers - this will enhance this mainstreaming of race within the business plan process.
For example, the role of the nurse is key. The nurse has an interface with a diverse group of customers whilst undertaking a very varied role. In tapping into this professional's knowledge base, experience and views you begin the process of analysis. However, a robust questioning approach about race and equality - perhaps involving external perspectives - will be necessary to enhance the business planning process.
Product planning
- Ask the question - 'what is my product?' 'What actual service am I providing?' 'Is it designed well enough to meet the needs of Black and Minority ethnic customers?’ For example, a breast-screening provider should question whether cultural considerations are being explored well enough in order to ensure an adequate take-up of the service from Asian women.
- Consider whether your 'product' might need to be packaged separately to meet the needs of Black and Minority ethnic customers. For example, it may be more advantageous to promote certain health promotion initiatives solely for a specific ethnic group. A number of health trusts have found that the take-up of sexual health initiatives increased amongst African and African Caribbean young males when this approach was used.
- Ask Black and Minority ethnic people their views about the 'product' before the implementation stage.
Implementation stage:
Organising level
- Ensure there is clarity about who has ultimate responsibility for delivery - and that all members of staff are clear about their role.
- Ensure that the implementation stage builds in a process for remedial action which can be enacted before the end of the process if necessary. For example, a local authority expressed a commitment to increasing the numbers of Black and Minority ethnic staff at senior levels. However, at the long-listing stage of the recruitment process they established that there were no Black and Minority ethnic applicants. Rather than continuing the process they agreed a process for attracting more Black applicants within an equal opportunities framework. The point is that this was sanctioned before implementing the recruitment process.
Implementation level
- Consider the appropriateness (or otherwise) of Black staff doing the 'implementation'. For example, it may be more suitable for an African nurse to be the 'first face' for comforting a particular African family who have just experienced a bereavement. Conversely, consider whether it is appropriate for only Black staff to be involved in 'Black issue' related themes.
- Could a particular service be better provided or 'implemented' by a Black and Minority ethnic group? Should you be working in partnership with an external body in delivering the particular service?
Controlling stage:
Measuring the results
- Ensure that systems are already in place to record and adequately measure the results. Previous discussions should have made clear exactly what you want to measure and why. However it is important that the systems are flexible enough to incorporate new data that may be relevant.
- Be clear about what is for internal and external use and ensure that sensitive and confidential data is not used inappropriately.
- There will need to be a qualitative element to the measuring and diagnosing stages.
Diagnosing the results
- Utilise Black and Minority ethnic staff, customers and external groups (using appropriate mechanisms) when diagnosing the results.
- Make sure that you relate the emerging themes to the core aims of the organisation to ensure relevance and to reinforce their importance.
Taking corrective action
- This is important. Failure to do so will invalidate the whole process and will often lead to resentment from Black and Minority ethnic staff, customers (also potential customers) and will ultimately impede the organisation's quest to deliver its agenda.
- Ensure that the corporate systems (both at formal and informal levels) consider the data emerging from the whole process and that corrective action is taken.
Making policy and planning work for your team
The checklist introduced above provides a useful catalyst for planning change. However, what is required is ongoing discussion and dialogue within the organisation and within your team.
Exercise 3.1 Group activity: As a group, consider:
(a) What legislation, policies / initiatives (in your organisation) are designed to address the issue of race and equality? (Make a list - outlining anything that comes to mind - even if you are unsure of its accuracy. Discuss the list as a group and try to reach a consensus.
(b) What are the barriers or blockages to the implementation of the policies identified? (Again, list them - but this time have a robust discussion about the issues. Encourage both disagreement and consensus).
(c) How can the organisation overcome these blockages? (Be as specific as possible here. This list will form the beginning of a strategic discussion towards an action plan for your organisation - using the legislation and your organisation's policy framework as a starting point. To develop this further, refer to the Equality Standard Guidance notes 1 on Audit and self-assessment.)
A holistic policy and planning process
The provisions for a Race Equality Scheme and the Equality Standard pose a series of questions designed to help organisations establish a robust policy and planning framework. An effective organisation would therefore have the following elements which would, in turn, assist the organisation's mainstream objectives.
- An up-to-date equality policy. This policy would make provision for the needs of Black and Minority ethnic groups who may also experience multiple discrimination (i.e. on the grounds of age, disability, sexuality, etc).
- Written policies that are in line with the 1976 Race Relations Act as amended by the 2000 Act and the CRE's Codes of Practice and other relevant legislation.
- Corporate and departmental policies that have been endorsed by senior officers and relevant Management Boards.
- Readily available documented evidence which demonstrates the above.
- Racial Equality Action plans that are specific, measurable, realistic and time-tabled; and endorsed at corporate and directorate level.
- Racial Equality plans that are 'active' within all directorates.
- Clearly defined organisational structures that are resourced to ensure racial equality implementation and reviews.
- Regular consultation with staff and service users about the content of the relevant policies.
- Use of relevant data - e.g. Surveys, workforce (ethnic) profiles, etc. to inform policy development and implementation.
- Ethnic monitoring systems.
- Job descriptions with integrated racial equality objectives.
- Performance indicators for senior managers.