NHS Action Plan on Racial Discrimination (Hansard, 2 July 2001)

§ Baroness Whitaker
asked Her Majesty's Government:
How they propose to take forward the National Health Service action plan on racial discrimination.

§ Lord Hunt of Kings Heath
My Lords, much work has been done through the Tackling Racial Harassment programme to develop and disseminate practical tools to tackle harassment. We shall shortly publish guidance based on that. We are now initiating a new phase of action to ensure that tackling harassment is performance-managed as a mainstream human resources priority.

§ Baroness Whitaker
My Lords, I thank my noble friend for that positive Answer. However, can he say whether, and, if so, when, he will publish the research on racism in the NHS that was carried out with the participation of more than 500 NHS staff by Lemos and Crane and completed last autumn?

§ Lord Hunt of Kings Heath
My Lords, the report of the analysis of staff attitudes to racial harassment will be published when it has been peer reviewed, as is normal practice for research commissioned by the department. As I said, we shall also publish guidance as soon as possible.

§ Lord Dholakia
My Lords, will the Minister invite the Commission for Racial Equality to mount a formal investigation, as has occurred in a number of other government departments—in particular, in the Prison Service—to examine the extent of racial discrimination? Once the extent of racial discrimination has been proved, and bearing in mind that a substantial part of NHS services is provided by people from ethnic minorities, will he say whether such an investigation could be backed up by statutory obligation through the issue of a non-discrimination notice that can be monitored regularly?

§ Lord Hunt of Kings Heath
My Lords, I do not believe that I am able to give that commitment. But I shall certainly commit the department to discussions with the Commission for Racial Equality, whose advice we often seek and greatly value. The noble Lord makes an important point in relation to the NHS workforce; for example, approximately 33 per cent of hospital medical staff come from black and minority ethnic groups. I believe that we must do everything that we can to ensure that the NHS has, and supports, an environment in which racial discrimination is not tolerated.

§ Lord Clement-Jones
My Lords, from the recent report of the King's Fund, Racism in Medicine, it is clear that in many cases the problem starts in medical 626 schools. Can the Minister say what action he, together with his colleagues in the DES, has taken to ensure that the problem is tackled at that point?

§ Lord Hunt of Kings Heath
My Lords, the noble Lord raises an important point which I suggest applies as much to nursing courses at universities as it does to medical schools. He will understand that it is primarily a matter for universities. We are committed to a policy of diversity and equality of opportunity in the health service. Clearly we work in collaboration with our university colleagues. We welcome the fact that the Council of the Heads of Medical Schools is addressing those issues via their statement of guiding principles for the admission of medical students. However, it is certainly a matter which the Department of Health will continue to discuss with the relevant government departments and individual medical schools.

§ Lord Lester of Herne Hill
My Lords, is the Minister able to tell the House approximately when the new positive obligations that will be imposed on the health service and on universities, including medical schools, under the Race Relations (Amendment) Act will be brought into force?

§ Lord Hunt of Kings Heath
My Lords, I am not able to give the noble Lord a specific answer to that question. However, clearly it is most important that the amendment to the Race Relations Act, which will have such an important role to play in the provision of public services in the future, is taken seriously. It is also important that a full implementation programme is put in place to ensure that the provisions of the Act are seen to be as sensitive as possible to racial diversity in relation to the experience of people who work under and use those services.

§ Baroness Howells of St Davids
My Lords, if the Government do not propose to use the CRE, will the Minister tell the House how they will monitor and evaluate what happens during the modernisation programme? We are concerned about how the decision-makers will take into account what the professionals and patients say in relation to the delivery of the service.

§ Lord Hunt of Kings Heath
My Lords, we have set national targets for NHS employers to take effective action to tackle harassment. We shall also require local employers to publish information on progress in their annual equality statements. As part of the zero tolerance campaign, we are planning guidance and publicity materials on how to deal with NHS service users and members of the public who harass, bully or demonstrate violence towards NHS staff. We are also committed to issuing guidance on the withdrawal of treatment in the last resort from abusive and violent patients and members of the public, including from those who demonstrate racial abuse towards staff. I expect clear guidance to the NHS about how it is to take forward these issues to form part of our overall performance management system in the health service. 627 We are determined that the NHS will prove to be a model employer and provider of services in such circumstances.

Lord A.vebury
My Lords, does the Minister agree that the problem of violence against staff has been in existence for a long time? What advice has been given to hospitals about the growing menace of racially motivated attacks on ethnic minority staff in accident and emergency departments? Is that not an urgent problem which needs to be addressed before any guidance is issued?

§ Lord Hunt of Kings Heath
My Lords, I could not agree more with the noble Lord. I believe that violence towards NHS staff is reprehensible under any circumstances; how much more so when there are racist elements to it. Often the circumstances in which the attacks, either verbal or physical, take place are those in which staff are trying to do their best for people. As an employer, we have a major responsibility to ensure that staff are supported in all ways possible. Part of the work that we are carrying out in relation to the no-tolerance policy, which I commend to the House, involves offering specific guidance in those areas. Good practice is to be seen in many parts of the NHS. Clearly one of our aims is to ensure that that is shared across the service as a whole.

§ The Earl of Onslow
My Lords, before we become over-excited, my daughter, who works in the accident and emergency service, says that harassment and bloody-mindedness in accident and emergency departments is normally related to drink and has nothing to do with racism. It is a matter of yobbish behaviour by everyone, and it does not matter whether the nurse is white, black, pink or khaki. It is the yobbish behaviour that is important. Let us not become too hung up about the racial element, which distorts our judgment in these matters.

§ Lord Hunt of Kings Heath
My Lords, I do not agree with that. Of course, examples of yobbish and hooligan behaviour are to be seen in people from all backgrounds. It is something that we deplore and must take action against. However, there is sufficient evidence from any number of studies that some NHS staff from black and minority ethnic backgrounds have been subject to particularly scurrilous and disturbing attacks, whether physical or oral. As employers and citizens, we must do everything that we can to stamp that out, and it is why we must have a policy of no tolerance. It is simply not acceptable that staff should have to put up with some of the behaviour that they experience at present.

§ Lord Harrison
My Lords, does my noble friend recognise that there is a higher incidence of diabetes—both types 1 and 2—among the black and Asian community? Is it possible that some indirect racial discrimination is occurring in terms of the provision of resources?

§ Lord Hunt of Kings Heath
My Lords, my noble friend is right to identify particular aspects of illness among different groups in this country. We are developing a national service framework in relation to diabetes which I hope will tackle the issues that he has raised. In ensuring that we provide services to the whole of our community, it is important that we get right our employment policies and the issue of entry to medical and nursing schools. I believe that if we sort out matters relating to employment and the way in which staff are dealt with, that will have a major impact on service provision.

§ Baroness Carnegy of Lour
My Lords, is this not far too important a matter for the Government to try to micro-manage at the centre? One million people work in the National Health Service. How can the Government manage that? If the law is up to date, why do they not leave it to local t rusts to ensure that the law is enforced?

§ Lord Hunt of Kings Heath
My Lords, we do not micromanage the health service. We have a performance management system that focuses on the core targets that we expect local NHS bodies to deliver. We have to back that up with guidance and ensure that it is achieved. On the issue that the noble Baroness raised, action will of course be taken at the local level. We depend on leadership at that level to ensure that our aim is achieved. Our job at the centre is to provide helpful guidance and advice and to back that up with robust performance management in those areas in which it is absolutely vital to deliver a service throughout the country.

§ Lord Roberts of Conwy
My Lords, does the Minister agree that the most prominent form of discrimination in the health service involves postcode prescribing? Have the Government got new initiatives to deal with that?

§ Lord Hunt of Kings Heath
Yes, my Lords. Our initiative involves the National Institute for Clinical Excellence, which is designed to remove the postcode prescribing that we inherited. It helps to ensure that there is robust advice throughout the NHS about which treatments, drugs and clinical pathways of care work best. That is having and will continue to have an enormous effect in ensuring consistency of approach throughout the country.