Barriers to Accessing Health Care Services

In this essay I am going to critically analyse diversity within the National Health Service (NHS. I will briefly focus on barriers to accessing health care services in relation to age, race, disability, gender and culture and sexual orientation. I will consider the barriers which have unintentionally been put into place within different health services for both service users and members of staff, and the measures that have been taken in order to redress these issues by the government, NHS and Department of Health (DOH).

Diversity is the inclusion of all irrespective of an individual’s age, race, capabilities, cultural background, gender or sexual orientation. The St. Helens and Knowsley NHS trust affirm this ideal describing diversity as, “Different individuals valuing each other regardless of skin, intellect, talents or years. ” This is a quote the St. Helen’s and Knowsley trust have used from the Equality Act 2000 on their website to show their beliefs surrounding diversity.

In society every individual is born differently, such as hair colour, skin colour, male or female, sexual orientation (depending on your belief that sexual orientation is genetic and not environmental), born into different religious and cultural backgrounds. As the U. K. has become ever more a multi-cultural society, issues such as diversity and anti-discriminatory practices have become ever more significant within our society. An individual who has been treated differently or received an unequal quality of service based on a preconceived idea due to a minority group they may identify themselves with have been discriminated against.

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Within the NHS these minority groups are known as characteristics, as in characteristics which help build an individual’s idea of their own self-concept. Since the Equality Act was up-dated in 2010 the NHS have not only included race, culture, gender, capabilities, religious beliefs and sexual orientation but also now include, pregnancy/ maternity, marriage/civil partnerships and carers as part of their protected characteristics policy. (http://www. nhs. uk). For the first time the law also protects people who are at risk of discrimination by association or perception. This could include, for example, a carer who cares for a disabled person” (http://www. nhs. uk) There are two forms which discrimination can take place the first is called direct discrimination. Direct discrimination is when an individual is treated differently usually negatively or unfairly compared to others based on the individual identifying themself with one of the above protected characteristics.

Indirect discrimination is when a law, policy or procedure has been put into place, which applies to everyone, but this law, policy or procedure will disadvantage individuals who associate or identify themselves with the above protected characteristics. However due to organisations focusing too much on anti-discriminatory practice a new controversial concept of positive discrimination has begun to emerge, this is also being called positive/ affirmative action.

Positive discrimination is where minorities or individuals, who associate or identify themselves with the protected characteristics, are given preferential treatment to others. An example of this would be two candidates who are both equally qualified for a job, however one candidate is a white, heterosexual male and the other candidate is a black, homosexual female, by positive discrimination the second candidate would receive the position.

Positive discrimination can be due to pressure felt by the organisation to employ a diverse work force, to fill a quota to ensure the organisation cannot be accused of being discriminatory or historical guilt for issues such slavery. “The idea of positive discrimination came from the US where an ‘affirmative action’ programme has been used to try and ensure the make-up of certain workplaces reflects that of society. ” (http://www. findlaw. co. uk) It has been suggested that the root cause of discrimination is due to prejudice.

Prejudice is a stereotyped, pre-conceived idea of the way an individual or social group should portray themselves within society (Walsh et al, 2005). For example all Irish people drink alcohol excessively. “Prejudices can be a result of your own beliefs and values, which can often come into conflict with work situations. ” (Pg. 194, Nolan et al, 2005). There are no laws in place against being actively prejudice, this is why the law concentrates against discriminatory practices. (Walsh et al, 2005. )

Ageism is commonly thought of as discrimination against the elderly; many nursing and health and social care textbooks affirm this belief, Kydd et al (2009, Pg. 49) state that “Ageism is the generalisation of old age as a social problem, this has contributed to the negative stereotyping and ageist practices in relation to older people. ” However this is a false perception. Ageism can affect individuals of all ages, for example in 2004 the upper age limitations of free breast screening were 69, (http://www. imsersomayores. sic) however due to a growing older population this age restriction was raised to 73 in 2010 and the lower age limitation remained at 47. (http://www. cancerscreening. nhs. uk). Studies carried by the cancer research charity show “The 5 Most Commonly Diagnosed Cancers in Females, Average Percentages and Numbers of New Cases, by Age, UK, 2007-2009” (http://www. cancerresearchuk. org). Breast cancer is highest in both categories of women aged 25-49 and 50-74, however in the group 25-49 breast cancer was more prevalent by 10% (43%) compare to the 34% in the group of women aged 50-74.

These figures show there is a need for the lower age restriction to be reduced. This NHS policy for age restrictions on breast screening needs to be reviewed as it can be viewed to be discriminatory towards women in the UK under 47 who are proven to be in need of this health service. Racism is the belief that one race is superior to another; (walsh et al, 2005) throughout history millions have faced discrimination and persecution due to this belief the most prevalent examples of this is in the Jewish community and the Black community.

As the UK continues to become a more diverse, multi- cultural society racism continues to plague Britain. Penketh (2000, Pg. 7) affirms this by stating, “Black people are more likely to be ‘stopped and searched’, arrested, imprisoned and even to die in custody than whites. ” Studies carried out by Unison, the UK’s largest healthcare trades union found that 70% of their non-Caucasian client’s employed by the NHS had experienced ‘racism or racial discrimination’ at work, some employees had experienced verbal abuse and physical abuse in relation to their race. (http://www. unison. org. uk).

From this study the NHS have brought out an initiative to help eradicate racism within the NHS, part of this initiative is to have a better complaints and redress system in place, as three quarters of the employees in this study who experienced racism or racial discrimination were unsatisfied with the outcome when the incident was reported to their management. Disablism refers to prejudices against individuals who have suffered ‘mental, physical or sensory impairments’. In the past words such as lunatic, spastic and cripple were acceptable words used within health care settings as a way to describe an individual with specific needs.

These terms are still rife within society today. (Walsh et al, 2005). Goodley (2011, Pg. 24) states “People with some form of impairment are likely to experience social disadvantage, a lack of opportunities and unfair discrimination. ” Barton (2002) agrees with this as Barton theorises that individuals with a sensory, physical or mental impairment will at some stage in their life experience oppression in both institutional and individual forms, this can be due to absence of choices, barriers to funding, unforeseen deterioration in their impairment or general ignorance.

Within the NHS discriminatory practices occurs on a regular basis despite programmes such as ‘Valuing People Now’ being released by the DOH in 2009, this was a three year strategy to help improve the quality of life for individuals with learning difficulties. This year MENCAP have released a report called ‘Death by Indifference: 74 deaths and Counting. ’ This report highlights the failings within the NHS to provide an equal quality of care for those with specific needs and learning difficulties.

The main areas of failing that subsequently lead to the needless deaths of many patients with learning difficulties are failure to recognise pain, poor communication, diagnostic overshadowing, and delayed treatments, inappropriate DNR’s and lack of basic care. Throughout the report it is emphasised the lack of compliance not only to the Equality Act but also the Mental Capacity Act, in relation to DNR’s being allocated to patients without the consent or the knowledge of the patient’s family, friends or advocate. Again a major issue within the report is the NHS complaints and redress system in place. MENCAP,2012) “In this report we deal with the inadequacies of the NHS complaints process.

On average it can take 18 months- 2 years to reach the Local stage, and between 2 years- 4 years to complete the ombudsman stage. ” (MENCAP,2012, Pg. 7). Sexism is the belief that one gender is superior compared to the opposite sex, it is generally felt that women tend to be sexually discriminated against within society more so than men. (Walsh et al 2005). Within the health care profession a patient may express a preference in the gender of the health care practitioner (HCP) who provides their personal care (Smith t al, 2011). This is not to be seen as sexual discrimination against the HCP, by noncompliance with the patient’s request this can be viewed as discrimination against the patient’s religious and cultural beliefs. However due to under funding and under staffing with the NHS the ability for HCP to fulfil these requests has been compromised. “Modesty in dress and a requirement to be treated by a doctor/nurse of the same sex is also important in some religions. NHS staff should consider these requirements in order to preserve the dignity of the patient.

However, it is not always possible or feasible to provide same-sex attendance, particularly without adequate notice that this might be an issue, and this should be made clear at the time of making appointments” (DOH, 2009) The Royal College recognise the need for a review within staffing levels within their 2011 report Mandatory Nurse Staffing levels, they also acknowledge the impact staffing levels have on a patient, they state, “There is a growing body of evidence which shows nurse staffing levels makes a difference to patient outcomes, patient experience, quality of care, and the efficiency of care delivered. (RCN, 2011). Within a female dominated profession such as nursing it is felt that males tend to be more so discriminated against sexually than females. A recent example of this on a national news level is the case of Andrew Moyhing, a male student nurse who won a sexual discrimination case against the NHS. He was told by a female staff nurse that he would need to be chaperone by a member of staff as he attached an electro-cardio machine to a female patient, due to ‘intimate care’ required .

Mr Moyhing felt this was unfair as female students on the same ward were unsupervised when carrying out personal hygiene and intimate care on male patients. The Equality Opportunities Commission supported Mr Moyhing releasing this statement, “The Employment Appeal Tribunal was right to find that it was not acceptable to have a chaperoning policy based on lazy stereotyping, Male nurses are still seen as a bit of an oddity simply because there are so many more women in the profession than men despite the fact that so many doctors are male. ” (www. ews. bbc. co. uk/1/hi/health). The charity ManKind this year released a report presenting the ‘Seven Challenges Male Victims Face’, it highlights various forms of sexism especially within statutory service such as the NHS, “Practically all training with in the police, NHS and local authorities is aimed at women as the victims, men as the perpetrators. ” (See appendix 2). Cultural discrimination is when a society does not accommodate or recognise the needs of an individual or group of people from a different religious or cultural background.

As a society there will be expectations of what the ‘social norms’ are, what is acceptable and what is not acceptable. When an individual or social group show beliefs or needs that do not fit in with our own social norms they can be met with hostility and intolerance. (Walsh et al, 2005). “Cultural barriers can prevent, for example consideration of spiritual, relational or dietary needs that do not conform to traditional expectations. ” (www. bridgingthegap. scot. nhs. uk).

There are many areas of patient care which are can be jeopardised due to ignorance of cultural beliefs, examples of these which are emphasised in the NHS guidelines for cultural and religious beliefs are: Diet- many religions are restricted as to what types of food they can eat, and how the food was prepared, for example an orthodox Jew will not eat pork or any meal that has come into contact with a pork product, Muslims also have similar beliefs surrounding food preparation.

Personal Hygiene- as mentioned before patients often express preference to the gender of the HCP who assist with their personal care. An orthodox Muslim will only wash in running water, therefore offering a basin of water to wash in may be seen as offensive. Palliative care and Dying- each religion has different views are to how a body should be ‘laid out’, when a patient dies the patient is given the Last Offices, if a patient is Christian a bible is also usually set in the room, however some religions find it offensive for anyone except the family to ‘lay the body out’. http://www. bfwh. nhs. uk). This is why more importance needs to be emphasised on patient admissions and filling in the ADL forms to the best of our ability, as it can prevent any future offence or discriminatory practices. As you can see in the Activities of Daily Living (ADL) (see appendix one) spiritual needs are mentioned, however the contents of the ADL will vary from trust to trust and all trusts do not include religion or spiritual needs.

In the caring profession patients have shown signs of frustration, confusion and anger as their cultural beliefs are not met, over looked or ignored. (Leininger, 1991). Discrimination based on sexual orientation, Roper, Logan and Tierney identify sexuality as one of the ADL (Mckenna et al, 2008), within each NHS trust it varies as to what is recognised as an ADL. As you can see (appendix one) the trust I work for have not included sexuality.

Many people within society see sex as a taboo subject and therefore find it a difficult topic to approach and discuss openly, however sexual health is a part of holistic health and should be taken as seriously as any other aspect of health such as mental, emotional or physical. The World Health Organisation defines health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. ”(WHO, 1948). Studies have shown that the homosexual community are greatly disadvantaged and are the least likely group that identify with the protected characteristics to access health services.

There are a variety of reasons due to this such as, a patient may not be openly gay, when they do access health services a majority of the time assumptions are made the reason for accessing that health service is related to the patients sexual health, also when homosexuals do access sexual health services they feel a stigma of promiscuity has been attached to the homosexual community. (Dunn et al, 2010). In conclusion from this essay I have realised barriers to health service access are a key factor in differential health outcomes among population groups within society. WHO, 2001) Although policies and procedures have been put in place by governing bodies to decrease the occurrence of discriminatory practice, these policies are not always effective; they are only effective when they are enforced by the organisation. Within the health care profession we must always strive to respect an all aspects of an individual’s identify and self-concept (Walsh et al, 2005). Simple measures such as filling in an ADL to the best of your ability can be a preventative method to causing future offence, or discrimination to a patient.

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