Ethnic inequalities have been found across a vast range of NHS services, a review has concluded, with differences being seen in access to mental healthcare, maternal and neonatal services, digital services, genetic testing and genomic medicine, and to the NHS workforce itself.
The review, funded by the NHS Race and Health Observatory and led by academics from Manchester University in conjunction with Sheffield and Sussex universities, found differences across each area studied. There were, it concluded, also differences between ethnic minority groups, with some communities found to have particularly poor access, experiences and outcomes.
The review has recommended “critical action” should therefore be undertaken by organisations, including NHS England, NHS Improvement and NHS Digital.
Some of the largest inequalities were found in mental healthcare, where treatment for Black groups was particularly poor. The review also found a lack of research into specific areas, including how outcomes may differ for ethnic minority babies in neonatal healthcare settings. Just one study was found to investigate health disparities in the care of ethnic minority newborn babies.
It found GPs were less likely to refer ethnic minority patients to the Improving Access to Psychological Therapies programme compared to White patients. Barriers were also faced by patients who delayed or avoided seeking help for health problems because of their fear of racist treatment from NHS healthcare professionals.
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Strikingly, there was evidence that ethnic inequalities in adult mental healthcare were being reproduced in younger people, with one study in the review showing that Black children were 10 times more likely to be referred to Child and Adolescent Mental Health Services (CAMHS) via social services rather than their GP service, in comparison to White British children.
In maternal care, there were some positive relationships with midwives – however, this was limited by poor communication between women and health providers. Women who did not speak English as a first language also often lacked access to quality interpreting services.
The one study researchers found that focused on ethnic inequalities in care for newborn babies, showed Asian babies were over-represented in admissions to neonatal units for jaundice.
Overall, the review of maternal healthcare found evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading to some ethnic minority women feeling ‘othered’, unwelcome, and poorly cared-for.
With respect to the NHS workforce, the impact of racism on careers and professional development was also explored in the review, and there was evidence of an ethnic pay gap affecting Black, Asian, Mixed and Other groups, and to a lesser extent, Chinese staff.
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“For too many years, the health of ethnic minority people has been negatively impacted by a lack of high-quality ethnic monitoring data recorded in NHS systems; lack of appropriate interpreting services for people who do not speak English confidently and delays in, or avoidance of, seeking help for health problems due to fear of racist treatment from NHS healthcare professionals,” said lead investigator Dr Dharmi Kapadia, lecturer in sociology and member of Manchester University’s Centre on Dynamics of Ethnicity.
“Our review confirmed that all of these issues are still to be tackled by the NHS. The evidence on the poor healthcare outcomes for many ethnic minority groups across a range of services is overwhelming, and convincing. The time for critical action on ethnic inequalities in healthcare is now,” she added.
