‘Culture change’ planned for Suffolk health services to address BAME inequality

Councillor James Reeder Picture: SUFFOLK COUNTY COUNCIL (Image: Suffolk County Council)

A series of measures are being planned to help begin to tackle the health inequalities in the Black, Asian and Minority Ethnic (BAME) communities in Suffolk.

Healthleaders from across the county attended a conference which they say was a wake-up call to the problems starkly exposed by the Black Lives Matters protests and coronavirus – and highlighted the need for a complete culture change.

It emerged early on in the pandemic that those of BAME background were disproportionately affected by the deadly wave of Covid-19, but as healthcare leaders in Suffolk have acknowledged, that disproportionate impact has been ingrained in care for years.

At the What Are We Missing conference, those leaders were able to learn what it is really like for those communities by listening to those who have suffered first hand.

Andy Yacoub (CEO Healthwatch Suffolk). Picture: GREGG BROWN

Louise Hardwick, head of partnerships at Ipswich and East Suffolk Clinical Commissioning Group (CCG), said: “To me, that was absolutely inspiring. There was nobody standing up saying ‘this is what we do’ in that defensive mode.

“The whole event was a wake up call, it was uncomfortable listening, it is still uncomfortable listening. This for us is a complete culture change – we have got to wake up and smell the coffee.”

Suffolk County Council cabinet member for public health James Reeder said: “I think it is one of the most uncomfortable meetings I have sat in,” he said.

“To be told the absolute truth about where we are going wrong, and where we need to go was so powerful.”

Dean Dorsett, from Burlington Primary Care in Ipswich, said: “All of the statistics that shock us, and do continue to shock us, have been in the system for decades.

“There was a decades-long groundswell before all of this happened – a black African-American woman is five times more likely to die in pregnancy and childbirth, a Pakistani woman is three-and-a-half times.

“The BAME community and other vulnerable communities, communities like Roma and the sex workers who are not heard from, they have been shouting this from the rooftops for years and years, and the combinations of the Black Lives Matter movement and Covid helped to bring it to the forefront.”

In the short term, a series of measures are being planned such as distributing masks in key areas like Norwich Road in Ipswich, while BAME inequalities are set to be a standing item on future meeting agendas.

Elsewhere, public sector leaders across the county are being called upon to pick up the baton too. Indeed, all public service organisations are being asked three things – support for immediate actions to help BAME communities through Covid-19 – particularly where the threat of a second spike exists – to adopt the relevant recommendations in the Doctors of the World report and to support the development of a deep and wide-ranging strategy to address the inequalities.

That culture change is not the work of a moment, and the health chiefs who have pledged to make such a change have said it is not an overnight fix. They hope to fix the problem within a generation, and if one What Are We Missing event can get that ball rolling it shows the power of the community voice. It is clear that those already around the table are committed to the cause.

Andy Yacoub, Healthwatch Suffolk chief, added: “If we could change a culture locally and bring about that change, the eyes of the country will be on us. This is not happening anywhere else.”

Those that were there say that Dr Ed Garratt, chief officer for the CCGs, admitted the health system has got this wrong, and vowed to put BAME inequality high up the agenda. For the CCG that is where it needs to be – mental health, physical health and BAME inequality.

Those problems have been starkly exposed in a report, called Doctors of the World which has been shared round health professionals and statutory organisations, and forms the starting point for a series of short and long term measures to tackle the issue head on.

And while that is addressing all aspects of healthcare in Suffolk, it also spans much, much wider.

“We are looking at the wider determinants of health,” confirmed Dr Imran Qureshi from Leiston Surgery.

“The biggest gains are not the medicines we prescribe or the surgical procedures, it is the wider socio-economic factors.

“This is way, way wider than just health. This is talking to our housing colleagues, our county councils, borough councils, public health. If you miss one bit of this the outcomes will never be so good.”

Crucial to that is the ongoing dialogue with the communities who have suffered. That includes a seat at the very table where measures will be drawn up that hope to eradicate systemic health inequalities.

“As organisations and as professionals you have blind spots,” Dr Dorsett said. “If you have power you shouldn’t have blind spots. You should be inquisitive, you should be going out to your community and asking if you have done your job right.”

He added: “We need to have the community on board, but we cannot just have that by sending invite letters. There is going to be a sharing of responsibilities, so we are going to have to devolve our ego and power to the communities.”

Mid Suffolk District Council leader Suzie Morley said she left feeling “deeply ashamed”.

Phanuel Mutumburi, business and operations director at the Ipswich and Suffolk Council for Racial Equality (ISCRE), continued: “We quickly picked up that while some fantastic work was being done across the system, not a lot of the people within BAME communities were connecting with those.

“It might be guidance about what needs to be done, it might be some of the initiatives like providing food and support during Covid-19.

“But many people either did not know that those things were available or they were aware of them but didn’t know those things applied to them.

“If we continue on that path we are going to continue leaving people behind, and that is completely unacceptable.”

Those access problems can include a language barrier, cultural or religious beliefs on medicine and other wider factors such as previous healthcare experiences, employment status and housing conditions.

Tellingly, the event was all about what health chiefs call the “lived experience” – those with first hand accounts of failing to get the support they need. The public leaders took a back seat, listening.