Opinion

Equality, diversity and social care

Alan Rosenbach Sector Commentator

The European Convention on Human Rights and Fundamental Freedoms (ECHR) 1950 was created by the Council of Europe and should not be confused with the European Union. The Council of Europe was set up after the Second World War to protect human rights and the rule of law and to promote democracy across Europe.

As Winston Churchill put it “ we need the ECHR to confront all forms of tyranny ancient or modern, with forces that are unconquerable.”

Since the mid 1960s we have put in place equality and diversity legislation. The purpose is to protect individuals from discrimination and protect our human rights. It is against the law to discriminate because of:

–        Age

–        Being or becoming a transsexual person

–        Being married or in a civil partnership

–        Being pregnant or on maternity leave

–        Disability

–        Race including colour, nationality, ethnic or national origin

–        Religion, belief or lack of religion/belief

–        Sex

–        Sexual orientation

What does this mean for social care?

Social care (and health care) is part of our wider societal structures. It is a reasonable assumption to make that how we deliver care for those with age and disability is a reflection of our wider societal attitudes to these issues. Human Rights, inclusion, equality and diversity have since 2010 had a more negative press. There are significant inter generational differences with older people being seen as the beneficiaries of better economic times and whose needs are now being paid for by a younger generation who have not had it so good. Attitudes to learning disability and mental illness are still negative and we have to guard against inequalities in care because of these differences.

Every person requiring social care whatever his or her background or beliefs is entitled to receive help without prejudice. Inclusion must be at the heart of the care process. Organisation leaders providing care must set the tone and make sure that diversity and difference is appreciated not judged negatively and that inclusion is at the heart of care provision. This relates to both staff and those they care for. Care staff must actively promote inclusion in the every day interactions. All of us need to reflect on our own prejudices and how these influence the way we interact and react with those in the care system.

How well is the system working?

Older people receive poorer levels of care than younger people with the same

conditions. For example, older people are far less likely to receive psychological therapies for mental illness and more likely to be prescribed drugs. Drug trials generally do not include older people in their samples although it will be older people who will be prescribed these medications.

In-patients in acute hospitals with dementia are over three times more likely to die during their first admission to hospital for an acute medical condition than those without dementia. 42% of unplanned admissions in England to an acute hospital of people over 70 have dementia.

In general, people from black and minority ethnic groups are:

:

–        more likely to be diagnosed with mental health problems

–        more likely to be diagnosed and admitted to hospital

–        more likely to experience a poor outcome from treatment

–        more likely to disengage from mainstream mental health services leading to social exclusion and a deterioration in their mental health.

People with learning disabilities are much more likely to experience poorer outcomes to the rest of the population for cancer, arthritis and diabetes. They also have higher rates of avoidable mortality (death) than the general population.

The implications of these findings are that we still have a distance to travel to make sure that there is equal treatment for all those needing care and support. The debate is often characterised by quality of life considerations and how to share the finite resources fairly. This adds to the inter generational tensions and possible in some cases for underlying prejudices to be the sole determinant of whether care is delivered at all.

Regulatory oversight by the Care Quality Commission

The CQC is unambiguous that equality, diversity and human rights underpin the regulatory model and how they act as an employer.

They reported in the state of care 2015/16 “Although we have seen some examples of good practice in adult social care during the year, comparison with equivalent evidence from last year suggests that the amount of work on equality for people who use services is, at best, relatively static. There may be a widening gap between policy and putting this into practice in residential services.”

As an employer CQC must also make improvements. They published their annual report in the same week that the BBC were required to publish the pay bands for their highest paid earners. The gender pay gap between the Chief Inspectors was glaringly obvious.

How to improve equality, diversity, inclusion and human rights protections

The legislation over many years has provided us with a robust framework in which we all need to work to enhance and protect these valuable rights. Government, leaders of care organisations, front line staff and those of us who receive care must all wave the banner for our rights to being treated and cared for with dignity, respect and humanity no matter who we are or what our beliefs.

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