In equal measures: promoting diversity in social care

Professor Martin Green OBE, Chief Executive, Care England

There is a lot of talk about equality and diversity in health and social care, and the initiatives that are supposed to deliver this are walking along a well-worn path. Over many years there have been attempts to make sure services are more equitable and do not discriminate against particular groups.

Despite all these good intentions, we still have a system that discriminates against certain people, and there are still certain communities that do not get the same access to care and support as others. We have clear data sets proving inequality lies at the heart of the health and care system. Despite all the initiatives developed over the years, there is still clear evidence that services do not necessarily get delivered in equitable ways.

It is interesting to note that some data sets talk about life expectancy and show that for various geographical and socio-economic reasons, some areas, and some groups of people, have a lower life expectancy, and the gap between these groups is widening. In order to address this, we need some very clear public health strategies that look at how people access support throughout their life. Also, there is a need sometimes to give people more information which enables people to change their behaviours in order to have healthier lives.

As well as the public health inequalities that affect populations very differently, there is also a range of issues around access to services, which can have a huge impact on a person’s health, well-being and life, and these issues around inequality of access need to be addressed as a matter of urgency.

There is clear evidence that some people, because of characteristics such as their ethnicity, socio-economic status, disability or age, are not getting equal access to the services that could improve their lives and their health. It is disappointing to see that despite significant amounts of money that have been invested in this issue by the NHS, local authorities and independent services, we still see huge inequalities in access to health and care.

One of the areas that are often neglected in this debate is the issue of ageism, which is absolutely rife in all aspects of society but is particularly evident in the care and health sectors.

Despite being a protected characteristic under the equality and human rights act, we have seen little progress in the way in which older people are treated by local authorities when they access care. It is still quite amazing to me that we have a system that is supposed to be person-centred and delivering personalised care, and yet the majority of local authorities have standard rates for residential care. This is not the case when it comes to young adults with other conditions, where there is a tendency to commission services based on need. For older people, the local authority sets a fee. It then expects the care provider to deliver the personalised care package that will enable people to live well with their long-term conditions. If you look at how the commissioners in health and care commission services for an older person who is living with advanced dementia and compare this with how they commission services for a younger person with learning disabilities and autism, despite having similar cognitive abilities, the approach from local authorities is very different.

I have seen many wonderful care plans for younger people that ensure their lives are full of a range of activities and personal connections, which I do not see commissioned in the same way for older people.

This ageism affects so much of the system, including regulation. For example, why do the CQC have a rule on the size of services for younger people, but they do not have a similar position on older people’s care? When I have challenged organisations around these sorts of issues, they often use the excuse that older people are somehow ‘different”. This was an excuse that was once used to justify inequalities relating to race, sexuality, gender and disability, and it was not valid for those discriminatory practices, and it is certainly not appropriate as an excuse for ageism.

There is a lot to do to ensure that there is equality of access to health and care services, and I hope that as we challenge these issues, we will not forget ageism also needs to be addressed.




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