Barts Health Equality and Human Rights Impact Assessment Report

www.brap.org.ukHealth inequalities issues for patientsRetaining the body of expertise that has developed over the years was cited as an importantfactor in the delivery of fair and effective patient care:“I’m a nurse, and as such I know that there is often value placed on quantitativeinformation, especially in relation to some condition. But Newham has collected veryrelevant qualitative data and has a really good understanding of its population. I’m notsaying that we can’t do more. There are some good examples of projects I have beeninvolved in where having a better understanding of the community really made adifference to the services on offer.”There was also a sense that the merger provided an opportunity for the new organisation torevaluate how equalities practices are implemented:“I do think we can do much more to change what we do to fit with the needs of patientswithin our community though. Many of the groups that we see have very poor healthliteracy and this is compounded by a lack of English literacy. They do not understand howto employ many of the preventative health measures that we are promoting to thepopulation at large. They can live perfectly well inside their own bubble – until they have ahealth episode which requires them to interact with the system. Most people would find ithard to navigate themselves around the health system, and for those with little healthliteracy it is a nightmare. They tend to interact with the system in the same way as theydid when they were back home – they need a ‘health navigator’.”The issue of poverty and social class also remerged, as staff highlighted concerns about theaccessibility of services for those on lower incomes:“We are currently analysing the results of a project to understand more about who doesnot attend appointments we are only just getting the preliminary data. We have found thatthere is a band of poorer white communities that circle Newham – these are the peoplewho are most likely not to attend. Finances tend to be the main reason for nonattendance.Many of our patients have co-morbidities - they often have severalappointments to attend, at different hospitals or different conditions. I know of exampleswhere people have made decisions about which appointment they should attend - basedon what they perceive to be their needs at the time. Routine appointments - such ascheck-ups for diabetes, do suffer under this type of decision making. However it is oftenthese type of routine appointments which pick up on issues before they occur. We havemore A&E usage - people just go from crisis to crisis.”184