Putting people first: Equality and Diversity Matters 2 - Think Local Act ...

2 Putting people first – equality and diversity matters 2About CSCIThe Commission for Social Care Inspection (CSCI) was set up in April 2004. Its main purposeis to provide a clear, independent assessment of the state of social care services in England.CSCI combines inspection, review, performance and regulatory functions across the range ofadult social care services in the public and independent sectors.CSCI exists to promote improvement in the quality of social care and to ensure public moneyis being well spent. It works alongside councils and service providers, supporting andinforming efforts to deliver better outcomes for people who need and rely on services toenhance their lives. CSCI aims to acknowledge good practice but will also use its interventionpowers where it finds unacceptable standards.Reader InformationDocument PurposeFor informationAuthorCommission for Social Care InspectionPublication Date August 2008Target AudienceDirectors of adults' social services, chief executives andcouncillors of councils with social services responsibilitiesin England, social care providers, academics and socialcare stakeholders.Further copies fromcsci@accessplus.co.ukCopyright© 2008 Commission for Social Care Inspection (CSCI) Thispublication may be reproduced in whole or in part, freeof charge, in any format or medium provided that it is notused for commercial gain. This consent is subject to thematerial being reproduced accurately and on proviso that itis not used in a derogatory manner or misleading context.The material should be acknowledged as CSCI copyright,with the title and date of publication of the documentspecified.Internet addresswww.csci.org.uk/professionalPriceFREERef. No.CSCI-QSC-157-20000-AHS-092008CSCI-232

Putting people first – equality and diversity matters 2 3ContentsQuality issues in social care ....................................4The Equality and Diversity Matters series....................4How have we developed this bulletin? .........................4Summary of key points .............................................6Introduction ..............................................................81. What is this bulletin about? ...............................82. Important issues .................................................93. How well do social care services respond tothe needs of black and minority ethnic peopleusing services? .................................................13Good practice works for everyone ..........................174. Assessments and care plans that work forblack and minority ethnic people .................... 175. Choice and control ............................................. 21Specific issues for black and minority ethnicpeople using services.............................................3711. A home from home ............................................3712. Who supports us?..............................................4113. Understanding each other ................................4514. Connections .......................................................4715. Reaching out ......................................................5116. Checklists for action ..........................................5417. Useful resources ......................................... 5818. Appendix – relevant sections of the CareHome Regulations and Domiciliary CareAgencies Regulations ................................. 59All equal – key issues in equality and diversity ....246. Management and leadership ............................247. Staffing ................................................................268. Monitoring ethnicity ..........................................289. Tackling prejudice and discrimination............ 3010. Involving black and minority ethnic people whouse services .......................................................35Social Care Policy and Practice

4 Putting people first – equality and diversity matters 2Quality issues in social carePromoting improvements in social care andstamping out bad practice for the benefit of thepeople who use care services are key functionsof the Commission for Social Care Inspection(CSCI). The Commission has a commitmentto promote equality and diversity in all that itdoes.The Equality and DiversityMatters seriesThis bulletin is the second in a series of threedesigned to help service providers meet the newpersonalisation agenda within Putting peoplefirst 1 by addressing equality and diversitymatters. This bulletin focuses on black andminority ethnic people using services. The otherbulletins cover equality for lesbian, gay, bisexualand transgender people, published in March2008, 2 and disability equality, due in December2008. We are producing these bulletins to: support service providers to ensure thatservices are personalised so they meet theneeds of a diverse range of people highlight and increase understanding of thekey issues for diverse groups of people usingservices share what we have learnt about goodpractice in equality and diversity matters from1. Department of Health (2007) Putting people first: ashared vision and commitment to the transformationof adult social care. London: Department of Health2. Commission for Social Care Inspection (2008)Putting people first: Equality and Diversity Matters1 – providing appropriate services for lesbian, gay andbisexual and transgender people. London: Commissionfor Social Care Inspectioninspecting services and from hearing frompeople who use services identify practical steps that can be taken byservice providers to improve the experiencesof people who use social care services. Whilst the series is primarily written to assistpeople providing social care services, someof the issues raised are also relevant tocommissioners seeking to ensure that theservices they commission meet the diverseneeds of their communities.How have we developed thisbulletin?We have used a number of sources of informationto write this bulletin, including: Examining the National Minimum Standards(NMS) for care services to look at the keyissues relating to equality and diversity. Focus groups with black and minority ethnicpeople, using a range of services includinghome care, adult placement schemes, carehomes and those receiving Direct Payments 3in lieu of services. Individual interviews with black and minorityethnic people using services, particularlyfocusing on people living in care homes. Theinterviews and focus groups included 63people who identified as African, Chinese,Caribbean, Indian, Pakistani, Irish, Polish andpeople of dual heritage. We involved older3. Direct Payments are cash payments given to peopleby councils, so that they can purchase social careservices themselves instead of being provided withservices

Putting people first – equality and diversity matters 2 5people and younger adults, including peoplewith physical and sensory impairments,people with learning difficulties and peopleusing mental health services. We includedpeople who identified as Buddhist, Christian,Jewish, Muslim, Hindu and Sikh as well asthose who do not follow a faith.A representative sample of Annual QualityAssurance Assessment (AQAA) forms (400 intotal) completed by managers of home careagencies and care homes, reporting the workthey have carried out to make their servicesaccessible and appropriate for a diverse rangeof people.Discussion groups with service providers whoare leading the way in providing appropriateservices for black and minority ethnic people.Social Care Policy and Practice

6 Putting people first – equality and diversity matters 2Summary of key pointsThe key to achieving appropriate social careservices for black and minority ethnic peopleis personalised support that addresses theneeds of the individual, rather than adaptingservices based on generalisations about culturalrequirements. Personalisation is at the core of thePutting people first protocol, 4 which describes thevision and commitment for the transformation ofsocial care.Yet, personalised services cannot be achievedfor black and minority ethnic people by justresponding to individual needs as they arise.Services need to take a systematic approach toremoving barriers that may prevent black andminority ethnic people receiving appropriatesupport. These barriers include organisationalprocesses or assumptions and the behaviourof individual staff, which may amount to eitherintentional or unwitting discrimination.Black and minority ethnic people told us that theywant: accessible information about services leadingto options about which services they use control over decisions about their future services that recognise differences in people’scultures, without making assumptions support from staff with positive and respectfulattitudes towards them services that enable them to have contact withpeople that are important to them and to beconnected to communities to feel safe and be free from discrimination opportunities to give feedback and to improveservices.Despite race equality legislation being in place for30 years, the experience of black and minority4. Department of Health (2007) Putting people first: ashared vision and commitment to the transformationof adult social care. London: Department of Health

Putting people first – equality and diversity matters 2 92. Important issuesDefinitionsThe use of various words and phrases in raceequality work has been the subject of muchdebate. Definitions of what constitutes an ‘ethnicgroup’ also change. The list below gives workingdefinitions for this bulletin; it is not possible togive definitions that are agreed universally.Black and minority ethnic – we have used thisterm to include all groups that are not recordedunder the ‘white British’ ethnic group category,as it is not correct to assume that minority ethnicgroups are only defined by skin colour or race. Thisapproach is supported by the Office for NationalStatistics. Where we have referred to evidencefrom others that relates only to ‘non-white’minority ethnic groups, we have indicated this.Culture – encompasses the culture, artistic andintellectual accomplishments, religious beliefsand values of people who share the same ethnicorigin. 9Direct or intentional discrimination – treatingpeople less favourably purely on the basis of theirethnic origin.Institutional racism – the collective failure ofan organisation to provide an appropriate andprofessional service to people because of theircolour, culture or ethnic origin. It can be seen ordetected in processes, attitudes and behaviourwhich amount to discrimination through unwittingprejudice, ignorance, thoughtlessness and raciststereotyping which disadvantage minority ethnicpeople. It persists because of the failure of theorganisation openly and adequately to recogniseand address its existence and causes by policy,example and leadership. 10Refugee – someone whose asylum applicationhas been successful and who is allowed to stayin another country having proved they would facepersecution back home. 11Asylum seeker – a person who has left theircountry of origin and formally applied for asylumin another country but whose application has notyet been decided. 12Diversity within black and minority9 10 11 12ethnic communitiesBlack and minority ethnic people usingservices are very diverse. There are the obviousdifferences in terms of ethnicity, for examplethe needs of African Caribbean people maybe different from the needs of those fromBangladeshi communities. There are particularissues for people from smaller or relatively newcommunities. Provision of specific services,or even basic requirements such as access tointerpreters, may be especially limited.However, it is important to look beyond ethnicityor culture alone; otherwise, there is a dangerof replacing a lack of cultural awareness withassumptions and stereotypes based on the idea9. Social Services Inspectorate (1998) They look aftertheir own, don’t they? Inspection of community careservices for black and ethnic minority older people.London: Department of Health10. Macpherson, W (1999) The Stephen Lawrence Inquiry:report of an inquiry by Sir William Macpherson ofCluny. London: the Stationery Office11. The Refugee Council website(www.refugeecouncil.org.uk)12. The Refugee Council websiteSocial Care Policy and Practice

10 Putting people first – equality and diversity matters 2that people from the same cultural background allhave the same needs. People’s needs and desiresare based on a complex mix of experience,identity and preferences.Some studies have shown that the differencesbetween the experiences of men and womenfrom minority ethnic groups are sharper than thedifferences between minority ethnic groups. 13There are also differences in terms of age. Foreveryone, expectations of our roles and ambitionschange with age. For black and minority ethnicolder people and younger people using services,there may also be differences in their knowledgeof how ‘the system works’ and familiarity withlanguage, based on whether people have beenbrought up in the UK, which affects confidence inusing services.Black and minority ethnic people under 60 weretwice as likely to tell us that they had faceddiscrimination when using services or thatservices did not meet their needs, comparedto older people. This may be because youngerblack and minority ethnic people have higherexpectations of services and more confidence tovoice concerns.“[I don’t] feel good about, you know, makingcomplaints or telling people what to do. Ithink you won’t be welcome if you do that”Older person living in care homeIf people have arrived to the UK as refugeesor asylum seekers, their needs may also bedifferent to those of other black and minorityethnic people using social care. For example,13. Chahal, K (2004) Experiencing ethnicity:discrimination and service provision. Joseph RowntreeFoundation: York

Putting people first – equality and diversity matters 2 11older refugees may face a greater sense of lossabout their past life, trauma associated with pastexperiences and greater poverty, in addition toissues in common with other black and minorityolder people such as language barriers and theloss of social networks. 14A study by the Refugee Council also found thatdisabled asylum seekers had a high level ofunmet need, due to the different framework ofsupport for asylum seekers. 15Where people may be subject to discriminationon other grounds, being from a black or minorityethnic group may make discrimination morelikely. For example, black and minority ethnicyoung disabled people may face low expectationsin education due to a mix of race discriminationand disability discrimination. 16 The firstbulletin in this series indicated that lesbian,gay or bisexual people from black and minorityethnic communities were more likely to faceprejudice from services on the grounds of sexualorientation than lesbian, gay or bisexual peoplewith a white British background. 1714. Patel, B and Kelley, N (2007) The social care needsof refugees and asylum seekers: race equalitydiscussion paper 2. London: Social Care Institute forExcellence15. Patel, B and Kelley, N (2007), Ibid16. Bignall, T and Butt, J (2000) Between ambition andachievement. London: Joseph Rowntree Foundationand Bristol: Policy Press17. Commission for Social Care Inspection (2008)Putting people first: Equality and Diversity Matters1 – providing appropriate services for lesbian, gay andbisexual and transgender people. London: Commissionfor Social Care InspectionFor this reason, it is important to read the otherbulletins in the series to understand the way thateveryone using services may experience a varietyof issues relating to equality and diversity.What black and minority ethnic peopleusing services wantThere are obviously dangers in generalising aboutwhat ‘black and minority ethnic people want’. Thestarting point in considering what someone usingservices needs and how these needs are metshould always be finding this out from the personhimself or herself.The needs of black and minority ethnic peopleusing social care are often the same as thoseof other people; however, the needs may needmeeting in different ways. 18 Black and minorityethnic people have shared experiences of racismand disadvantage and, for many older people,shared experiences of migration, which influencetheir interaction with social care services. 19 Anunderstanding of these common factors helps toput individual needs into context and to promoteanti-discriminatory practice.Black and minority ethnic people have a rightto expect services that are going to understandand respond to their individual needs and not tosubject them to race discrimination. The peopletaking part in interviews and focus groups saidthat they want:18. Social Services Inspectorate (1998), Ibid19. Butt, J, Box, L and Cook, SL (1999) Respect – learningmaterials for social care staff working with black andminority ethnic older people. London: Race Equality UnitSocial Care Policy and Practice

12 Putting people first – equality and diversity matters 2Accessible information to enable them tomake choices about services, for exampleDirect Payments, and to know their rights,including how to challenge discrimination.Participation in decisions about their future,particularly in assessments and reviewing careplans. People said that meant that adequatetime should be given for meeting with theperson, timely and clear communicationbetween staff and the person using the service,and advocacy available if needed.Choice and control in the services that theyuse, including good information and support ifthey choose Direct Payments and the option ofusing specific services for or run by black andminority ethnic communities.Their cultures to be recognised, whilstavoiding assumptions based on stereotypes.Services should understand the importance ofproviding culturally appropriate support andhave knowledge of how this can be done, aswell as engaging with individuals to find outhow they want their support to be provided.To make choices about how they engage withothers including opportunities to take an activerole in their families and in their communitiesand to develop friendships. These choices areimportant in reducing isolation, which can havea detrimental impact on well-being.Support from staff that have positive andrespectful attitudes towards them. Someblack and minority ethnic people want stafffrom the same community, particularly ifEnglish is not their main language. Someprefer to choose the gender of staff or staffwho they think communicate well and havepositive attitudes. Others stressed the needfor staff training to cover race equality issues.To feel safe and be free from discrimination,whether this is obvious prejudice or moresubtle discrimination. Where black andminority ethnic people do experiencediscrimination, they want opportunities toraise concerns easily and providers to respondin ways that are supportive to the personmaking the complaintAn opportunity to improve services – forthemselves as individuals and collectively.People particularly wanted to meet as groupsof black and minority ethnic people to shareexperiences for peer support and to changeservices for the better, including challenginginstitutional racism.

Putting people first – equality and diversity matters 2 133. How well do social careservices respond to the needsof black and minority ethnicpeople using services? 94% of services reported that they werecarrying out some general work aroundequality and diversity, such as advisingstaff of equality policies or carrying out stafftraining. Some of this activity will undoubtedlyinclude equality work around race equality. 37% of providers gave examples of the specificequality work they have carried out aroundrace equality (this compares to 33% who gavean example relating to disability equality and9% who gave an example relating to equalityfor lesbian, gay or bisexual people): 24% of services said that they had carriedout work to make their services moreculturally appropriate, for example inthe food that they provide or activitiesorganised. This was the most common typeof activity for care homes. 8% of services said that they had workedon language support for black and minorityethnic people, for example throughproviding interpreters or translating writtenmaterials. 8% of services said that they had carriedout work on staffing, such as allowingpeople using services to choose supportfrom staff from their own culture. 7% of services said they had carried outwork to enable black and minority ethnicpeople using services to maintain contactswith their communities. 6% of services said they had carried outwork to positively recruit more black andminority ethnic staff. This was the mostcommon type of activity for home careagencies, with 16% of providers havingcarried out this work.The number of providers who said they hadworked specifically on race equality wasSocial Care Policy and Practice

16 Putting people first – equality and diversity matters 2and minority ethnic people may also haveparticular anxieties about using a service,fearing it may not meet their needs or thatthey will face discrimination. Providers canincrease take-up from black and minorityethnic communities by targeted publicity andoutreach activities as well as making servicesmore appropriate for black and minority ethnicpeople.Race equality legislationThe Race Relations Act 1976The Act defines three types of unlawful racialdiscrimination: direct discrimination, indirectdiscrimination, and victimisation. Direct discrimination takes place if a personis treated less favourably than someone froma different racial group. Segregating peoplebecause of their racial origins is also unlawful. Indirect discrimination takes place whenpeople from a particular racial group cannotmeet a rule, condition or practice that shouldapply equally to everyone. If the rule putspeople from that racial group at a disadvantage,and if the rule cannot be justified, this will beindirectly discriminatory. For example, if a localmedical practice refuses to accept tenants froma nearby housing estate as patients, and mostof the tenants on the estate are of Bangladeshiorigin, this will be indirectly discriminatory,unless the practice can give good reasons forits policy.The law also protects people from beingvictimised for bringing a complaint of racialdiscrimination, or for backing someone else’scomplaint. For example, if a white employeewho has given evidence in her Asian colleague’sracial discrimination case against the companyis penalised in any way, she may be ableto bring a case of victimisation against heremployer. 26The Race Relations (Amendment) Act 2000Most public authorities now have a statutorygeneral duty under the amended Race RelationsAct to promote race equality. This means theymust do whatever they can to: eliminate unlawful racial discriminationpromote equal opportunities, andencourage good race relations.Most public authorities also have other specificduties under the Act. These cover the way theyprovide services and employ people, as well ashow they make policy. 27When private or voluntary sector providers enterinto a contract or partnership with a council, andthe race equality duty applies to that work, thecouncil must ensure that the provider complieswith the duty. Providers therefore will need tounderstand the legal duties that councils haveunder this Act and the practical guidance availableon how to meet those duties.26 2726. CRE (2003) The law, the duty and you: the RaceRelations Act and the duty to promote race equality –a guide for public employees. London: Commission forRacial Equality27. CRE (2002) The duty to promote race equality – aguide for public authorities. London: Commission forRacial Equality

Putting people first – equality and diversity matters 2 17Good practice works for everyoneGood practice in assessment, person-centredplanning and self-directed services forms animportant foundation for ensuring personalisedservices, appropriate for a wide range of people.Current social care reforms, particularly thedrive to increase the personalisation of adultservices, as in Putting people first 28 shouldenable more people to benefit from theseapproaches in the future.and where there is an important need to build uptrust with the person using the service. 29Service providers need to tackle the specificbarriers to race equality in admission procedures,assessment and care planning processes. Only6% of service providers gave specific examples of4. Assessments and careplans that work for black andminority ethnic peopleGood assessments and care plans directed bythe person are key to individualised services,yet less than half the people that we spoke tofelt that their needs as a black or minority ethnicperson were adequately considered at their lastassessment.Some black and minority ethnic people criticisedthe length of the assessment process orinfrequency of review.“My most recent assessment carried outin November, although culture etc wasconsidered, I am still waiting for the results inMarch”Person with a learning disabilityThese delays have greater significance for blackand minority ethnic people who have previouslyfaced race discrimination when using services28. Department of Health (2007) Putting people first: ashared vision and commitment to the transformationof adult social care. London: Department of Health29. Butt, J, Box, L and Cook, SL (1999), IbidSocial Care Policy and Practice

18 Putting people first – equality and diversity matters 2work to promote race equality or consider culturein assessment and care planning, though otherslisted ‘culture’ or ‘ethnicity’ as a factor that theywould consider in assessment or care planning.These barriers include:Communication barriers“I was given enough information but not in mylanguage”Focus group participantAs well as obvious language differences, olderCaribbean people who use patois or peopleusing English as a second language may not beconfident that they understand or have beenunderstood. These difficulties may increase ifsomeone has had a stroke or has dementia. 30Information barriersBlack and minority ethnic people often faceparticular barriers to obtaining information aboutsocial care services (see section 14) whichmay affect how they advocate for themselves inassessment and care planning.As someone moving into residential care, with nofamily nearby, commented:“I have been here once before and I took aliking to it and then I suppose when theymentioned this place I said yes, I’d like to goback there. But what I suppose I didn’t realiseor take into consideration that I was going tobe here for a long time or for good.... As I say,it’s just that I pay the £500 a week, whichI think is a bit expensive because if you’regoing to be [somewhere] for a long time themoney that I have is going to go down, there’sno doubt about it”Care staff may also be poorly informed due toassumptions about black and minority ethnicpeople in general, stereotypes about particularcultures or lack of knowledge about appropriateresources or services.Differences in valuesWe all have values; we may not even be awarethat these are affecting our understanding orjudgement of someone else’s situation.“[In assessment] there is the potential for anethnocentric model becoming dominant... thismeans that the values of one ethnic groupbegin to be seen as natural or normal, and ourassessment and actions are influenced by this” 31Providing a checklist of values for differentcultures is inappropriate, as it could lead tostereotyping.30. Butt, J, Box, L and Cook, SL (1999), Ibid31. Butt, J, Box, L and Cook, SL (1999), Ibid

Putting people first – equality and diversity matters 2 19“The attention given to cultural difference byprofessionals can sometimes compromiseholistic needs assessment and care, leadingto the partial and inaccurate assessment ofneeds” 32Assessors need to avoid stereotyping orseeing one ethnic group’s lifestyle as the norm.Assessments may focus on ‘difficulties andrisk’ rather than considering the strengthsof the person or meeting outcomes, if thereare communication barriers or a lack ofunderstanding due to differences in values. 33“I had an assessment from the hospital. I wasput in residential care but I didn’t like that soI got home care instead. It actually costs lessfor the home care and I’m happy to be in myown home. I don’t think my culture was takeninto account. It’s just a production line – it’sonly my healthcare needs that they worryabout not me as a person”Older personUnderstanding the experience of racism anddisadvantageMany black and minority ethnic people haveexperienced racism, which can affect people’sself-esteem and confidence and make themreluctant to approach services or wary of theassessment process.The impact of racism and disadvantage iswider than just previous experience of socialcare services. People from Black African orCaribbean, South Asian or Irish backgroundsare likely to experience greater rates of illnessand impairment than white people from Britishbackgrounds. Black and minority ethnicdisabled people are likely to have lower incomesand worse housing than their white Britishcounterparts. 34 Refugees and asylum seekersmay have experienced traumatic events suchas detention, torture and/or the death of lovedones, and once in the UK often face poverty andacute anxiety about their legal status as well asisolation, language barriers and a lack of socialnetworks. 35This will affect both people’s social care needsand the range of choices available to meet theseneeds.Though some black and minority ethnic peoplehave prospered, assessors need to be sensitiveto the potential impact of these wider factors interms of people being able to exercise choice andcontrol.32. Gunaratnam, Y (2006) Ethnicity, older people andpalliative care. London: National Council for PalliativeCare and Policy Research Institute on Ageing andEthnicity33. Butt, J, Box, L and Cook, SL (1999), Ibid34. Butt, J (2006), Ibid35. Patel, B and Kelley, N (2007), IbidSocial Care Policy and Practice

20 Putting people first – equality and diversity matters 2Good practice pointers – assessment andcare planningEnsure staff can confidently balanceavoiding stereotypes with a recognition ofcultural needs, including being alert to wheresomeone’s situation may be more unusualwithin their culture or where there areadditional issues due to refugee or asylumstatus.Make sure that people have accessibleinformation, in advance of the assessmentor admission, about the process and serviceoptions that is clear about what the service canprovide (for example which tasks home carestaff will carry out).Develop staff knowledge about specific supportfor black and minority ethnic people that couldbe part of a care plan.Enable people to have access to appropriateadvocates or interpreters and find out who elsethe person wants at any meeting, for examplefamily members, but do not use relatives orfriends as interpreters.Allow enough time to establish goodcommunication in face-to-face meetings,especially if there are language or culturaldifferences.Ask people open questions to help reinforcepeople’s cultural heritage, and enable people toexpress any particular concerns about usingservices, for example:who is it important that you stay in contactwith?what support do you need to keep up theserelationships?how do you like to spend your time?what support do you need to keep up theseactivities?what is important to you about any supportthat you have?do you have any particular worries about thefuture that you would like to talk about?Regularly update people about the progress ofthe care plan following assessment includingany changes to staff involved.Develop the skills of staff from a range ofcommunities to lead on assessment and careplanning. Do not use multilingual staff purelyas interpreters as these are different roles andavoid using black and minority ethnic staff as‘cultural experts’.Make sure care plans have a summary ofthe person’s expectations of how care will beprovided, including any cultural requirements,that is accessible to all staff.Enable people to have a ‘trial period’ usinga service and review care plans soon aftersomeone starts the service, by asking theperson whether their needs are being met inthe best way.

Putting people first – equality and diversity matters 2 215. Choice and controlPeople having a choice and taking control of theirsupport is at the heart of the transformation ofsocial care. The black and minority ethnic peoplethat we spoke to had mixed views on how wellthey had been able to exercise choice in theservices that they used.“No choice was given, nothing was available”Person with a learning disability“I am well supported in all the choices, I havea chance to work”Disabled person, using home careAccessible information, in an appropriate formand language, is an essential requirement toenable black and minority ethnic people to makeinformed choices.Getting the service right first timeSeveral of the people we spoke to had startedto use services in an emergency, for exampleon hospital discharge. These people sometimeshad little choice and were initially placed ininappropriate services but were then able to movewhen their care plan was reviewed, to servicesspecifically for their community.“There was no synagogue there, so he feltvery isolated. So that’s why they brought himhere, because they had synagogue here... hisreligious needs are fulfilled here, that’s whyhe got in here and as well Polish language,there’s a lot of Polish staff here”Carer of older personOthers moved from one generic service toanother, because they had faced racism fromstaff and from others using the service. Gettingthe services ‘right first time’ would obviously bepreferable.Generic or specific services?Black and minority ethnic people want tohave a choice of services. Many people preferservices provided by the black and minorityethnic voluntary and community sector, not onlybecause they are culturally specific and enablecommunication in the person’s own languagebut because people feel that they will be safeand understood. Many black and minority ethnicorganisations also provide advocacy. 36“The service does take care of my culturalneeds, it is very nice here - everyone is reallygood. There is no need to change anything; Iwould go to the manager if there was. All myneeds are met with regard to food”Older person in a care home for the South AsiancommunityHowever, black and minority ethnic people shouldbe able to choose specific services as a positiveoption, not because mainstream services areunable to meet their needs.36. Chahal, K (2004), IbidSocial Care Policy and Practice

22 Putting people first – equality and diversity matters 2Using Direct Payments and IndividualBudgetsThe use of Direct Payments or Individual Budgetsshould increase people’s control over the servicesthat they use. A general issue raised, however,was the use by some people, particularly olderpeople, of Direct Payments to employ youngerrelatives, such as grandchildren, as personalassistants. Whilst this could meet their needswell, there could also be potential conflictsof interest and questions about whetherpaying relatives might reduce the options forindependent living, if the family becomes relianton the income from these payments. Peoplealso raised a number of issues about makingDirect Payments work for black and minorityethnic communities that are borne out by otherstudies: 37 Many black and minority ethnic people stillhave little knowledge about Direct Payments;these were not raised as an option in theirassessments. People needed more advocacy and support toorganise their care this way. There is a shortage of people to work aspersonal assistants. Some black and minorityethnic people had difficulty in obtainingculturally appropriate personal assistants.37. For example, Stuart, O (2006) Will community-basedsupport services make direct payments a viableoption for black and minority ethnic service usersand carers? Stakeholder participation race equalitydiscussion paper 1. London: Social Care Institute ofexcellence

Putting people first – equality and diversity matters 2 23 People found it difficult to get information onhome care agencies that provided appropriatestaff, as an alternative to employing personalassistants or to cover times when personalassistants were not available because ofholidays or sickness.The first bulletin in this series raised factors thatwere valued by lesbian, gay and bisexual peopleusing Direct Payments that are relevant to othergroups facing prejudice: choice and consistency of worker flexibility over times and tasks whichenable people to maintain contact with theircommunities control in deciding what to do if a worker isdiscriminatory. 38Choice and control – good practicepointersProvide accessible information on care andsupport options, including Direct Payments,that addresses the concerns of black andminority ethnic people.Ensure people have appropriate advocacy toexercise choice.Offer any specific services for black andminority ethnic people as an option but not theonly choice.Home care recruitment agencies shouldpublicise their service, in accessible formats,to black and minority ethnic people consideringDirect Payments and should be able to answerquestions such as the language skills ofavailable workers.Give people a choice about which staff workwith them (see section 12).Involve people using services in staffrecruitment, including assessing staff attitudeson equality issues.Increase flexibility of service times and tasksto help people maintain contact with theircommunities and meet their cultural andreligious needs38. Commission for Social Care Inspection (2008)Putting people first: Equality and Diversity Matters1 – providing appropriate services for lesbian, gay andbisexual and transgender people. London: Commissionfor Social Care InspectionSocial Care Policy and Practice

24 Putting people first – equality and diversity matters 2All equal – key issues in equality anddiversity6. Management and leadership“Research has shown that organisationsthat are successful in this area of diversity[race equality] are in that position because ofeffective leadership” 39Managers have a crucial role in taking action onrace equality; to improve services for people,remove institutional racism, set the ethos of theservice and to give staff a clear ‘steer’.Many managers are developing specific supportfor black and minority ethnic staff, workingwith black and minority ethnic organisations todevelop services and using local information tomap future needs for the service. However, this isnot always as part of an overall equality strategy.The Race Relations (Amendment) Act 2000 placesa duty on public sector providers to promoterace equality, as well as some specific duties inrelation to service provision and employment.Voluntary or private providers with councilcontracts also need to comply with these duties.Guidance to the Act provides useful informationon taking a structured approach to race equalitythrough developing an action plan to implementa race equality strategy, as well as other stepssuch as consulting with black and minority ethniccommunities. 4039. Race Equality Unit (2004) Race equality throughleadership in social care. London: the Association ofDirectors of Social Services, the Social Care Institutefor Excellence and the Commission for Social CareInspection,40. Commission for Racial Equality (2002) The duty topromote race equality: a guide for public authoritiesLondon: the Commission for Racial Equality

Putting people first – equality and diversity matters 2 25Management and leadership – goodpractice pointersInvolve black and minority ethnic peopleusing services, staff and people from outsidethe organisation to develop a race equalitystrategy.Link this to your business plan and allocateappropriate resources.Use the guidance available for the duties topromote race equality under the Race Relations(Amendment) Act 2000.Discuss race equality as a regular item atmanagement meetings and develop managerswho are committed and confident in dealingwith race equality issues.Cascade race equality objectives into individualperformance plans.Support and consult with black workers’ groups.Openly report progress on race equalityobjectives and publicise consultations and theirresulting actions.Make race equality an explicit part of all qualityassurance processes and development work.Identify and address both direct and indirectracism (see section 9).Assess the effect of all your policies on blackand minority ethnic people and other groupswho may face discrimination or disadvantage.Refer to race equality in communications suchas internal newsletters, management and teambriefings and external publicity.Work with your local council to map/auditcommunity groups and community needs anddevelop new services in response to identifiedneed.Good practice example – Anchor TrustAnchor Trust operates a number of businesses,including care services. In 2006 Anchorcommissioned a corporate review to confirm thatpractices with respect to race equality were fit forpurpose.Each business unit within Anchor carried out a selfassessmentevaluation of their current practicesagainst a list of key criteria relating to race equality.The self-assessment was a ‘gap analysis’ whichhighlighted any areas where current practices couldbe extended and developed.This method was informed by an assessmentframework from the Commission for RacialEquality and so helped Anchor to promoterace equality, as laid out in the Race Relations(Amendment) Act.The review enabled good practices to be capturedand shared, and the assessments led to specificaction plans that detailed activities to develop raceequality themes.“The review provided an opportunity to clarify toboth staff and customers that Anchor regardsrace equality issues of high importance. A keyoutput of the project was the development of anupdated corporate diversity statement, whichclarifies expectations of behaviours with respectto race equality. By increasing awareness in ourworkforce, our customers can expect high qualityservices from staff who are informed on the keyrace equality issues.”The review process will be revisited at appropriateintervals to ensure that momentum is maintained.Sharing good practice on race equality issues willalso remain to be a feature.Anchor is linking this with work on other diversitytopics, such as disability equality, to ensure thatregular reviews become ingrained into workingpractices.Social Care Policy and Practice

26 Putting people first – equality and diversity matters 27. StaffingTwo-thirds of the black and minority ethnicpeople using services agreed with the statementthat suitable staff supported them; older peopletended to agree with this more than youngerpeople.Equality is everyone’s responsibilityRace equality is the responsibility of everyonedelivering services. Frontline staff shouldbecome:“Confident and competent workers whocommunicate effectively, use theirknowledge in a non-stereotypical manner anddemonstrate flexibility in their approach. Theywill have the resources to draw on and haveaccess to managers who are knowledgeableabout diversity and are competentsupervisors” 41Learning and developmentMore staff training was a frequent request whenwe spoke to black and minority ethnic people,particularly those using home care. The surveyof service providers indicated that 55% hadensured that their staff had training on equalityand diversity issues, which is likely to includetraining on race equality. Only 4% of providersmentioned training on race equality or diversityissues specifically relating to ethnicity. Thereis no one ‘best method’ for delivering training41. Butt, J (2006), Ibidthat addresses race equality. 42 Learning is acontinuous process and it is therefore importantthat any training is reinforced through, forexample, team meetings, staff supervisionsessions and observation of practice.Role of black and minority ethnic staffThe role of black and minority ethnic workers indelivering services that meet the needs of peoplefrom their communities is the subject of muchdebate.Having a diverse workforce will undoubtedlybring additional experiences and skills into aservice but there are dangers in assuming thatthe presence of black or minority ethnic staff will,in itself, tackle race discrimination. Often black orminority ethnic staff are not in senior positions tomake change.Using black and minority ethnic staff as ‘culturalexperts’ can shift the emphasis from tacklingracism to looking at different cultures, whichleaves institutional racism unchallenged. This canalso lead to generalisations that inadvertentlyreinforce stereotypes because it is difficultfor anyone to be an ‘expert’ on all aspects oftheir own culture. This approach can impedethe development of black and minority ethnicstaff; the worker’s other skills may not beacknowledged and they may have difficultiesmoving beyond specialist roles. 4342. Butt, J (2006), ibid43. Harris, V and Dutt, R (2004), Ibid

Putting people first – equality and diversity matters 2 27Supporting black and minority ethnicstaffBlack and minority ethnic staff in social caredo play a positive role in the provision of moreappropriate services to black and minority ethniccommunities and to the improvement of practicewith all people who use services. However, theymay face a lack of development opportunities orcareer progression, conflict as a result of bringinga different perspective, racial harassment orviolence, and torn loyalties if they are caughtbetween the expectations of black and minorityethnic communities and the agency that employsthem. 44 Management strategies to retain anddevelop black and minority ethnic staff need toaddress these experiences.Enabling black and minority ethnic people usinga service to have choice about the staff thatsupport them is covered in section 12.Staffing – good practice pointersAssess attitudes of potential staff to a range ofequality issues, including race equality, as partof the recruitment and selection process.Assess training needs on equality regularly andensure all staff receive training which coversrace equality on an ongoing basis, for examplethrough self-directed learning. Considerinvolving black and minority ethnic peopleusing services in delivering training.Ensure regular and consistent messages aboutrace equality are given to staff by managers,and there are opportunities for staff to developtheir practice through staff supervision andteam meetings.All staff should be expected to treat blackand minority ethnic people fairly and withoutprejudice. If they do not, action should be taken.Retention of black and minority ethnic staffshould be considered before recruitment;review equality and harassment policies, careerprogression, and staff support and supervisionto see how they are working for black andminority ethnic staff.Develop ways to gain the views of black andminority ethnic staff, including anonymousfeedback, for example through questionnairesand exit interviews.Consider establishing a black and minorityethnic staff forum, and be clear whether it is forpeer support, consultation with management orboth.44. Harris, V and Dutt, R (2004), IbidSocial Care Policy and Practice

28 Putting people first – equality and diversity matters 28. Monitoring ethnicity“Service providers can only tell if they aremaking progress in making their servicesavailable to all sections of the population byethnic monitoring and by seeking the views ofpeople from minority ethnic communities” 45Monitoring ethnicity in service delivery is betterestablished than monitoring other equality areas,such as sexual orientation or faith, but needsto be carried out in a sensitive way. Serviceswill need to establish the best ways to collectmonitoring information, ensure that staff aretrained on how to collect information and, mostimportantly, decide how the data will be used toimprove the service.As well as ethnic monitoring of service use, forexample of referrals and numbers of people usingthe service, it is important to incorporate ethnicmonitoring into quality assurance processes,such as surveys of people using services. Thisenables the provider to consider questions suchas: Do we understand the diverse needs of blackand minority ethnic communities? Do our services meet the diverse needsand aspirations of black and minority ethniccommunities? Do we provide an appropriate and professionalservice to black and minority ethniccommunities? Do we achieve equally high outcomes for allethnic groups in all our various activities? 46The Department of Health has produced aPractical guide to ethnic monitoring in the NHSand social care 47 for public sector organisations,which may also be useful for voluntary andindependent sector providers.Ethnic monitoring in services– goodpractice pointersDecide on how you will use ethnic monitoring,for example to improve take-up of services byblack and minority ethnic people; then whichprocesses require monitoring, for examplereferrals, admissions, quality assurance.Ensure senior managers explain to staffwhy monitoring is important and give stafftraining or guidance on their role in monitoring,particularly if questions are going to be askedverbally.Make the purpose of monitoring clear topeople completing the form or being asked thequestion.Ask everyone the ethnic monitoring question– self-classification is a fundamental principle.Where this is not possible because the personusing the service is unable to understand thequestion, ask their closest relative or friend.Obtain consent – if someone does not want toanswer any monitoring question, that shouldbe respected.45. Chahal, K (2004), Ibid46. Chahal, K (2004), Ibid47. Department of Health (2005) Practical guide toethnic monitoring in the NHS and social care. London:Department of Health

Putting people first – equality and diversity matters 2 29Make confidentiality clear – tell people who willsee the forms and ensure that no individual canbe identified from any reporting, for examplereporting back at an organisational level ratherthan a service level.Use the 2001 Census codes for ethnicmonitoring as this is a national standard butanalyse the ‘other’ category carefully to pick upissues for smaller communities.Monitoring ethnicity should be carried outalongside other monitoring questions, forexample regarding age, gender, sexualorientation and disability. Monitoring religionand belief should be a separate question toethnic monitoring.Report back to people to show how monitoringhas improved services.Social Care Policy and Practice

30 Putting people first – equality and diversity matters 29. Tackling prejudice anddiscriminationRace discrimination manifests itself in manydifferent ways. Service providers need to beaware of and sensitive to these in order to tacklediscrimination effectively.Of the black and minority ethnic people that wespoke to, 23% said that they had experiencedprejudice or discrimination whilst using services.Only 13% of the older people felt that they hadfaced discrimination compared to 53% of thepeople under 65, with a further 18% of youngerpeople not sure if they had faced prejudicecompared to 9% of older people who wereuncertain.We cannot conclude that there is morediscrimination in services for younger peoplebecause there may be various reasons forthis difference, including under-reporting ofdiscrimination by older people. These issues areexplored further in this section.Direct discriminationPeople using social care services can face directracism from individual members of staff, such asverbal abuse, racially motivated physical abuse orintentionally poor care, such as being ignored ordeliberately excluded.Some black and minority ethnic people that wespoke to had experienced direct discriminationfrom staff:“Sometimes they [some staff] call me names”Older person“I was more, like, manhandled when otherswere more, like, talked to and guided, youknow, to a room”Person using mental health servicesThere needs to be a zero tolerance of intentionalracism in order to both protect individual blackand minority people using services from abuseand send a clear message to all staff that it isunacceptable. Discriminatory abuse is one of thesix types of abuse identified in the Department ofHealth No secrets guidance; 48 reports of racismmay need to be handled under safeguarding(adult protection) procedures. Some directdiscrimination may also be a criminal offence.In order to tackle direct discrimination, providersmust not rely on people using services reportingincidents; they need to encourage other staff touse whistle-blowing procedures and to ensurethat supervisory staff observe day-to-daypractice.48. Department of Health (2000) No Secrets: guidance ondeveloping and implementing multi-agency policiesand procedures to protect vulnerable adults fromabuse. London: Department of Health

Putting people first – equality and diversity matters 2 31Indirect discriminationBlack and minority ethnic people using servicesmay also experience indirect discrimination orinstitutional racism. 49“Most discrimination and racism is subtle, forexample I do not receive much information inmy own language”Focus group participant“I have faced both [race discriminationand disability discrimination]. A lot ofassumptions are made at assessment”Disabled personStaff with supervisory responsibility mayneed support to identify and deal with poorpractice that may be caused by unconsciousdiscrimination.Discrimination from other people usingservicesPeople need to be free from harassment ordiscrimination by others using the service, inorder to be safe.“I have experienced racism in the servicesI use... yes I experience racism from fellowservice users, the staff tell me to take nonotice”Older personSometimes this is more difficult to address thandiscrimination from staff, for example if theperpetrator is less aware of their actions through49. See section 2 for definitions of these termshaving dementia or another cognitive impairment.However this type of prejudice cannot be ignored.Each situation needs to be consideredindividually and may involve safeguardingprocedures. Providers should ensure that thewishes of the person being discriminated againstare central. They will need to consider whether itis possible to continue providing a service to theperpetrator, whether they must ensure that theydo not have contact with the victim, or how bestto challenge their behaviour. Racial harassmentor violence from people using services towardsblack and minority ethnic staff should also beincluded in harassment policies.Reporting concerns aboutdiscriminationThere were a number of reasons why black andminority ethnic people did not always reportdiscrimination to service providers.Some older people had lower expectations ofservices and described experiences that otherswould define as discrimination but still said, whenasked, that they had not faced prejudice.Everyone may have more fears about raisingconcerns as they get older. If people havemigrated to the country, their relationshipto authority may be affected by both theirperception of their position in the host countryand the role that authorities played in their birthcountry.“They ask me how I feel here, if they ask me Itell but I don’t initiate”Older person living in residential careSocial Care Policy and Practice

32 Putting people first – equality and diversity matters 2Some people who did not speak Englishexpressed uncertainty about whether staff andother people using the service ever said anythingracist about them but assumed that this was notthe case.Others expressed fear of repercussion if theyreported staff, particularly if they were moreuncertain about whether they had experienceddiscrimination.“You feel they don’t want to talk with you, theyjust want to come in and out. They might belike that anyway to everyone, I don’t know.But I feel they really don’t want to be there,so it could be racism. They are all whiteand English so far, so maybe. I haven’t saidanything to them, you don’t know what mighthappen if you do”Older person using home careWays people using services handleracismBlack and minority ethnic people using serviceshave developed various strategies for handlingdiscrimination, other than reporting it formally.Some people were anxious not to be seen as‘troublemakers’ and talked about their ownbehaviour, to avoid overt discrimination:“If you are not difficult to other people thenother people won’t give you a hard life”Older person living in residential care“I have never faced any racism here. I am agood person and get on with others”Older person living in residential care

Putting people first – equality and diversity matters 2 33Whilst intentions to get on well with others arepositive, this could affect a person’s well-being ifit leads to modifying their own behaviour in orderto avoid racism or seeing any discrimination assomething that they have brought on themselves.Others had ‘voted with their feet’ and changedservices if they faced prejudice.“[I faced] subtle racism, which I dealt with ina diplomatic way and then stopped using thatagency”Person with a learning disability using home careOthers decided to put up with the discrimination,either for fear of repercussion or because theythought that they did not have any other options.One person living in a care home who hadexperienced verbal abuse said:”If you want to complain you have to go to theoffice and complain, and that’s difficult to goto them”Older person living in residential careOnly five of the 400 services said they had takenparticular action to improve their mechanismsfor tackling complaints of race discrimination.Information about services and rights canprovide people with an important safeguardagainst racism, abuse and discrimination. 50 Butinformation alone is not enough if people are notconfident to come forward. Strategies need to bein place to encourage people using services toshare their experiences, to enable staff to identifyand report discrimination and to address howcomplaints are handled if they do arise.Implications of under reportingUnreported discrimination, whether this is dueto uncertainty about whether discrimination hastaken place or because of fear of the implicationsof disclosure, has major implications for serviceproviders. Firstly, it can affect the well-being ofindividual black and minority ethnic people usingservices. Secondly, service providers need toknow when people are experiencing racism orother forms of discrimination, in order to takeaction to prevent it happening in the future.50. Social Services inspectorate (1998), IbidSocial Care Policy and Practice

34 Putting people first – equality and diversity matters 2Tackling race discrimination – goodpractice pointersPrevent discrimination by addressing theorganisational culture and staff attitudes.Set clear standards on acceptable staffbehaviour, communicate these to staff andmonitor practice.Encourage people using services to report theirexperiences through both formal and informalmethods, for example by enabling people to feelconfident to approach the manager.Ensure staff are aware why black and minorityethnic people using the service may notreport complaints and work with individualsto increase trust, their expectations of servicequality and to share concerns.Ensure service user guides make clear theorganisation’s expectations of both staff andpeople using services, around all equality anddiversity issues.Ensure policies on complaints, harassmentand discrimination are available to everyoneusing the service in an accessible formatand that these specifically mention racialharassment and discrimination, confidentialityand non-victimisation and the availability ofindependent advocacy.Always check whether a report ofdiscrimination should be dealt with as asafeguarding issue or requires disciplinaryaction to be taken.Be clear if there are limits on confidentiality, forexample if a complaint is a safeguarding issue,and keep people informed about the progressof their complaint, as far as possible.Intentional racism, or other intentionaldiscrimination, from staff should be considereda serious disciplinary matter and included inthe disciplinary policy.Ensure staff are familiar with whistle-blowingprocedures and raise the profile of using theseprocedures when staff witness discrimination.Monitor the types of complaints received andactions taken, to see whether these indicatethe need to change any services.Consider a programme of work with peopleusing the service to look at prejudice anddiscrimination.

Putting people first – equality and diversity matters 2 3510. Involving black and minorityethnic people who use servicesIt is only by engaging with black and minorityethnic people who use services that providerswill be able to improve their services. Black andminority ethnic people using services should beviewed as having valuable and unique expertise,which cannot be substituted by engaging withblack and minority ethnic professionals or‘community leaders’. Building trust and allayingpeople’s real fears about getting involved is vital. 51There are different levels of involvement – frominformation, to consultation, partnership and ‘usercontrol’. In all these levels, black and minorityethnic people may face particular barriers to their51. Begum, N (2006) SCIE Report 14: Doing it for themselves:participation and black and minority ethnic service users.London: Social Care Institute for ExcellenceSocial Care Policy and Practice

36 Putting people first – equality and diversity matters 2involvement. They may face language barriersin the information provided or have to deal withprejudice or stereotyping from others in involvementinitiatives led by people using services.Black and minority ethnic people using servicesneed to be involved on the same basis as others,so providers should ensure that all their ways ofinvolving people are accessible to them.Providers may also want to consider developingspecific ways of involving black and minorityethnic people, such as peer support groups. Peersupport groups for young black and minorityethnic disabled people have been shown toprovide emotional support, the opportunityfor friendship and an opportunity to discussissues in a comfortable space. 52 Supportingindividual participation, as well as group-basedparticipation, can also help black and minorityethnic people to contribute. 5352. Bignall, T, Butt, J, and Pagarani, D (2002) Something todo – the development of peer support groups for youngblack and minority ethnic disabled people. Bristol:Policy Press and London: Joseph Rowntree Foundation53. Begum, N (2006), ibidInvolving Black and minority ethnicpeople who use services – good practicepointersMake sure that existing ways of involvingpeople are accessible to the black and minorityethnic people using the service, for exampleby asking people their preferred languagefor materials, whether they want informationin written or audio format and by providinginterpreters on request at meetings.Use different tools for feedback includingenabling people to express themselves indifferent ways, through talking, writtenformats, etc.Make sure that that you ask people using theservice about their views on race equality, forexample in surveys.Work with existing groups of people usingservices, for example through residents’meetings on issues of prejudice anddiscrimination, to enable these groups to be amore comfortable environment for a diverserange of people.Consider developing specific ways to involveblack and minority ethnic people using theservice, such as individual interviews or aninvolvement or peer support group for blackand minority ethnic people.If there are few black and minority ethnicpeople using the service, make contact withpeople who could potentially use the service,for example through voluntary or communitygroups, to ask their views on what is importantto them in service provision.

Putting people first – equality and diversity matters 2 37Specific issues for black and minorityethnic people using services11. A home from homeCulturally appropriate servicesProviding culturally appropriate services wasthe area of race equality work most frequentlymentioned by care homes – 24% of care homesfor older people and 30% of care homes foryounger adults said that they had taken action inthis area.Living in an environment that reflects youridentity is very important in maintaining a senseof dignity, choice and control. Everyone has‘cultural needs’ which impact on their sense ofidentity, but when someone is in a minority theseneeds can remain unmet if they are overlooked,assumptions are made or resources are notallocated to meeting them.Replacing a lack of consideration for culturewith generalisations about cultures should beavoided, as it can lead to stereotyping or culturalmisunderstandings. Diversity within cultures isexplored more in section 2. ‘Cultural competence’is a skill supported by the organisation, ratherthan a set of knowledge about different cultures.One definition of cultural competence is thatit is a set of behaviours, attitudes and policiesthat come together in a system, to enableprofessionals to work effectively when peopleusing those services have a different culture totheir own. 54There may be particular challenges for servicesin establishing a culturally appropriateservice where the person does not use verbalcommunication, especially if they do not haverelatives or friends who know the person’spreferences well. In these circumstances,services need to enable people to indicate theirpreferences in a range of ways, for exampleseeing how people respond to different choices ofappropriate food.54. Isaacs, MR and Benjamin, MP (1991) Towardsa culturally competent system of care. VolumeII: programs which utilize culturally competentprinciples. Washington DC: CASSP Technical AssistanceCenter, Center for Child Health and Mental Health PolicySocial Care Policy and Practice

38 Putting people first – equality and diversity matters 2FoodWhen we talked to black and minority ethnicpeople living in care homes about whether theservice met their needs, food was an aspect thatpeople frequently mentioned. Eating food thatreflects your cultural identity is important notonly in terms of choice and control, but for itssocial significance, for example in eating withothers and celebrating occasions, and its spiritualor religious significance. The way that people eattheir food also varies between cultures and thisshould be catered for.”The food they offer is Chinese and I’m happyabout it. For Chinese New Year they cookspecial food, say for example some cakes”Older person living in residential care“You don’t get all the food that you like, youdon’t get that kind of food, you get what theydecide that the English should have, youknow. The kind of food that I used to have wasgreen bananas, sweet potatoes, you don’t getthat... I myself I like to cook. I’m a good cook; Iused to cook years ago. I’m not allowed that,I’m not allowed to go in the kitchen”Older person living in residential careWhere there are only one or two people in a carehome who require food from a particular culture,some services have responded creatively byoffering this food as a menu choice to everyoneor by preparing dishes in larger quantities andfreezing individual portions.Awareness of different cultural requirementsaround food is important, but it is no substitutefor asking people what they want. These issuesare explored in the Commission for Social CareInspection bulletin Highlight of the day.“An Asian man moved into a care home forAsian lifestyles. His partner was white and itwas stated that he had enjoyed a diet of Asianand British food throughout his life. Whilst inthe home it was assumed that the man wouldonly want and enjoy Asian food... When thecare home asked the man what food he wouldlike to eat, he responded stating both Britishand Asian food” 55Assisting people to have appropriate food isalsoimportant for home care services. The goodpractice example on page 44 describes how stafftraining has helped to provide a more appropriateservice for black and minority ethnic people usinghome care, as well as those living in care homes,and how providing people with food of their choicecan support good nutrition.Home environmentSome care homes enable people to maintainlinks with their culture through being able topersonalise their environment, for examplebringing their own furniture and decorating theirrooms they way they want. Thought should alsobe given to communal areas, by asking peopleliving in the home whether there are any changesthat they would like and trying to ensure that arange of views are acted on, not just the majorityview.55. Commission for Social Care Inspection (2006), ibid

Putting people first – equality and diversity matters 2 39Personal careThe way that personal care tasks need tobe carried out also varies between cultures,including different approaches to physicalcontact, ways of washing and skin and haircare. Personal care can be about very intimaterelationships and tasks and has a large impact onprivacy, dignity, rights and well-being.Many providers personalise support by askingpeople how they would like each task to becarried out and who they would like to carryout the task. Meeting these needs may meanmaking changes to the facilities in care homes,for example in some South Asian cultures, peopleneed to wash using running water.Religious or spiritual practiceSome people may have religious or spiritualpractice that needs to be carried out at homerather than at a place of worship, such as prayeror meditation. Others may not have a place ofworship that is accessible to them.Care homes can facilitate these individual needsand home care services also need to ensure staffrespect the religious or spiritual requirementsthat someone has in their own home, which mayaffect the timing of visits.Muslim women living in a care home told CSCI thatfasting during Ramadan was difficult for thembecause they cannot eat after sunrise, whichcan be as early as 4am, but there are no staffavailable to make them food at this time of day.Again these requirements vary greatly betweenindividual people and it is not useful to work fromlists or base these on assumptions, for example‘always take your shoes off when you enter aMuslim home’. 56There are multi-faith calendars available whichcan help to raise awareness of important datesfor different religions, as well as often providingbackground information about the faith itself (seethe resources section). These can be a usefulstarting point, but dates and other informationshould be checked with individuals usingservices, as there may be many variations withinfaiths.HealthcareThere are cultural and faith-based differencesin the way that people view healthcare and thetreatments that people would like to receive;for example, the Quran contains a range ofteachings for Muslims about health. Some blackand minority ethnic people may want to seea practitioner from their own culture or usemedicines or other types of therapy from theirown culture. These should be considered in thesame way as other treatments within any policyon medication and an appropriate framework ofrisk assessment.There are an increasing number of culturallyspecific health services that black and minorityethnic people using social care services may beable to access, for example mental health supportgroups and healthy living activities. Information56. Butt, J (2006), IbidSocial Care Policy and Practice

40 Putting people first – equality and diversity matters 2about these may be found from mainstreamhealth services such as GPs or from localvoluntary sector organisations.End-of-life careSerious illness, death and dying can increase theimportance of ethnic, gender and faith identitiesand intensify experiences and feelings of socialexclusion for older people. Yet, at this difficultpoint, many black and minority ethnic people findaccess to palliative care services mystifying. 57The palliative care, older people and ethnicity(PALCOPE) project has produced a rangeof information for health and social careprofessionals and for black and minority ethnicpeople using services, available from the PolicyResearch Institute on Ageing and Ethnicity (seethe resources section).Enabling people to feel at home – goodpracticeAsk people about their preferred food and try tomeet these needsLook at ways for people using the service tocook for themselves if they wishThink creatively about meeting people’s dietaryrequirements – for example, consider offeringmenu choices that reflect a range of cultures toeveryoneAsk people how they prefer to eat their foodEnable people living in care homes topersonalise their own spaceAsk people about changes to the communalareas and act on a range of views, rather thanthe majority viewEstablish with each individual what theirpreferences are for personal care and how thehelp should be providedMake changes to the facilities, if required, tomeet people’s personal care requirementsAsk people whether they have any religious orspiritual practice or requirements and how theservice can respect or facilitate theseSupport people to see health professionals oftheir choice and to use medicines from theirown cultures or non-traditional medicines(within an appropriate framework of medicationpolicy and individual risk assessment)57. Gunaratam, Y (2006), Ibid

Putting people first – equality and diversity matters 2 4112. Who supports us?‘Matching’ staff based on ethnicityPeople have complex identities and ‘matching’of staff based on ethnicity or culture shouldbe a choice offered to someone rather than apresumed best option. It should not be used as away of white staff avoiding the responsibility ofworking with black and minority ethnic people inan appropriate way. In reality, in many services,such as most care homes, ‘matching’ may onlybe possible for a key worker, not for all the staffworking with someone. This means that all staffneed to have skills to work appropriately withblack and minority ethnic people.The Skills for Care Annual Workforce Surveysuggests that 17% of the entire independentsector social care workforce are people fromnon-white minority ethnic groups. However, thisproportion varies by type of service provided,ranging from 23% in care homes with nursing to14% in domiciliary care. The relatively high level ofblack and minority ethnic staff in some servicesdoes not necessarily facilitate ‘matching’ peoplewho use services with staff as they may comefrom different minority ethnic communities.Social Care Policy and Practice

42 Putting people first – equality and diversity matters 2Some of the black and minority ethnic peopleusing services that we spoke to expressed apreference to be supported by people from theirown culture, especially if they wanted support ina language other than English. This was often amajor reason why people opted to be supportedby specifically black and minority ethnic services.“Communication is good. I understand themand the staff speak my language. I have achoice to have staff support me in my culture”Older person living in a care home for the SouthAsian communitySome people in care homes relied on domesticor catering staff for language support if therewere no care staff who spoke their language.People may want to specify people from their ownculture for specific tasks, such as personal care.For others, the attitudes of the workers were as,or more, important than the worker’s culturalbackground.“I can understand them but sometimes I thinkthey don’t understand me or they just aren’ttaking the time to listen. I would prefer peopleto understand my culture or show an interest,take notice of it. They do not have to be WestIndian”Older person using home careOne refugee told us that she specifically didnot want support from staff who came from hercountry of origin because she feared her familymay be persecuted if information about her waspassed on. Others may be more reluctant tocriticise a worker from their own background.Targeted recruitmentThis raises the question of when it is appropriate,for both generalist and specific services, to carryout targeted recruitment of staff from particularcommunities. Reviewing advertising strategiesand ensuring that recruitment processes donot unwittingly discriminate against blackand minority ethnic people is relativelystraightforward.It also lawful to more generally encourage blackand minority ethnic applicants to apply for posts,if there is evidence of under-representation, butemployers should check the legislation 58 carefullybefore doing this.The law regarding ‘positive action’ approachesis more complex, especially if a post is reservedfor someone from a specific community, andemployers are advised to seek legal advice beforeusing a genuine occupational requirement orqualification under the Race Relations Act. 59In the sample of service providers, 16% ofhome care services said that they had takensome action to recruit more black and minorityethnic staff, for example by reviewing how theyadvertised vacancies.58. Race Relations Act 1976, section 37. See alsoCommission for Racial Equality (2005) Statutory codeof practice for race equality in employment. London:Commission for Racial Equality59. Commission for Racial Equality (2005) Statutory codeof practice for race equality in employment. London:Commission for Racial Equality

Putting people first – equality and diversity matters 2 43GenderChoice about the gender of staff may also beimportant for some people, particularly forpersonal care tasks.“it doesn’t matter except for washing. I prefera woman and I get a woman to do that”Older person living in residential careSpecifying that a member of staff needs to beman or woman is also allowed under the SexDiscrimination Act, as a ‘genuine occupationalrequirement or qualification’ if the job needs to beheld by a person of that sex to preserve decencyor privacy because of likely physical contactor because people are likely to be in a state ofundress or using sanitary facilities. 60 Case lawhas established this clause may apply to careassistants. 61Staff continuityContinuity of staff can also be important,particularly for some black and minorityethnic people who may fear that staff will notunderstand their needs or that they will facediscrimination.Enabling people to choose staff – goodpractice pointersFind out from individual black and minorityethnic people using the service about who theyprefer to be supported by, including whetherthey would prefer support from people fromthe same cultural heritage. Try to meet thesepreferences.Enable people to choose the gender of staffsupporting them, where possible.Develop a recruitment strategy that looksat recruitment processes for all posts toensure that advertisements reach and attractapplicants from black and minority ethniccommunities.Ensure that selection processes do notunwittingly discriminate against black andminority ethnic candidates and that all relevantexperience is valued.Consider whether ‘targeted recruitment’ of staffmay be an advantage in meeting these needs –but first look at what needs to change and why.Seek advice on the law about recruiting stafffrom particular minority ethnic backgroundsor of a particular gender, before recruitingusing ‘genuine occupational requirements orqualifications’.Consider career progression opportunities forstaff who may want to move into roles wherethey have more direct contact with peopleusing the service, including any developmentneeds that staff may have, such as Englishlanguage support.60. Sex Discrimination Act 1977, section 7(2)(b)61. Lewis v Mortimer Homes Ltd ET/1101876/98 EOR DCLD42Social Care Policy and Practice

44 Putting people first – equality and diversity matters 2Good practice example – Care4YouSheffieldCare4You is Sheffield City Council’s in-houseprovider of home care services, residentialresource centres which provide rehabilitationand intermediate care, one care home for longerstays and the community response to the alarmalerts service. Care4You has developed a numberof initiatives aimed at making services moreculturally appropriate for a range of communities,including: Active recruitment of staff from minorityethnic communities, cascading advertisinginformation through community groups withthe aim of having a staff profile that matchesthat of the city as a whole. People using the service are given options toexpress choice of staff in terms of both genderand culture – having a particular culturalbackground is viewed as a skill in terms ofproviding an appropriate service. If choicescannot be met at all times, a solution isnegotiated. In 2006 a ‘food for thought’ trainingprogramme was initiated after a qualityassurance survey where people said that foodquality was excellent but choice was limited.The programme builds on the good practiceidentified in the Commission for Social CareInspection bulletin Highlight of the day 62 andaims to provide people with an excellent choiceof meals taking into account culture andpersonal preference, whilst also addressingissues of healthy eating. The training isdelivered to all catering and care staff and isreinforced by direct observation of staff.“Workers are given guidance on how to seek outthe individual’s food preferences and if these arenot suitable to support their good health, staff willencourage the service users to make an informeddecision about their choices, but the choice doeslie with the individual. Food for thought is integralto the delivery of services that meet the dignitychallenge” A DVD is available showing the variety ofservices available with the option to listen tothe dialogue in any of the five main languagesspoken in Sheffield.“In Care4you we aim all the time to work withthe premise that the people using our servicesare unique individuals with their own uniquerequirements and choices otherwise people arejust institutionalised in their own homes”6262. Commission for Social Care Inspection (2006) Infocus: Highlight of the day, London, Commission forSocial Care Inspection

Putting people first – equality and diversity matters 2 4513. Understanding each otherBeing able to communicate with staff is crucialfor all people using services; it enables peopleto express their wishes, understand what isgoing on around them and feel connected toothers. Having access to support that enablescommunication underpins human rights to betreated with dignity and respect and to takepersonal decisions.LanguageHaving access to staff who speak the samelanguage is a major reason why some peoplechoose to use services for specific black andminority ethnic communities.“All needs are taken into account... all staffcommunicate in my language”Older personSometimes people who do not speak Englishhave to rely on staff on particular shifts, domesticor catering staff or other people living in the carehome, as two older people explain:“The staff here are English speaking,especially the day staff, all of them areEnglish speaking apart from one staffmember on the night shift, who speaks mylanguage so I just cannot communicate withthem... I don’t know what to say to them. Ican’t ask for more, as long as I am providedwith food and a shelter I am happy, you know”“In the morning they give us notices and thensome people who can read the notices tell uswhat the arrangement of the day is like. Forexample when we will get a meal or when weshould wash ourselves before having a meal,things like that”Others relied on family members to sort out anyproblems when they visited. Whilst many peoplefeel more comfortable communicating throughsomeone they know, this can be problematic.Family members are not professional interpretersand may not convey information accurately;furthermore they may have a conflict of interest.Multilingual workers are important for enablingday-to-day communication but should notbe used as a cheap and easy alternative toprofessional trained interpreters where someoneneeds an independent voice, as this could causea conflict of roles.Where there are no, or few, staff that speak thesame language as someone using a service,providers will need to be creative in theirapproach to day-to-day communication. Onehome care provider told us about how theyhad provided a service to older Chinese peopleby providing the older people and staff with alist of useful phrases in Cantonese and theirequivalent English translation. The older personor staff member would point to the phrase onthe sheet to communicate – some staff alsolearned the Cantonese phrases using thismethod. When recruitment of some Chinesestaff had taken place, some older people optedto keep the existing staff because the trust andcommunication had developed so well.Of the sample of providers, 8% said that they hadcarried out some work on making their servicesSocial Care Policy and Practice

46 Putting people first – equality and diversity matters 2accessible to people speaking languages otherthan English.Communicating across culturesIt is important that staff directly providingsupport feel confident to ask black and minorityethnic people about how they want tasks to becarried out and how well the service is workingfor them.Enabling good communication is more thanproviding staff with appropriate language skills,interpreters or written materials in differentlanguages. Assumptions and cultural differencesin communication need to be addressed as well. 63Good verbal communication skills can help staffto communicate with everybody. Staff need to: find ways of checking that they have beenunderstood listen to the words that the person uses andtry to use their vocabulary use plain English and avoid jargon or idioms address the person in the way that they prefer allow enough time for communication.Non-verbal communication can also varybetween cultures, for example ‘yes’ is indicatedby nodding the head in some cultures and byshaking it in others. Staff need to be aware thatthere may be differences in these conventions,and to check with the person concerned or theirfamily if they are uncertain.Communication – good practice pointersTarget recruitment to employ staff with relevantlanguage skills (see section 11).Research local interpreting and translationservices and telephone interpreting serviceswhich can be used where ad hoc interpreting isrequired.Use interpreting services where it is importantthat someone using a service has anindependent and accurate voice, for exampleif reviewing a care plan. Offer people a choiceof interpreters, including choice of gender, ifavailable from the service.Offer people advocacy to aid communication insituations such as meetings.Ensure that the documents given to peopleusing the service are translated when required.Allow enough time for communication - thisdemonstrates respect.Provide training and support to staff to developtheir skills, including verbal communicationskills, awareness of cultural differences in nonverbalcommunication and respect for differentvalues and views.Try to maintain continuity of staff working withsomeone as communication and trust builds upover time.63. Note footnote number will need checking Butt, J, Box,L and Cook, SL (1999), Ibid

Putting people first – equality and diversity matters 2 4714. ConnectionsFamilies, friends and communitiesEveryone needs to maintain contacts with others– with their families and friends – as well ashaving wider links with the community throughhobbies, activities or religious worship. For blackand minority ethnic people these connectionsmay be particularly important in maintainingcultural identity and because families, friendshipsand community activities can provide a safespace and support in dealing with any racism. Theimportance of family connection can vary acrosscultures.These issues are individual and may vary withindividual preferences or other factors; forexample, if a black or minority ethnic personis a refugee or is lesbian, gay or bisexualor transgender, they may have differentrelationships within their communities which areimportant. 64Lack of contact with people that are important toyou leads to isolation and can lead to poor mentalhealth.“I don’t know, I still feel isolated, and I’mnot sure why it is really to tell you the truthbecause... I can talk to people... you know, Istill take it day by day and I still try and say64. for example, Safra Project (2003) Initial findings –identifying the difficulties experienced by Muslimlesbian, bisexual and transgender women in accessingsocial and legal services. London: Safra Projecthello to everybody and, and just keep it reallywithin myself”Person using residential mental health servicesThe role of servicesAround two thirds of black and minority ethnicpeople told us that services helped them to stayin contact with people and do things that wereimportant to them. This overall figure maskssome differences which may reflect the roles ofdifferent services. Only one third of people usinghome care services felt that the service helpedthem to stay in contact with people.“No I am not leading the life I want. Carers arenot confident to take me on public transport”Person with a learning disabilityAlthough 70% of people living in care homes feltthat services helped them stay in contact withpeople, many did not feel this was the role of theservice or they had low expectations of what thismeant.“No, it’s something that you do under yourown steam is that”Person using residential mental health services“Any relations or friends that call they’rebrought up here to show them where I was...as far as I know they’ve not turned anybodyaway that’s come to see me or anything likethat. No, I wouldn’t think that”Older personSocial Care Policy and Practice

48 Putting people first – equality and diversity matters 2Getting out and aboutIt is important that people living in care homesare able to maintain and develop contacts outsidethe home. Organised trips were appreciated bymany but did not meet some people’s needs.“People make arrangements, for example totake us to the library, but frankly speakingI’m not that interested because if they takeus to the group I cannot communicate withthe people there, or they give you some pieceof paper, some notice, and I can’t read it.Yeah, I would enjoy it better if they take us toa Chinese restaurant to enjoy some food orhave some Chinese tea there”Older personThis illustrates the importance of meetingeach individual’s need for contact with theircommunities, particularly those without relativesto help out.“My family come to see me and take me out,I get my religious needs taken care of, if thereis a function my son takes me”Older person living in residential care“Yeah I used to sing in a band, I likedsinging. My fun was dancing. But I’m in thiswheelchair. I would have to have someone topush me, or one of my family”Older person living in residential careSeveral people indicated a willingness to assist inorganising activities.

Putting people first – equality and diversity matters 2 49“A couple of years ago, when I first came hereI used to tell them, look I think the best thingis to hire a van. Get a van and we can do somuch. They could us take us out and go toplaces that I’ve never been before... but theywouldn’t pay”Older person living in residential careA sense of communitySome people who face significant access barriersor have particular health issues may prefer thecommunity to come to them, rather than goingout. Also, where people using services havecontact with each other, for example in carehomes and extra care housing schemes, serviceproviders need to consider how they promotegood connections, particularly to avoid peoplewho are in a minority feeling isolated or facingdiscrimination.Essentially some services are communities anddeveloping a sense of belonging and valuingdiversity could be useful in bringing peopletogether across boundaries within services. Thistype of work can also be useful if a service has adiverse staff team, in enabling staff and peopleusing services to develop respect for each other’sbackgrounds. Of the services we surveyed, 6%told us that they had undertaken some work ofthis sort, for example shared meals based onfood from different cultures.This work can extend beyond people usingservices and staff, to include visitors, relativesand people from the local community, as the casestudy in this section shows.The day-to-day arrangements in a care homeshould also assist positive relationships betweenpeople by simple actions such as ensuring thelayout of communal areas enables interaction,introducing people to each other and reducingexternal noise. 65How much people interact with others usingthe service should be a personal choice butservices should try to remove any barriers thatblack and minority ethnic people may face indoing this, whether these are physical barriers,communication barriers or the attitudes of others.Where people speak a number of languages, thismay involve developing activities that are notreliant on verbal communication, to help bringpeople together.65. Help the Aged (2008): My home life, issue 3: creatingcommunities. London: Help the AgedSocial Care Policy and Practice

50 Putting people first – equality and diversity matters 2Good practice example – St Matthew’sPlace, WolverhamptonSt Matthew’s Place is an extra-care housingscheme with a home care service, run by MidlandHeart. The scheme is in a local area where mostof the local people are white British in ethnicorigin. Over time, a number of African-Caribbeanpeople moved into the scheme. The staff identifiedthat, whilst many of the people living there weresociable, not everyone was culturally sensitive totheir new neighbours.The scheme decided that they wanted to gentlystart raising awareness of people living in thescheme to different cultures and started thisprocess with a Caribbean Cultural Awareness OpenDay. People living in the scheme, relatives andlocal people living nearby were all invited to anafternoon which included a display of Caribbeanartwork, a steel band, gospel choir, limbo dancingdisplay and Caribbean food, cooked fresh on site.“The day was very much about fun rather thanformally training people to understand differentcultures. The day was extremely popular andpositive. People living in the scheme appear tohave a greater respect for the Black and MinorityEthnic community and view it more positively.We have since held, Asian, Chinese, Italian andHungarian themed events or meals.”These follow up events reflected the culturalheritage of staff working in the scheme and ofthe wider local community. Midland Heart is nowreviewing the menus for the restaurants in all theirschemes.“Our aim is that the food we provide should reflectthe communities that we feel passionate about”Connections– good practice pointersEnsure staff recognise the importance forblack and minority ethnic people of staying incontact with people who are important to themand with their communities.Ensure that people living in care homes haveprivacy when family or friends come to visit.Ensure that services enable black and minorityethnic people to maintain and developrelationships with others, particularly thosewho have fewer visitors, in order to help peoplemaintain cultural identity.In care homes, ask people about the leisurefacilities within the home that enableconnections with communities, for examplemagazines, newspapers, TV channels, andwhether they need changing to be moreappropriate for people’s cultural heritage.Involve people using the service in planningactivities and ensure that these reflect thediversity of people using the service - considerworking in partnership with other providers toprovide appropriate activities.In care homes, enable good communicationbetween people using services on an everydaybasis, removing barriers to enable moreinteraction - look out for people who maybe isolated or who interact less with othersbecause of language or cultural differences.Provide people using the service with activitiesthat enable them to learn about each other, forexample through reminiscence work, activitiesthat do not necessarily require a shared language,and/or provide activities in a range of languages.Think about the aims for any event to bringpeople together and involve people using theservice, relatives, friends, staff and the localcommunity in planning and participating inparticular events such as meals or open days.

Putting people first – equality and diversity matters 2 5115. Reaching outCare providers will need to consider whetherpublicity about their services takes into accountthe information requirements of people fromblack and minority ethnic communities who maypotentially use their services.“If organisations are serious about pluggingthe knowledge gap about what support isavailable – and for which there is continuingevidence –they need to reach out to black andminority ethnic communities” 66Black and minority ethnic people oftenhave difficulty accessing informationabout services because the information isinappropriate or is not distributed in waysthat reach certain communities. People whoare relatively newly arrived to the UK mayalso have a lack of knowledge about howsocial care services operate here. 67 Asylumseekers may also face confusion aboutentitlements, due to frequent changes tolegislation. 68These difficulties are recognised in the RaceRelations (Amendment) Act, as service providerscovered by the specific duties under thislegislation have a duty to set out, in their raceequality scheme, their arrangements for makingsure that people have access to the informationand services they provide. 69In terms of initial knowledge about services, wordof mouth continues to be the principal sourceof information for many people in many blackand minority ethnic communities. 70 Publicityor promotion strategies need to take this intoaccount.For smaller providers it may not be realistic tocarry out face-to-face outreach or promotion ofservices to people who may potentially use them.It is therefore important to ensure that outreachworkers from other organisations that alreadyhave contact with black and minority ethnicpeople are knowledgeable about the service, asan alternative to relying on written materials.Some providers told us that they notifiedcommissioners, for example councils, of lownumbers of referrals of black and minority ethnicpeople.It is important that publicity and promotionstrategies designed to increase the awarenessof a service in black and minority ethniccommunities are developed alongside other workto make services more appropriate.66. Butt, J (2006), ibid67. Commission for Racial Equality (2002) The duty topromote race equality: a guide for public authorities.London: Commission for Racial Equality68. Patel, B, and Kelley, N (2007), Ibid69. Commission for Racial Equality (2002) The duty topromote race equality: a guide for public authorities.London: Commission for Racial Equality70. Home Office (2004) 2003 Home Office citizenshipsurvey: people, families and communities. HomeOffice Research Study 289. London: Home OfficeSocial Care Policy and Practice

52 Putting people first – equality and diversity matters 2Reaching out – good practice pointersUse ethnic monitoring information and dataabout the local community (for example,from the census) to look at whether thereare any particular black and minority ethniccommunities that you are not reaching or areunder-represented.Be clear, if there is any under-representationof particular communities within the service,whether this is due to a lack knowledge aboutyour service or barriers in accessing yourservice.If there appears to be a lack of knowledge aboutthe service in a particular community, talk topeople from that community about the bestways to reach people.Address the information needs of all peoplefrom particular communities, for exampleolder people may require different solutions,women and men may have different access toinformation.Include activities to address these issues inany publicity or promotion strategy.Link with staff in organisations that have directcontact with people from black and minorityethnic communities, for example outreach orcommunity workers.Increase opportunities for people fromparticular communities to have face-to-facecontact with the service, for example throughvisits, open days, and outreach talks tocommunity groups.Be honest about what services are on offer anduse face-to-face contact as an opportunity forfeedback from people who may use the servicein the future.Find out whether there are any communitynewsletters or mailings where you canadvertise the service, in addition to face-to-facework.Produce any publicity or marketing information,such as service brochures or leaflets, inlanguages that are commonly used locally.Remember that it takes time to developawareness of services within communities andconfidence for people to use services.Review publicity and promotion strategies fromtime to time

Putting people first – equality and diversity matters 2 53Social Care Policy and Practice

54 Putting people first – equality and diversity matters 216. Checklists for actionDeveloping services that promote raceequalityThis checklist gives a suggested order for puttingthe good practice points in this bulletin intoaction. Some of these points will benefit all peopleusing services. Services may wish to vary theorder, according to their own requirements.1 Decide how to involve blackand minority ethnic peopleusing services, staff andoutside agencies in developinga race equality strategy andputting it into action2 Develop a strategy forrace equality linked toyour business plan (usingguidance to the Race Relations(Amendment) Act) with clearactions which are carriedforward at management andindividual staff levels3 Decide what informationyou need to put the strategyinto action, including howethnic monitoring and qualityassurance can contribute tothisYes/NoPageref.252525284 Audit your processes andprocedures to check theypromote race equality –including assessmentand care planning, staffrecruitment, employmentpolicies which impact onretention of staff, publicityand promotion, informationto people using the service,complaints, safeguardingand disciplinary policies andinvolvement methods5 Consider staff learningand development needson race equality, includingenabling staff to examinetheir values and attitudes aswell as understanding theorganisation’s expectationson equality and practicalskills development, such ascommunication skills6 Develop ways of encouragingblack and minority ethnicpeople using the service tohave higher expectations ofservice quality, to take part inconsultation and involvementand to report any concerns ordiscrimination informally andformallyYes/NoPageref.2023273452273436

Putting people first – equality and diversity matters 2 55Yes/NoPageref.Yes/NoPageref.7 Consult with black andminority ethnic peopleusing the service to seewhether any practicalchanges in how the serviceis delivered are required,for example information,use of interpreters, food,environment, activities40465012 Consider whether targetedrecruitment of staff may bean advantage in meeting theneeds of black and minorityethnic people– but first lookat what needs to change andwhy, and then seek advicebefore developing yourapproach438 Assess how well the serviceenables people to maintainlinks with their families, friendsand communities and considerincreasing flexibility of supportto enable this235013 Consider whether any specificwork is required to enablepeople using the service,visitors and staff to feel partof a community and to valuediversity509 Develop your links with localinterpreting, advocacy andblack and minority ethniccommunity services and setaside a budget to make use ofthese services2023344614 Work with other organisationsto reach out to black andminority ethnic communitiesthat are not using the serviceand to develop your service tomeet their future needs5210 Consult with black andminority ethnic staff todetermine whether therecould be any improvementsto ensure retention anddevelopment, through generalstaff support systems orpositive action such as specificlearning and development or ablack and minority ethnic staffforum2715 Review your progress atregular intervals, openlyreport progress on raceequality objectives andpublish consultations and theirresulting actions2511 Monitor progress throughquality assurance, feedbackand direct observation25Social Care Policy and Practice

56 Putting people first – equality and diversity matters 2Supporting an individual black orminority ethnic person appropriatelyThis checklist is not a replacement for changingservices. It should be used alongside work onremoving barriers to race equality in the service,covered by the checklist above.Yes/NoPageref.Assessment, admission and care planning1 Give the person information in20advance of any meeting, in anaccessible format and includinginformation about the types ofsupport that services offer2 Use the communicationguidelines in this checklistto ask open questions that2046enable the person to expresstheir cultural needs and anyconcerns, whilst avoidingassumptions about needs3 Explain the process of20assessment and regularlyupdate the person aboutprogress4 Ensure you know aboutappropriate specific servicesfor people from the person’s2023community and offer these aspart of a range of options5 Ensure the care plan summary20includes how care will beprovided, including meeting anycultural requirements6 Review the care plan soonafter it starts, by enabling theperson to tell you whether theirneeds are being met in the mostappropriate way20Yes/NoCommunication and involvement7 Be aware of good practicein verbal communication –trying to use the person’s ownvocabulary, using plain English,addressing the person in theway they prefer and checkingback that you have beenunderstood8 Allow enough time forcommunication9 Be aware of any culturaldifferences in non-verbalcommunication10 Offer independent interpreterswhere someone does not speakEnglish as a first languageand needs an accurate andindependent voice and use adhoc interpreting services wherenecessary11 Ensure all written informationis provided in an accessibleformat of the person’s choice12 Encourage the person to feedback views and experiencesinformally so any problems canbe addressed13 Ensure any methods forinvolving people (such assurveys) are accessible to theperson if they do not speakEnglish as a first languageStaff support14 Find out who the person prefersto be supported by, includingchoice regarding ethnicityand gender, and look, with theperson, at ways of meetingthese needsPageref.4646464646343643

Putting people first – equality and diversity matters 2 5715 Try to ensure consistency ofstaffing to increase trust andcommunication16 Ensure that all staff haveaccess to information in thecare plan about how the personwants their needs to be met17 Support staff to ensure they areconfident in communicatingwith the person in a respectfuland appropriate way and indelivering the care planYes/NoPageref.462046Provide a culturally appropriate service18 Ask people about their preferred40foods (or enable them toindicate preferences in otherways) and think of ways ofmeeting these needs, includinghow they prefer to eat their food19 In care homes, enable the40person to personalise their ownspace20 Ask the person their40preferences for how personalcare tasks, such as bathing orhair care, are carried out21 Ask the person if they have40any religious or spiritualrequirements and how theservice can respect or assistwith these22 Support the person if theychoose culturally appropriatehealthcare treatments, withinany policy on medication and anappropriate framework of riskassessment40Maintaining connections23 Ask the person about theirimportant relationships,friendships and connectionsin the community and whathelp they need to maintain anddevelop these24 In care homes, ask the personabout the leisure facilitieswithin the home that enablepeople to keep their communityconnections, such asmagazines, newspapers or TVchannels25 In care homes, look out tocheck that the person isnot isolated by cultural orlanguage differences from thecommunication between otherpeople using the service26 In care homes, ask the personabout the activities arranged bythe home and ensure that theseare inclusiveTackling discrimination27 If someone has reported racediscrimination, offer themsupport and independentadvocacy28 Ensure the person is, whereverpossible, informed and involvedin the way the complaint ishandled29 As with any safeguardingissue, ensure that the person’swishes are at the centre of anyplan to address an incident ofdiscriminationYes/NoPageref.20505050343434Social Care Policy and Practice

58 Putting people first – equality and diversity matters 217. Useful resourcesPublicationsThe Social Care Institute for Excellence haspublished three race equality discussion papers,available from www.scie.org.uk/publications/raceequalitydiscussionpapers/index.aspThe duty to promote race equality: a guide forpublic authorities (2002) and the Statutory Codeof Practice for Race Equality in Employment(2005) and other Commission for Racial Equalityguidance on the law and factsheets are availablefrom www.equalityhumanrights.comRespect – learning materials for social care staffworking with black and minority ethnic olderpeople, Race Equality Unit London (1999) isavailable from www.reu.org.ukThe Joseph Rowntree Foundation publishes anumber of ‘Findings’ papers on race equality andservice provision, available from www.jrf.org.ukPractical guide to ethnic monitoring in the NHSand social care, Department of Health (2005) isavailable from www.dh.gov.ukInformation for people with learning disabilitiesfrom black and ethnic minority groups, Norah FryResearch Centre (2004) is available from www.easyinfo.org.ukMultifaith calendars – many local councilsproduce calendars which can be downloaded atno cost. The Festival Shop publishes a range ofmultifaith and diversity educational resourcesincluding a festival year calendar and poster,www.festivalshop.co.uk. The BBC website alsohas a useful section on different religions andfaiths www.bbc.co.ukOrganisationsEquality and Human Rights Commissionwww.equalityhumanrights.comCare Services Improvement PartnershipDelivering Race Equality in Mental HealthcareProgrammewww.actiondre.org.ukRace Equality Foundationwww.reu.org.ukCouncil of Ethnic Minority VoluntaryOrganisationswww.cemvo.org.ukThe Refugee Councilwww.refugeecouncil.org.ukAge Concern England (black and minority ethnicelders work, including the BME elders forum)www.ageconcern.org.uk/AgeConcern/BME_policy.aspPolicy Research Institute on Ageing andEthnicitywww.priae.orgNational BME Mental Health Networkhttp://bmementalhealth.org.uk/Ethnic Minority Foundationhttp://ethnicminorityfund.org.uk/index.aspBlack History Monthhttp://www.black-history-month.co.uk/

Putting people first – equality and diversity matters 2 5918. Appendix – relevantsections of the Care HomeRegulations and DomiciliaryCare Agencies RegulationsCare Home Regulations 200112(4) The registered person shall make suitablearrangements to ensure that the care home isconducted –(a) in a manner which respects the privacy anddignity of service users;(b) with due regard to the sex, religiouspersuasion, racial origin, and cultural andlinguistic background and any disability ofservice users.AcknowledgementsWe would like to thank the following organisationsand groups for their contributions to developingthis bulletin: Age Concern Trafford, Age ConcernWalsall, Harrow Association of Disabled People,CSCI Black Workers Group, Gallant 2000 andQ27 consultancies and the five care serviceswhich allowed us to interview people using theirservices.Domiciliary Care Agencies Regulations200213. Where the agency is acting otherwise than asan employment agency, the registered personshall make suitable arrangements to ensure thatthe agency is conducted, and the personal carearranged by the agency, is provided:(f) with due regard to the sex, religiouspersuasion, racial origin, and cultural andlinguistic background and any disability ofservice users, and to the way in which theyconduct their lives.Social Care Policy and Practice

How to contact CSCICommission for Social Care Inspection33 Greycoat StreetLondon SW1P 2QFHelpline: 0845 015 0120 or 0191 233 3323Email: enquiries@csci.gsi.gov.ukwww.csci.org.uk/professionalWe want people to be able to access this information. If you would like asummary in a different format or language please contact our helpline orgo to our website.Get monthly updates on news from CSCI – sign up to our email newsletterwww.csci.org.uk/professionalFrom April 2009, a new Care Quality Commission will take over the work of CSCI, the HealthcareCommission and the Mental Health Act Commission.CSCI-QSC-157-20000-AHS-092008CSCI-232This document is printed on 50:50 recycled stock. When you have finishedwith it please reuse it by passing it to someone else, thank you.