In England and Wales, 25.7% of the population are from ethnic minority groups. The views people share with us shows these groups face inequalities when they try to access healthcare.
This feedback supports research by the NHS Race & Health Observatory. In 2022, they highlighted key areas of healthcare where people from ethnic minority groups face inequalities: mental health care, maternal and neonatal healthcare, digital access to healthcare and genetic testing.
In this blog, we talk about systemic issues people can face as they try to get the healthcare they need. We’ve focused on waiting times, treatment by staff, dismissal of symptoms, and communication barriers. These are key trends that appear in our insight, though they’re far from the only issues people experience.
People who don’t speak English get poor communication support
A significant proportion (1.8%) of England’s population either doesn’t speak English well, or doesn’t speak it at all. Yet we still hear from people who don’t have the tools they need to communicate in healthcare settings.
For example, Healthwatch Surrey heard from an Asian/Asian British woman who recently had a stroke, and wasn’t getting the social care she needed. English was not her first language, and she was struggling to communicate with the social worker over the phone to discuss how her care needs had changed.
In 2016, the NHS developed the Accessible Information Standard, making it compulsory to offer care and information in accessible formats for people with learning disabilities or sensory impairments. But this doesn’t include translation services for those without sufficient English language.
Our work on language barriers in 2022 shows inadequate provision of interpreting services. This can have knock-on effects in areas like cost, where patients have to seek private services to communicate effectively.
It’s hard to navigate urgent care when there’s a language barrier. One experience we heard involved a misunderstanding about a Do Not Resuscitate (DNR) agreement.
One person spoke to Healthwatch Bristol about her 77-year-old mother’s experience when she was hospitalised. Her mother is Pakistani and unable to speak English. The doctors didn’t introduce themselves, but began speaking immediately about the need to register her agreement for a DNR.
Though her mother was reluctant, the doctors said that in cases of resuscitation, it was often necessary to use considerable force. In elderly patients, this involved hammering on their chest, often leading to broken ribs and trauma. Her mother was frightened and agreed to sign, but said she felt bullied and coerced. Later, she wanted to change her mind, but was told this was not possible without a GP’s agreement.
During an already very stressful time, miscommunication adds more stress. Others have similar experiences daily.
A shortage of interpreters means people may have to wait longer for an appointment. This contributes to a broader problem: that people in ethnic minority groups wait longer to receive care.
Getting care can take longer
NHS waiting times are longer for people of certain ethnic minority groups. Research shows Asian people are more likely to experience long wait times than any other ethnic group.
Our work on referrals shows people are less likely to receive swift or correct referrals if they are not white British.
We heard from someone in Hertfordshire who is housebound and disabled. They faced delays with their referral for an assessment for PTSD, and said they feel discriminated against because they are of non-British heritage. They didn’t experience such delays in London – only since they moved to Hertfordshire.
Discrimination can lead to waiting longer for the care people need.
A young woman from the Gypsy and Traveller community told Healthwatch Bedfordshire Borough she was concerned about the long waiting time for a doctor’s appointment, even for emergencies. She wanted to be understood by NHS and social care services, and for them to talk to her as an equal.
It may take people longer to get the care they need, and at the point of care, they can also experience discrimination based on ethnicity.
People from ethnic minority groups face discriminatory treatment
People have shared with us that when they do use primary care services, they face unfair, disrespectful or rude treatment.
In a story shared by Healthwatch Bristol, an individual who is part of “any other ethnic group” told us his dental work was “appalling, with ill-fitting fillings and wrongly aligned work”. His dental practice recently removed him from their patient list, apparently due to him missing three appointments. But he said this isn’t true, and that he never knew about these appointments.
He said the staff are rude, and he considers them to be clearly racially discriminating against him. His 13-year-old daughter still has treatment there, which he attends with her as she is autistic. He finds this uncomfortable, and said the staff are still rude to him.
Staff may also not listen to patients. Unconscious (or conscious) bias can lead to patients not being taken seriously and pain being dismissed. This means they aren’t offered the right treatments.
A person from Hackney shared her story with us after she suffered from pain in her hip.
“I asked for a CT scan, and they refused, were dismissive about the pain I was in, saying ‘it shouldn’t hurt that much’, but didn’t bother to figure out why the pain wasn't going away. They tried to get me to come off painkillers but didn't understand the pain was so bad that I couldn’t. Instead, they recommended that I did “acupuncture” and “massages”, but I knew the symptoms went deeper than that. The doctors were quite poor at listening to the specific pain symptoms I was describing…
I ended up going private, luckily, because my parents could support this financially – the private doctor listened to my symptoms carefully and gave me a CT scan (which is what I had originally asked for). This CT scan revealed that I had an osteoid osteoma – a painful benign tumour in my bone which needed radiofrequency ablation therapy to remove it. This was causing most of the pain.”
Not being listened to has been particularly highlighted as an issue in maternal health. Black women are at particular risk of poor maternal healthcare, with their experiences and pain being dismissed.
What steps do we recommend?
- We support the NHS Race and Health Observatory’s 10 steps hospitals can take to tackle ethnic inequalities in waiting lists.
- We urge NHS providers to investigate any instances of patients being refused access due to ethnicity or symptoms being dismissed. Under the NHS Constitution, patients have the right to access NHS services and not to be refused on unreasonable grounds. They also have the right not to be unlawfully discriminated against.
- Integrated Care Boards should collect and publish data on disparities in waiting times between patient groups, including different ethnicities. This is so providers can understand and address any inequalities.
- Adapt the NHS e-referral system or other care record systems to ensure that people’s communication preferences, including language, are recorded as early as possible.
- Review GP funding arrangements to make sure resources can be adjusted depending on the local population’s need for translation or interpreting support.
- Review Integrated Care Systems’ duties in providing interpreting and translation services.