The Equality Commission has set out its recommendations in relation to the next Programme for Government and Budget of the NI Executive. These include actions relating to health and social care, namely to:
identify and remove barriers to health and social care and well being experienced by particular Section 75 equality groups, including older people; lesbian, gay, bisexual people; trans people; Irish Travellers and other minority ethnic communities; and people with disabilities
ensure investment in health care to address the specific needs of equality groups, including the health care needs of people with disabilities; and young people’s mental health needs
Commission responses to PfG proposed delivery plans:
Further information is available on the Programme for Government section of our website www.equalityni.org/pfg
Health and social care is fundamental to people’s quality of life and general well being. A number of factors can contribute to health inequalities including socio-economic and environmental circumstances; lifestyle and health behaviour; and access to effective health and social care.
The Commission has highlighted barriers to accessing health and social care, experienced by particular Section 75 equality groups, such as older people; lesbian, gay and bisexual people; trans people; Irish Travellers and other minority ethnic communities. These include barriers relating to prejudice, information, language, culture and, particularly for rural people, lack or affordability of transport.
We have also highlighted the need to ensure investment in health care to address the specific needs of equality groups; for example, people with disabilities, including the sexual health and maternity needs of women with disabilities; as well as young people’s mental health needs and to address the high suicide rates among men, Irish Travellers, and young people.
We have raised concerns regarding barriers to accessing health and social care, including those faced by children and young people in accessing age -appropriate health care; as well as ageist attitudes experienced by older people, and stereotypes that portray older people as cared for, rather than care givers. Further, we have called for a full consultation on abortion law in Northern Ireland. There is also the need to ensure the collection by the Department of Health, of system wide data across the Section 75 grounds; and that appropriate account is taken of people’s multiple identities.
The Equality Commission is currently updating its evidence base on key inequalities in health. We will be looking at the following:
Access to health and social care services for migrant workers and new residents
Accessibility of health and social care services to older and disabled people
Attitudes of professional medical staff
Inequalities in investment in mental health and learning disability
Gender inequalities in access to health care
Poor levels of health experienced by Travellers
The impact of caring on health outcomes
Some of these themes emerged from the Commission’s 2007 Statement of Key Inequalities (pdf, see page 16) were health and social care is one of the six broad areas reviewed.
The Commission responds to key strategic documents produced by OFMdFM and government departments such as "Transforming Your Care", the 2011 review of the health and social care in Northern Ireland, and "Fit and Well: changing lives: 2012-2022", the 10 year public health strategic framework for Northern Ireland.
The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) aims to ensure that disabled people enjoy the same human rights as everyone else and that they can participate fully in society by receiving the same opportunities as others.
The Equality Commission for Northern Ireland and the Northern Ireland Human Rights Commission (NIHRC) are jointly responsible, as the Independent Mechanism for Northern Ireland (IMNI), for promoting, protecting and monitoring implementation of the Convention in Northern Ireland.
The Equality Commission and NIHRC have produced a working paper - Jurisdictional 'Parallel' Report on implementation in Northern Ireland. This sets out the issues in a range of areas that Government and others need to address to implement fully the convention.
In relation to health IMNI have identified issues concerning:
reform of the health service,
adequacy of mental health care
the monitoring and provision of support for disabled prisoners
the treatment of disabled people in health and social care settings
support for carers
We note the emphasis in the Bamford Review Action Plan 2009-11 on the need to involve service users, their families and carers in ‘a meaningful way in decisions about mental health'.
We welcome the commitment by the DHSSPS to introduce a new statutory right (under the proposed new Mental Health Capacity legislation) to an independent advocate, as reflecting the Bamford Review’s recognition of the important role of advocacy in a health and social care context.
With respect to accessible/inclusive communications, it should be noted that the Bamford Review of Mental Health and Learning Disability Services, concluded that there was clear evidence of under investment in such communications in Northern Ireland, compared with other regions within the UK.
Sexual Orientation and Health Policy Position
It is clear that LGB people experience specific barriers to equality when accessing goods and services, including access to health services.
We support recommendations made in independent research commissioned by OFMdFM which directs public bodies to implement equality mainstreaming, policy and practice for LGB people. These include:
ensuring effective staff training on LGB issues
investigating how their policies and practices may be homophobic and/or heterocentric
reviewing their procedures for consulting with LGB organisations
ensuring adequate levels of resources are made available to support the work of the LGB community and
setting meaningful targets in relation to sexual orientation equality.
The Commission also recommends that the NI Executive, Departments and other key stakeholders:
Adopt actions aimed at removing barriers experienced by LGB people when accessing goods and services and in the exercise of public functions
Implement proactive strategic targeting of services in order to meet the particular needs of LGB people.
The Commission has raised concerns in relation to the current lifetime ban on blood donations from gay or bisexual men resident in NI.
For further information:
Health is one of the key areas identified in a comprehensive policy paper (August 2014) setting out the Equality Commission’s priorities on racial equality.
Roma, Traveller, Black and minority ethnic (BME) and newcomer communities face a wide range of problems linked to health inequality. Poor life expectancy, high rates of infant mortality and high rates of suicide persist within the Traveller community. Difficulties accessing services, and a lack of cultural awareness by some healthcare staff also continues to impact on some BME groups.
The Commission also points to low levels of registration with GPs amongst certain groups, lack of information about services and the negative attitudes of some service providers as areas in need of improvement.
Specific recommendations include:
The Executive and DHSSPS co-ordinate actions to address the known health inequalities amongst BME, newcomer and Traveller population, ensuring that all policies result in measurable improvements in health outcomes for this group.
The DHSSPS gives consideration to the restrictions on failed asylum seekers in accessing primary and secondary care to ensure equality of access to primary and secondary healthcare based on clinical
need. The Commission further recommends that facilities and services for BME groups are underpinned by the AAAQ human rights framework.
The DHSSPS and HSC Trusts, provide information and services in a way which is consistent with equality of access and that staff are trained in anti-racism and cultural awareness.
The HSC Trusts work with BME, newcomer and Traveller populations to increase knowledge and confidence around access to services.
The development of a system for monitoring health inequalities experienced by ethnic minorities, including the comprehensive collection and review of data also by S75 category so that any adverse impacts of access / outcomes can be identified and addressed.
As part of an integration strategy, it is also recommended that DHSSPS:
identifies and addresses the specific disadvantages faced by refugees in obtaining and accessing appropriate services(including mental health services)
ensures that the needs of asylum seekers and refugees taken into account in the planning, commissioning and delivery of services
supports asylum seekers and refugees to understand their rights and entitlements to healthcare.
For more read our racial equality policy positions:
Racial Equality Guides for the Health sector
We have highlighted that ‘institutional racism can have a number of dimensions in health care, the most obvious being in terms of differential patient access and treatment. It can also be identified in employment policies, inadequate research and professional attitudes and health promotion.
Our publication 'Racial Equality in Health – A Good Practice Guide' (2002) is designed to provide practical advice to HPSS staff delivering the service. It also looks at ethnic monitoring in respect of racial equality in health and social care. The publication was updated as a shorter version in 2011.
In the Equality Commission’s Shadow Report to the Committee on the Elimination of Discrimination Against Women (CEDAW) in June 2013) we recommended that the Committee ask again that consultation be carried out on abortion law in Northern Ireland.
Dept of Justice consultation on the Criminal Law on Abortion: lethal foetal abnormality and sexual crime
The Commission believes that such a consultation should consider, among other things, the issue of women in Northern Ireland having the same access to reproductive health care as women in the rest of the United Kingdom.
In January 2015 the Equality Commission responded to the Dept of Justice (DOJ) consultation on the Criminal Law on Abortion: lethal foetal abnormality and sexual crime.
The Commission is disappointed that a full consultation on abortion has not been issued. However, it considers that that there is a pressing need to consider a change to the criminal law on abortion to provide for lawful termination of pregnancy as an option for women in certain limited and clearly defined circumstances, including on the ground of lethal foetal abnormality.