Diversity, Inclusion and Paent care London Women’s ... · PDF fileDiversity, Inclusion...

21
Diversity, Inclusion and Pa4ent care London Women’s Leadership Network Launch 12 th May 2016 Daghni Rajasingam FMLM Na4onal Lead for Inclusion

Transcript of Diversity, Inclusion and Paent care London Women’s ... · PDF fileDiversity, Inclusion...

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Diversity,InclusionandPa4entcare

LondonWomen’sLeadershipNetworkLaunch12thMay2016

DaghniRajasingamFMLMNa4onalLeadforInclusion

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90per100,000materni4es

1952-54

MaternalMortalityintheUK

11per100,000materni4es

2006-08

2009-12

10per100,000materni4es

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3

BMJQualityandSafety,Sept2013[onlineearly]:hRp://www.lums.lancs.ac.uk/nhs-quality/

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Maternaldeathrate2003-12(Threeyearrollingaverages)

0

2

4

6

8

10

12

14

16

2004 2005 2006 2007 2008 2009 2010 2011

Rateper100000m

aterni4e

s

Mid-yearofeachthree-yearperiod

DirectandIndirectmaternaldeathrate

Directmaternaldeathrate

Indirectmaternaldeathrate

48%reduc4onindirectmaternaldeathrate,p<0.001Nosignificantdecreaseinindirectmaternaldeaths,p=0.73

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Interna4onalcomparisons•  MBRRACE-UK–  10.1per100,000materni4es(95%CI8.9-11.5)for2010-12

•  MDEIreland–  8.6per100,000materni4es(95%CI5.2-16.6)for2009-11

•  FranceConfiden4alEnquiry–  10.3per100,000livebirths(95%CI9.1–11.6)for2007–09

•  NetherlandsConfiden4alEnquiry–  5.0per100,000livebirths(95%CI3.5-6.9)for2009-12

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MaternalmortalityratebyethnicgroupRateper100,000

materni4es95%CI Rela4ve

risk(RR)95%CI

Ethnicity(Englandonly) White(inc.notknown) 9.0 7.8-10.4 1 Indian 20.5 11.9-32.8 2.27* 1.30-3.74Pakistani 13.9 7.8-22.8 1.53 0.84-2.60Bangladeshi 11.1 3.0-28.4 1.23 0.33-3.20OtherAsian 8.1 2.9-17.6 0.90 0.32-1.99Caribbean 18.5 6.0-43.2 2.05 0.66-4.87African 26.9 17.6-39.4 2.98* 1.90-4.51Others/mixed 10.2 5.6-17.1 1.13 0.61-1.94*Significantlyraisedcomparedtowhitewomen

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Maternalmortalityratebyareaofresidence(IMDquin4le)

Rateper100,000

materni4es95%CI Rela4ve

risk(RR)95%CI

IMDQuin4les(Englandonly) I(Leastdeprived/ highest

20%) 8.2 5.6to11.6 1 -II 8.2 5.6to11.4 1.00 0.60to1.67III 8.9 6.4to12.0 1.09 0.67to1.77IV 11.0 8.5to14.0 1.34 0.87to2.12V(Mostdeprived/lowest20%)

12.1 9.7to14.9 1.48* 1.00to2.29

*Significantlyraisedcomparedtowomeninleastdeprivedareas

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Whatisthegap/need?

Womenwithchronichypertension2001-11

Black(N=564)

White(N=367)

*AdjustedOR

S4llbirth 11(2%) 3(1%) 2.41(0.67-8.71)Gesta4onatdelivery(w) 38(33-40) 39(38-40)** -Delivery<34weeks 59(10.5%) 12(3.2%) 7.25(2.67-19.74)Delivery<37weeks 129(22.9%) 41(10.8%) 2.91(1.68-5.03)Birthweight(g) 3060

(2560-3500)3300

(2920-3700)*-

SGA<5thCen4le 72(12.8%) 32(8.4%) 2.04(1.11-3.75)SGA<10thCen4le 109(19.3%) 48(12.7%) 1.81(1.11-3.00)NICUadmission 57(10.1%) 19(6.0%) 2.79(1.29-5.73)

LucyChappell2014

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TrustboardmembersinLondonanalysedbygender

Male Female Unknown

%female

Chair 28 10 26.3Chefexec 29 12 30.8

Execu4vemembers

132 96 42.1

Nonexecu4vemembers

137 89 39.4

Boardtotal

326 207 38.8

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TrustBoardmembersInLondonanalysedbyethnicity–Jan2014

White BME Unknown

%BME

Chair 37 1 2.5Chiefexecu4ve

37 1 2.5

Execu4vemembers

195 17 8.7

Nonexecu4vemembers

194 22 11.3

Boardtotal* 463 41 8.9

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BlackandMinorityEthnic(BME)Staff

•  1.3millionpeopleworkintheNHS

•  18%stafffromBMEBackgrounds

•  28%DrsfromBMEbackgrounds

•  38%ofHospitalDrs•  >5%seniormanagers

fromBMEbackgrounds

20%NursesandMidwives(qualifiedandunqualified)Risingto50%inLondon4BMECEOs1Exec&4DirectorofNursing>3%MedicalDirectorsSource:HealthandSocialCareInforma4onCentre

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Educa4onandTraining

hRp://www.gmc-uk.org/MRCGP_Final_Report__18th_September_2013.pdf_53516840.pdf

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Theevidencebase…

•  Whitestaff1.744mesmorelikelytobeappointedonceshortlistedthanareshortlistedBMEstaff(Kline2013)

•  BMEstafftwiceaslikelytoenterdisciplinaryprocessandmorelikelytobedisciplinedforsimilaroffences(Archibongetal2010)

•  Blacknursestake50%longertobepromoted(RCN)andarelesslikelytoaccessna4onaltrainingcourses

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“TheSnowyWhitePeaks”found…

•  1in40chairsandnoCEOinLondonisBME

•  17of40TrustshaveallwhiteBoardsbutover40%ofworkforceandpa4entsareBME

•  DecreaseinBMEBoardmembers

•  NotoneBMEexecdirectorinMonitor,• CQC,NHSTDA,NHSEngland,NHSLA,HEE

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• Thisisbestevidencedbythelinkbetweenethnicdiscrimina4onagainststaffandpa4entsa4sfac4on.

•  Thegreaterthepropor4onofstafffromablackorminorityethnic(BME)backgroundwhoreportexperiencingdiscrimina4onatworkintheprevious12months,thelowerthelevelsofpa4entsa4sfac4on.

•  TheexperienceofBMEstaffisaverygoodbarometeroftheclimateofrespectandcareforallwithinNHStrusts.

• (NHSStaffManagementandHealthServiceQualityResults•  fromtheNHSStaffSurveyandRelatedDataWest,Metal(2012)

ProfessorMikeWest–NHSQualityandStaffEngagement

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Healthcareinnova4onhampered…

•  Thereisevidenceofalinkbetweendiversityinteams(ateverylevelincludingBoards)andinnova4on.Ata4mewhentheNHSneedstotransformitscare,lackofdiversitymaycarryacostinpa4entcareforeveryone

•  TheHealthyNHSBoard2013:ReviewofGuidanceandResearchEvidence

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Whyworkforceracediscrimina4onisbadforallpa4ents:

•  Preventspa4entsgeungbeststaff•  Impactdivertsresourcesfrompa4entcare•  Discrimina4onmakesstaffill•  Howstaffarecaredforimpactsoncarethey

provide•  Diversityimprovesinnova4on+teamwork•  Unrepresenta4veBoardslesslikelytoprovide

pa4entfocussedcare

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Theendofdenial-SimonStevensMay2014

• “Itcan’tberightforexample–asRogerKline’srecentresearchhaspinpointed–thattenyearsaMerthelaunchoftheNHSraceequalityplan,while41%ofNHSstaffinLondonarefromblackandminorityethnicbackgrounds(similarinproporQontotheLondonerstheyserve)only8%oftrustboarddirectorsare,withtwo-fiBhsofLondontrustboardshavingnoBMEdirectorsatall.SimilarpaSernsapplyelsewhere,andhaveactuallybeengoingbackwards.”

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• Knowingisnotenough• Wemustapply• Willingisnotenough• Wemustdo


“My Doctor Never Told Me THAT Would Happen!” A Paent ... · PDF fileA Paent-Centered Approach to Informed Consent ... • Paent has right to know and choose who will treat ...

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