Poorly served

     For 20 years, people with learning difficulties from ethnic
    minorities in the UK have experienced insufficient and inadequate
    services, despite sometimes desperate levels of need.(1) Recent
    policies and legislation have raised expectations that learning
    disability partnership boards will remove discriminatory barriers
    preventing anyone from having access to high quality

    Department of Health initiatives to help partnership boards meet
    these expectations include a framework for action, leadership
    training courses, prioritising ethnicity for learning disability
    development fund spending, and national and regional networks for
    services to share good practice.(3)

    Despite these initiatives, there are questions about whether all
    services are seriously committed to eradicating the inequalities
    experienced by people with learning difficulties from ethnic
    minorities. For example, the director of the Valuing People support
    team has recently highlighted ethnicity as a key priority for
    service improvement.(4)

    To inform a report on ethnicity for the DH minister for community,
    the Valuing People support team funded a national survey of all
    learning disability partnership boards in England, conducted
    between December 2004 and February 2005.

    Partnership boards varied massively in their commitment to
    improving services for people from ethnic minorities. Only half of
    the 82 partnership boards responded, although the survey came from
    the director of the Valuing People support team and stated that the
    findings were to inform a report requested by a DH minister.

    Some responding boards stated that strategic planning to meet the
    needs of people from ethnic minorities was a low priority. This was
    often in localities where few people from ethnic minorities were
    known to, or were slotted reactively into, existing services or
    where information systems were not seeking to identify or
    accurately record people’s ethnicity.

    In these areas, people with learning difficulties from ethnic
    minorities are likely to have many unmet needs, be unaware of
    services and how to gain access to them, and be offered services
    that are far from person-centred or culturally relevant. It is
    unclear how these partnership boards can claim to be fulfilling
    their legal duties under the Race Relations Amendment Act 2000 to
    eliminate unlawful discrimination, promote equal opportunities and
    promote good race relations. Worryingly, few boards mentioned
    taking action to meet these legal requirements.

    About three-quarters could provide detailed information on the
    ethnicity of people with learning difficulties known to local
    services, although fewer partnership boards (46 per cent) could
    provide estimates of the expected population of people with
    learning difficulties in their locality. Where partnership boards
    provided this information, white people tended to be
    over-represented and south Asian people under-represented within

    Electronic databases were reported to be the most useful source of
    information, as long as they were integrated across services and
    staff recorded information comprehensively. Having dedicated
    workers to gain information from people from ethnic minorities and
    to maintain the database were essential in obtaining quality

    Information seemed to be such an important issue that many boards
    were focusing on collecting better information through research
    projects before developing strategic action plans or changing
    services. It is important that once these initial research projects
    have been completed, agencies develop reliable information systems
    to routinely provide accurate information on ethnicity, religion,
    and spoken or written languages.

    Just over half of partnership boards had changed the way they
    worked to address ethnicity issues, most commonly by setting up an
    ethnicity subgroup, appointing an ethnicity champion, or increasing
    the number of members from ethnic minorities, including staff,
    local organisations and users or carers. Many boards also reported
    that they had developed strategies to improve services for people
    from ethnic minorities, although these were mainly focused on
    gaining information and writing strategy documents rather than
    changing the way services worked.

    Almost a quarter spent an average £19,000 of their Learning
    Disability Development Fund allocation on improving services for
    people from ethnic minorities, most commonly on funding development
    workers and training staff. 

    Examples of good practice provided by partnership boards revealed a
    narrow range of activities undertaken with people from ethnic
    minorities. Most frequently mentioned examples of good practice
    concerned making themselves more effective, gaining information,
    supporting family carers, promoting advocacy, day service
    modernisation and increasing workforce diversity. But five or fewer
    boards mentioned good practice concerning important aspects of
    people’s lives, including children, transition, education or
    lifelong learning, employment, benefits, a place to live, health,
    person-centred planning, direct payments, or leisure, friendships
    and relationships.

    Many seemed to be at the beginning of a cycle of improvement,
    involving gaining information, improving partnership board working
    and developing strategies. These boards need to build on this to
    develop a broad range of service supports if meaningful changes are
    to happen in the daily lives of people with learning difficulties
    from ethnic minorities.

    Most boards mentioned obstacles to improving services. Although
    some reported that a lack of staff time and a lack of resources
    were obstacles, similar numbers mentioned organisational obstacles
    such as competing priorities, a lack of organisational commitment,
    the operation of boards, and problems in staff recruitment,
    training, retention and promotion. Other obstacles concerned the
    nature of the locality, for example large rural areas with
    scattered ethnic minority communities that resulted in difficulties
    in working strategically.

    Partnership boards in different areas may require specific
    information and support depending on locality. For example, an
    urban unitary authority with well-established and substantial
    ethnic minority populations and a large rural authority with
    scattered ethnic minority communities may need different strategies
    to identify and support people with learning difficulties from
    ethnic minorities.

    From their responses to this survey, some boards are making
    progress. But a worryingly large number of partnership boards do
    not view improving services for people from ethnic minorities as a
    high priority, resulting in a lack of strategic leadership and
    action. While recent initiatives have been successful in helping
    many boards make progress this is not universal, with some seeing
    removing discriminatory barriers as an optional extra that is
    irrelevant to them.
    If we don’t want to be reading articles like this in 20 years’
    time, all partnership boards and we as individuals need to accept
    our legal and moral responsibility to do what we can to remove
    discriminatory barriers wherever we find them.

    Chris Hatton is professor of psychology, health and
    social care at the Institute for Health Research at Lancaster
    University. He has been involved in research with people with
    learning difficulties for more than 15 years, with a longstanding
    interest in improving services for people from ethnic

    Training and learning
    The author has provided questions about this article to
    guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl
    and individuals’ learning from the discussion can be registered on
    a free, password-protected training log held on the site. This is a
    service from Community Care for all GSCC-registered

    Learning disability partnership boards have a
    responsibility to eradicate the discriminatory barriers to services
    experienced by people with learning difficulties from ethnic
    minorities. A national survey of partnership boards reveals that
    progress has been slow and some boards view people from ethnic
    minorities as a low priority.

    (1) G Mir, A Nocon, W Ahmad, and L Jones, Learning
    Difficulties and Ethnicity, Department of Health, 2001
    (2) Department of Health, Valuing People: A New Strategy for
    Learning Disability for the 21st Century, The Stationery Office,
    2001; and Home Office, Race Relations (Amendment) Act, The
    Stationery Office, 2000
    (3) Valuing People support team, Learning Difficulties and
    Ethnicity: A Framework for Action, DH, 2004; and Association for
    Real Change, The National Learning Disabilities and Ethnicity
    Network Newsletter, No 5, January 2005
    (4) R Greig, The Story So Far.., Department of Health, 2005

    Further information
    This survey was funded by the Valuing People support team,
    but the views expressed in this article are those of the

    Contact the author
    E-mail: chris.hatton@lancaster.ac.uk

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