Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Fermanagh - Your Life in Your Hands

This project intends to build on the success in equipping individuals with mental health problems, who are obese, with the skills necessary to make healthier lifestyle choices.Particpants will work as a group and support each other. A range of sessions were held on health issues of importance to clients (stress, exercise, mental health) through information workshops, training, pharmacy clinics, cooking etc. For the participants involved in the project their confidence has grown and they are able to share their learning with others at the centre. The clients are aware of other services and how to access them. The pharmacist role played a visit to the doctors to help clients get the best out of their appointment. The mental health of those involved has also imporved and has spurred them on to make changes in their overall lifestyle.

The Healthy Weight Challenge

To help encourage, facilitate and empower people to adopt healthy lifestyles and to raise awareness of obesity and its causes in order to reduce its prevalence within the target community. Outcome Through Health Classes, Leaflets and Posters, people have developed their knowledge and understanding of obesity. The relationship between members of the community and the pharmacist has also developed as as has the Pharmacists links with GPs, Dieticians, Leisure Centre Management etcï_… All participants thought the healthy weight challenge was a good idea, made them more aware of health and the pharmacy was able to offer advice, information, support and health checks. regular monitoring also helped have a positive impact on participants desire to lose weight and also had positive impact on their efforts to have healthier lifestyle.

Belcoo green gym project

The aim is to work with children as a means to communicating to family and friends. The practical side of the project will take local children out of the classroom surrounding and into the natural environment. The children involved will participate in growing their own fruit and vegetable garden and learn the importance of healthy diet alongside other key stage development issues such as recycling and food chains.

Action Cancer

The pharmacist will hold sessions with particpants to raise breast awareness in the Ardoyne and Shankill areas and provide information on health issues they want more detail on. Five essions were carried out by the pharmacist on women's health - mainly breast awareness with 53 women attending in total. The pharmacist gave health related information to the women and discussion followed. Each group attending were unique and each discussion brought up different concerns and interests. Cancer Lifeline a community group attended the session and have since made links with the pharmacist and Action Cancer.

Active Life Club

The project aims to target older peoples local needs and create awareness of health issues and healthier lifestyles in later years. Five information sessions (medicine, stress management, role of the pharmacist etc) were held with older people. The pharmacist offered 1-1 support and group work was also built into the sessions. The pharmacist is now more aware of older people's needs and the future services they can provide. Older people are now better informed about their health and wellbeing. The project has empowered them to be more independent and have a greater rapport with their pharmacist. 65 older people benefited from the project. The pharmacist is now signposting older people to the Active

AMH New Horizons Belfast

This project focuses on individuals learning more about their health and wellbeing and developing action plans that they will take responsibility for. This will allow participants to examine and challenge issues which impact on their mental and physical health, including medicines. This project will involve users, staff, pharmacist and other providers. Like all projects this is a 2 way learning process, the staff will be use the pharmacy as a resource and the pharmacist will gain more awareness of health issues and the impact of living with mental health issues.

AMH New Horizons, Fermanagh

This is their 3rd BCPP project and is a Level 3. Previous projects highlighted the complex health issues facing those with significant mental health problems. From their successful partnership, the pharmacist now sits on their steering group. This project will build upon previous work and aims to provide people with the skills to make healthier lifestyle choices. Participants, the pharmacist and other providers will work in partnership to design a programme that will focus on the participants supporting each other and relaying their learning to others in the centre.

Ballymena Youth Bank

This project will work with 14-25 year olds to increase their understanding of health issues relevant to their age group and increase their skills to encourage other young people to become actively involved in promoting health and raising health awareness through the YouthBank grant-making scheme. 10 sessions will be carried out.

Orchard Pharmacy

Engaging the community through a health column in the local press under the direction of the Southern HSSB. Outcome: This ongoing project is working towards promoting health care in the wider community and enabling the general public to better understand the range of services offered by community pharmacy. The health column is publicised in the local press across the SHSSB area and has worked to increase people's awareness of health and has focused on local needs and information, linking in with national and local health promoting campaigns

Mid Ulster Locality Group

To improve the pharmaceutical care in the community for older people and their carers working towards giving carers support and raising their awareness of the support which is on offer to them.

Windsor Pharmacy - Valerie Addy

To date this project has underwent phase 1 and is undergoing the implementation of phase 2. The first phase aimed to make students aware of issues surrounding STIs and their health implications. In phase two, the project aims at determining the most appropriate means of disseminating information about sexually transmitted diseases.

Colin Community Area Pharmacy Partnership

This project has worked towards promoting positive mental health by integrating pharmacy services with other local support structures already in existence to support those experiencing mental health issues.

Belcoo Pharmacy

To promote the health and well-being amongst families in the rural and isolated community of Belcoo by focusing on the children, their health and the positive message they can bring to their families.

North Down & Ards AMH

AMH, founded in 1963, one of the largest regional voluntary sector organization in NI, has provided a range of services for people with mental health difficulties and learning disabilities. AMH Ards offers a range of person centred activities eg training in IT, administration, catering, literacy and numeracy, crafts etc. They have completed 2 Level 2 applications. This Level 3 application will endeavor to build on the success of the second project, encouraging and building capacity for people to identify their own health needs, enable them to benefit from a range of support services, including pharmacy available to them. In addition, it will continue to educate and involve pharmacists in the road to mental health recovery. 4 programmes (7 weeks long ï¿_ 3 with the pharmacist) will be delivered each year (2 at each of the centers in Ards and Bangor). This more formal programme will be supplemented by ongoing support, staff training (2 sessions) and 4 informal drop in sessions and more general health events. At all of these sessions, the pharmacists will either lead on or attend.