Race Relations Act 1976

It is unlawful under the Race Relations Act to discriminate on racial grounds, either directly or indirectly. Racial grounds cover not only race, but also colour, nationality (including citizenship), and ethnic or national origin. Groups defined by reference to these grounds are referred to as racial groups.

Direct discrimination

Direct discrimination is defined as treating a person less favourably than another on grounds of race and includes the segregation of people on racial grounds.

For example: A receptionist in a dental practice tells black patients that there are no appointments available. She does so only on the basis of their colour.

For example: A family doctor in a joint practice refers all black patients to the Indian doctor at the practice, solely because of their colour and not because of their particular needs.

Indirect discrimination

Indirect racial discrimination consists of applying, in the circumstances covered by the Act, a requirement or condition which, although applied equally to people from all racial groups, is such that a considerably smaller proportion from a particular racial group can comply with it than others; which cannot be shown to be justifiable irrespective of the colour, race, nationality, or ethnic or national origins of the person to whom it is applied; and which is to the detriment of the person concerned because she or he cannot comply with it.

‘Justifiability' means that there should be an objective balance between the discriminatory effect of the requirement or condition and the reasonable needs of the party applying the requirement or condition. The needs must be objectively justified, and it is not sufficient simply to assert that the needs exist and that they are considered to be reasonable.

For example: A community health clinic produces information leaflets in English about breast cancer and screening. The leaflets are distributed in an area where a substantial proportion of the population are not fluent in English. The health clinic refuses to translate the leaflets into the most commonly used languages in that area. In effect, this means that patients are required to read and understand English if they are to benefit from the advice contained in the leaflets.

Victimisation

It is unlawful under the Act to discriminate by victimising someone. A person is victimised if he or she is given less favourable treatment than others in the same circumstances because it is suspected or known that he or she has brought proceedings under the Act, or given evidence or information relating to such proceedings, or alleged that discrimination has occurred.

For example: A nurse in a health centre gives evidence in proceedings brought under the Race Relations Act against a doctor who has been accused of racial discrimination towards black patients. The nurse is subsequently dismissed on unsubstantiated grounds.

Instructions or pressure to discriminate

It is unlawful for a person to instruct or attempt to put pressure on someone to contravene the Race Relations Act. Such pressure need not be applied directly; it is unlawful even if it is applied in such a way that the other person is likely to hear about it.

For example: An optician instructs his receptionist not to register any more patients from a particular locality because of the large proportion of Africans living there.

Liability for discriminatory acts rests both with the person who does the discriminating as well as the person who gives the instruction or applies the pressure.

Health provisions of the Act

It is unlawful for anyone concerned with the provision of primary health care services to discriminate on racial grounds by refusing or deliberately omitting to provide the services; or as regards their quality; or the manner in which, or the terms on which, they are provided.

For example: Afro-Caribbean people presenting symptoms of cancer are only prescribed aspirin because the GP does not take the time to reach a proper diagnosis.

It is lawful to provide access to facilities or services to people from a particular racial group in order to meet their needs in respect of education, training, welfare, or access to any other ancillary benefits.

For example: A district health authority provides resources for a centre to provide information, counselling and screening on sickle-cell anaemia and thalassaemia for the African, Caribbean, Asian and Mediterranean communities.

For example: A retail pharmacist displays information about certain drugs in Gujerati and Urdu.

Employment

It is lawful to appoint someone from a particular racial group where the job involves providing people from that group with personal services to promote their welfare, and where those services can most effectively be provided by someone from that racial group.

For example: A district health authority employs an African woman to provide counselling and information on HIV/AIDS to other African women in a community health clinic. A large proportion of these women do not understand English well and, moreover, might find it difficult, or feel reluctant, to discuss sexual practices with a male worker. This service would, therefore, be provided most effectively by an African woman. It is important, however, with all section 5(2)(d) posts, to demonstrate that the appointment represents more than just a preference and that it will fulfil a need.

An employer is liable for any discriminatory act performed by an employee in the course of his or her employment, even if it was done without the employer's knowledge or consent - unless the employer took all reasonably practicable steps to prevent such discrimination.

For example: Staff at a community health clinic deliberately omit to give full advice and counselling to Asian women on the full range of contraception available. The clinic’s management would be liable for the actions of its staff, even if it could claim to have been unaware of what had happened. However, if the management can show that it took all reasonable and practical steps to prevent discrimination, it would be relieved of liability.

Advertisements

It is unlawful to publish, or cause to be published, an advertisement which indicates, or might reasonably be understood as indicating, an intention to perform an act of discrimination, whether that act be lawful or unlawful. (For exceptions, see the Race Relations Act 1976.)

For example: A notice distributed among GPs in a particular area advises doctors to check the passports of all new ethnic minority patients, to ascertain their right of abode and, thereby, their entitlement to treatment.

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The NHS and Community Care Act 1990

The changes introduced as a result of the White Papers, Promoting Better Health and Working For Patients, and the NHS and Community Care Act 1990 have had a significant impact on primary health care services:

• FHSAs are now accountable to their regions rather than directly to the Department of Health.
• Health authorities have become purchasers of community health services via contracts with NHS trusts, Directly Managed Units, and the private or voluntary sectors.
• Larger GP practices are eligible to apply for budgets in order to purchase a range of in- and out-patient hospital services directly rather than through the district health authorities.

Areas of concern

There are three major areas of concern in respect of the NHS and Community Care Act 1990 and the provision of health services to ethnic minority communities.

Language and communication

It is vital that purchasers and providers of primary health care services give proper consideration to the translation of all relevant information into the various languages used in their area and the provision of interpreting services, wherever necessary. Equally important is the matter of choosing the most appropriate channels of communication.

Consultation and participation

Purchasers and providers of primary health care services will need to plan consultations specifically with their local ethnic minority communities, to ensure that their views and participation in the planning process are secured. The arrangements should take into consideration the different languages spoken, the form of the consultation, and the venue.

Ethnic minority services

Purchasers and providers of primary health care services cannot be sure that services are free from racial discrimination and that they are appropriate, adequate and accessible to people from ethnic minority communities unless they consult them fully about the services that should be provided, assess the services, and evaluate their effectiveness jointly with the local communities.

General practitioners are now working under new contracts, and first-wave GP fundholders are using their budgets effectively. The FHSAs are monitoring both these changes in primary care. While it is true that single-handed practitioners find it more difficult to provide a comprehensive range of services, this has little to do with budget-holding. The underlying causes tend to be professional isolation, proportionately higher costs, and smaller surgeries.

Providers of primary health care services who have contractual agreements with the health authority and the FHSA should be advised to demonstrate that they have considered the needs of people from ethnic minority communities and included anti-discriminatory measures in their procedures and policies.

One way of evaluating the effectiveness of a contractor's racial equality record is for health authorities and FHSAs to include performance indicators of the contractor's racial equality practices as part of the information required for inclusion in any approved list of contractors, or in the actual terms of contracts.

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