The current structure and systems of the quality standards can do little more than if they didn't exist in terms of equality.
They're limited to a few statements about expected patient care and the only way I can seeing this help equality is ensuring a basic standard of service is offered to all patients.
The problem is when the qofs aren't meant. What I mean is the disadvantaged groups will still be over represented when it comes to those who failed to get a basic standard level of care. They'll also be under represented in the unmeasured quantity: those who got above the basic level of care.
I've already mentioned two opportunities to alter the current qof based on existing documents and proposals. The first relates to problems in the diagnosis of depression which is skewed to not recognise common behaviours and self reported symptoms in men. This was argued in Mind's men and mental health campaign. The other was the lack of mental health screening in the alcohol dependence qof. Self medication is common. Many addicts do not receive appropriate mental health (or likely physical care). The dual diagnosis strategy suggests joined up thinking is a way forward and addiction services and treatment should link with mental health. Mind's men and mental camapaign may also touch on this subject.
Both are equality issues. The first is hard to reduce to a qof but the second isn't. Addicts should have mental health screening and involvement as a standard part of their care pathway.
So, in my opinion, there are already problems with the current qofs and the equality duty.
It sort of goes further. What is most important is impact. This requires monitoring. What I mean is there's no point monitoring qofs without being able to see which groups and types aren't getting the basic standard. Then there's the other problem of affecting poor performance, the far greater challenge in my opinion.
The list of electronically recorded patient characteristics needs to be suitable to encompass the list of equalities act protected characteristics and nices protected groups. This also needs to provided in conjunction with full records for their treating physician.
This creates a powerful data set for monitoring and research into healthcare inequalities. The physician information is necessary to identify biases and, where necessary, identify exceptionally poor performance. These are basic standards which should be offered to everyone and if this doesn't happen then the systems to rectify the problem need the data to do it right.
It is important this data is highly secure and unavailable to any entity other than a computer or a law court at patient level. Physicians and patients shouldn't be allowed access to this information in any way just like any other information about equal ops is protected by the highest levels of confidentiality.
In the modern age knowledge is power and if the aim is to really shift then inequalities then without the data there is just guesswork involved and therefore little impact.
If surmounting health inequalities and inequality in general is a priority for nice then let me begin to talk about the issue and solutions.
First and foremost, equality is about a sort of judgemental blindness. As a principle equality means the worst types of people are treated the same as the very best and in practice it means a minimum standard is offered to absolutely everyone.
It means the Queen gets the same basic level of whatever as a convicted serial mass murderer and rapist. At least in practice. What I believe is the measure of equality is the life experience and outcomes of the worst person, rather than the average being raised. I feel the valuation is important to discuss in a little more detail in how that's relevant in the new nhs and in regard to nice.
This relates to the measurement system. Performance managment theory comes out of practices used in for profit businesses with simple bottom lines and measures. Its still relatively new in health and social care and it requires a little fine tuning in practice.
I worked in performance management in childrens services. An important quantity was the stability of a child's placement and more than 2 changes in a year for a lot of children was a bad thing. I instituted a simple system where the children on the cusp of being moved more than 2 times in a year were checked on about this issue by their social worker. This was great for impacting a key performance indicator and used the system to genuinely help children.
But I failed when it came to what children's social care exist to do, in my opinion. It exists to help the worst off be less worst off.
Changing placements more than 2 times in a year is bad, just as being a looked after child is bad. But moving placements 14 times in a year is a lot worse. That kid... she had a bad life. Childrens social care exists to help people like her but the performance management reporting system didn't capture her experience. The KPI only looked at the average disadvantaged person, not the experience of the most disadvantaged.
I may be an idealist in this respect but sometimes this is the only mentality which will affect equality. Ultimately equality is about reducing the outcome difference between advantaged and disaqdvantaged groups. It is homogonising outcomes against a trend of widening diversity of life opportunity and other outcome measures.
The advantaged do so much better today than ever before. Though the worst off are hopefully doing better than the worst off a century ago the difference between their outcomes and those who are significantly advantaged has grown significantly. This is very well evidenced.
Therein lies the challenge of equality and meeting the duty. There's a problem but how can it be impacted upon?
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