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BME mental health By Dr Chris Udenze MRCGP & Edited by Irene Amadi A meeting of experienced GPs and Clinical Commissioners (CCG) sat down together to discuss a controversial contract awarded to a Housing Association. The contract was designed to help people in the BME community with mental health needs. The controversy was that a contract has been awarded to this Housing Association, instead of better qualified organisations. This association has no experience of mental health, or community engagement, also, the group were concerned that a ‘white organisation’ cannot deliver this kind of service. However, skin colour is not the issue. The association lacks cultural competence and understanding of mental health issues. Some people might feel that the Nottingham counselling service is a white organisation, despite its very dynamic and experienced chief executive, its multicultural board and its multicultural team of counsellors. But it has a strong tradition of being a highly respected, very professional, Patient /client centred provider, for nearly 40 years, which already reaches out to a lot of black members of the community, and like many other organisations sitting around that table last night, are desperately in need of additional funding. Thus, this contract could have given them the funds they need to allow them to continue to deliver care, making them more suitable to undertake the project. They won’t learn that this is why half the psychiatric wards are over represented with African Caribbean patients, admitted for months if not years, at around £1000 a week- much more for secure beds at the Wells Road centre, and many of these admissions could be prevented or made much shorter by adequate funding services in the community. There are a tiny superficial and cosmetic changes, a few black receptionist to give organisations , the right image, a few black faces on the leaflets and rhetoric about being equal opportunity employers - rather than acknowledging that things are not equal, and that health care reflects general society inequalities, but still the establishment does not acknowledge its own structural and subconscious racism and learn from black and ethnic minority communities rather than trying to tell us what we need. Why are things changing? The government introduced a new bill in Parliament over two years ago, and it is just now coming into effect. The Health and Social Care Bill is one of the longest and most complex laws to be passed, with over a 1000 amendments made since it was first published as the White Paper: Equity and Excellence: Liberating the NHS. The idea is that ‘The Market’ ie

competition between private health care providers will improve services and lower costs; clearly competition, lossleaders, BOGOF, and other tricks of the market provide us with cheap service but will not lead to an evidence based appropriate health care system. On the brighter side, most responses to the White paper reflect on the possible opportunities and minimise the threats. There are opportunities for Social Enterprises and multinational corporations to tender as providers, but it is predictable who is already geared up to exploit these opportunities, and who will be awarded most of the lucrative contracts. In this case, excellent local, well trusted organisations like BACIN, Awaaz, Nottingham Counselling Service and Nottingham Hospice found it difficult to compete against multi-nationals like Virgin and Circle Healthcare who have big marketing departments and the funds to undertake TUPE (Transfer of Undertakings (Protection of Employment). The key idea is to get a panel of GPs to ‘Commission’ (ie buy) health services from ‘any willing provider’ and abolish the Primary Care Trusts (the Health Authorities) . Great! Your local GP will decide how health services are funded rather than some faceless bureaucrat in an ivory tower. But health service planning is a difficult job requiring the expertise of specialists in Public Health who can have an overview of all medical conditions and what treatments are most effective, and GPs are trained for family medicine and most don’t have time to start being part-time commissioners as well.

Mojatu Nottingham Magazine M017  

When faced by social and cultural practices that disempower and hinder us from leading happy and fulfilled lives, most people feel overwhelm...

Mojatu Nottingham Magazine M017  

When faced by social and cultural practices that disempower and hinder us from leading happy and fulfilled lives, most people feel overwhelm...

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