PSA: Perspectives on discriminatory behaviours in health and care (12 April 2023)

Summary

The Professional Standards Authority (PSA) commissioned this research to help inform a consistent and appropriate approach by the regulators and registers towards the various types of discrimination in health and care. The research was undertaken to help PSA understand better the views of the public and service users on the following key questions:

• What constitutes discriminatory behaviour in the context of health and care?
• What impact discriminatory behaviour may have on both public safety and confidence?

Through looking at these two areas, the research also drew out views from participants on how health and care professional regulators should respond to different types of discriminatory behaviour.

Content

Key findings

The notion that all patients should be provided the same standard of care and respect was at the heart of what the public and patients expected from health and care professionals. Within this, equality and diversity were understood as both providing a standard of service that was universal (the same for everyone), as well as ensuring inclusion so different needs were recognised and met. Discriminatory behaviours were therefore defined as those where some patients were denied the same standard of care or respect or they were subject to practices that were not inclusive of their particular needs.

As part of the research, some participants shared experiences of health and care professionals’ behaviours they felt were discriminatory and linked to their protected characteristics. Examples of such behaviours included:

• Verbal remarks which patients felt were disparaging.
• Making assumptions and being judgemental about patients.
• Not listening to patients.
• Not meeting additional needs of patients, for example, communication needs.

In a small number of cases, patients also reported what they perceived as more serious discriminatory behaviours, including aggressive behaviour in mental health hospitals, and harassment of Muslim women wearing a veil.

Further discussions prompted by using a range of scenarios involving potentially discriminatory behaviours revealed key factors the public and patients considered when assessing whether behaviours were discriminatory. These included:

• Intent – whether a behaviour was intentionally discriminatory or stemmed from a lack of knowledge and understanding.
• Outcomes for patients and how vulnerable the patient was – whether the impact was serious and negative for patients, which would be exacerbated if a patient was deemed vulnerable.
• Frequency – whether a particular behaviour was an isolated incident or part of a pattern of behaviour. Most felt that discriminatory behaviours could potentially cause significant harm to patients, as well as undermine their confidence in health and care professionals and services more broadly.

Such behaviours were perceived to potentially impact on:

• Patients’ mental health and wellbeing, as direct experiences of discriminatory behaviours could make patients feel uncomfortable, anxious, confused, embarrassed, or distressed, depending on the severity and kind of behaviour in question; • Patients’ physical health and wellbeing, as many thought they would attempt to avoid professionals who behaved in this way, which could make accessing health services more difficult.
• Patients’ confidence in health and care professionals, as discriminatory behaviours were perceived to undermine core values and professionalism expected in health and care.
• Patients’ safety when using health and care services, as many felt that witnessing such behaviours would make them question whether these professionals may harbour other prejudices that could impact on their treatment too.