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Case study: Diverse interests


3 September 2014

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A healthcare commissioner is exploring new ways of working to ensure health and care services are accessible to black minority and ethnic communities

A healthcare commissioner is exploring new ways of working to ensure health and care services are accessible to black minority and ethnic communities
NHS Heywood, Middleton and Rochdale clinical commissioning group (HMR CCG) plans and buys healthcare services for a culturally and ethnically diverse population, with high levels of deprivation and health inequality. The CCG is led by the 38 GP practices in the Rochdale borough, serving a population of approximately 235,800. The CCG’s mission is to ensure the people of the borough are healthier and have a better future.
The borough’s population and health
There is a significant gap in life expectancy within the borough, with the most deprived population groups living on average 10 years less than those in the most affluent groups.
Black and minority ethnic (BME) communities make up approximately 18.3% of the borough’s population, according to 2011 census figures.
The table highlights that the South Asian (Indian, Pakistani, and Bangladeshi) community makes up approximately 15% of the population in Rochdale. This shows that the South Asian community is the highest BME population in the borough and therefore the area the CCG has focused our engagement efforts so far.
The issue
It is widely known that people from South Asian communities are at higher risk of developing chronic health conditions, such as diabetes. It is therefore important that NHS HMR CCG engages with and educates this population about prevention, symptoms and local health services. 
As part of the CCG’s approach to continue developing relationships with local South Asian groups, it decided to make use of existing community expertise, knowledge and relationships to reach out to this population by commissioning BME Health Matters (BMEHM) to deliver a number of different projects.
BMEHM established itself with the aim of supplementing health provision in, predominantly, South Asian communities. The CCG is working with BMEHM to better understand how to engage with minority communities in culturally appropriate ways. This includes engagement in a number of different languages, and in places they are comfortable with, such as mosques.
Mosque visits
As a commissioner of local health services, it is particularly important that the CCG understands the different cultures in the Rochdale borough and how they influence the choices people make about their lifestyle and how they use health and other services. 
In a bid to understand more about Muslim and South Asian culture, members of the CCG were invited by Rochdale Council of Mosques to visit a local mosque.
The first visit, in February, marked the start of a two-way exchange of views and gaining real insight into the way the people in these communities live. For example, one of the lessons learnt from this visit was that Muslims see mosques as a community hub, rather than a place of worship, with this view even extending to health matters. 
A series of visits is being planned to give more members of the CCG the opportunity to experience these cultures first hand. 
Rochdale Council of Mosques is an umbrella organisation representing 15 mosques across the borough. One benefit of the CCG’s relationship with the organisation is the ability to share key messages with Imams, who will in turn disseminate them across South Asian communities. This approach helped in dispelling myths among the community surrounding the seasonal flu vaccination which was preventing people from being vaccinated.
Focus groups
NHS HMR CCG commissioned BMEHM to carry out a series of focus groups with South Asian communities. The objectives of the focus groups were two-fold: to examine how members of South Asian communities can help to reduce the incidence of long term conditions, such as diabetes and heart disease; and to find out how these communities feel the CCG can improve the health and wellbeing of their communities. 
Some interesting themes and issues were highlighted at the focus groups which the CCG is keen to explore. Representatives from the CCG will be revisiting the groups after Ramadan to discuss the issues raised in order to understand what is working well, and where the CCG needs to improve or adapt services for these communities.
Dementia
The number of people with dementia from BME groups is expected to rise significantly as the population ages, as reported by the All-Party Parliamentary Group Report in  .   July 2013.
Alongside this, NHS HMR CCG recognises that it needs to ensure dementia services are culturally sensitive, as families of people with dementia are reluctant to use services which don’t meet cultural or religious needs.
Research by Moriarty, Sharif and Robinson (2011) found that in BME communities there are taboos associated with dementia. For example, the belief that when dementia became more severe it was assumed the person was ‘going mad’. To help break such stigmas, the CCG commissioned BMEHM to hold a series of awareness raising community events with Pakistani, Kashmiri and Bengali communities. The project linked traditional dementia services in the borough with targeted South Asian services in culturally appropriate ways, for example language, hospitality, culture, religion and respect.
The workshops were kept informal and engaged with more than 150 people – including men, women, children, carers, family members of those displaying signs of dementia and community activists.
Community allotment
In order to help the CCG work with BME communities in a comfortable environment, the CCG has funded a community allotment, overseen by BMEHM. The Dera urban farm project was established to recreate the idea of a Dera – where communities in Pakistan had an irrigation system which allowed water for just one hour a week. At the Dera, communities come together to grow herbs and spices, among other crops.
The Dera urban farm project was created in a bid to encourage openness and support to sufferers of dementia and their carers in a fun and practical way.  
Uptake from community groups and local people using the allotment has been fantastic. Five community organisations use the Dera farm on a weekly basis, including carers and people with dementia from BME communities. There are around 50 regular users and it is anticipated this will increase as further referrals are made to the allotment as an alternative to medical treatment.
Mr Fazand Ali, aged 76, has suffered a stroke and is experiencing the onset of dementia. He is a regular user of the allotment and said: “It has been great to go to the Dera farm and remember my childhood in a farm setting. Going to the allotment has given me something to look forward to, especially meeting people and having a good chat.”
A 65-year-old carer, who cares for her granddaughter with a disability and uses the farm, said: “The Dera farm has been really relaxing for me personally. When you’re a full time carer you just haven’t got the time to do things you want. We really enjoy ourselves at the allotment.”
It is a priority for the CCG to engage with and understand all groups in our community so that we can commission the best healthcare services to all. We are really pleased we’ve been able to begin gaining such useful insight into these communities which will help us to think about healthcare services from their perspective.
The CCG is continuing to build strong relationships with the borough’s BME groups, with further engagement planned through focus groups, communication with Imams, additional mosque visits and other engagement events, such as an allotment open day later this year. 

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