Feature

Listen so that people will talk

Establishing a dialogue with minority ethnic groups is a particular challenge, say Belinda Pratten and Shelly Choudhury

Since the publication of Local Voices in 1992, health authorities have been urged to involve their local communities in commissioning. Establishing a dialogue with local people is no easy task and it is even more difficult to involve groups who do not speak English as their first language. Yet it is clear that black and minority ethnic communities may have a poor understanding of how the healthcare system works and face particular difficulties getting the services they need.

‘Speaking for Ourselves’ was a pilot project set up by Camden health and race group with support from Camden and Islington family health services authority to work with local black and minority ethnic groups. The aim was to establish a dialogue with these groups, to raise their awareness and expectations of health services and to feed their concerns back to the HA. To achieve this a series of seminars were held with people from the Bengali, Greek Cypriot, Somali and Chinese communities in Camden between October 1994 and February 1995.

Particular attention was paid to working with people from these different communities within existing community groups, to enable them to set their own agenda.

Each group nominated someone who spoke both English and their mother-tongue to lead the session. This person was then given information by an FHSA senior manager about the role of the FHSA, what people could expect from their GP and from other family practitioner services, including the advocacy service, as well as how to get further information and advice and how to make a complaint. This was supported by leaflets in each community’s language and a copy of the FHSA’s medical directory for further reference.

Although a delay in the publicity for the two Bengali sessions meant these were not well attended, each of the other seminars were attended by approximately 40 people. The feedback from community workers was very enthusiastic.

One said: ‘It was very useful. It helped that it was held in a place they knew, they were comfortable here, so could ask questions. They needed the information - for example, people didn’t know they could change their GP.’

An evaluation of the project confirmed that those attending had little prior knowledge of health services. The exception to this was that all those from the Greek Cypriot and Chinese communities who took part in the evaluation knew of, and most had used, an optician. It turned out that in both instances the community centres had arranged for an optician to hold a regular session at the centre.

The evaluation also showed that having the sessions held in their own languages and led by someone they knew meant that people felt able to contribute and to discuss their concerns. The informality of the occasion and the flexibility of organisation was welcomed. For example, the Somali seminar was held at the community health council premises where it was possible to set aside a room for prayer and the organisers were able to incorporate this activity into the session.

An important element of this project was to identify ways of involving groups which would enable them to set their own agenda. The Camden approach has enabled communities to think about what sort of event would be most useful to them and what they need to make it happen. This has been crucial to the project’s success.

Many of the groups working with black and minority ethnic communities have little or no funding. By providing organisational support and funding for publicity as well as for those taking on additional work, such as facilitating sessions, the seminars could take place without placing too great a strain on the groups themselves. As one community worker told us: ‘In an organisation like ours, where there’s only one worker, it’s very difficult to come to meetings or go to training sessions because you have to keep your service going. When you’re not there the service has to close.’

The project also highlighted the benefits of a community development approach to building relationships between the HA and the community. The knowledge, experience and contacts in both the statutory and voluntary sectors which Camden health and race group has built up were invaluable in terms of getting the project up and running and providing support to ‘front line’ community groups.

Equally important was the willingness of the HA to fund development work of this kind and to work to community-led agendas, and providing information and back-up materials.

The project has enabled relationships to develop between community workers and the FHSA. We hope that these can form the basis of a longer term dialogue.