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ï»żDiscrimination in Health and Social Care

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Discrimination has many meanings and involves numerous different ways people can discriminate against others. Discriminations can be as simple as someone making a judgment against someone else by the way they dress or the way they speak or it can be the people are discriminated because they choose to be different or have a disability, different colour of skin or religion. Discrimination is unfair treatment of a person action based on prejudice.

There are two main types of discrimination. Indirect discrimination is more complicated and may not be deliberate. An example of indirect discrimination could be that a GP surgery requires patients to provide a proof of address when registering. This applies to all new patients regardless of their protected characteristic. But Gypsies are less likely to be able to provide proof of address and therefore they’ll find it more difficult to register. This is indirect discrimination against Gypsies because of the protected characteristic of race. The rule seems fair, but it has a worse effect on this particular group of people. The second type of discrimination is direct discrimination.

This occurs between two individuals. An example of direct discrimination would be a private dentist charging a person of Asian origin more for the same treatment than someone who is white British. This would be direct discrimination as they have been treated differently and worse than the British person because of their race which is a protected characteristic. Direct discrimination is unlawful under the Equality Act and legal action can be taken if someone feels they have been discriminated against. Institutional discrimination is where large organisations work in a way that discriminates.

Someone can be discriminated because of their race. For example, a company might not consider an applicant because the applicant is of a different race to all of the other workers in the company. Culture is also very important for every individual. It shows their identity. Cultural discrimination means when an individual is from a different background or culture and follows his/her rules truly, but are disliked by other people because of their different lifestyle and therefore does not give them equal rights in their daily lives. Someone can also be discriminated against for their religion. Within a care setting there can be many religions. For example, someone could be of the Muslim faith and they have a set of values that they believe in. They could get discriminated against because carer doesn’t believe or simply doesn’t understand the faith. They may discriminate against this person because they don’t provide time for them to pray or they don’t respect the way they dress or don’t provide the right food for that religion.

Disability discrimination is the unfair treatment of a person with a physical or mental impairment. An example of disability discrimination is that someone with a disability not getting a job because they are not abled bodied and could be seen by the company as not able enough. In order to reduce disability discrimination, the UK government introduced the disability discrimination act to ensure people with disabilities get equal rights and get treated the same as able-bodied people. The disability discrimination act makes it unlawful to discriminate against someone who has a disability. The act covers employment, access to goods, facilities and services of organisation, education, buying and renting a property and transport.

Age discrimination happens when someone is treated unfavorably because of their age, without justification, or is harassed or victimised because of their age. There have been some controversies regarding the dispensing of certain very expensive drugs to older people because of their shorter life expectancy, due to their age. Some people have argued that the money would be better spent on drugs for younger people. However, denying a person a drug due to their age may open the health service to considerable legal risk, and legal advice needs to be sought first before decisions like this are made.

Our social class is apparent from the place where we live. The higher class, the better the place is kept and maintained. This inequality has also infiltrated health and social care. In the foreword to a Department of Health publication, Alan Milburn MP, former Secretary of State for Health, stated that the poor are far more likely to get cancer than the rich, and their chances of survival are lower too; the letter carries on to say that health care is a “postcode lottery”.

Gender discrimination is also present in the 21st century. A person cannot be discriminated against because of their gender. Under the Gender Equality duty 2007, all organisations, including health and social care services, cannot discriminate unfairly due to a person’s gender. Equal rights to access, health care and rights must be adhered to.

Sexual orientation can refer to a person who is attracted to another person of the same ex (gay and/or lesbian), the opposite sex (heterosexual) or both sexes (bisexual). Discrimination against someone due to their sexual orientation is against the law. If someone feels discriminated against due to their sexual orientation or feels they are discriminated against they can seek legal help.

A person’s health status can sometimes mean they are discriminated against. Sometimes difficult decisions have to be made regarding a person’s medical treatment, taking into account the cost of treatment, their expected quality of life after treatment and their overall life expectancy. People making these decisions should always keep questioning their own assumptions and prejudices, and do their best to balance the welfare of individual patients with broader funding considerations.

Family status could also lead to discrimination. Family status can lead to a variety of judgements including being discriminated against because you have gay and/or lesbian parents, single parents, parents of different genders, parents of different races with mixed race children and other family groupings.

Lastly, discrimination on the grounds of cognitive ability may arise because of a brain injury, a learning disability or difficulty, or a person’s social class or education. It can be easy to discriminate against people with cognitive disabilities but care must be taken not to do so. ‘Valuing People Now’ is a government strategy which aims to improve the lives of people with learning disabilities, and those of their families and carers.

How Rights Can Be Infringed

Individuals working in and using health and care settings can have their rights infringed. In health care settings, power can be abused covertly and overtly. Hidden use of power to discriminate can lead health and social care professionals to treat someone differently from someone else. This means that a person may not get the same level of treatment, which may jeopardise their health and well-being. An example of covert power abuse can include removing responsibility from a person in their work. For example, a deputy nurse may remove responsibility from a newly qualified nurse on a repeated occasion because they feel they are not good enough, which over time may dis-hearten the nurse and make them not want to go to work anymore. An overt abuse of power includes openly using power to discriminate. This will have similar outcome to covert abuse of power. However, if a person being treated notices that they are being discriminated against, it will have a negative impact on their recovery, their health and perhaps even their mental health.

An example of overt abuse of power could include verbal abuse or personal insults to someone lower than you. For example, a manager using verbal, personal insults to one of their employees with a purpose to put them down. Prejudice can also affect people working or using health or care settings. Negative, preconceived ideas about an individual, arising from a person’s negative ideas about that individual. This can affect the individual’s health or social care. Stereotyping can also affect people in the health and social care sector. Assumptions are sometimes made about an individual, which could affect their health care in a negative way. Giving people labels, mostly negative ones, is very unprofessional and could lead to different levels of health and social care being given to particular individuals. Prejudice, stereotyping, assumptions and labelling can lead to negative outcomes.

For example, if someone in care is exposed to constant stereotyping and labelling then this could lead to mental health issues. If they carry on being exposed to it then it could lead to depression or similar mental health illnesses. Bullying and abuse can also affect people in the health and social care industry. Bulling is using someone’s power to intimidate another person. There are different forms of bullying, such as physical, written and verbal, all can which lead to distress or even mental health issues. Abusive situations can occur due to stress or lack of staff supervision or training, and will definitely lead to the abused individual’s health and mental state deteriorating. Bullying and abuse can happen in health and social care settings. Abuse or bullying can sometimes can happen in care homes as staff are often left alone with older people, who can often be vulnerable. This gives staff in the care home an opportunity to blackmail the service users to do as they are told and bully/abuse them if they don’t do what they are told.

Potential Effects of Discriminatory Practise
Discriminatory practice is where someone is discriminated against because of their gender, age, vulnerability or if they’re disadvantaged. Discrimination can have a very negative effect on people because it could hurt their feelings and self-esteem, or even in some cases hurt someone physically. Being discriminated against can have many potential effects on a person’s mental and physical wellbeing. Marginalisation is when people feel they are not part of the main group in society. The ‘Journal of Social Work’ has explored a wide range of discrimination cases involving marginalisation. For example, the April 2009 edition looked at the oppression and marginalisation of older lesbian, gay men, bisexual and transgendered people in homophobic societies, and in November 2009 it looked at cases of marginalisation of children with HIV/AIDS. It concluded that there was clear cases of marginalised of minority groups. In health and social care no one should be marginalised, no matter what their background, circumstances, sexual orientation or health status.

An example of marginalisation in a health or social care setting could be a youth worker excluding a homosexual teenager based on his sexuality. This could lead the teenager to become depressed or develop anxiety because the way he was treated. They may begin to exclude themselves from others and start to feel that all staff in health and social care settings will treat them the same. This may stop them from attending other, more important provisions such as doctors’ appointments. Disempowerment is when someone makes a person or group less powerful or confident. They will feel disempowered. They may be willing to fight against this, and in some cases will win their case. However, many do not and they lose the will to fight against discrimination. As a result of this, they may become depressed, devalued and disempowered, which in turn may lead to more health issues.

This may lead to health issues and may lead to them taking tablets which could make them unhappy and anxious as they believe they have a serious medical condition. An example could be an elderly patient being told by her carer that she is not useful; this is making the patient feel disempowered. Low self-esteem and self-identity can also be an effect of discriminatory practice. Discrimination can lead to people losing their self-worth or self-esteem. Some vulnerable people may have low self-esteem before they start using health and social care services. A person with low self-esteem will experience negative self-identity, which brings a feeling of worthlessness and depression. The health and social care professional needs to ensure that an individual’s self-esteem is maintained if it is high or can be raised if it’s low, to help the person cope with their situation. This can lead to feelings of worthlessness and depression.

They may become withdrawn and isolate themselves within their home to make them feel alone and that no one is there for them. An example of low self-esteem can include an emotional teenager being targeted and bullied. This would result in them having low self-worth or best known as low self-esteem. Restricted opportunities can be an effect of discriminatory practise. All types of discrimination may lead to a person not using health and social care provisions and this can lead to poorer health. The discrimination may be by an individual, health organisations or even by the government. They may start to feel as if they are unable to access services in place and could result in them not receiving the care they need. If they do not receive treatment, or the correct treatment, they may become even more unwell. Another effect of discriminatory practise can include negative behaviours such aggression or criminality.

Negative behaviour, aggression or crime can be partly caused by discrimination. Living in poverty and experiencing discrimination can affect an individual’s behaviour. People may experience hardship and then take their frustrations out on police, teachers and health and social care professionals. People may take out their anger on those they see in a position of power and health professionals can find themselves being verbally or physically attacked. People may have anger management problems and they may take this out on the health and social care professional. Drug users may also display negative behaviour whilst in care. An example of negative behaviour within health and social care settings is someone living in poverty shouting at a policemen because they feel they are in a lower authority than the policemen. This may lead to verbal and physical abuse. There are also effects of overriding people’s rights, both by the use of power and force and also by the use of statutory powers such as sectioning under The Mental Health Act.

All organisations have to comply with the Human Rights Act. However, there are some cases where the Act can work in different ways. These include the use of statutory powers and cases when a person’s rights have to be removed by force or power. Statutory powers are used, for example, when a child is taken away from abusive parents. Although the parents’ rights are being affected, the child’s right to health and safety takes precedence even if the parents objected. This may require a range of services, including social services, the public and health professionals as well as the legal profession, working together to ensure that the rights of the child are protected, even at the expense of the rights of the parents. A person’s rights are sometimes taken away by force or power, for example, if someone with psychiatric problems is detained in hospital under the Mental Health Act 1983 or the Mental Health (Care and Protection) Act 2003. They can also be forced to accept treatment. This is done in the patient’s best interests, even though they may not want to take the medication. Loss of rights may lead to sleeplessness, lack of confidence, low self-esteem, becoming withdrawn and lack of interest in anything.

Assess Effects of Three Different Discriminatory Practises
Underperformance of students of some ethnic groups at GCSE:
It is believed that the some ethnic groups do not perform as well at GCSE than others. It’s thought that black boys underperform in their exams. Only 31.9% of black boys managed five A to C passes one year against the national average of 51.9%. There are also statistics from 2006/07 that states that only 34% of Black Caribbean children were achieving 5 or more A*-C’s and only 40% of Black African were achieving 5 or more A*-C’s. However, in 2010/11 these figures rose and now 59% of Black Caribbean were achieving 5 or more A*-C’s and 79% Black African were achieving 5 or more A*-C’s.

This may be down to many reasons, including low expectations of teachers. To try to resolve and raise the grades of black people, a doctor introduced the policy of separating black boys from other pupils for English, maths and science. The boys were pulled out of lessons if they were identified as struggling in one or more of the disciplines. He said that, as a result of the segregation, the pupils had begun to make considerable improvements. The segregation of black boys during lessons and underperforming in lessons can have both short and long term effects. Short term effects of being segregated can include feeling withdrawn from the rest of the class and feeling isolated. In the short term, segregation can also lead to teenagers turning to drinking and drugs because they feel the need to attract the attention of adults. Studies of short-term outcomes observed positive effects such as raised academic achievement due to the ability to concentrate more but also negative effects such as racial prejudice or fear from being separated due to the colour of their skin.

Segregation can also have long term effects on the black boys. Long-term outcomes may refer to educational attainment, occupational attainment, adults’ intergroup relations, crime and violence, and civic engagement. Research about the effects of segregation, carried out in America, found out that being segregated in school for at least half of a child’s school time meant that education was significantly associated with higher scores on the sense of control and, in turn, better systolic blood pressure, grip strength and peak expiratory flow. Generally, segregation has a small but beneficial impact on blacks, for example education achievement, and a clear beneficial impact on longer-term outcomes such as school attainment, like level of education attained and earnings. However, segregating black boys from the class can result in problems involving cross-racial friendships, acceptance of cultural differences, and inclines in racial fears and prejudice as children of different races are separated.

Short-term and long-term effects of segregation are found for minority and majority students alike. Students who weren’t segregated are more likely to live in diverse neighborhoods as adults than those students who were segregated. Institutional discrimination in public bodies shown up by the Stephan Lawrence case: On the 22nd of April 1993, Stephan Lawrence was murdered by a gang of white teenagers while waiting with his friend, Duwayne Brooks, at a bus stop in Feltham. The police initially thought the killing was drug and gang related, and Brooks was arrested in line with the theory. After, the police received information about four white youths who had been involved. These youths were place under observation, but were not arrested until the beginning of May, by which time any evidence had been lost. Duwayne Brooks picked out Neil Acourt in an identity parade as one of the attackers, but this and other evidence was not enough to get the Crown Prosecution Service to prosecute the 5 youths that the police thought were involved.

In 1996, the Lawrence family start a private court case against Neil Acourt, Knight and Dobson at the Old Bailey. The judge ruled the evidence as insufficient and they were acquitted. After years of protests led by Stephan’s mum, Doreen, who believed the police had failed to investigate the murder properly and mistreated the family due to racism, an inquiry under Lord MacPherson began. The inquiry concluded that the police investigation was “marred by a combination of professional incompetence, institutional racism and a failure of leadership by senior officers”. The charge of institutional racism in particular prompted a series of changes within the Metropolitan police, such as having the police subject to wider laws on racism and opening up the force to many more black and Asian officers. After this, changes started to happen. In 1999, the head of the Metropolitan police force apologised to the Lawrence family for the faults and institutional racism which the force had shown in the murder investigation.

In 2005, the government changed the law so people could be charged with the same crime more than once, leaving open the chance to re-prosecute the five. In 2012, new techniques enabled blood spots on clothing to be identified as Stephen’s and Gary Dobson and David Norris were convicted of the murder. They got life imprisonment, however the other three remain free. There were many examples of institutional discrimination through the Stephan Lawrence case. The whole police force was reluctant to investigate the murder and didn’t make a considerable effort to find out what happened. The inquiry into the death of Stephan Lawrence outlined ways in which the case was a victim of institutional discrimination. The inquiry quotes that “institutional racism is in our view primarily apparent in what we have seen and heard in the following areas: a) Investigation including the family’s treatment at the hospital, the initial reaction to the victim and witness Duwayne Brooks, the family liaison, the failure of many officers to recognise Stephen’s murder as a purely “racially motivated” crime, the lack of urgency and commitment in some areas of the investigation. b) Countrywide in the disparity in “stop and search figures”.

Whilst we acknowledge and recognise the complexity of this issue and in particular the other factors which can be prayed in aid to explain the disparities, such as demographic mix, school exclusions, unemployment, and recording procedures, there remains, in our judgment, a clear core conclusion of racist stereotyping. c) Countrywide in the significant under-reporting of “racial incidents” occasioned largely by a lack of confidence in the police and their perceived unwillingness to take such incidents seriously. Again we are conscious of other factors at play, but we find irresistible the conclusion that a core cause of under-reporting is the inadequate response of the Police Service which generates a lack of confidence in victims to report incidents. d) In the identified failure of police training; as evidenced by the HMIC Report, “Winning the Race” and the Police Training Council Report, and the clear evidence in Part 1 of this Inquiry which demonstrated that not a single officer questioned before us in 1998 had received any training of significance in racism awareness and race relations throughout the course of his or her career.”

Institutional racism, whether used intentionally or unintentionally, can have significant effects on the people involved. They may start believing all the stereotypes and therefore begin to live up to them to match them or may start to suppress certain parts of themselves and try to change themselves to the race that they think is superior to theirs. They can start reverse racism toward the races that stereotype them, or really start to feel self-loathing which can cause them to become depressed, angry or at worse suicidal. Anxiety can also be a common effects of institutional racism. If they are strong minded they can actually use the racism to test their strength and challenge people’s beliefs even becoming a role model for others. There’s many possibilities depending on the severity and the length of time that the racism persisted, but most of the time the outcomes would be negative. Discrimination against people with mental health problems in employment: There have been signs that people with mental health problems have been discriminated when it comes to employment.

The law only recognises discrimination against people who suffer from mental health conditions if they can prove they fall within the definition of having a disability. The definition of a disability is “a physical or mental impairment which has a substantial and long term adverse effect on his [or her] ability to carry out normal day to day activities”. This is particularly difficult in the case of “invisible” conditions such as anxiety, depression, bipolar disorder and obsessive compulsive disorder. The fact that these cannot be easily proved makes achieving fairness a difficulty. A mental illness refers to the extreme end of difficulty felt by some people at different times of their lives. They can become confused and feel out of touch with reality that means they can barely cope with everyday living. Being discriminated due to their mental health can have a dramatic effect on the person.

They may begin to stop applying for jobs as they expect to be rejected or excluded. They may also have a lower self-esteem and as they think they aren’t good enough and this could lead to a low self-worth. Other effects of being discriminated include depression, suicidal thoughts, being ashamed of who they are and becoming isolated or withdrawn from society. Mental health can occasionally make the sufferer have to make the tough decision to quit their job as working can be too much of a struggle. Most recent surveys suggest the 73% of people with mental health conditions are unemployed.

This shows that, although the Government and mental health organisations are trying to encourage people to work, over half of the sufferers in the UK don’t feel like they are able to go to work. It is also thought that only 40% of employers would consider employing someone with mental health problems. This shows that the stigma surrounding mental health problems still exists and this can prevent people getting a job. There are many occasions where discrimination can be used in health and social care. Discrimination can happen intentionally as a way of asserting authority over some, or unintentionally through lack of training. Either way, discrimination can have a major effect on the vulnerable service users.

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