Diversity in Cleft Care for Great Britain and Ireland – Why it matters.
Patients born with a cleft are inherently diverse and there is recognition that access to elements of cleft care, such as speech therapy in the community, dental care and returning adults is not currently universal. Understanding the diversity of our patients is more important than ever, at a time when funding streams for specialised services (including cleft services) are set to change.
Diversity is often associated with social justice but this is just one end of a spectrum. Although, at its core, diversity from a demographic perspective is the practice of including and involving people from all backgrounds, it can also be viewed from a cognitive perspective, which involves the inclusion of people who think and problem solve differently. Diversity in media is a hot topic, but we encourage you to look beyond the hype and consider diversity in cleft care for Great Britain and Ireland as a potential route to tangible benefits for patients and professionals.
Demographic differences include race, gender, religion, sexual orientation, social class and age. The introduction of Integrated Care Systems in 2024-25 will be an upheaval to cleft services but will offer an opportunity to target resources and funding at sections of society that need it the most. Data will be vitally important to understand the diverse needs of our patients and to demonstrate the impact of care delivered. Our aim remains to serve our patients as best as we can and that involves being cognisant of accommodating their unique and diverse needs where possible.
A reflectively demographically diverse workforce in healthcare has been shown to help build trust, promote patient compliance and increase patient satisfaction. It is intuitive that the better a patient is represented and understood by care professionals, the better they can be treated. In many ways, cleft care in Great Britain and Ireland could be considered to be ahead of the diversity curve compared to other healthcare specialties. For example, women are well represented amongst cleft leadership positions and the multi-disciplinary nature of cleft care promotes a culture of teamwork, flattened hierarchy and transparency. But conversely, we are not gender diverse in the nursing and allied health professional groups and overall there is little diversity in other protected characteristics. Current research in other areas of healthcare has demonstrated that discrimination, bullying and harassment are endemic within the NHS. Due to a paucity of research specifically relating to demographic diversity in cleft, it would be naïve to assume that there are not systemic or specialty-partisan disparities and inequalities within cleft teams, which could then influence patient care.
Cognitive differences include perspectives, experiences, insight and thinking styles. There is substantial evidence in both business and healthcare sectors that cognitively diverse teams have better problem solving, greater morale, and greater retention. Matthew Syed has described the concept of synergising the abilities of individuals with diverse ways of thinking to create an uplift in cognitive intelligence. This is highly relevant for cleft care in Great Britain and Ireland, two decades on from CSAG, when we need innovative ideas to further improve clinical outcomes and run services efficiently. The challenge will be to maintain hard-fought national standards and outcomes achieved over the last 20 years whilst keeping an open mind to diverse experiences, both national and international, that could be beneficial and allow our services to grow. Data, its dissemination and dialogue, will play a vital role in providing an evidence-based approach.
In a nutshell, diversity is not just about treating people equitably and without discrimination. It is about individualised care, taking into account the difference that each patient has and their unique perspective.
Resources
A 2021 report from the NHS has demonstrated systemic inequalities in the healthcare system with discrimination evident at every career stage. The report stated an indisputable moral and legal case for NHS trusts to increase diversity of workforces. There is robust evidence to demonstrate benefits of diversity including improved quality of care for patients, sustainable workforce supply and increased efficiency of services.
A 2021 report from the Royal College of Surgeons of England conducted by Baroness Helena Kennedy QC recommended diversity to be at the core of healthcare interdisciplinary teams.
Anti-Racism and Allyship 7 day Journey is a brilliant resource to raise awareness and insight
The Lancet Series on racism, xenophobia, discrimination and health published in December 2022 examines how the historic systems and structures of power and oppression and discriminatory ideologies have shaped policy and practice today, and are root causes of racial health inequities.
The British Journal of Surgery publication of Sexual Harassment in the NHS surgical workforce
The King's Fund Equality and Diversity in Healthcare Hub