London is one of the most diverse cities in the world. It has a vibrant mix of ethnic cultures, each person representing a section of the world but also unique in their own right. Different ages, genders and physical and mental impairments add to the diversity. There are also strong gay, lesbian, bisexual and transgender communities. There are cultures, sub cultures and individuals too diverse to do justice to here. More than 300 languages are spoken and more there are around 50 non indigenous communities with 10,000 people or more. (Cultural Diversity in Britain: A Toolkit for cross-cultural co-operation. P Wood et al. Joseph Rowntree Foundation)

The doctors, dentists and health care professionals we train deliver services to these individuals and communities. Equipping them to do this in the most appropriate way will improve patient care and help address health inequalities. That is what Cultural Competence should be about.

We recognise the subject of Cultural Competence is complex and there are conflicting views and opinions. The information in these web pages is offered as a resource to our trainees, trainers and training providers and aims to provide useful tools and information. It does not claim to represent an authoritative guide. Indeed a key message is that to be effective Cultural Competence needs to be grounded in and reflective of the local community. Consequently, standard tools and models are unlikely, by themselves, to address local issues.

Where London Deanery fits in

The London Deanery recognises that its trainees and the faculty in London work for patients that are, in some respects, amongst the most diverse in the country. This means that the promotion of equality must be embedded into the work we do.
The London Deanery Equality Scheme and Action Plan have been published and set out our aims in meeting our duties in respect of gender, disability and race equality. However, we are not satisfied with simply complying with relevant legislation. We wish to understand best practice from elsewhere, consider new areas, such as the emergence of cultural competence, and to benchmark activities to improve and embed equalities issues across our work. One approach to this was commissioning a survey of diversity and cultural competence training in London to get a feel for activity already taking place. Only about a quarter of our Trusts responded so the results must be treated with some caution but they provide a useful starting point for dialogue and further research.

National Scene

There is a growing national recognition that to be effective, and to address health inequalities, healthcare provision must be cultural competent. A key factor in shaping this understanding was a 2004 enquiry into the death of David “Rocky” Bennett, a 38 year old African Caribbean. The inquiry concluded that he was a victim of institutional racism. The following statement by the Chairman goes to the heart of the concerns:

"Black and ethnic minority citizens should not have to claim their rights, they should be given them as a matter of course. They are not demanding more than they are entitled to, nor are they claiming preferential treatment. They are simply asking for justice, which has been denied them for too long."
Sir John Blofeld, Chairman of the independent inquiry team

The UK Government and other health and social care organisations have taken steps towards developing training to promote culturally responsive care in Mental Health services and beyond into other service areas. However, the method by which this might be achieve and the likely benefits are unclear and the training approach been challenged. Some believe that it is necessary to address the problem at the institutional level. With regards to the training approach, there is little consensus as to content, method of delivery etc.