Inequalities in service provision: an examination of institutional influences on the provision of district nursing care to minority ethnic communities

This paper reports on the selected findings from a larger ethnographic stud y of the provision of district nursing care to patients from different ethn ic backgrounds. The two-stage study was undertaken in an English community National Health Service (NHS) trust serving an ethnically diverse populatio n. The first stage comprised an organizational profile in order to analyse the local policy context, including specific responses to ethnic diversity. Data were collected by means of in-depth interviews with managers. The sec ond stage entailed a participant observational study focusing on six distri ct nursing teams. Purposive sampling was used to identify four teams with h igh minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field-notes were analysed by drawing upon the principles of dimensional analysis. The paper focuses upo n institutional influences on the provision of care to minority ethnic comm unities. An analysis of the allocation of district nursing resource to diff erent general practitioner (GP) practices identified marked inequalities in the district nursing provision which impacted upon the services provided t o minority ethnic patients. Single-handed, inner city GP practices with a l arge minority ethnic practice population received a much smaller allocation of nursing staff than single group practices serving a smaller and predomi nately white practice population. The reasons why this situation existed ar e explored and an explanation offered as to why it had not been rectified. Observation of caseload management indicated that despite differences in th e size of the practice populations served by the respective teams, all pati ents referred for nursing care received it. However, several covert process es appeared to limit the caseload size of those teams with large practice p opulations so that it remained manageable within the limited nursing resour ce available. It is concluded that although nurses at an individual level d id not appear overtly to disadvantage minority ethnic patients, institution al forces conspired to perpetuate the disadvantage experienced by minority ethnic communities.