Last reviewed 8 July 2021
Health and Social care providers need to deliver services that recognise the social, cultural and linguistic needs of service users and ensure these are appropriately met, enabling individuals to feel understood and valued. In this feature, Deborah Bellamy explores why it has become increasingly important for care services to deliver person-centred culturally sensitive care, how the CQC’s guidance underpins this, what the relevant CQC regulations are, as well as key questions, tips and what training is available.
The CQC guidance Culturally Appropriate Care (2021) affirms person-centred care has always been essential. The Covid-19 pandemic made cultural and heritage issues more significant due to restrictions, limited opportunity for families and communities to join up and reduced interaction with those who understand service users’ identity and validate their culture.
CQC guidance: Culturally Appropriate Care
The CQC advocates the need for culturally appropriate care (also called “culturally competent care”) in adult social care settings, sensitive to cultural identity or heritage, observant of and responsive to beliefs or conventions determined by cultural heritage. Cultural identity or heritage may be based on ethnicity, nationality or religion or associated with an individual’s sexuality or gender identity. Lesbian, gay, bisexual and transgender people have a particular culture as do deaf people who use British Sign Language.
The Department of Health and Social Care (DHSC) believes this will enhance understanding of cultural influences and identity and is pivotal to treating everyone with respect and dignity to facilitate personalised care and support planning.
How culturally appropriate care is relevant to CQC regulations and key questions
Understanding and communicating effectively with those of different cultures is based on person-centred care. Culturally appropriate care is relevant to:
Also the CQC Key Lines of Enquiry.
Documenting and facilitating cultural considerations about medicines, such as exploring options with service users wishing to celebrate Ramadan and adjusting medication schedules.
Protecting service users from harassment or discrimination and over characteristics protected by the Equality Act.
The service reflects cultural, ethical, and religious needs when planning meals and drinks and cultural needs considered as to the décor of premises or service users’ rooms.
If service users lack capacity to make a specific decision, the service considers cultural preferences when applying the Mental Capacity Act by consulting those close to them. See the Mental Capacity topic.
Staff support service users in culturally sensitive ways, acknowledging when individuals’ preferences are not being addressed or appropriately respected.
Knowing and respecting individuals, displaying compassion, and ensuring visitors feel welcome.
Involving service users, their families or carers in developing care plans, incorporating and identifying needs on the grounds of equality characteristics and how such needs are met, ensuring regular reviews.
Staff have access to appropriate training to help meet these needs.
Supporting service users to participate in culturally relevant activities.
In end-of-life care, service users’ needs relating to equality characteristics are considered and religious beliefs and preferences respected.
The service has a positive person-centred culture that is open, inclusive, empowering and promotes equality and diversity.
Leaders, managers and staff demonstrate good understanding of equality, diversity, and human rights, encouraging service users to communicate views and concerns and action is taken to develop service and culture.
The service investigates workforce inequality and acts upon it. Staff feel they are treated equally, and staff voices heard to shape the service and organisational culture.
CQC examples of culturally appropriate care
The CQC clarifies that care workers do not have to be specialists in diverse cultures, but it is of benefit to understand how culture affects aspects of care provision, based on assessment of individual needs, without making assumptions or judging. Examples given consider variations of culture that affect areas of service delivery, such as healthcare, emotional support, religious or spiritual rituals, personal appearance, personal or shared spaces, gardens, planned activities, community influences and relationships, cross-cultural communication and staffing.
The CQC suggests it is important that:
the service user or representatives are asked about cultural preferences and for providers to meet these, where feasible, enabling them to live their most complete lives, contributing to wellbeing, dignity and self-respect
there may be only minor changes required to make an impact to service users and while staff may be concerned questioning families, most are keen to share their cultural beliefs and traditions to enhance understanding
supporting individuals at the end of their life has always been important but where staff do not share the same faith it is imperative, particularly in time of restricted visiting practices, to be aware of wishes and preferences and plan accordingly as part of end-of-life planning.
Care staff represent a wide range of ethnic groups and some service users’ cultural needs may be met more completely if they are closer to cultural norms in the service in which they live. It could be assumed matching staff from the same culture would be the service user’s preference, but this may not be the case. Those able to speak the native language of a service user may be willing to teach others a few words or phrases.
Multicultural workforces may be more sensitive to different cultural backgrounds and perspectives which can create more empathy, understanding and respect, and result in increased flexibility and tolerance.
Staff from minority groups may also encounter discrimination from service users or others so ensuring staff support is available and their involvement and inclusion is important.
Dementia and diversity
According to Social Care Institute for Excellence (SCIE), more than 25,000 older BME people live with dementia in the UK. Those with dementia may identify more strongly with the culture from earlier years as they age.
For lesbian, gay, bisexual and transgender and (LGBT+) people, living with dementia can be additionally stressful some believe care services may not be willing to understand their needs and fear discrimination.
SCIE has produced resources to support workforce development for those working with service users from the following cultures and backgrounds:
black, Asian or minority ethnic background (BAME)
lesbian, gay, bisexual or transgender (LGBT)
These resources may be accessed on the SCIE website.
The Diversity Trust also provides online learning materials and films for making care homes more inclusive for older LGBT+ people in England and Wales. More information is available from the Diversity Trust website.
Training that focuses solely on facts can be limiting. Approaches developing wider interpersonal skills, such as communication, empathy and respect can help foster better awareness and relationship building.
The culture of the service needs to be open and inclusive, so care workers feel empowered and learn to be part of a culturally diverse, supportive team by observing good practice, sharing awareness, and demonstrating this ethos. See the Standard 3: Duty of Care training module.
Those working in health and social care need to be aware of characteristics protected by the Equality Act. The SCIE offers resources exploring implications of the Equality Act.
SCIE also has information on the use of reminiscence for people with dementia, which could be used to explore aspects of earlier lives to help build a fuller cultural picture. Some service users may need emotional support as revisiting memories may have painful connotations so discussing this with family members may be advisable.
Skills for Care offers resources based on Standard 4 of the Care Certificate, focusing on equality and diversity, encompassing protected characteristics, and can be accessed on the Skills for Care website.
Tips to support culturally appropriate care
Display a wall chart incorporating key dates of cultural or religious events to help plan theme-based or focused activities. Even in pandemic times festivals can be celebrated by watching films, listening to services on the radio, sharing foods, or use of social media to link with families or friends.
Ensure service users’ cultural needs form part of their care planning and review under the relevant sections of the care plan.
If a translator is requested, when they are speaking look at the service user and communicate with them as if no language barrier exists. If an interpreter is not available, translation technology can be useful; however, it may not be totally accurate.
Body language and eye contact become more important where there is a language barrier. Use active listening and ask service users to repeat back what they have understood. If clarity is needed, listen to the words used and try and mirror vocabulary.
Service users need to provide informed consent for medical procedures or personal care. If a service user is unfamiliar with a clinical procedure the care worker may need to explain in detail, why the procedure is needed and what to expect during and after the procedure. Showing an appropriate video clip may help underpin information.
Everyone who works in health and social care has a responsibility to increase cultural awareness to ensure cross-cultural encounters are approached in a confident manner thus improving the cultural competence to help combat bias and discrimination.