What is Perceived Unfairness in Health and Social Care?

Perceived unfairness in health and social care refers to the individual or collective feeling that systems, services, or experiences are unjust or unequal. This perception can arise when patients, service users, or employees feel that they are not treated equitably or that resources are distributed unfairly. Unfairness can be subjective, influenced by personal values, experiences, and societal norms.

People expect fairness when accessing health and social care services. They often view fairness as equal opportunities for treatment, respect, and access for all groups, regardless of socio-economic status, ethnicity, gender, or other characteristics. When these expectations are not met, the perception of unfairness can grow, leading to dissatisfaction with services and negative outcomes.

Types of Perceived Unfairness

Perceived unfairness can take many forms. Below are some common examples:

• Inequities in access to services: Service users may feel that they do not have the same opportunities to access certain treatments or therapies as others.
• Bias or discrimination: Individuals may perceive prejudice based on ethnicity, gender, sexual orientation, disability, or other characteristics.
• Unequal allocation of resources: This could mean fewer resources being allocated to specific areas, such as rural communities or particular health conditions.
• Unfair treatment by staff: Patients or service users may feel disrespected, ignored, or treated differently than others within the care setting.
• Workplace injustice: Staff in health and social care settings may feel undervalued, underpaid, or treated unequally compared to their peers.

Each of these examples can result in feelings of unfairness, either individually or collectively.

Causes of Perceived Unfairness

Several factors contribute to perceived unfairness in health and social care. These factors include systemic challenges, individual actions, and social inequalities.

Systemic Issues

Systemic issues are problems within the wider health and social care system that can cause unfairness. Limited funding and resources often lead to unequal distribution. For example, certain treatments may be more widely available in urban centres than in rural areas. Similarly, long waiting lists for specialist services can result in some people feeling excluded or prioritised less.

Sometimes, the way policies are implemented can unintentionally cause unfairness. For example, age-based policies for certain procedures might leave younger or older groups feeling discriminated against. Healthcare rationing—when only specific groups gain access to treatments due to cost—can also result in frustration and feelings of injustice.

Bias and Discrimination

Bias can affect the way decisions are made in health and social care settings. Discrimination based on race, gender, sexual orientation, or disability can occur, whether due to prejudice or unconscious bias. For example, research has shown health outcomes in ethnic minority groups often lag behind white British groups, leading to perceptions of systemic racism.

Communication Barriers

Poor communication is another source of perceived unfairness. When patients feel excluded from decision-making about their care, they may believe their opinions are disregarded. Complex medical jargon can add to this problem, making users feel undervalued and less informed.

Economic Inequalities

Health and social care can feel unfair when economic inequality plays a role. For example, individuals from poorer backgrounds might struggle to afford transportation to health providers, access private care options, or adequately support loved ones in social care settings. Wealthier individuals may be able to secure better services, creating a divide.

Cultural Expectations

Different cultural backgrounds influence how individuals view fairness. In some cultures, family involvement is paramount in decision-making for care. Systems that discourage family input can feel unfair to certain communities. Similarly, some groups may expect emotional support while others may prioritise efficiency over empathy. The failure to accommodate diverse needs can lead to resentment.

Impacts of Perceived Unfairness

Perceived unfairness has serious consequences. These effects can harm individuals, communities, and organisations:

Mental and Emotional Impacts on Service Users

When patients feel treated unfairly, they may experience stress, anger, or depression. This can affect their willingness or ability to engage in services, potentially worsening their health. For example, a person who feels ignored by a GP may delay seeking help for worsening symptoms.

Effects on Trust

Trust is vital in health and social care. When individuals perceive unfairness, their trust in care providers and systems diminishes. Without trust, patients may become less likely to follow medical advice, engage with health services, or disclose sensitive information.

Organisational Consequences

Employee perceptions of unfairness in health and social care settings can reduce morale and productivity. Staff members who feel undervalued may leave roles or reduce their effort, worsening recruitment and retention problems. These consequences may lead to compromised care quality for patients.

Widening Inequalities

If perceived unfairness remains unaddressed, it can deepen inequalities. For example, individuals who distrust systems might stop accessing care altogether. Over time, this can exacerbate health disparities between different groups.

Examples of Perceived Unfairness

Real-life examples help illustrate how perceived unfairness happens.

• Waiting Times: A patient waiting months for an operation feels unfairly treated when they hear someone else had surgery within weeks. Unless criteria for prioritisation are explained, this can breed resentment.
• Cultural Barriers: A migrant family may feel excluded if healthcare providers do not accommodate their language or cultural needs during a medical appointment.
• Age Discrimination: Elderly individuals often feel dismissed in healthcare settings, believing that younger patients are given preference. This can lead to feelings of worthlessness.

Tackling Perceived Unfairness

There are actions that health and social care organisations can take to address and reduce perceived unfairness. Acting to solve these issues can restore trust and improve outcomes.

Training to Reduce Bias

Training can help staff recognise unconscious biases and address them. By improving awareness, organisations can ensure that decisions about care delivery and patient treatment are equitable.

Transparent Communication

Service users and employees need clear and honest communication about how decisions are made. Transparent reasoning for resource distribution, policies, and waiting lists can help people understand why certain decisions occur. Clear communication also involves giving individuals enough information to make informed choices about their care.

Involving Service Users

Service users should feel included in the care process. Involving them in planning and decision-making can reduce perceptions of unfairness. Care plans should be created collaboratively, allowing users to openly express their preferences and concerns.

Improving Access

Access issues can be addressed by ensuring that all areas, including underserved ones, have adequate resources. Transport options, virtual appointments, and mobile clinics could all help reduce accessibility problems.

Monitoring and Auditing

Organisations should regularly monitor and audit their practices to identify disparities and areas of unfairness. By tracking outcomes across population groups, organisations can spot problems and act early.

Listening to Feedback

Service users and employees are often the best source of information about perceived unfairness. Organisations should provide safe, accessible ways for individuals to offer feedback. Regular public consultations and staff surveys could uncover hidden inequities.

Cultural Competency

Health and social care workers need cultural competency to understand and respect diverse cultural practices and values. This helps reduce feelings of cultural exclusion linked to unfairness.

Legal Frameworks and Policies

In the UK, legal frameworks aim to prevent unfairness in health and social care. For example, the Equality Act 2010 protects individuals from discrimination. This law ensures equality regardless of race, gender, disability, sexuality, or religion. The NHS Constitution also sets out principles regarding access, respect, and non-discrimination.

The Care Quality Commission (CQC) monitors standards in health and social care services. During inspections, it evaluates fairness alongside quality to ensure services meet legal and ethical requirements.

Conclusion

Perceived unfairness can shape how people view health and social care in the UK. Whether caused by systemic barriers, communication issues, or bias, the effects are significant. Tackling unfairness is critical for building trust, improving outcomes, and reducing inequalities. By investing in training, communication, access, and cultural competency, organisations can work to make health and social care fair for all.