Culturally Appropriate Care and Support

Culturally appropriate care (also called ‘culturally competent care’) is care that is sensitive to people’s cultural identity or heritage. This includes the things you can see and the things you cannot see (also known as cultural values or beliefs).

If care is not sensitive to people’s cultural identity or heritage, the impact can be devastating for the person and their sense of wellbeing.

Everyone is part of a culture, and everyone therefore has a cultural need to be met.

How to be sensitive to cultural identity or heritage in practice will vary from person to person. For some people ethnicity, nationality or religion will be important. For others it might be their sexuality, gender identity or other life experience or event.

You should never make assumptions or generalisations based on what you think you know, regardless of how well informed you may be. For example, not all Asian or African people like spicy food.

It is also important to understand that cultural identity can change over time. This is because life events and experiences can lead to someone changing their beliefs or reprioritising what is important to them. This may be more pertinent when someone has a progressive illness e.g., dementia, or if they are approaching the end of their life or has experienced a significant life event.

To provide care that is truly culturally appropriate, you must therefore be alert and responsive to the aspects of culture or heritage that a person identifies with (or doesn’t identify with) or believes at the time that the care is being provided.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

Providing culturally appropriate care and support is integral to meeting several of the regulations that the service is required to meet.

The Equality Act 2010

Under the Equality Act 2010 it is unlawful to discriminate against someone because of any of the following protected characteristics:

• Age;
• Disability;
• Race (ethnicity and nationality);
• Religion or belief;
• Sex or gender;
• Sexual orientation;
• Gender reassignment;
• Pregnancy and maternity;
• Marriage and civil partnership.

A failure to provide culturally appropriate care could also be seen as a breach of the Equality Act 2010.

The Care Act 2014

Under the Care Act 2014, there are 9 categories of individual wellbeing (see table below).

If the service has been commissioned directly by the local authority, or if the person has arranged the service themselves after receiving information and advice from the local authority, you have a responsibility to promote individual Wellbeing.

The local authority will want to know how you have promoted the person’s individual Wellbeing when they carry out a review of their Care and Support Plan.

For further information see: Promoting Individual Wellbeing

Providing culturally appropriate care can undoubtedly have a positive impact on a person’s sense of wellbeing in all categories. Likewise, providing care that is not sensitive to cultural identity and heritage can have a negative impact.

The table below provides just a few examples to demonstrate how culturally appropriate care can have a positive impact on the different categories of individual Wellbeing:

Anti-discriminatory recording is an important part of culturally appropriate care.

For guidance about referring to or writing about ethnicity, see GOV.UK: Writing about ethnicity. 

Under regulation 9 (3) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) the service must understand any cultural, religious and spiritual needs as part of the assessment process. 

Cultural needs should be recorded on the person's individual care or support plan, along with information about how individuals and the wider service should meet those needs. 

Everyone is personally responsible for making sure they understand the cultural needs of a person before providing them with support. This will involve reading the individual care or support plan but could also involve doing some independent research into specific cultural practices, to increase your knowledge, understanding and confidence. However, when doing so remember not to make generalisations or assumptions.

Because cultural needs can change over time, it is important that these needs are reviewed regularly.

These reviews do not have to be formal and can be a simple conversation with the person (or their representative if they lack the capacity to make decisions about their needs) to obtain their views on the matter.

These conversations should identify:

• Whether there has been a change in cultural need;
• What action the service may need to take to adapt to any changes;
• How well the service is meeting cultural needs; and
• Any improvements that need to be made to how cultural needs are being met.

If a person’s cultural needs change, their individual care or support plan should be updated to reflect this and all staff supporting the person must quickly be made aware of the changes.

Everyone should:

• Ask questions about cultural needs, especially if unsure;
• Try to understand and meet people’s preferences at all times;
• Be curious about what the important things are to help people live their fullest lives.

Top tips

• Encourage people to be open about their cultural identity and heritage;
• Provide a safe and secure space for the person to express their views openly and honestly;
•  Do not just ask about needs around religion or nationality, remember things like age, family, employment history, neurodiversity, religion, disability, gender and sexuality can all be important aspects of a person’s culture;
• Ask people about their preferences often, in recognition that cultural needs can change over time;
• Ask people if they are happy about how their cultural needs are being met.

If the person is finding it difficult to understand what is being asked of them, or if you cannot understand what they are telling you, you must not assume they do not have capacity to make decisions about how their cultural needs are met. Instead, you must explore available options to support communication. Depending on the specific circumstances, this could include involving a family member or friend who understands their communication needs, or arranging for an advocate, interpreter or Speech and Language Therapist (SALT).

When involving family members, be aware of any potential conflict or disagreement between their views and those of the person. 

See Section 6, Disagreement with family members 

If the person has appropriate support and is still having difficulty understanding or communicating, a mental capacity assessment may be necessary.

If they lack capacity, you will need to work through the best interests process as set out in the Mental Capacity Act 2005.

See: Mental Capacity

You must be respectful of other people’s cultural needs, identity and beliefs, even when these may be in direct conflict with your own personal beliefs. This is called a non-judgmental and non-biased approach.

This applies to the cultural identity and beliefs of the people being supported by the service, and also of colleagues.

You must never act in a way that could make anyone else feel that their cultural identity or belief is wrong, misplaced or not important. Neither must anyone else act in such a way towards you. 

Such behaviour is discriminatory. If you witness such behaviour you must report it.
See: Whistleblowing

Wherever possible a proactive approach should be taken to celebrating cultural identity.

The staff team should be aware of, and encourage people to participate in:

• Local events that are taking place, such as festivals, carnivals etc.;
• Religious and cultural events of importance, such as Ramadan, Chinese New Year and Pride;
• Other activities that may be of interest, such as TV shows, radio broadcasts or podcasts.

Managers should both create and take advantage of opportunities to promote culture and culturally appropriate care.

Examples could include:

• Discussing culture and how to meet cultural needs in supervision and staff meetings;
• Being aware of community networks and events that can support the service to provide culturally appropriate care;
• Promoting effective communication with families when planning how to best meet cultural needs;
• Celebrating good practice within the service;
• Seeking feedback from people using the service and their families, and using this feedback to learn;
• Understanding cultural differences within the staff team, and using the cultural knowledge and skills of the team in a positive way.

As part of their core training, all staff should receive training about working in a person-centred way that incorporates providing culturally appropriate care and support. 

If staff are completing the Care Certificate this topic is one of the standards covered. If not, managers will need to identify and support access to appropriate training opportunities.

Managers should review the learning needs of staff and arrange suitable refresher training as necessary.
Managers should also identify any specific training or development that staff may need to meet a specific cultural need a person may have. 

For further information about training see Section 8 of this handbook: Learning, Development and Supervision

It might be helpful to match staff with people from the same culture, for example as a keyworker or to support with a particular cultural activity.

However, do not make assumptions about this. There are nuances within cultures that may make a match not as appropriate as first thought.

It is important the person has a choice and does not object to the proposed match.  
The staff member should also be aware of the proposed match and be able to express a view about the appropriateness of this.

If the service is consistently unable to meet a person’s cultural need this should be acknowledged, and reasonable adjustments explored to meet the need.

Depending on what adjustments are needed, it may be necessary to consult with the commissioning body.

Where adjustments cannot be made and the service continues to be unable to meet a cultural need, the impact of this on the person’s individual wellbeing should be established. Where there is a negative impact consideration should be given to terminating the service and supporting the person to transition to a more suitable provision.

Managers should take steps to ensure that the cultural identity and heritage of the staff team is also recognised, valued and celebrated. Embedding a whole-service culture of valuing and celebrating cultural identity and heritage in this way will help ensure that the cultural needs of people using the service are met as a matter of course. 

Some ideas for recognising, valuing and celebrating staff culture include:

• Having a clear policy and zero tolerance approach to all racism and discrimination;
• Addressing quickly any racism or discrimination felt by staff from colleagues, people who are receiving support or the public;
• Talking about cultural identity in supervision and finding out if the staff member has any unmet needs;
• Inviting staff to talk to colleagues about their culture and heritage to provide a more understanding, inclusive and supportive culture;
• Organising in-service activities that recognise the cultural events and celebrations that are important to staff members;
• Making use of the skills staff have that are not strictly part of their job. For example, a member of staff who shares the same language as someone using the service could teach their colleagues a few useful phrases or demonstrate how to prepare an authentic meal (It's important to ask them first if they are happy to do this and not assume that they would be).