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The spectrum of vulnerability

Professional collaboratives have a vital role to consider the needs of the populations they serve and to identify those who may not currently attend or gain the full benefit from services.

Health boards must have ‘due regard’ to the need to eliminate unlawful discrimination, harassment, and victimisation as well as to advance equality of opportunity and foster good relations between people who share a protected characteristic and those who do not. The protected characteristics covered by the equality duty are:

  • Age
  • Disability
  • Gender reassignment
  • Pregnancy and maternity
  • Race
  • Religion or belief
  • Sex and sexual orientation

Although there is no universally accepted categorisation of vulnerability, it is recognised that:

Vulnerable populations are groups and communities at a higher risk for poor health as a result of the barriers they experience to social, economic, political and environmental resources, as well as limitations due to illness or disability.’ (NCCDH; 2022) 

Person-centred services should be flexible to meet each individual need. However, in many high-demand core services such flexibility is challenging to achieve and access is often facilitated by families, friends and carers. Difficulties arise when an individual does not have an advocate to provide support. Where services have recognised and responded to need such advocacy should not be necessary, but it is unusual to find such adaptations available to all. Past experiences of participants and members of their social networks when engaging with the healthcare system and providers in the community can strongly influence subsequent behaviours and expectations.

It is important that the scope of ‘vulnerability’ is not expanded too widely, as it will then cease to have value as a concept for service design. Collaboratives might use the following list to reflect on the actions taken by local services to facilitate access to services for individuals facing the following challenges:

  • Dementia
  • Domestic violence and victims of sexual assault
  • Ethnic minority communities
  • Gypsy, Roma and Traveller communities
  • Homelessness
  • Learning disabilities
  • Mental health
  • People seeking sanctuary: Refugees, asylum seekers and migrants
  • Prison health and ex-offenders
  • Sensory and physically challenged
  • Sex workers
  • Substance misuse
  • Veterans
  • Welsh language delivery of services for vulnerable groups (see Annex A)