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Ethnicity data in health: why measurability matters

Ethnicity data in health: why measurability matters. Giovanna Maria Polato Dr Veena S Raleigh Informatics Healthcare Commission 26 March 2007. Healthcare Commission’s role. Assess NHS performance against DH standards, NSFs, NICE guidance, national targets etc

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Ethnicity data in health: why measurability matters

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  1. Ethnicity data in health: why measurability matters Giovanna Maria PolatoDr Veena S RaleighInformaticsHealthcare Commission 26 March 2007

  2. Healthcare Commission’s role • Assess NHS performance against DH standards, NSFs, NICE guidance, national targets etc • Monitor compliance with equality legislation • Healthcare Commission committed to reducing inequalities in all aspects of health and healthcare • eg thematic reviews: selection criteria include potential to reduce health inequalities • Health Commission review of race equality • Health Commission support to improving ethnicity data • National targets indicator on ethnicity coding since 2003 • Healthcare Commission sponsorship of ethnicity coding in CDS

  3. Equality legislation • Race equality duty • Disability equality duty • Gender equality duty • Employment equality (age) regulations • Employment equality (religion & belief) regulations • Sexual orientation discrimination in provision of goods and services • Focus today on ethnicity: - age, gender fairly well covered in available data- but not disability, religion, sexual orientation

  4. Ethnicity data: why measurability matters • Profound ethnic differences in risk factors, health status, access to healthcare and outcomes • Growing numbers and proportions of BME populations • Evidence of widening health inequalities generally • BMEs 13% of E&W population (2001 ONS census) • BMEs high proportion of spearhead PCT populations,risks to achievement of national targets • Potential users of data: - commissioners- providers- patients, choice agenda- public- regulators

  5. Availability and usage • Issues: incomplete coverage, variable coding quality, low use • Births and deaths data: by country of birth, not ethnicity (about half of E&W population is UK-born) • >90% of health contacts occur in primary care: no data • Ethnicity coding mandatory for inpatients since 1995, but still c20% incomplete • Ethnicity coding not required for patients treated out of hospital (HSCIC addressing ethnicity coding in all CDS) • HSCIC report: ethnicity missing/invalid in 84% of 2004/05 outpatient records, but as high as 95% for some providers • Poor awareness of utility of data • Poor utilisation by commissioners and providers

  6. Infant mortality by mother’s country of birth* Rate/1000 live births Source: ONS

  7. Percent of records with valid ethnicity coding: HES, MHMDS Percent

  8. 0% Percent of records with valid ethnicity coding: acute trusts, HES 2005/06 Percent 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Trusts

  9. Percent of records with valid ethnicity coding: MHMDS 2005/06 non-inpatients Percent

  10. Mental health: admission ratios by ethnicity, 2006* Admission ratios Source: Count me in census, E&W = 100

  11. Learning disabilities: admission ratios by ethnicity, 2006* Admission ratios Source: Count me in census, E&W = 100

  12. Making the most of available data

  13. Diabetes: proportional admission ratios, 2005/06 HES PARs (Eng=100)

  14. Newham LA: 2001 ONS census population and 2005/06 HES FCEs Population non-white: England 9%, Newham 60%

  15. Newham: 2005/06 HES FCEs vs IMD 2004, by electoral ward FCEs/1000 population

  16. Independent sector issues • Growing plurality of service provision • Blurring of lines between NHS and IS service provision • Need to monitor IS on comparable basis with NHS • Data flows generally poor/non-existent for NHS-commissioned services from IS • Where centrally contracted services (eg ISTCs), strong levers • But many IS services locally commissioned eg mental health:- 11% of MH inpatients in PVH, but not included in MHMDS- 20% of LD inpatients in PVH • Significant and growing volumes of NHS patients in the IS

  17. Ways forward • Highlight the importance of ethnicity data for a range of users • Improve the state of play vis:- coverage- coding completeness and quality- usage • Facilitatory role of key stakeholders: DH, HSCIC, ONS, CfH, PHOs, HC • Promote more effective use of ethnicity data by:- SHAs- commissioners- NHS and IS providers

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