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Commissioning for Diversity: Where Are We Now?

This article explores the current state of commissioning for diversity in healthcare, focusing on health inequalities, ethnicity, and smoking. It discusses the prerequisites for tackling ethnic differentials in health and health care, the political environment, NHS culture, effective communication, analytical capacity, and the knowledge base required. The article also highlights the importance of good data and access issues, using the London story as an example. It concludes with a summary of the challenges and recommendations for moving forward.

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Commissioning for Diversity: Where Are We Now?

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  1. Commissioning for diversity: where are we now?Dr Sandra Husbands for Dr Bobbie JacobsonDirector www.lho.org.uk

  2. APHO and the Regional Public Health Observatories SCOTPHO NEPHO NWPHO INIsPHO YHPHO EMPHO EEPHO WCH LHO lead areas: Health inequalities Ethnicity Smoking WMPHO SEPHO SWPHO

  3. Pre-Requisites for Tackling Ethnic Differentials in Health & Health Care INVISIBLE ETHNIC INEQUALITIES POLITICAL ENVIRONMENT NHS CULTURE EFFECTIVE COMMUNICATION INVISIBLE ETHNIC INEQUALITIES ANALYTICAL CAPACITY KNOWLEDGE BASE GOOD DATA

  4. Political Environment • Legislative • National Health Priorities • Local Political Commitment

  5. National Health Policy: Which Dimensions of Inequality are covered?

  6. NHS Cultures • Input vs outcome cultures • Demographic factors

  7. Commissioning a Patient-led NHS • Fitness for Purpose: highlighted the need for NHS organisations to be information-led • New commissioning environment • PbR & PBC • Value for money, e.g. Save to Invest • Financial balance • Smart commissioning needs good intelligence

  8. Good Data: what is needed? • Strategic approach to ethnic monitoring with key health datasets outside the acute sector with mandatory ethnicity recording • 90% + complete recording of census 16 groups • High quality ethnicity recording based on self assessment

  9. Data Access Issues: The London StoryEthnicity Coding Completeness in London: 2005/06 Source: Hospital Episode Statistics (HES), The Information Centre for health and social care. 2005/06 HES data provisional. Analysed by LHO.

  10. Ethnicity Coding Completeness in London: The Big Improvers Source: Hospital Episode Statistics (HES), The Information Centre for health and social care. 2005/06 HES data provisional. Analysed by LHO.

  11. Knowledge Issues • The Limited Evidence Base • Understanding Differences in relation to need for Health Care • Translation of knowledge into commissioning decisions

  12. Using the Knowledge Base: The Example of CHD - 1

  13. Using the Knowledge Base: The Example of CHD - 2

  14. Using the Knowledge Base: The Example of Breast Cancer

  15. Analytical Capacity & Expertise: Ethnic Differentials in Health & Health Care & the Workforce

  16. Summary: Where are we? • Ethnicity recording completeness in hospital inpatient data has improved greatly, but mandatory recording still unstrategic and of questionable quality • Relationship between Equalities Legislation and Health Policy still unclear • The biggest challenge is now to move on from recording and use the data we have wisely to inform commissioning.

  17. National Full Report. Indications of Public Health in the English Regions. No.4: Ethnicity and health http://www.lho.org.uk/viewResource.aspx?id=9840 Ethnic disparities in health and health care: a focused review of the evidence and selected examples of good practice: Full Report http://www.lho.org.uk/viewResource.aspx?id=8831 How to Analyse Ethnic Differentials in Health – Toolkit and Q&A http://www.lho.org.uk/viewResource.aspx?id=10625 Equal Access, Equal Care? Can London Deliver the Race Equality Action Plan for Mental Health http://www.lho.org.uk/viewResource.aspx?id=11962&rsid=http://www.lho.org.uk/ Ethnic Disparities in Health & Health Care: A focused review of the evidence http://www.lho.org.uk/viewResource.aspx?id=8831 Missing Record: The case for recording ethnicity at birth & death registration http://www.lho.org.uk/viewResource.aspx?id=7954 Search www.lho.org.ukYou can find all PHO resources via this site. LHO Resources on Ethnicity & Health

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