Recording Quality Ethnicity Data

1. Recording Quality Ethnicity Data Dr Kambiz Boomla

2. Recording Quality Ethnicity Data Dr Kambiz Boomla Senior Lecturer Centre for General Practice & Primary Care Queen Mary University of London

3. Content of presentation • policy background and legislation • racism direct and institutional/the McPherson report • local contexts and targets • why record ethnicity • group exercise • how to record

4. The policy context – why collect ethnic category information? • The Race Relation Amendment Act • The NHS Plan • NHS workforce • To track changes in morbidity and mortality • Improving public health by developing services appropriate to the needs of different ethnic minorities

5. Why we have to do this: • Race Relations Act 1976 says: • Direct racial discrimination is treating a person less favourably than another on the grounds of race. • Indirect racial discrimination means applying a requirement or condition which although applies to all, can only be met and benefited by a considerably smaller proportion of a minority group and cannot be justified other than on racial grounds

6. The Race Relations (Amendment) Act 2000 • Came into force on 1st April 2001 • Duty on all public bodies including GP practices to promote race equality and have due regard to race equality in carrying out their functions • Extends the provision of the act to cover indirect discrimination (failure to provide equitable services to black and minority ethnic groups) • Places a statutory duty on the public services to eliminate unlawful racial discrimination and to consider the race equality implications in all of the policies that shape their operations

7. The Human Rights Act 2000 • Prohibits inhuman and degrading treatment and prohibits discrimination • Likely to apply to inability of patients in the health service to communicate effectively with practitioners, or to do so in inappropriate ways, e.g. using children to interpret during a consultation

8. Direct discrimination/direct racism • Refusal to provide a service (Section 20 of the race relations Act 1976) makes it unlawful for anyone concerned with the provision of healthcare services to discriminate on racial grounds byrefusing or deliberately omittingto provide the services; or as regards quality; or the manner in which, or the terms on which, they are provided.

9. Institutional racism and the McPherson report • ‘The collective failure of an organisation to provide a proper service to people because of their colour, culture or ethnic origin. • It can be seen or detected in processes, attitudes and behaviour which amounts to discrimination. • This is through unwitting pressure, ignorance, thoughtlessness and stereotyping which disadvantage minority ethnic people.’

10. Questions arising from the Macpherson report • Are we acting fairly? • Does the service we provide reach all the communities it’s meant for and does it meet their needs? • Are we providing the same professional standard in every situation?

11. Topical example: death of Rocky Bennett in psychiatric unit • Sir John Blofeld’s report: • “The views of our witnesses were unanimous, institutional racism is present throughout the NHS. Final responsibility lies fairly and squarely with the Department of Health” • Staff themselves not racist, and were found kind, taking Rocky to football matches, but were unaware of the “corrosive and cumulative effect of racist abuse on a black patient”, seeing black patients as “more aggressive, alarming and difficult to treat” • Out of 100,000 black people, 28 end up in secure units • Out of 100,000 white people, only 4 end up in secure units. • Without ethnic monitoring, these figures cannot be revealed and explanations cannot be sought

12. Local contexts • By November 2003 each PCT meant to have Ethnic Monitoring Action Plan • Identify various pilot projects and methodologies • Have a robust and extensive staff training plan based on DoH “Ethnic Monitoring Training Pack” • http://www.doh.gov.uk/ethnicity2001guidance/index.htm • Clear objectives set for use of information within service planning and delivery

13. targets, targets, targets – east London • by March 2004, 50% of all directly provided and GP practices must reach 75% valid ethnic coding – not met • by March 2005, 100% of practices must reach 75% valid ethnic coding • by March 2006, 100% of practices must reach 95% valid ethnic coding

14. House of Lords definition of ethnic group Essential features • A long shared history • A common cultural tradition In addition, some of the following may be present: • A common geographical origin from a small number of common ancestors • A common language • A common literature • A common religion

15. How ethnicity differs from culture and race

16. Inequalities in health • 46% increased CHD mortality in South Asian women • 110% increased of CVA mortality in African-Caribbean women • Suicide amongst young South Asian women 300% greater than majority population • 300% increased prevalence of, and mortality from Diabetes in Asian population

17. But - • Above view also present ethnic minorities as the disadvantaged problem ethnicities • Many disease more common in whites • Breast cancer and some other cancers

18. Why keep records of a patient’s ethnic group? We want to ensure that we are providing an appropriate and accessible service for the whole of the community By……

19. By … • Assessing who is using the service now • Identifying the health needs and patterns of illness among all ethnic groups • Highlighting any gaps in service provision

20. By… • Measuring the outcome of the service response to these highlighted gaps • Developing staff awareness of, and response to, the individual needs of different ethnic groups

21. Equality vs equity in service provision • Providing a service that treats everyone equally assumes everyone is the same • Equity in service provision means delivering a service that recognises, respects and meets the needs of the individual • Providing an equitable service is not about giving people the same service, it is about them receiving a comparable service that meets their needs

22. Group exercise • Working as a group: • Think of ways in which information about ethnic groups could be used to improve services within your area • Think of barriers to recording such information in practices

23. Ethnic monitoring categories (1991 Census)

24. Ethnic monitoring categories(2001 Census) 16 + 1

25. Subcategories

26. So how to do it? • New patient ethnic profiling form • Include ethnicity field in new patient check templates • Include ethnicity field in chronic disease management templates in QOF of new contract • Include audit of 9i codes

30. Why can data quality be poor • Patchy use of race information at local level – so people think the information they record is not being used • Patients not wanting to categorise themselves because of uncertainty about why information requested • Data collectors feeling uncertain and thinking collecting information emotive issue

31. Good practice in collecting data • Senior management signed up to principles • All staff trained • Principles of self classification recognised • Staff comfortable and can answer patient queries • Data only collected once

32. Special issues • The very young • Parent can respond • Baby not automatically categorised same as mother • Permanently confused • Relative can assign • Those not understanding English • Form translation, use of linkworkers/advocates • http://www.doh.gov.uk/ethnicity2001guidance/ethnicguidance.pdf

33. Recording Quality Ethnicity Data Dr Kambiz Boomla Senior Lecturer Centre for General Practice & Primary Care Queen Mary University of London