Understanding Diversity & Inequality In Healthcare

Understanding Diversity & Inequality In Healthcare

Commissioning for diversity: where are we now? Dr Sandra Husbands for Dr Bobbie Jacobson Director www.lho.org.uk APHO and the Regional Public Health Observatories SCOTPHO NEPHO NWPHO INIsPHO YHPHO EMPHO EEPHO WCH WMPHO SEPHO SWPHO

LHO lead areas: Health inequalities Ethnicity Smoking N VI SI B E ET H NI C N E Q U A LI TI

E S Pre-Requisites for Tackling Ethnic Differentials in Health & Health Care POLITICAL ENVIRONMENT NHS CULTURE EFFECTIVE COMMUNICATION INVISIBLE ETHNIC INEQUALITIES ANALYTICAL CAPACITY KNOWLEDGE BASE GOOD DATA Political Environment Legislative National Health Priorities

Local Political Commitment National Health Policy: Which Dimensions of Inequality are covered? Target Geography Life Expectancy X Age Ethnicity X Cancers X

CHD/Stroke X Teenage Pregnancy X Mental Health DRE SEG X Infant Mortality Smoking Gender

X X X Disability Sex. Orientation NHS Cultures Input vs outcome cultures Demographic factors Commissioning a Patient-led NHS Fitness for Purpose: highlighted the need for NHS organisations to be informationled New commissioning environment PbR & PBC Value for money, e.g. Save to Invest Financial balance Smart commissioning needs good

intelligence 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 Data Access Issues: The London Story Ethnicity Coding Completeness in London: 2005/06 Bromley Hospitals Royal National Orthopaedic Hospital Barking, Havering & Redbridge Hospitals Royal Brompton & Harefield Epsom & St Helier University Hospitals Queen Mary's Sidcup The Lewisham Hospital St George's Healthcare

Ealing Hospital North West London Hospitals University College London Hosp Chelsea & Westminster Healthcare St Mary's Whipps Cross University Hospital Kingston Hospital Barnet & Chase Farm Hospitals Guy's & St Thomas' Barts & The London The Hillingdon Hospital Homerton University Hospital Royal Free Hampstead Hammersmith Hospitals King's College Hospital The Whittington Hospital Mayday Healthcare Queen Elizabeth Hospital West Middlesex University West London Mental Health Moorfields Eye Hospital North Middlesex University Hospital Great Ormond Street Hospital

The Royal Marsden South London & Maudsley Newham Healthcare Barnet, Enfield & Haringey Mental Health Oxleas South West London & St George's Mental Health Camden & Islington Mental Health & Social Care Trust East London & The City Mental Health Central & North West London Mental Health Acute / Specialist Trust mean Mental Health Trust mean 0 10 20

30 40 50 60 70 80 Percentage of FCEs with stated ethnicity (%) Source: Hospital Episode Statistics (HES), The Information Centre for health and social care. 2005/06 HES data provisional. Analysed by LHO. 90 100 Ethnicity Coding Completeness in London: The Big Improvers

100.0 Percentage of FCEs with stated ethnicity (%) 90.0 Mental Health Provider Trusts mean 80.0 Acute and Specialist Trusts mean 70.0 60.0 Barnet And Chase Farm Hospitals Queen Mary's Sidcup Oxleas 50.0 40.0

30.0 20.0 10.0 0.0 2002/03 2003/04 2004/05 2005/06 Source: Hospital Episode Statistics (HES), The Information Centre for health and social care. 2005/06 HES data provisional. Analysed by LHO. Knowledge Issues The Limited Evidence Base Understanding Differences in relation to need for Health Care Translation of knowledge into commissioning decisions

Using the Knowledge Base: The Example of CHD - 1 Using the Knowledge Base: The Example of CHD - 2 Using the Knowledge Base: The Example of Breast Cancer E th n i c i ty Proportional Admission Ratios by Ethnicity for London Residents: Breast Cancer 2003/04 All Ethnicities Not stated Not known Other Chinese Other Black Black African Black Other Asian

Bangladeshi Pakistani Indian Other Mixed W hite & Other White White Irish White British 0 50 100 PAR 150 200 Analytical Capacity & Expertise: Ethnic Differentials in Health & Health Care & the Workforce 1200

1000 800 600 Full Toolkit, 1040 FAQs , 736 400 200 0 Web Downloads September 06 to January 07 Full Toolkit FAQs 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. LHO Resources on Ethnicity & Health 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.uk You can find all PHO resources via this site.

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