Findings from an audit of PCT Race Equality Schemes Ruth Thorlby King’s Fund
Aim of the research KF work focus: access to services Get an overview of the scope of activity being undertaken in the NHS to improve access to services Use Race Equality Schemes as a likely source of record for local activity ‘Old’ PCTs PCTs: spend 80% of NHS budget and have a key commissioning role
Methods Attempt to find the most up to date Race Equality Scheme via the internet March-August 2006 Three attempts to access crashed websites and a thorough search of each website “Process” questions: eg could we find it, could we find an action plan? “ Content” analysis: eg what information about the population, what PCT understood by “race equality” in relation to health services; what sort of action to address any inequalities in access?
Findings Process: 184 Race Equality Schemes found via websites (61% of all-303- PCTs ); 10 out of date schemes; 19 (permanently?) crashed websites; 90 PCTs (30%) with no RES on websites at all Most available RES documents also had action plans (153; 78%) and 87 Trusts had also published a breakdown of their staff by ethnic group (but not generally broken down by grade)
Findings: population Of the 284 functioning websites, 64 published no information on the ethnic breakdown of the population (22.5%) 3 PCTs cited data from the 1991 Census Some PCTs had attempted to supplement census data and estimate travellers, migrants and other new arrivals through a variety of methods
Findings: health needs Most PCTs reproduced a list of “ethnic health” inequalities with no explanation (eg South Asians=heart disease) but a few referred to deprivation as an important factor driving ill health National prevalence data cited sometimes: but only a few examples of PCTs which had attempted to apply/model the data locally Gaps in data for morbidity/mortality flagged up by a few PCTs: difficult to calculate “need” accurately
Findings: redressing inequities in access? “Equity of access”: a few very good definitions, but mostly not explained or explored 20% of PCT schemes did not include “access to services” as a function relevant to the legal duty Some PCTs have multiple projects to improve access but: Gaps in service use data flagged up as a key problem Monitoring the ethnicity of service use: 35% of Race Equality Schemes made no mention of monitoring service uptake by ethnicity at all 52% of Schemes state the importance of having the data but very few concrete examples of data collection through pilots or other initiatives at primary care level (13% or 24 PCTs) Few references to HES analysis
Implications of research Research using Race Equality Schemes: may not be a good way of capturing NHS activity but: raises questions about the purpose of the document Equity of access: poorly understood Data gaps (or limited use of available data): preventing PCTs from generating a clear picture of potential inequities Whose responsibility is it to generate accurate data to allow the NHS to comply with equalities legislation?