Ethnic Monitoring in Health in areas with small ethnic populations Wolfson Research Institute Monday 26 th March 2006 Dr David Chappel Assistant Director, NEPHO

Some issues to consider Why do it? Ethnic Populations in the NE (denominator) Quality of Ethnic Monitoring Data in the NE (numerator) Examples of usage and problems

WHY MONITOR ETHNICITY?

Why monitor ethnicity? Race Relations Act, 2000 Reduce health inequalities Fair provision of services Patient experience Prevent ill health

What is ethnic monitoring & why is it important to health services? ‘Ethnic monitoring is a process you use to collect, store and analyse data about people ethnic backgrounds. You use ethnic monitoring to: Highlight possible inequalities Investigate their underlying causes; and Remove any unfairness or disadvantage’. Commission for Racial Equality,

Office for National Statistics Ethnic Categories, Census 2001 White British Irish Other Mixed White & Black Caribbean White & Black African White & Asian Other Mixed Asian or Asian British Indian Pakistani Bangladeshi Other Asian Black or Black British Caribbean African Other Black Chinese or other ethnic group Chinese Other ethnic group

ETHNIC POPULATIONS IN THE NORTH EAST

Population of the North East 2001 Census –Total Population 2,515,442 (100%) White British – 2,425,592 (96.43%) BME (other than White British) –89,850 (3.57%) White –2,455,416 (97.61%) BME (other than White) –60,026 (2.39%)

NE Ethnic population (largest ethnic groups) White British 2,426,000 (96.4%) Other White 21,000 (0.8%) Pakistani 14,000 (0.6%) Indian 10,000 (0.4%) White Irish 9,000 (0.4%) Bangladeshi 6,000 (0.25%) Chinese 6,000 (0.25%)

LA/ PCT populations Other White than British Otherthan White No% % Northumberland Gateshead Newcastle upon Tyne North Tyneside South Tyneside Sunderland

LA/ PCT populations Other White than British Other than White No% % Durham Hartlepool Middlesbrough Redcar and Cleveland Stockton-on-Tees Darlington

Issues Denominators are very small –Outside of Newcastle there are only two non-white populations more than 1000 and there are 39 with less than 100 people Denominators may be inaccurate –Some questions over census –They have changed dramatically in the last 6 years – particularly with dispersal of asylum seekers (one estimate 18,000) many in Black ethnic groups

ETHNIC MONITORING DATA

Quality of Ethnic Monitoring Completion rate as measure of quality Comparison of NE to other regions Completion rates across the region

Data source EngNENWYHEMWMEELoSESW Free primary school meals 2004 (PLASC) Free secondary school meals 2004 (PLASC) Hospital admissions 2002/03 (HES) Drug treatment 2003/04 (NDTMS) AIDS/HIV 2003 (SOPHID) TB surveillance (ETS) Children in need, February Non-medical workforce, September Medical workforce, September Table 3.1 Ethnicity data completeness (% incomplete) by region

Ethnicity data quality in the North East Hospital Episode Statistics (HES) 2003/4 One of the best NHS data sources Ethnicity field ‘mandated’ since 1995 All admissions to NE trusts (892,111 records) –No ethnicity data in 17.3% All admissions to NHS Trusts for NE residents (756,556 records) –No ethnicity data in 13.0%

Acute Trust Ethnic Monitoring Completeness of HES 03/04 NHS Trust%incomplete% BME City Hospitals, Sunderland0.69%2.03% County Durham and Darlington15.83%1.11% Gateshead Health9.97%1.30% Newcastle upon Tyne Hospitals10.91%3.14% North Tees and Hartlepool0.01%1.47% Northumbria Healthcare24.95%0.69% South Tees36.77%0.79% South Tyneside0.61%1.92% Other34.96%8.20%

Mental Health Trusts Completeness of HES NHS Trust%incomplete% BME County Durham And Darlington Priority Services 0.00%1.35% Newcastle, North Tyneside and Northumberland 3.60%1.78% Northgate and Prudhoe0.00%2.62% South of Tyne and Wearside Mental Health4.64%1.44% Tees and North East Yorkshire16.87%6.03%

HES completeness by PCT PCT% Incomplete%BME Hartlepool4.00%0.79% North Tees8.31%2.08% Durham Dales17.60%0.76% Darlington12.30%1.93% Derwentside17.35%0.60% Durham & CLS12.87%1.45% Easington4.05%0.69% Sedgefield14.67%0.78% Middlesbrough25.99%1.84% Langbaurgh25.04%1.16%

HES completeness by PCT PCT % Incomplete% BME Northumberland Care Trust25.11%0.51% Newcastle PCT9.78%5.35% North Tyneside PCT15.40%1.17% Gateshead PCT10.20%1.48% South Tyneside PCT2.93%1.86% Sunderland Teaching PCT2.66%2.04%

SMALL NUMBERS IN THE NUMERATOR

PROBLEMS WITH THE DENOMINATOR

EXAMPLE OF STOP SMOKING SERVICES

Stop Smoking Services (SSS) Reviewed equity of Stop Smoking Services N = 28,203 –missing data on ethnic group 252 –missing data on PCT of residence 2692

% White attending SSS N, T&W SHA99.4% Northumberland99.1% Newcastle100.0% North Tyneside100.0% Gateshead99.5% South Tyneside98.5% Sunderland100.0%

% White attending SSS CDTV SHA99.2% Durham and Chester-le-Street99.4% Derwentside100.0% Easington99.4% Sedgefield99.9% Durham Dales100.0% Darlington98.9% Hartlepool99.7% North Tees98.6% Middlesbrough98.4% Langbaurgh99.9%

SSS – success rates (4 week quitters) WhiteMixed Asian or Asian British Black or Black British other ethnic groups Percent quit (Number) 53% % 50 45% % 20 40% 35

Bhopal et al. Newcastle Heart Project: Smoking prevalence (%) IndianPakistaniBangladeshiEuropean Men (South Asian combined, 33% Women (South Asian combined, 3%) 15231

Conclusion Ethnic Monitoring is an important tool in reducing inequalities It is feasible to collect data. However, There are major problems with the data on populations (denominator) in the North East Where populations are very small the numerator can also be unstable There are other qualitative mechanisms of finding out if groups are accessing services

Further Information Ethnic Monitoring: A Guide for Public Authorities’, CRE, Analysing Ethnic Differentials in Health Services and the Workforce: A Tool Kit for Local Agencies’, London Health Observatory. ‘A Practical Guide to Ethnic Monitoring in the NHS and Social Care’, DH, 2005