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

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

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

4. Political Environment Legislative National Health Priorities Local Political Commitment

5. TargetGeographyAgeGenderSEGEthnicityDisabilitySex. Orientation Life Expectancy XX Infant Mortality X CancersX CHD/StrokeX Teenage Pregnancy XX SmokingX Mental Health DRE X 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 Story Ethnicity 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. 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=9840http://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 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 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/ 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.www.lho.org.uk