1. Ethnicity data in health: why measurability matters Giovanna Maria Polato Dr Veena S Raleigh Informatics Healthcare Commission 26 March 2007

2. 2 Healthcare Commission’s role Assess NHS performance against DH standards, NSFs, NICE guidance, national targets etc Monitor compliance with equality legislation Healthcare Commission committed to reducing inequalities in all aspects of health and healthcare eg thematic reviews: selection criteria include potential to reduce health inequalities Health Commission review of race equality Health Commission support to improving ethnicity data National targets indicator on ethnicity coding since 2003 Healthcare Commission sponsorship of ethnicity coding in CDS

3. 3 Equality legislation Race equality duty Disability equality duty Gender equality duty Employment equality (age) regulations Employment equality (religion & belief) regulations Sexual orientation discrimination in provision of goods and services Focus today on ethnicity: - age, gender fairly well covered in available data - but not disability, religion, sexual orientation

4. 4 Ethnicity data: why measurability matters Profound ethnic differences in risk factors, health status, access to healthcare and outcomes Growing numbers and proportions of BME populations Evidence of widening health inequalities generally BMEs 13% of E&W population (2001 ONS census) BMEs high proportion of spearhead PCT populations, risks to achievement of national targets Potential users of data: - commissioners - providers - patients, choice agenda - public - regulators

5. 5 Availability and usage Issues: incomplete coverage, variable coding quality, low use Births and deaths data: by country of birth, not ethnicity (about half of E&W population is UK-born) >90% of health contacts occur in primary care: no data Ethnicity coding mandatory for inpatients since 1995, but still c20% incomplete Ethnicity coding not required for patients treated out of hospital (HSCIC addressing ethnicity coding in all CDS) HSCIC report: ethnicity missing/invalid in 84% of 2004/05 outpatient records, but as high as 95% for some providers Poor awareness of utility of data Poor utilisation by commissioners and providers

6. 6 Infant mortality by mother’s country of birth* Rate/1000 live births Source: ONS

7. 7 Percent of records with valid ethnicity coding: HES, MHMDS Percent

8. 8 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Trusts Percent Percent of records with valid ethnicity coding: acute trusts, HES 2005/06

9. 9 Percent of records with valid ethnicity coding: MHMDS 2005/06 non-inpatients Percent

10. 10 Mental health: admission ratios by ethnicity, 2006* Source: Count me in census, E&W = 100 Admission ratios

11. 11 Learning disabilities: admission ratios by ethnicity, 2006* Source: Count me in census, E&W = 100 Admission ratios

12. 12 Making the most of available data

13. 13 Diabetes: proportional admission ratios, 2005/06 HES PARs (Eng=100)

14. 14 Newham LA: 2001 ONS census population and 2005/06 HES FCEs Population non-white: England 9%, Newham 60%

15. 15 Newham: 2005/06 HES FCEs vs IMD 2004, by electoral ward FCEs/1000 population

16. 16 Independent sector issues Growing plurality of service provision Blurring of lines between NHS and IS service provision Need to monitor IS on comparable basis with NHS Data flows generally poor/non-existent for NHS-commissioned services from IS Where centrally contracted services (eg ISTCs), strong levers But many IS services locally commissioned eg mental health: - 11% of MH inpatients in PVH, but not included in MHMDS - 20% of LD inpatients in PVH Significant and growing volumes of NHS patients in the IS

17. 17 Ways forward Highlight the importance of ethnicity data for a range of users Improve the state of play vis: - coverage - coding completeness and quality - usage Facilitatory role of key stakeholders: DH, HSCIC, ONS, CfH, PHOs, HC Promote more effective use of ethnicity data by: - SHAs - commissioners - NHS and IS providers

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