Transcript 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
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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
90.0
Mental Health Provider Trusts
mean
Percentage of FCEs with stated ethnicity (%)
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
Ethnicity
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
White &
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
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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
•
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