Commissioning for diversity:

where are we now?

Dr Sandra Husbands for Dr Bobbie Jacobson

Directorwww.lho.org.uk

APHO and the Regional Public Health Observatories

LHO lead areas:Health inequalitiesEthnicitySmoking

NEPHO

NWPHO

YHPHO

EMPHO

WMPHO

SWPHOSEPHO

EEPHO

SCOTPHO

INIsPHO

WCH

POLITICAL ENVIRONMENT

GOOD DATA

NHS CULTURE

KNOWLEDGE BASE

ANALYTICAL CAPACITY

INVISIBLE ETHNIC INEQUALITIES

INVISIBLE ETHNIC INEQUALITIESINVISIBLE ETHNIC INEQUALITIES

Pre-Requisites for Tackling Ethnic Differentials in Health & Health Care

EFFECTIVE COMMUNICATION

Political Environment

• Legislative

• National Health Priorities

• Local Political Commitment

Target Geography Age Gender SEG Ethnicity Disability Sex. Orientation

Life Expectancy

X X

Infant Mortality

X

Cancers X

CHD/Stroke X

Teenage Pregnancy

X X

Smoking X

Mental Health DRE

X

National Health Policy: Which Dimensions of Inequality are covered?

NHS Cultures

• Input vs outcome cultures

• Demographic factors

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

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 StoryEthnicity 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.

0 10 20 30 40 50 60 70 80 90 100

Central & North West London Mental Health East London & The City Mental Health

Camden & Islington Mental Health & Social Care TrustSouth West London & St George's Mental Health

Oxleas Barnet, Enfield & Haringey Mental Health

Newham Healthcare South London & Maudsley

The Royal Marsden Great Ormond Street Hospital

North Middlesex University Hospital Moorfields Eye Hospital

West London Mental Health West Middlesex University Queen Elizabeth Hospital

Mayday Healthcare The Whittington Hospital

King's College Hospital Hammersmith Hospitals Royal Free Hampstead

Homerton University Hospital The Hillingdon Hospital

Barts & The London Guy's & St Thomas'

Barnet & Chase Farm Hospitals Kingston Hospital

Whipps Cross University Hospital St Mary's

Chelsea & Westminster Healthcare University College London Hosp

North West London Hospitals Ealing Hospital

St George's Healthcare The Lewisham Hospital

Queen Mary's Sidcup Epsom & St Helier University Hospitals

Royal Brompton & Harefield Barking, Havering & Redbridge Hospitals

Royal National Orthopaedic Hospital Bromley Hospitals

Percentage of FCEs with stated ethnicity (%)

Mental Health Trust mean

Acute / Specialist Trust mean

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.

Acute and Specialist Trusts mean

Mental Health Provider Trusts mean

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

2002/03 2003/04 2004/05 2005/06

Pe

rce

nta

ge o

f F

CE

s w

ith

sta

ted

eth

nic

ity

(%

)

Barnet And Chase Farm Hospitals

Queen Mary's Sidcup

Oxleas

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

Proportional Admission Ratios by Ethnicity for London Residents: Breast Cancer 2003/04

0 50 100 150 200

White BritishWhite Irish

Other WhiteWhite &

Other MixedIndian

PakistaniBangladeshiOther Asian

BlackBlack African

Other BlackChinese

OtherNot known Not stated

All Ethnicities

Eth

nic

ity

PAR

Analytical Capacity & Expertise: Ethnic Differentials in Health & Health Care & the Workforce

Full Toolkit, 1040

FAQs , 736

0

200

400

600

800

1000

1200

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

• 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 evidencehttp://www.lho.org.uk/viewResource.aspx?id=8831

• Missing Record: The case for recording ethnicity at birth & death registrationhttp://www.lho.org.uk/viewResource.aspx?id=7954

• Search www.lho.org.uk You can find all PHO resources via this site.