Ethnic Monitoring in Healthin areas with small ethnic populations

Wolfson Research InstituteMonday 26th March 2006

Dr David ChappelAssistant 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, www.cre.gov.uk

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

thanBritish

OtherthanWhite

No % No %Northumberland 5860 1.91 2969 0.97

Gateshead 5891 3.08 3053 1.60Newcastle upon

Tyne24277 9.35 17852 6.88

North Tyneside 5826 3.04 3688 1.92South Tyneside 5319 3.48 4147 2.71

Sunderland 8086 2.88 5236 1.86

LA/ PCT populations

Other White

than British

Other thanWhite

No % No %

Durham 9637 1.95 5089 1.03

Hartlepool 1737 1.96 1042 1.18

Middlesbrough 10323 7.65 8456 6.27

Redcar and Cleveland

2860 2.06 1473 1.06

Stockton-on-Tees 6745 3.78 4924 2.76

Darlington 3289 3.36 2097 2.14

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 Eng NE NW YH EM WM EE Lo SE SW

Free primary school meals 2004 (PLASC) 2.3 3.0 1.7 1.4 1.3 1.5 2.8 1.6 4.4 2.9

Free secondary school meals 2004 (PLASC)

3.4 4.3 2.3 1.6 2.0 2.2 4.2 2.5 6.1 4.8

Hospital admissions 2002/03 (HES) 36.0 19.0 33.0 45.0 30.0 25.0 42.0 34.0 47.0 42.0

Drug treatment 2003/04 (NDTMS) 15.6 15.3 11.3 17.1 3.3 2.2 25.9 9.5 30.2 22.9

AIDS/HIV 2003 (SOPHID) 3.0 3.3 1.8 0.7 0.7 1.2 1.6 4.0 2.4 0.5

TB surveillance 2000-02 (ETS) 6.6 1.8 1.2 2.7 43.4 1.3 3.0 5.0 3.8 1.5

Children in need, February 2003 8.0 5.0 10.0 6.0 6.0 9.0 15.0 8.0 6.0 8.0

Non-medical workforce, September 2004

11.7 8.6 7.8 6.9 7.3 10.7 17.7 16.8 15.8 9.0

Medical workforce, September 2004 2.0 1.1 1.4 1.6 1.1 2.0 3.0 1.9 2.6 2.5

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 MonitoringCompleteness of HES 03/04

NHS Trust %incomplete % BME

City Hospitals, Sunderland 0.69% 2.03%

County Durham and Darlington 15.83% 1.11%

Gateshead Health 9.97% 1.30%

Newcastle upon Tyne Hospitals 10.91% 3.14%

North Tees and Hartlepool 0.01% 1.47%

Northumbria Healthcare 24.95% 0.69%

South Tees 36.77% 0.79%

South Tyneside 0.61% 1.92%

Other 34.96% 8.20%

Mental Health TrustsCompleteness 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 Prudhoe 0.00% 2.62%

South of Tyne and Wearside Mental Health

4.64% 1.44%

Tees and North East Yorkshire 16.87% 6.03%

HES completeness by PCT

PCT % Incomplete %BME

Hartlepool 4.00% 0.79%

North Tees 8.31% 2.08%

Durham Dales 17.60% 0.76%

Darlington 12.30% 1.93%

Derwentside 17.35% 0.60%

Durham & CLS 12.87% 1.45%

Easington 4.05% 0.69%

Sedgefield 14.67% 0.78%

Middlesbrough 25.99% 1.84%

Langbaurgh 25.04% 1.16%

HES completeness by PCT

PCT % Incomplete % BME

Northumberland Care Trust 25.11% 0.51%

Newcastle PCT 9.78% 5.35%

North Tyneside PCT 15.40% 1.17%

Gateshead PCT 10.20% 1.48%

South Tyneside PCT 2.93% 1.86%

Sunderland Teaching PCT 2.66% 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 SHA 99.4%

Northumberland 99.1%

Newcastle 100.0%

North Tyneside 100.0%

Gateshead 99.5%

South Tyneside 98.5%

Sunderland 100.0%

% White attending SSS

CDTV SHA 99.2%

Durham and Chester-le-Street 99.4%

Derwentside 100.0%

Easington 99.4%

Sedgefield 99.9%

Durham Dales 100.0%

Darlington 98.9%

Hartlepool 99.7%

North Tees 98.6%

Middlesbrough 98.4%

Langbaurgh 99.9%

SSS – success rates (4 week quitters)

White

Mixed

Asian or Asian British

Black or Black British

other ethnic groups

Percent quit

(Number)

53%

28006

50%

50

45%

110

65%

20

40%

35

Bhopal et al. Newcastle Heart Project: Smoking prevalence (%)

Indian Pakistani Bangladeshi European

Men (South Asian combined, 33%

14 32 57 33

Women(South Asian combined, 3%)

1 5 2 31

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 unstableThere are other qualitative mechanisms of finding

out if groups are accessing services

Further Information

• www.cre.org.uk• Ethnic Monitoring: A Guide for Public Authorities’, CRE,

2002.• 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