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Improving Ethnic Data Collection

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

Improving Ethnic Data Collection for Equality and Diversity Monitoring

Introduction

The reduction of health inequalities is a key priority for the Scottish Government. Inequalities related to deprivation are well known, but there are also important health inequalities related to ethnic group and other aspects of the diversity of the Scottish population. Addressing ethnic inequalities in health requires accurate and complete information to target interventions and monitor progress towards reducing inequalities. This publication relates to the quality and completeness of information on ethnicity in hospital discharge and new outpatient appointment data.

Key points

  • For Scotland as a whole there have been substantial improvements in the recording of ethnic group. Completeness of recording has more than doubled over the last two years for both acute hospital discharges and new outpatient appointments.
  • Despite this improvement, the recording of ethnicity remains low: a valid ethnic group code was recorded in only 37% of acute inpatient and daycase records (SMR01) in the quarter ending March 2010 and only 25% of new outpatient appointment records (SMR00).
  • Over the last two years Golden Jubilee National Hospital (GJNH), Lanarkshire, Greater Glasgow and Clyde (GGC), Dumfries and Galloway, Highland, Ayrshire and Arran and Grampian have made significant improvements in recording, with several other NHS Boards achieving modest improvements.
  • However, some NHS Boards continue to shown little or no improvement in recording. For SMR01 records and/or SMR00 records, Tayside and the Island Boards continue to have recording levels below 1%.

These figures are summarized in the Briefing Paper Download PDF [120KB]


Charts and tables

Inpatient and day case discharges

For acute inpatient and day case discharges (SMR01 data) the overall level of completeness for ethnic group recording was 37.5% for NHS Scotland for the quarter ending March 2010 (see Figure 1). The highest levels of recording for this quarter were seen at the Golden Jubilee National Hospital (99.1%), Lanarkshire (85.5%) and Borders (64.9%). Dumfries and Galloway (46.7%), Greater Glasgow and Clyde (45.7%) and Ayrshire and Arran (43.0%) were all above the national average.

Several NHS Boards had recording levels below 10% for this quarter. Lothian and Forth Valley had completeness levels of 6.5% and 3.7% respectively while four Boards (Tayside, Orkney, Shetland and Western Isles) had recording levels below 1% in the quarter ending March 2010.

Figure 1: Percentage of discharge episode records (SMR01) with a valid ethnic group by NHS Board of Treatment; quarter ending 31st March 2010

Percentage of discharge episode records (SMR01) with a valid ethnic group by NHS Board of Treatment; quarter ending 31st March 2010

Note 1: that figures include as 'complete' those who declined to state their ethnic group. Please refer to the Guidance Notes below.

The overall level of completeness for Scotland has risen from 15.1% in the quarter April-June 2008 to 37.5% in January-March 2010 (see Figure 2). This increase has been driven by several Boards that have made significant progress during the past two years.

Golden Jubilee National Hospital has achieved a significant improvement in the level of recording, increasing from 1.1% to 99.1% during this period, as has Dumfries and Galloway, (rising from 0.1% to 46.7%) and Highland (increasing from 2.0% to 34.7%). Greater Glasgow and Clyde, Ayrshire and Arran and Lanarkshire have also seen notable increases between June 2008 and March 2010.

Four Boards (Orkney, Shetland, Tayside and Western Isles) had recording levels persistently below 1% throughout the period (June 2008 to March 2010).

Figure 2: Percentage of discharge episode records (SMR01) with a valid ethnic group by NHS Board of Treatment and quarter: quarters ending June 2008 to March 2010

Percentage of discharge episode records (SMR01) with a valid ethnic group by NHS Board of Treatment and quarter: quarters ending June 2008 to March 2010

Note 1: that figures include as 'complete' those who declined to state their ethnic group. Please refer to the Guidance Notes below.

Note 2: That these figures may not correspond exactly with figures released previously. This is because databases are continually updated and corrected.

SMR01 Ethnicity Completeness up to 31st March 2010 by NHS Board and quarter. Download Excel File [26KB]


New outpatient appointments

For new outpatient appointments (SMR00 data) the overall level of completeness for ethnic group recording was 24.6% for Scotland as a whole for the quarter ending March 2010 (see Figure 3). The highest levels of recording for this quarter were seen at the Golden Jubilee National Hospital (99.4%), Lanarkshire (71.4%) and Borders (43.7%). Greater Glasgow and Clyde (37.4%) and Grampian (35.5%) were above the national average.

Many NHS Boards had recording levels below 10% for this quarter. Dumfries and Galloway, Forth Valley, Lothian and Ayrshire and Arran had completeness levels of between 7.5% and 3.0% while four other Boards (Tayside, Orkney, Shetland and Western Isles) had recording levels below 1% in the quarter ending March 2010.

Figure 3: Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by NHS Board of Treatment; quarter ending 31st March 2010.

Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by NHS Board of Treatment; quarter ending 31st March 2010

Note 1: that figures include as 'complete' those who declined to state their ethnic group. Please refer to the Guidance Notes below.

Improvements have been made in recording on SMR00, although the levels remain lower than for SMR01. The overall level of completeness for Scotland has risen from 10.3% in the quarter April-June 2008 to 24.6% in January-March 2010 (see Figure 4). As with SMR01, this increase has been driven by several Boards that have made significant progress during the past two years.

Golden Jubilee National Hospital has achieved a significant improvement in the level of recording, increasing from 0.0% to 99.4% during this period, as have Greater Glasgow and Clyde (rising from 9.6% to 37.4%) and Grampian (increasing from 10.0% to 35.5%). Lanarkshire have also shown a notable increase during this period.

Four Boards (Orkney, Shetland, Tayside and Western Isles) had recording levels persistently below 1% throughout the period (June 2008 to March 2010).

Figure 4: Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by Health Board of Treatment and quarter: quarters ending June 2008 to March 2010

Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by Health Board of Treatment and quarter: quarters ending June 2008 to March 2010

Note 1: that figures include as 'complete' those who declined to state their ethnic group. Please refer to the Guidance Notes below.

Note 2: That these figures may not correspond exactly with figures released previously. This is because databases are continually updated and corrected.

SMR00 Ethnicity Completeness up to 31st March 2010 by NHS Board and quarter. Download Excel File [22KB]


Guidance notes

The percentage with a valid ethnic group relates to records completed with a valid ethnic group or patient refusal codes only. Records completed with 'Not Known' codes or left blank are not deemed to be a valid ethnic group.

Patients are not compelled to provide information about their ethnic group and a 'declined to provide' response is included in the total of valid codes in these figures.

Ethnic Group cannot be recorded on the Patient Administration System at some hospitals at present, and so this information may be collected locally but not recorded on SMRs submitted to the national database.

Data from January to March 2010 are provisional and may not be complete.


Why collect and monitor ethnicity?

Collecting information on the ethnic group of people who use the health service is important to ensure that the NHS in Scotland is treating people fairly. Data are essential in order to:

  • Monitor the impact of NHS services and policies on different ethnic groups. For example, statistics on the use of NHS services could highlight the need to improve access for some groups.
  • Better understand the health needs of different ethnic groups. For example, statistics on health problems that are more common in particular groups could help target services more effectively.
  • Check that NHS Scotland is making progress towards meeting its targets on tackling racism and discrimination and promoting equality.

Background

Routine recording of ethnicity is required in order to demonstrate that the NHS in Scotland is meeting the legal obligations of the Race Relations Amendment Act 2000. This requires statutory bodies, including the NHS, to "eliminate unlawful racial discrimination and to promote equality of opportunity and good relations between people of different racial groups."

This is supported at Scottish Government and NHS Board level by policy commitments to promote equality and to eliminate discrimination, as set out in the Fair for All Policy (HDL51, 2002). This committed the NHS to promote equality and diversity and to work for a fairer society where everyone is valued and respected. Fair for All also requires all parts of the NHS to respond sensitively to the needs and circumstances of individuals from all backgrounds.

A key aim of The Equality and Diversity Information Programme (EDIP) is that all health information systems should be able to collect and share diversity information to support individual care, identify inequalities, monitor progress towards reducing those inequalities and demonstrate compliance with equalities legislation.

The Scottish Health Council Patient Focus Targets 2007/08 provided an incentive for NHS Boards to increase the routine collection of information on ethnic group within acute hospital discharge records (SMR01) and new outpatient appointment records (SMR00). The National Diversity Information Network (co-ordinated by EDIP) worked with service delivery NHS Boards to support data collection by providing a communication and monitoring toolkit. More recently the Ministerial Taskforce on Health Inequalities outlined (in the ?Equally Well? report) the importance of collecting data on ethnicity as well other equalities data. EDIP reports to the Mutuality, Equalities and Human Rights Board on progress made by the NHS in regard to ethnicity monitoring.

In September 2009 the Director of Healthcare Policy and Strategy wrote to all NHS Board Chief Executives seeking improvement in equalities data collection and monitoring, particularly in the recording of ethnicity via SMR00 and SMR01. This letter required Boards to produce an action plan to improve recording, outline how progress will be measured and to include plans for widening equality data collection. NHS Scotland and the Information Services Division will offer Boards support to improve equality data capture and monitoring.

Complete routine equalities data would allow the NHS to monitor services to ensure that all the people of Scotland are being treated fairly and equally, help assess the health needs of different groups and enable the NHS to monitor progress towards reducing inequalities.

In summary, the current lack of data means that NHS Scotland is unable to monitor inequalities in the health of the Scottish population by ethnic group (or by disability, sexual orientation or other determinants of inequality). The fact that ethnic group is recorded in hospital discharge data in England in over 90% of episodes demonstrates that better recording is feasible. The current low level of recording highlights the need for further action to improve information about the health of different ethnic groups in Scotland.


Footnotes

Discharge statistics are derived from data collected on discharges from non obstetric and non psychiatric hospitals in Scotland (SMR01).

New outpatient statistics are based on new attendances at outpatient clinics in all specialties (except A&E and Genito-Urinary Medicine) in Scotland (SMR00). The analysis is based on a subset of the dataset comprising patients who received a new appointment at a consultant-led outpatient clinic.

The next publication will be due for release at the end of February 2011.

Source: ISD SMR01/SMR00
Date extracted: July 2010


© ISD Scotland 2010
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