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 support monitoring and health improvement. This publication relates to the quality and completeness of information on ethnicity in hospital discharge and new outpatient appointment data.

Key facts

• For Scotland as a whole there have been substantial improvements in the recording of ethnic group. Completeness of recording approximately doubled between mid 2008 and mid 2009 for both hospital discharges and new outpatient appointments.
• Despite this improvement the recording of ethnicity remains low: a valid ethnic group code was recorded in only 31% of inpatient and daycase records (SMR01) in the quarter to September 2009 and only 21% of new outpatient appointment records (SMR00).
• Over the last two years Golden Jubilee National Hospital (GJNH), Lanarkshire, Greater Glasgow and Clyde (GGC) and Borders in particular have made significant improvements in recording, with some 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, Forth Valley, Tayside and the Island Boards continue to have recording levels persistently below 1%.
  

These figures are summarised in the  briefing paper  [447 KB]

Charts and tables

Inpatient and daycase discharges

For inpatient and daycase discharges (the SMR01 database) the overall level of completeness for ethnic group recording was 30.8% for Scotland as a whole for the quarter ending September 2009 (see Figure 1). The highest level of recording for this quarter was Golden Jubilee National Hospital (86.4%), closely followed by Lanarkshire (83.9%). Continuing improvement was also noted in Greater Glasgow and Clyde (40.3%).

All other NHS Boards had recording levels below 30%, although there was an improvement in recording in Dumfries and Galloway (10.2%) for this quarter. Five Boards (Forth Valley, Tayside, Orkney, Shetland and Western Isles) had recording levels below 1% in this quarter ending September 2009.

Figure 1: Percentage of discharge episode records (SMR01) with a valid ethnic group by Health Board of Treatment; quarter ending September 2009.

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 7.1% in the quarter Oct-Dec 2007 to 30.8% in Jul-Sep 2009 (see Figure 2). This has been driven by a small number of Boards that have made significant progress during the past two years.
Golden Jubilee National Hospital have achieved a significant improvement in the level of recording, increasing from 0% to 86.4% during this period, as have Lanarkshire, increasing from 16.3% to 83.9%.

More modest improvements have been made in other Boards during this period. However, five Boards (Forth Valley, Tayside, Orkney, Shetland and Western Isles) had recording levels persistently below 1% throughout the period (October 2007 to September 2009) and are therefore not included in Figure 2.

Figure 2: Percentage of discharge episode records (SMR01) with a valid ethnic group by Health Board of Treatment and quarter: October 2007 to September 2009.

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 30th September 2009 by NHS Board and quarter.

New outpatient appointments

For new outpatient appointments (the SMR00 database) the overall level of completeness for ethnic group recording was 21.2% for Scotland as a whole for the quarter ending September 2009 (see Figure 3). The highest level of recording for this quarter was Lanarkshire (62.4%), followed by Borders (40.7%) and Greater Glasgow and Clyde (35.8%).
All other NHS Boards had recording levels below 21.0% for this quarter. Six Boards (Dumfries and Galloway, Forth Valley, Tayside, Orkney, Shetland and Western Isles) and GJNH had recording levels below 1%.

Figure 3 Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by Health Board of Treatment; quarter ending 30th September 2009.

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 4.7% in Oct-Dec 2007 to 21.2% in Jul-Sep 2009 (see Figure 4). As with SMR01, this has been driven by a small number of Boards that have made significant progress during the past two years.
Lanarkshire have achieved a significant improvement in the level of recording, increasing from 9.7% to 62.4% during this period. Borders have also increased from 28.1% to 40.7% during this period.
More modest improvements have been made in other Boards during this period. However, six Boards (Dumfries and Galloway, Forth Valley, Tayside, Orkney, Shetland and Western Isles) had recording levels persistently below 1% throughout the period (October 2007 to September 2009) and are therefore not included in Figure 4.
Golden Jubilee National Hospital, has started an exercise to populate the SMR00 figures retrospectively, hence the figure of 42.2% is demonstrated in quarter Jan-Mar09.

Figure 4: Percentage of new outpatient appointment records (SMR00) with a valid ethnic group by Health Board of Treatment and Quarter: October  2007 to September 2009.

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 30th September 2009 by NHS Board and quarter.

Guidance notes

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 can not 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 July to September 2009 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. Regular monitoring is 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, monitor 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 of EDIP worked with service delivery NHS Boards to support the 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.

Complete routine data would allow the NHS to monitor services to ensure that people of all ethnic groups are being treated fairly and equally and to help assess the health needs of different groups.

In summary, the lack of relevant 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

Discharges 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.

Source: ISD SMR01/SMR00
Date extracted: January 2010.

Main contact: joan.jamieson@nhs.net

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