Joan Jamieson

Equality and Diversity Information Programme Manager, Information Service

Division

ISD Equality & Diversity Information ISD Equality & Diversity Information Programme (EDIPProgramme (EDIP))

Men’s Health Forum Scotland

19th October 2007

What will I talk about this morningWhat will I talk about this morning

•Brief overview of Information Services Division (ISD)

•Current information about men in relation to ethnicity and health – how easy and with what cost?

•Heart of the problem in Scotland

•What is the NHS doing : EDIP

•Consulting & Engaging with service users

Information Services DivisionInformation Services Division (ISD(ISD))

A national organisation

Part of NHS National Services Scotland

Supporting the collection of health information - (pre-) cradle to the grave

Providing health statistics, information technology & related services for NHS Scotland

Western Isles

HighlandGrampian

Tayside

Shetland

Orkney

FifeForth ValleyGreater Glasgow & Clyde

Borders

Lothian

Dumfries & Galloway

Ayrshire & Arran

Lanarkshire

Ethnic Groups in Scotland Census 2001Ethnic Groups in Scotland Census 2001

All People White Indian

Pakistani and other

South Asian Chinese Other

Ethnic Minority

%

Scotland 5062011 4960334 15037 39970 16310 30360 2Argyll & Clyde 420491 416347 775 1040 801 1528 0.99

Ayrshire & Arran 368149 365640 489 459 670 891 0.68Borders 106764 106175 73 106 103 307 0.55

Dumfries&Galloway 147765 146796 118 174 244 433 0.66Fife 349429 345003 514 1470 750 1692 1.28

Forth Valley 279480 276300 344 1286 455 1095 1.15Grampian 525936 517392 1074 1586 1627 4257 1.65Glasgow 867150 827832 6564 20676 4912 7166 4.75Highland 208914 207243 165 388 271 847 0.88

Lanarkshire 552819 546260 911 2756 1202 1690 1.2Lothian 778367 756584 2713 7094 3974 8002 2.88Orkney 19245 19159 17 7 17 45 0.44

Shetland 21988 21756 19 59 27 127 1.06Tayside 389012 381517 1244 2816 1243 2192 1.96

Western Isles 26502 26330 17 53 14 88 0.65

Age by ethnic group Scotland Census 2001Age by ethnic group Scotland Census 2001

National Insurance Number Allocations to

Overseas Nationals Entering the UK ( abbreviated)

NI Allocations 2006/07 All Poland India

Rep of Lithua

nia Slovak

Rep South Africa

Australia

Pakistan

France

Rep of Latvia

All UK Parliamnetary 662,390 171,380 45,980 30,850 27,420 23,970 23,820 22,270 17,170 14,330Edinburgh East 3,230 1,180 90 20 60 60 300 40 80 10Edinburgh North and Leith 3,880 1,550 180 20 50 80 370 30 100 30Edinburgh South 1,510 320 60 10 30 30 120 20 80 10Edinburgh South West 2,100 710 170 10 40 30 100 20 60 20Edinburgh West 960 330 110 10 20 30 50 20 10 10Total 11,680 4,090 610 70 200 230 940 130 330 80Glasgow Central 2,710 700 380 30 250 20 90 230 60 20Glasgow East 190 90 10 - 20 - 10 10 10 -Glasgow North 1,180 310 100 - 10 10 80 40 50 10Glasgow North East 900 270 60 50 20 20 10 10 20 20Glasgow North West 540 210 20 10 10 - 30 20 10 -Glasgow South 630 200 20 20 20 10 20 80 10 30Glasgow South West 510 280 30 30 10 10 10 20 10 10Total 6,660 2,060 620 140 340 70 250 410 170 90

http://www.dwp.gov.uk/asd/asd1/niall/registration_tables.xls

Massive prevalence (%) of glucose intolerance Massive prevalence (%) of glucose intolerance (diabetes & IGT)(diabetes & IGT)

0

5

10

15

20

25

30

35

40

45

Men Women

EuropeanIndianPakistaniBanglad'

(NHP, 25-74 years)

CHD mortality among those aged 25 years and older, compared to people living in England and Wales

0 50 100 150

Born in Pakistan

Born in India

Born in Republic of Ireland

Born in Northern Ireland

Born in England and Wales

Born in Scotland

Lives in England and Wales

SMRw omen

men

Source: Fischbacher et al 2007

Lives in Scotla

nd

Ethnic Groups- what is routinely known?Ethnic Groups- what is routinely known?

Completeness of Ethnicity Recordings for Discharges for All Scotland

0.0

6.5 6.6 6.7 7.1 9.3 10.1 6.39.6 10.2

0

10

20

30

40

50

1996/1997

1997/1998

1998/1999

1999/2000

2000/2001

2001/2002

2002/2003

2003/2004

2004/2005

2005/2006

Finanical year

Perc

enta

ge C

ompl

ete

Scottish Diabetes Survey 2005: completeness Scottish Diabetes Survey 2005: completeness of recording of ethnicity by NHS Boardof recording of ethnicity by NHS Board

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Health Board

eth

nic

ity

: %

co

mp

lete

ne

ss

20

05

Heart of the Problem in Scotland Heart of the Problem in Scotland DiscriminationDiscrimination

Structural -The law of itself is not capable of eliminating discrimination and change does not comes easily to institutions like the NHS.

Cultural - stereotyping e.g asylum seekers as all having HIV /people with learning difficulties finding speaking in groups very stressful

Institutional -e.g lack of detailed information on ethnicity- “statistical invisibility can lead to political invisibility which in turn prevents an appropriate agenda being developed” (Bhrolchain 1990)

Personal - being Black & HIV positive could be less favourably treated due to beliefs and attitudes of some who deem HIV as a punishment for their sexual/ drug practices.

Johnson, A ( 2006), Structural, Cultural, Institutional and Personal Discrimination,

Equality & Diversity Programme Equality & Diversity Programme RemitRemit

•designed to help NHS Scotland identify and meet the needs of minority ethnic and diverse groups

•promote social inclusion and narrow health inequalities

•comply with new laws, regulations and good practice; and

•develop information systems that record necessary details with minimum additional fuss and bother.

Context of the Equality & Diversity Context of the Equality & Diversity ProgrammeProgramme

Legal and Policy drivers:•Anti Discrimination Laws e.g RRAA2000, DDA•Fair for All health service care and delivery•Patient Centred Care – Involving people•Partnership working

Priority for NHSScotland:

Current lack of relevant data means that the NHS is Scotland is unable to demonstrate non discriminatory practice or any inequalities in the health of the Scottish population by :

•Ethnic group/relgion/transgender/disability/sexual orientation/or other determinants of inequality

Public Consultation MeetingsPublic Consultation Meetings

Consultation Definition : Inviting participants opinions, informing them, reporting their voices and using results to inform recommendations for collecting equality and diversity data.

To hear and understand what people across Scotland have to say about providing more personal information to support their healthcare through:

•Presentation•Discussion•Questionnaire

General Issues Raised by Participants General Issues Raised by Participants related to their use of the NHSrelated to their use of the NHS

Language barriers

Unsuitable hospital Appointment times

Problems describing their symptoms

Medication worries

Lack of time with GP

Dietary & suitability of hospital food

Reading & understanding NHS letters/information.

Transport & mobility problems

Translation and interpretation services

Concerns about the ethnic categories

Perception of lack of NHS staff knowledge

Being asked the same questions repeatedly

Why NHS wants to know

your religion

NHS 24

Data Collection DesignData Collection Design

Self classification/self completion difficult:

•Literacy

•Language

•Understanding of terminology

•Who can help

•Many dependent on relatives

•Poor sight

•Shaky hands

•Too many questions at one time

Personal Approach preferred

•GP registration

•Practice Nurse

•Community Nurse

•First referral consultation

What participants want 1What participants want 1

Although willing to give more personal information a number of requirements were mentioned by participants:

•Forms/questionnaires - easy to understand & complete

•Clear explanation about the reasons for the data collection

•Stakeholders should be involved in preparation & planning

•Staff trained in equality & diversity should ask these questions

•Interpreters should be available to support service users

•Clear & concise information with regard to confidentiality & security of this personal information

•Assurance that the information will be used to support culturally competent health care and to improve services

•To be asked before this information is shared outside the healthcare sector

•Informed about how to change this information

•More consideration as to who, where and when this personal information is collected

•Further consultation on the religious & sexual orientation questions

What participants want 2What participants want 2

Conclusion Conclusion Overall participants agreed they would support the NHS in terms of the

collecting and providing more personal information.

Ingredients for success include:•Communication at National, Local, individual level with appropriate information and in preferred format.

•Local stakeholder involvement of people at the preparation, planning and design.

•Benefits clear and unambiguous – be honest.

•NHS make use of the information to improve individual care and service delivery balanced with confidentiality & security reassurance.

•GP practice level where people know the start of the collection.

•Questions, Language, Definitions,Terminology require refinement and user involvement.

•Further consultation around capture of ‘spiritual care’/relgion, sexual orientation, disability.

Closing thoughtClosing thought

Mr Malik has arrived at the hospital to be admitted to hospital for heart surgery.

The GP referral includes the following:

•Mr Malik uses a wheel chair,

•He manages to look after himself apart from assistance with bathing and showering

•He would prefer a male practitioner to assist with personal care

•He would like his local Imam to pray with him before surgery.

 

Outcome – Mr Malik feels that having his particular needs met made all the difference in his recovery.

 

Question Can the NHS make this happen?