Findings from an audit of PCT Race Equality Schemes Ruth Thorlby King’s Fund

Aim of the research  KF work focus: access to services  Get an overview of the scope of activity being undertaken in the NHS to improve access to services  Use Race Equality Schemes as a likely source of record for local activity  ‘Old’ PCTs  PCTs: spend 80% of NHS budget and have a key commissioning role

Methods  Attempt to find the most up to date Race Equality Scheme via the internet  March-August 2006  Three attempts to access crashed websites and a thorough search of each website  “Process” questions: eg could we find it, could we find an action plan?  “ Content” analysis: eg what information about the population, what PCT understood by “race equality” in relation to health services; what sort of action to address any inequalities in access?

Findings  Process: 184 Race Equality Schemes found via websites (61% of all-303- PCTs ); 10 out of date schemes; 19 (permanently?) crashed websites; 90 PCTs (30%) with no RES on websites at all  Most available RES documents also had action plans (153; 78%) and 87 Trusts had also published a breakdown of their staff by ethnic group (but not generally broken down by grade)

Findings: population  Of the 284 functioning websites, 64 published no information on the ethnic breakdown of the population (22.5%)  3 PCTs cited data from the 1991 Census  Some PCTs had attempted to supplement census data and estimate travellers, migrants and other new arrivals through a variety of methods

Findings: health needs  Most PCTs reproduced a list of “ethnic health” inequalities with no explanation (eg South Asians=heart disease) but a few referred to deprivation as an important factor driving ill health  National prevalence data cited sometimes: but only a few examples of PCTs which had attempted to apply/model the data locally  Gaps in data for morbidity/mortality flagged up by a few PCTs: difficult to calculate “need” accurately

Findings: redressing inequities in access?  “Equity of access”: a few very good definitions, but mostly not explained or explored  20% of PCT schemes did not include “access to services” as a function relevant to the legal duty  Some PCTs have multiple projects to improve access but:  Gaps in service use data flagged up as a key problem  Monitoring the ethnicity of service use: 35% of Race Equality Schemes made no mention of monitoring service uptake by ethnicity at all  52% of Schemes state the importance of having the data but very few concrete examples of data collection through pilots or other initiatives at primary care level (13% or 24 PCTs)  Few references to HES analysis

Implications of research  Research using Race Equality Schemes: may not be a good way of capturing NHS activity but: raises questions about the purpose of the document  Equity of access: poorly understood  Data gaps (or limited use of available data): preventing PCTs from generating a clear picture of potential inequities  Whose responsibility is it to generate accurate data to allow the NHS to comply with equalities legislation?