QOF Plus Year 1 - Imperial College London
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QOF Plus Year 1 - Imperial College London

QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London

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12.07.2015 Views

The Department of Health states that the 16 code national standard should be used as aminimum for collecting and reporting on the ethnic group of patients, service users and staff. Thisis as follows:White British Indian CaribbeanIrish Pakistani AfricanOther White Bangladeshi Other BlackWhite and Black Caribbean Other Asian ChineseWhite and AsianWhite and Black AfricanOther Ethnic GroupNot stated / refusedOther MixedPriority and relevance to national policyThe Government white paper ‘Saving Lives: Our Healthier Nation’ highlighted the need for moreresearch into the needs of ethnic minority groups and the aim of improving the health of themost marginalised members of society (DoH, 1999).The Race Relations Act 1976 and The Race Relations (Amendment) Act 2000 place a generalstatutory duty on public authorities to promote race equality and monitor policy and servicedelivery for different ethnic groups. Specific duties have also been placed on listed authorities(including the Department of Health, NHS trusts, primary care trusts, special health authoritiesand strategic health authorities) to assist them in meeting the general statutory duty. The specificduties include a requirement to collect and publish a specific set of information relating to theethnicity of employees and to assess, consult on and monitor the impact of policies and serviceson the promotion of race equality.The Operating Framework for the NHS in England 2008-09 lists reducing inequalities as an explicitpriority (DoH, 2007a).DemographyAccording to Census 2001 data (ONS, 2002) from a population of 165,242 in Hammersmith andFulham, 22.2% of the population reported a non-white ethnic group, which included 5% blackCaribbean, 5% black African, with various other ethnicities (including Indian, Pakistani, Banglaeshiand Chinese) making up the remaining 11%. There are also sizable Polish and Irish communities.33.6% of the population reported being born outside the UK.There are also known to be significant numbers of refugees and asylum seekers in Hammersmithand Fulham, and a study by Lukes et al. (2002) found that 6.3%-7.2% of the population inHammersmith and Fulham were asylum seekers or refugees (9,800-11,300).The ethnic composition of wards in Hammersmith and Fulham is strongly associated withdeprivation levels. The four most deprived wards in Hammersmith and Fulham have the largestBlack and Minority Ethnic (BME) populations (Zeuner, 2008).52

Associated Morbidity and MortalityThe incidence, prevalence, and mortality of many diseases are known to vary by ethnic group,and those in certain ethnic groups experience inequities in access to prevention, treatment, andpalliative health and social care services. There are also differences in the quality of services andoutcomes of treatment and care for different ethnic groups (London Health Observatory, 2006).Local contextHammersmith and Fulham ranks 59 (out of 354) for deprivation in local authorities in England,and 28% of the population live within the most deprived fifth of areas nationally. The deprivationlevel has not substantially changed since 2004. The north of the borough is particularly deprived,although deprivation and wealth often occur in close proximity. The borough has a particularlyhigh level of income deprivation that affects children, and almost 10,000 children live in lowincomehouseholds. High proportions of school pupils speak English as an additional languageand are eligible for free school meals (Zeuner, 2008)In the last few years, NHS Hammersmith and Fulham has made significant progress in ethnicityreporting. However, the quality of ethnic recording in community services and general practiceremains relatively poor.Review of evidence to support proposed indicatorsThe current QOF includes an indicator relating to recording of ethnicity for newly registeredpatients.Soljak et al. (2007) suggest that “it is clearly feasible to extend the recording of ethnicity at thetime of new patient registration to all patients with QOF diseases across the UK as a next step,”and the findings of their study suggest that “lack of recording is a proxy for overall poor quality ofrecording and of clinical care.”Senior (1994) has highlighted that collection of routine data on ethnicity alone masks a number ofimportant factors influencing service use or health needs, including significant differencesbetween patient groups in the same ethnic category. Gerrish (2000) suggests that a wider rangeof variables including language may be more appropriate from the perspective of both researchand planning.Research shows that language and communication issues are important barriers to care,influencing many aspects of service use (Hargreaves, 2007; Levy, 2005). There is evidence thatpoor communication with GPs due to language barriers is associated with confusion regardingadvice and the medicines prescribed (Free et al., 1999) and is a key factor associated with delayeddiagnosis and misunderstood treatment regimens (Green et al., 2002). Research suggests that useof services such as Language Line, community interpreting services and health advocates byservice providers remains patchy, and in many areas, interpreting services are considered to beinadequate and of poor quality, costly, and with many service providers lacking adequate training(Gerrish, 2004; Murphy et al., 2002).53

The Department of Health states that the 16 code national standard should be used as aminimum for collecting and reporting on the ethnic group of patients, service users and staff. Thisis as follows:White British Indian CaribbeanIrish Pakistani AfricanOther White Bangladeshi Other BlackWhite and Black Caribbean Other Asian ChineseWhite and AsianWhite and Black AfricanOther Ethnic GroupNot stated / refusedOther MixedPriority and relevance to national policyThe Government white paper ‘Saving Lives: Our Healthier Nation’ highlighted the need for moreresearch into the needs of ethnic minority groups and the aim of improving the health of themost marginalised members of society (DoH, 1999).The Race Relations Act 1976 and The Race Relations (Amendment) Act 2000 place a generalstatutory duty on public authorities to promote race equality and monitor policy and servicedelivery for different ethnic groups. Specific duties have also been placed on listed authorities(including the Department of Health, NHS trusts, primary care trusts, special health authoritiesand strategic health authorities) to assist them in meeting the general statutory duty. The specificduties include a requirement to collect and publish a specific set of information relating to theethnicity of employees and to assess, consult on and monitor the impact of policies and serviceson the promotion of race equality.The Operating Framework for the NHS in England 2008-09 lists reducing inequalities as an explicitpriority (DoH, 2007a).DemographyAccording to Census 2001 data (ONS, 2002) from a population of 165,242 in Hammersmith andFulham, 22.2% of the population reported a non-white ethnic group, which included 5% blackCaribbean, 5% black African, with various other ethnicities (including Indian, Pakistani, Banglaeshiand Chinese) making up the remaining 11%. There are also sizable Polish and Irish communities.33.6% of the population reported being born outside the UK.There are also known to be significant numbers of refugees and asylum seekers in Hammersmithand Fulham, and a study by Lukes et al. (2002) found that 6.3%-7.2% of the population inHammersmith and Fulham were asylum seekers or refugees (9,800-11,300).The ethnic composition of wards in Hammersmith and Fulham is strongly associated withdeprivation levels. The four most deprived wards in Hammersmith and Fulham have the largestBlack and Minority Ethnic (BME) populations (Zeuner, 2008).52

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