Gathering equality data in the health service

Although staff at Sheffield primary care trust are increasingly engaged in carrying out equality impact assessments on their work using a new tool - which has proved to be more acceptable and easier to apply than previous attempts - they are continually thwarted by a lack of data on service users.

There is a need, for example, to monitor ethnicity data, because there is a growing black and minority ethnic population in Sheffield. The census data for 2001 shows a 9 per cent BME population, but Sheffield city council figures show that by 2005 this had risen to 13.5 per cent, mainly due to immigration from new EU states such as Poland and Slovakia. Thirty per cent of births in 2006 were to mothers from these communities.

Some ethnic minority groups are disproportionately affected by some diseases. For instance, people of Pakistani origin are six times as likely to develop type 2 diabetes, at a much younger age, than the white British population. Lesbian and bisexual women have a higher risk of suicide, self-harm, and alcohol and drug misuse than heterosexual women and we need to ensure we commission primary and secondary mental health services that meet their needs. Women are less likely to be referred for full diagnostic procedures for chest pain than men, even though they are at similar risk of circulatory disease.

Multiple strands

Equality information on race, religion, sexual orientation, age, gender and disability are essential to our public health disease prevention strategies and to planning the services we provide and commission. Sheffield PCT aims to become a world class commissioner and recognises that this will be impossible to achieve without addressing equality issues.

In December 2007, an audit was undertaken as a baseline study to establish the extent to which primary care services monitor data on all aspects of equality. This audit covered the PCT's own provider services as well as GP practices, dental practices, community pharmacists and optometrists. A total of 371 questionnaires were distributed across the PCT.

Respondents were asked which information they routinely collected and the results were unsurprising. Staff were most likely to collect age and gender information and least likely to collect sexual orientation and religion/belief information. If services did not collect information, they were asked why not.

Required information

Despite research consistently demonstrating the link between health, disease, access to care and uptake of screening to race, religion, sexual orientation, age, gender and disability, the audit results indicate that there is a strong feeling that this information should not be asked for unless the information is required for individual clinical care.

A group of representatives from all directorates met to agree an action plan that includes raising public awareness of the fact we will be collecting this data, explaining why we need it and letting people know they have the right to refuse to give it. Hopefully, this work will be done in partnership with other public organisations that have similar requirements for data collection. At the same time, we will be supporting clinicians to understand the links between inequalities and ill-health and working with our local medical committee and others to this end.

A full version of the report and action plan is available at www.sheffieldpct.nhs.uk