The Covid-19 pandemic has highlighted the extent and impact of ethnic disparities in health to communities, health services and the government. However, poor quality data on ethnicity obscures the true extent of ethnic differences in health, and hampers work to address health and care inequalities.
Our 2021 report, supported by the NHS Race and Health Observatory, found systematic biases in the recording of ethnicity in NHS-funded care, which disproportionately impact on minority ethnic groups. One difference we identified was fewer records with a valid ethnic group for care provided in the independent sector compared with NHS providers.
Data provided by the Private Health Information Network (PHIN) shows that ethnicity coding by private providers for privately funded care is considerably lower than for NHS-funded care. The ethnic group code is missing in over 80% of records submitted to PHIN from independent providers, compared with only 13.5% of NHS-funded and provided elective inpatient care. For a very high proportion of private activity, ethnicity is recorded as “not stated”, which is intended to be used when a patient chooses not to give their ethnicity when asked. NHS sites delivering privately funded care also had a much higher proportion of records that were “not stated”, and also a high proportion of data with “other” ethnic group codes.
There is a strong case for private providers to engage their patients and staff to record the ethnic group, in order to improve quality and provide person-centred care. Private health care organisations providing care to NHS-funded patients also need to be able to demonstrate equitable access and that care is provided to patients of all ethnicities, which is not possible without comprehensive and accurate recording of ethnicity.
Work is underway to align private health care and NHS data – improving ethnicity coding as part of a wide programme to standardise records will be a valuable step to enable analysis of quality and access to care, however it is funded and provided.