The findings of the present study indicate that recording of ethnic group has not been considered a priority by LHCCs despite the importance of ethnicity in determining prevalence and complications of diabetes.
Of the LHCCs 66% did not collect data based on the 2001 census Ethnic Categories. Without this basic information, it is difficult for LHCCs to even begin to identify their demographic profile in order to assess the health needs of their minority ethnic population, although a demographic profile is a basic requirement of providing culturally sensitive and competent services.
GPs records & SIGN-55
The high response of GP practices and community services indicating that they do not record ethnic group (69%) can, in part, be attributed to current information systems. However, there seems to be some inconsistencies in respondents' responses, as 58% state that SIGN-55 guidelines , which indicates ethnic group as one of the core data items, is recorded on GP systems, but appears not to be acted upon. It is no surprise, therefore, that 80% of respondents report their inability to combine ethnic demographic data with other data sources to plan services and monitor complication trends between ethnic groups. Having such information would seem to be an important starting point in the ability of NHS organisations to reach a position to target their finite resources more effectively. The absence of robust information is disconcerting, in that diabetes is reported to be specifically identified by 71% of LHCC plans. Only one LHCC supplied their LHCC plan, describing their demographic profile by ethnic group and their intention to target more effectively Minority Ethnic Groups by joint working with a neighbouring LHCC and involving leaders of local minority ethnic health group.
From the comments section, there is also evidence that altering attitudes of NHS organisations requires ongoing change management, education and training. In some LHCCs numbers appear to be small as some respondents concluded: "...As percentage very low (referring to Minority Ethnic Groups) there is no specific section within the LHCC plan. All patients are treated equally within the LHCC," and another: "Numbers are so small we do not have a specific programme for ethnic groups," and another: "As patient records are confidential don't know what SIGN-55 data is recorded."
The findings that only 55% of LHCCs have access to interpreters, 55% do not record cultural/religious requirements, 24% have no culturally appropriate dietetic counselling and 33% have no appropriate health information materials available suggests that much is still required in improving the patient journey for ethnic minorities within the NHS.
Training and development of NHS staff are needed to help bring about such radical service improvements, giving people at the frontline the opportunity to develop appropriate skills and resources to do a better job . This builds on Our National Health , which gave a commitment to: "...Ensure that NHS staff are professionally and culturally-equipped to meet the distinctive needs of people and family groups from minority ethnic communities". Therefore, it is concerning that 42% of respondents report that their LHCC staffs are not trained in diabetes in relation to Minority Ethnic Groups and 13% are unsure. Patients normally have their first contact with Primary Care staff, who manage 90% of patient contacts within the NHS.
Limitation of the study
Similar to all research, this study had limitation. Since there was lack of census data on the number of ethnic minorities in each LHCC, therefore we could not compare and analyse the differences between LHCCs.