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P-3 A reflective review of referrals by ethnicity considering local demographics
  1. Sarah Maan,
  2. Leena Patel and
  3. Corinna Midgley
  1. Saint Francis Hospice, Essex, UK


Background National work identifies risk of poorer access to palliative care services for people from ethnic minorities (Calanzani, Koffman, Higginson, 2013; Dixon, King, Matosevic et al., 2015) .

We provide hospice beds and 24/7 community specialist palliative care support to three neighbouring boroughs with widely differing demographics. Low referrals of people from ethnic minorities have traditionally been attributed to our more diverse communities being younger.


  • Identify our most ethnically diverse borough and determine whether referrals to our services reflect that diversity.

  • Include consideration of public health data for mortality/age/social deprivation which could contribute to any identified disparity in ethnic representation.

Methods Local census data (2011) (Office for National Statistics) for each borough was reviewed by ethnicity. For the most diverse borough, referrals to hospice services were reviewed for Jan. 2019 – Dec. 2020. These were categorised and compared with local census data. Public health data, including age, mortality and social deprivation, was also reviewed to contextualise the borough and its likely palliative care need.

Results From the census, our most ethnically diverse borough had a 42% non-white population, compared to our least diverse borough with a 6% non-white population. Hospice referrals from our most ethnically diverse borough were lower than expected for size, compared with our other boroughs.

Referrals by ethnicity:

2019 – Black 6% (22) Asian 8% (27), Mixed 2% (7), White 84% (295), Other 0% (1)

2020 – Black 7% (29), Asian 9% (39), Mixed 1% (3), White 82% (343), Other 1% (4)

i.e. there was a small increase in % referrals for people from ethnic minority backgrounds from 2019 (16%) to 2020 (18%).

Census data identified a younger borough population, but with more social deprivation and higher all-cause mortality.

Conclusion Taking common variables that may influence referral to our service into consideration, we learned that despite the younger age profile, this borough has significant health needs, not reflected in our referral rates, especially for people from ethnic minorities.

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