'Equal but different'
NHS Telford and Wrekin Clinical Commissioning Group (CCG) is committed to commissioning the very best care for the diverse population we serve, recognising that services need to be designed with equality, diversity and human rights at the core of business and decision making.
We are committed to eliminating unlawful discrimination and promoting equality of outcomes for our diverse population. We aim to do this by ensuring that the values underpinning equality, diversity and human rights are central to our policy making, service planning, employment practices and commissioning.
For our staff, we recognise and value difference and aim to create a working culture and practices that recognise, respect, and value difference for the benefit of the organisation and the individual.
The CCG works to a number of statutory and policy drivers, which underpin the Equality and Diversity Agenda. The main pieces of legislation and policy drivers are set out below.
Our Duties and Responsibilities
As a public sector organisation, the CCG must comply with specific equality duties that require it to evidence how it pays due regard to the needs of diverse and vulnerable groups in the exercising of its responsibilities. For the purposes of this strategy, this includes compliance with the Equality Act 2010, Human Rights Act 1998, and relevant sections of the Health and Social Care Act 2012.
Equality Act 2010
The Equality Act was introduced to harmonise the raft of existing equality legislations, making it easier for people and organisations to understand discrimination law. The Act provides protection to groups of people who may be discriminated against because of certain characteristics they share. It provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. The groups protected by the Act include:
- Age - People of different ages including children, young and older people
- Disability - People with a long-term condition, or with mental, physical, sensory, learning disability or impairments, or a combination of these
- Gender Reassignment - People who have changed, or are in the process of changing, their sex
- Marriage and Civil Partnership - People who are married or in a civil partnership
- Race - People characterised by shared ethnicity, language or culture
- Religion or Belief - People with or without a religion or belief
- Sex - Men and women
- Sexual orientation - People who identify as Lesbian, Gay, Bi-sexual or Trans
- Pregnancy and Maternity - Women who are having or have just had a baby.
The Equality Act sets out the Public Sector Equality Duty. This duty requires public bodies to consider all individuals when carrying out their day-to-day work – in shaping policy, in commissioning and delivering services, and in relation to their own employees. It requires the CCG, when carrying out its duties, to have due regard to the need to:
- Eliminate unlawful discrimination, harassment and victimisation, and other conduct prohibited by the Act
- Advance equality of opportunity between people who share a protected characteristic and those who do not, i.e.:
remove or minimise disadvantages suffered by people due to their protected characteristics;
meet the needs of people with protected characteristics; and
encourage people with protected characteristics to participate in public life or in other activities where their participation is low.
- Foster good relations between people who share a protected characteristic and those who do not
- Tackle prejudice and promote understanding between people from different groups.
The Equality Act 2010 (Specific Duties) Regulations 2011
The Equality Act also sets out specific duties to help the CCG better perform the Equality Duty. It does this by requiring the CCG to be transparent about how it responds to the Equality Duty. The Government believes that the CCG should be accountable to its service users and be open to public scrutiny. The duties, therefore, provide the public with the information they need to challenge and hold the CCG to account for its performance on equality.
The specific duties require the CCG to:
- Publish sufficient information to show that it has considered the three aims of the general duty when making decisions, and the equality data that underpins those decisions
- Publish Information related to persons who share protected characteristics who are employees, or others affected, such as service users
- To publish the information in a manner that is accessible to the public.
To comply with the requirements of the Equality Act 2010, the CCG will work to continually:
- Monitor its workforce and analyse any unintended variations
- Assess the health needs of its local communities, and to
- Commission programmes and services to address health inequalities
- Carry out Equality Impact Analysis to inform its decision making
- Involve member practices, communities, staff, patients and the public in its decision-making processes
- Produce an equality strategy and annually measure the CCG’s performance against it
Human Rights Act 1998
The CCG has obligations under the Human Rights Act 1998 that, as a public body, it must at all times act in a manner compatible with the rights protected in this Act and safeguard these for patients and staff in its care and employment. Human rights are underpinned by a set of common values and have been adopted by the NHS under the acronym FREDA. The FREDA principles represent:
- Fairness, e.g. fair and transparent grievance and complaints procedures
- Respect, e.g. respect for same-sex couples, teenage parents, older people
- Equality, e.g. not being denied treatment due to age, sex, race etc.
- Dignity e.g. sufficient staff to change soiled sheets, help patients to eat/drink
- Autonomy, e.g. involving people in decisions about their treatment and care.
The Equality and Human Rights Commission states that putting human rights principles into public service practice is in the public interest. Evidence shows that public bodies taking human rights seriously treat people better. The CCG will endeavour to embed a human rights-based approach in the way that it commissions services and in its role as an employer. This approach is not new, and is evident in NHS policy initiatives such as Dignity in Care, Essence of Care, Standards of Better Health, and the Knowledge and Skills Framework.
Health and Social Care Act 2012
The CCG has a legal duty under the Health and Social Care Act 2012 to reduce inequalities between patients regarding their ability to access health services, and with respect to health outcomes, as well as to ensure that services are provided in an integrated (joined up) way. The Act also places duties on the CCG to promote the NHS Constitution, to enable choice, and to promote patient, carer and public involvement. To discharge this responsibility effectively, the CCG will need to work with its partners to reduce health inequalities among those in greatest need and embed this requirement into its joint health and wellbeing strategies. The CCG will also need to demonstrate how it will provide culturally sensitive services and ensure all patients can exercise choice and be involved in decision making.
The Act also requires the CCG to work with its local Healthwatch organisations, to provide information to the CQC and Health and Wellbeing Board about essential levels of safety and quality of its providers. The CCG engagement strategy sets out in greater detail how we will work with Healthwatch and its predecessor bodies to achieve this aim.
Analysing the equality impact of our policies, decisions, strategies and services helps the CCG to meet the requirements of the Public Sector Equality Duty, ensuring the needs of protected or disadvantaged groups and communities are understood and addressed appropriately. We are required to demonstrate that we have had due regard for the general equality duty.
How do we demonstrate due regard?
The CCG is committed to ensuring that it demonstrates due regard to the general duty when making decisions about policies and services. We have embedded the requirement to undertake an Equality Analysis into our decision making processes. This ensures that we continually work to understand and respond to the diversity of patient experience in health access, care and outcomes, and to recognise and value the importance of using equality analysis to address health inequalities.
All committee reports require the author to consider how their report relates to equalities in general and to ensure that due regard is given to the general equality duty.
Other groups the CCG considers in its Equality Analysis
When analysing the impact of our policies and strategies, we do not limit the exploration of barriers and experiences to purely those protected characteristics detailed above. There are other socially excluded groups, for example – homeless people, gypsies and travellers, sex workers and migrant groups who often need support and help to navigate the health system effectively and who may access healthcare in ways which do not necessarily meet their particular needs, for example an over-reliance on A&E services. In this regard, there is also a clear economic case for considering the way in which such groups access and use healthcare services.
For example there is evidence of high rates of emergency care among certain socially excluded groups:
- Homeless people are estimated to consume eight times more hospital inpatient services than the general population of similar age and make five times more A&E visits
- Gypsies and travellers are reported to be more likely to visit A&E than a GP because of issues of trust
- Alcohol misuse is associated with 190,000 hospital admissions each year. Around 70% of A&E attendances between midnight and 5am on weekend nights are alcohol related.
Equality and Diversity Strategy
In response to the Public Sector Equality Duty we have identified four equality objectives for the period 2015-19, accompanying these objectives is a two year action plan (2015-17) which details the work we will be undertaking to achieve our equality objectives.
In 2017 we will review our progress and design a further action plan to take us up to 2019.
Progress against the actions and objectives is reported regularly to the Quality and Safety Committee, which has delegated responsibility for equalities governance.
NHS Equality Delivery System (EDS)
The NHS Equality Delivery System (EDS) is a performance framework enabling organisations to review their performance on equality and diversity, and to identify future priorities and actions. It is designed to help organisations to deliver better outcomes for patients and communities and better working environments for staff.
Central to the EDS is a set of 18 outcomes aligned to four goals. These outcomes focus on the issues of most concern to patients, carers, communities, NHS staff and Boards. The four EDS goals are:
- Inclusive leadership at all levels
- Empowered, engaged & well-supported staff
- Improved patient access and experience
- Better health outcomes for all
It is against these goals and the accompanying outcomes that we will assess and grade our performance and determine collectively the action to be taken. The EDS grades are set out below:
- Excelling (Purple)
- Achieving (Green)
- Developing (Amber)
- Undeveloped (Red)
NHS Telford and Wrekin CCG has implemented EDS and completed annual assessments. Evidence was gathered against each of the 18 outcomes:
We have used the assessment of our equalities performance to set new Equality Objectives which will be delivered through a robust action plan over the next four years.