Introduction
NHS North West embraces the diversity of people from all groups in society, regardless of age, race, religion, belief, disability, gender (including gender reassignment) or sexual orientation. We are committed to eliminating unlawful discrimination and promoting equality of outcomes for everyone. 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 community engagement and involvement.
The Public Sector Equality Duty (part of the Equality Act 2010)
Like all public sector bodies, NHS North West must comply with the Public Sector Equality Duty. This means that, as an employer and also as the leader of the NHS in the region, we must take into account the need to
- eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Equality Act;
- advance equality of opportunity between people who share a protected characteristic and people who do not share it; and
- foster good relations between people who share a protected characteristic and people who don’t share it.
What are protected characteristics?
The Equality Act makes the following characteristics 'protected' - so it is now unlawful to discriminate against, bully or harass, anyone on the grounds of:
- age
- disability
- gender reassignment
- marriage and civil partnership status (but only in respect of eliminating unlawful discrimination)
- pregnancy and maternity
- race – including ethnic or national origins, colour or nationality
- religion or belief – including lack of belief
- sex
- sexual orientation.
This includes ensuring that nobody is discriminated against, bullied or harassed because of their association with anyone in the protected groups listed above; or because of the perception that they have any of these protected characteristics.
As well as taking all the above into account, we must clearly demonstrate how we are doing this in everything we do. Below and on the linked pages are more details about the progress we have made in the last four years.
An overview of equalities work in the NHS in the North West
Despite many decades of equality legislations, many public sector organisations struggle to demonstrate meaningful and sustainable outcomes for protected groups.
The NHS workforce as a whole still fails to reflect the diversity of the communities it serves, while feedback from people in 'protected characteristics' groups show that services are still on the whole ignoring their needs, resulting in poor outcomes and health inequalities.
To redress this, NHS North West
This evidence-led approach has meant that the SHA has a comprehensive analysis of where the region stands (this being our performance management role). This includes
- a detailed, objective and consistent baseline
- an understanding of the gaps, and
- a clear understanding of how organisations have already progressed, and the barriers which can stand in the way of that progress
Tackling inequalities through strategic leadership
NHS North West's role is to set the strategic direction for NHS bodies in the region and to ensure that they are performing to agreed standards and targets. This includes reducing health inequalities, eliminating discrimination in services and as employers, and actively promoting inclusion, diversity and human rights.
in 2008 we launched a five-year Equality and Diversity strategy, Narrowing the Gaps, which was based on a regional evidence-gathering exercise Landscape of the Region. The five strategic goals set out in Narrowing the Gaps covered the key areas where the NHS in the region needed to improve performance on equality.
Goal 1: Increase the diversity and representativeness of the NHS workforce and improve their working lives
Goal 2: Develop data to monitor, information to manage and knowledge to act
Goal 3: Develop the right services: targeted, useful and used
Goal 4: Move beyond legal compliance to initiating best practice
Goal 5: Develop our specialists and leaders
Four years into the strategy, outcomes include the national adoption of the Equality and Diversity Leadership Competency Framework and EPIT, our outcome-based performance measurement tool; alongside demonstrable improvements in the cultural competencies of NHS bodies in the region. EPIT measured performance in a cosnistent, objective, outcome-led manner on each of the five strategic goals listed above.
Within 18 months, the number of PCTs able to evidence tangible ‘achieving’ outcomes affecting at least three equality target groups has doubled (see charts below).
Securing equalities work into the new NHS landscape
The SHA is in the process of preparing to be disbanded by 2013,. So, over the past 12 months we have been working to ensure that the equalities gaps we identify are addressed or continue to be addressed through embedding our approach in new and emerging NHS organisations
Tackling inequalities through focusing on outcomes
NHS North West set out to assess how well NHS bodies in the North West are doing by looking at the outcomes they achieve. We ask: What difference have you made to inequalities in health or employment experienced by groups with one or more protected characteristics?
We carried out this performance management task through our Equalities Performance Improvement Toolkit. Primary care trusts/commissioner organisations use this system to self-assess on the outcomes of their policies, strategies and interventions (inputs).
They must demonstrate measurable changes to one or more communities with protected characteristics to score as 'developing', 'achieving' or 'excelling'. These scores are then validated by the SHA.
Provider organisations such as hospital trusts also go through the same process, but their PCT/commissioners validate these self-assessments, thus ensuring accountability all the way through the system.
What did we find?
The evidence from EPIT Goal 1 is that, in spite of interventions, the diversity of the workforce still doesn’t match the demographics of the populations which North West organisations serve. The EPIT system clearly demonstrates to managers that lack of properly disaggregated data in their organisations means it's difficult to fully comprehend where the gaps lie.
However, the North West workforce informationwebsite eWin provides managers with the tools to analyse their workforce more comprehensively. In addition, resources such as our Sexual Orientation Monitoring Workbook (published in July 2011) can help organisations to close gaps in the data. We plan to support our NHS organisations to continue to address this through the way they conduct the new national Equality Delivery System and how they attempt to shape the future workforce.
EPIT Goal 2 evidence shows that organisations have made good progress in gathering and analysing data to support their decision-making and planning. Our plan is to continue supporting PCT clusters to ensure this approach is embedded in the way that the new Clinical Commissioning Groups (CCGs) work. NHS North West's online evidence library HELP is one of the tools developed to help organisations find good quality data..
On EPIT Goal 3, the evidence is that organisations have made very strong progress in using disaggregated data to inform targeted commissioning plans, and to build novel approaches to public health interventions. The evidence suggests that the benefits of this are increasingly well understood.
Similarly, on Goal 4, there is evidence that organisations are strengthening their own governance to assure continued attention to outcomes.
Our aim is to support PCT clusters to transfer their expertise and understanding of these goals, and the working ethos that underpins them, into CCGs and Health and Well Being Boards.T
On Goal 5, we can see that organisations are supporting and strengthening the roles of their Equality and Diversity leads and have improved board support and leadership. A key tool to support this goal is the national NHS Equality and Diversity Leadership Competency Framework which we published in September 2011.The SHA, in partnership with the Department of Health, led a national project to develop this framework.
In addition, we are continuing to ensure that E&D staff undergo systematic and structured personal development as leaders on this agenda (Institute of Leadership & Management Level 4 in Equality and Diversity).
By the end of 2011, 28 E&D leads from across the North West have undertaken this programme, while another 11 are now embarking on the programme. Our aim is that two thirds of people responsible for E&D leadership are trained to the ILM 4 standard.
Results of the North West Equality Performance Improvement Toolkit
This system for performance measuring NHS bodies across the region was designed to support the five-year regional strategy, Narrowing the Gaps. However, the national performance measurement system, the NHS Equality Delivery System, was launched in November 2011.
North West NHS Bodies are therefore in the process of transferring into this new system and so the charts below show only the results of Year 1 and Year 2 of EPIT.
However, within the 18 months of EPIT's operation, the number of PCTs able to evidence tangible ‘achieving’ outcomes affecting at least three equality target groups has doubled (see below).
Below are charts showing the results separately for EPIT Year 1 and EPIT Year 2
