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Equality and Inclusion

Promoting equality, diversity, human rights and inclusion is at the heart of our values. This leads us to ensure that we commission, redesign and decommission services fairly and that no community or protected group in Cheshire is disproportionately affected.

We continue to work in partnership with providers, voluntary and community sector agencies and other key organisations to ensure that we advance equality of opportunity and meet the requirements of the Equality Act 2010. We embrace equality, diversity and inclusion not just because it is the ethical thing to do, but because it allows us to harness a wide range of experience, ideas and creativity while complying with anti-discrimination legislation.

One of the key principles of the NHS Constitution is that:

"The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population."

The Health and Social Care Act 2012 states that each commissioning group must, in the exercise of its functions, have the regard to the need to:

  • Reduce inequalities between patients with respect to their ability to access health services
  • Reduce inequalities between patients with respect to the outcomes achieved for them by provision of health services
  • Promote the involvement of patients and their carers in decisions about provision of the health services to them
  • Enable patients to make choices with respect to aspects of health services provided to them.

NHS Cheshire Clinical Commissioning Group is committed to eliminating unlawful discrimination and promoting equality of opportunity for all. We do this in the way we commission healthcare services and by aiming to develop a diverse and well-supported workforce which reflects the population we serve.

The Equality Act (updated 2011) and the NHS Constitution help set the standard for Clinical Commissioning Groups to follow. This means we should:

  • Eliminate unlawful discrimination, harassment and victimisation
  • Promote equality of opportunity between people who share a protected characteristic, as well as those who do not. Protected characteristics include age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership and pregnancy and maternity
  • Foster good relations between people who share a protected characteristic and those who do not

How will we do this? It involves:

  • Removing or minimising disadvantages suffered by people due to their protected characteristics.
  • Taking steps to meet the needs of people from protected groups where these are different
  • Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

As a commissioner (buyer) of services, the CCG is committed to making sure equality and diversity is a priority when we plan and commission local healthcare services. To do this we work closely with our communities to understand their needs and how best to commission the most appropriate services to meet those needs.

As an employer, we are committed to ensuring we have a diverse workforce by providing fair and equal access to all job opportunities, including access to career development and training opportunities for existing and future staff. To do this we aim to recruit the best talent that we can and remove any barriers to ensure that we have the widest possible pool of talent to draw from.

The Equality Act 2010 replaced previous anti-discrimination laws with a single Act and set outs national principles, which will be followed in Cheshire, to ensure the successful delivery of health and social care services, namely:

  • To involve and empower people
  • To target different communities through effective partnerships
  • To ensure excellence in our health and social care services
  • To become a high performance, high reputation organisation through partnership working.

Section 149 of the Equality Act sets out the Public Sector Equality Duty (PSED) - a duty on public bodies and others carrying out public functions. It ensures that public bodies consider the needs of all individuals in their day to day work – in shaping policy, in delivering services and in relation to their own employees.

The Equality Duty supports good decision-making – it encourages public bodies to understand how different people will be affected by their activities so that policies and services are appropriate and accessible to all and meet different people's needs. By understanding the effect of their activities on different people, and how inclusive public services can support and open up people's opportunities, public bodies are better placed to deliver policies and services that are efficient and effective. The Equality Duty therefore helps public bodies to deliver the Government’s overall objectives for public services.

The Equality Duty replaces the three previous public sector equality duties – for race, disability and gender. It covers the following nine protected characteristics:

  • Age
  • Disability
  • Gender reassignment (transgender)
  • Pregnancy and maternity
  • Race – this includes ethnic or national origins, colour or nationality
  • Religion or belief – this includes lack of belief
  • Sex
  • Sexual orientation
  • Marriage and civil partnership

The Equality Duty has three aims. It requires public bodies to have due regard to the need to:

  • Eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Act
  • Advance equality of opportunity between people who share a protected characteristic and people who do not share it
  • Foster good relations between people who share a protected characteristic and people who do not share it.

The Equality Duty is supported by specific duties which require public bodies to publish relevant, proportionate information demonstrating their compliance with the Equality Duty and to set themselves specific, measurable equality objectives.

Clinical Commissioning Groups are responsible for the 'Public Sector Duty' which means:

  • Setting equality objectives every four years 
  • Publishing equality data (patient data, workforce data) on an annual basis
  • Ensuring all providers complete the Equality Delivery System (EDS) and that EDS is written into contracts
  • Completing Equality analysis (Equality Impact Assessments)
  • Ensuring the corporate website includes Equality and Diversity and is fully accessible

The Equality Delivery System 2 (EDS2) is a tool to help the CCG review its equality performance and to identify future priorities and actions. Its aim is to enable the NHS to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse.

At the heart of the EDS is a set of 18 outcomes grouped into four goals. These outcomes focus on the issues of most concern to patients, carers, communities and staff. It is worth noting that while the EDS2 tool is mandated for commissioning and provider organisations, not all 18 outcomes contained within it are directly applicable to CCGs. The CCG has identified and focuses its efforts on achieving six key outcomes. The outcomes were identified based on availability of evidence (case studies, examples of good practice etc) so as to enable the ability to demonstrate progress.

It is against these outcomes that performance is analysed, graded and action determined. The grading of the CCG is carried out by local people across Cheshire on a yearly basis, and who form an independent stakeholder panel.

The four national EDS goals are:

  • Better health outcomes
  • Improved patient access and experience
  • A representative and supported workforce
  • Inclusive leadership

The six CCG outcomes are:

  • Services are commissioned, designed and procured to meet the health needs of local communities (Link to Goal - Better Health Outcomes)
  • When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse (Link to Goal - Better Health Outcomes)
  • Screening, vaccination and other health promotion services reach and benefit all local communities (Link to Goal - Better Health Outcomes)
  • People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds (Link to Goal - Improved patient access and experience)
  • People report positive experiences of the NHS (Link to Goal - Improved patient access and experience
  • People’s complaints about services are handled respectfully and efficiently. (Link to Goal - Improved patient access and experience).

On each outcome the CCG could be graded Underdeveloped, Developing, Achieving or Excelling.

Each year the CCG reviews its performance against its equality objectives, provides evidence of how it is performing against the EDS goals and undertakes a self-assessment with an independent panel. This is reported to the Governing Body.

An Equality Impact Risk Assessment (EIRA) is a systematic way of seeing how any policies may affect groups of people differently based on the protected characteristics of diversity. They are similar to risk assessments. In the same way a risk assessment would be taken forward, an EIRA allows the assessor to identify potential problems and resolve or minimise them where possible. EIRAs make sure that the services provided in Cheshire work well for everyone.

NHS England introduced the NHS Workforce Race Equality Standard (WRES) following a number of national reports which have highlighted disparities in the number of BME people in senior leadership positions across the NHS, as well as lower levels of wellbeing amongst the BME population.

In April 2015 the WRES became a mandatory requirement and requires NHS organisations to demonstrate progress against nine indicators of workforce equality, including a specific indicator to address the low levels of BME Board representation.

The WRES now forms part of CCG assurance framework, the NHS standard contract and the CQC inspection regime. It is expected that year on year all NHS organisations will improve workforce race equality and that these improvements will be measured and demonstrated through the annual publication of data for each of the WRES indicators

NHS Cheshire CCG welcome the introduction of the WRES and see it as a useful tool to identify and reduce any disparities in experience and outcomes for NHS staff and job applicants of different ethnicities.

NHS Cheshire Clinical Commissioning Group (CCG) work closely to bring people and local organisations together to help ensure a personal, fair and diverse health and care system. Our CCGs also believe that equality and diversity include addressing health inequalities and should be embedded into all our commissioning activity.

Our Annual Equality, Diversity and Inclusion report September 2018 sets out how we will continue to deliver on our Equality and Inclusion Strategy 2018-2021 and our agreed Equality Delivery System 2 (EDS2) framework linked Equality Objectives. The report also evidences how CCGs are meeting their public sector Equality Duty (PSED) in all their planning and decision making.

This is a requirement of the Equality Act 2010 and the PSED 2011.

The Equality Act 2010 (applies to all organisations within the UK) makes it unlawful to discriminate, harass or victimise people because of a reason related to their protected characteristic.

The public sector Equality Duty (section 149 of the Act) came into force on 5 April 2011. The Equality Duty is supported by specific duties, which came into force on 10 September 2011. The specific duties require public bodies to annually publish relevant, proportionate information demonstrating their compliance with the Equality Duty; and to set themselves specific, measurable equality objectives. Publishing relevant equality information will make CCGs transparent about their decision-making processes, and accountable to their patients, service users, stakeholders and staff.

In addition, the Health and Social Care Act (2012) 14T Duties place responsibilities on CCGs to reduce inequalities. Each Clinical Commissioning Group, must in the exercise of its functions, have ‘due regard’ to the need to:

  • Reduce inequalities between patients with respect to their ability to access health services and
  • Reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.

The Equality and Human Rights Plan for NHS Cheshire Clinical Commissioning Group is our first step in outlining our approach to equality, diversity and human rights. This plan outlines the assurance that the strategic direction of the Clinical Commissioning Group is towards promoting equality and challenging and eliminating unlawful discrimination not just through the services that it is responsible for commissioning but also through its day to day practices across the organisation. It sets out the commitment of the Clinical Commissioning Group to adhere to its statutory obligations, ensuring compliance with the Public Sector Equality Duty and the Human Rights Act. It also highlights the national and local drivers that will shape and influence our approach and commitment to valuing the diversity of service users and employees.

Along with our Organisational Development Plan and Engagement and Communications Strategy, this will guide us in the delivery of our organisational vision, values and principles. This includes ensuring that local services are transformed through meaningful engagement and partnership working with our patients, carers, local communities, local authorities, the voluntary, charity and faith sector and provider organisations.