EQUALITY DELIVERY SYSTEM

BASELINE ASSESSMENT – Reviewed March 2013

The Equality Delivery System (EDS) for the NHS is a toolkit that has been introduced to support organisations in meeting the requirements of the Equality Act 2010. NHS North Yorkshire and York published an Equality Plan and Objectives for 2012-16 in order to achieve compliance with the Public Sector Equality Duty. Whilst developing the Equality Plan and Objectives, Scarborough and Ryedale and Clinical Commissioning Group ( SRCCG) was mindful of the four objectives and 18 outcomes of the EDS, engaged local partner organisations and communitiesas well asconsidering knowledge from a range of sources including:

  • The North Yorkshire Joint Strategic Needs Assessment (JSAN) in particular the Scarborough JSNA and the Ryedale JSNA.
  • Information from the Public Health Observatory
  • Information from Racial Justice in North Yorkshire( RAJINY)
  • National publications and research, for example, from the Department of Health, Equality and Human Rights Commission and Professional Lobbying Group Stonewall.

Using the EDS, NHS Scarborough and RyedaleClinical Commissioning Group (SRCCG) has now reviewed the baseline assessment of progress on equality and diversity. This assessment has built on local work to date, gathering information from across the organisation and using this to make an initial gradingof our equality performance. Identified actions are being taken forward through the Equality Plan and Objectives or through routine CCG business. The organisation can be rated as:

  • Undeveloped(Red) – no evidence at all or evidence for few or none of the protected groups
  • Developing (Amber)– evidence for some protected groups
  • Achieving(Green) – evidence for most protected groups
  • Excelling(Purple) – evidence for all protected groups

The protected groups include:

  • Age
  • Disability
  • Gender reassignment
  • Pregnancy and maternity
  • Marriage and civil partnership (only in relation to the requirement to have due regard to the need to eliminate discrimination and generally only applies to workplace practices)
  • Religion or belief (or lack of belief)
  • Race, including ethnic or national origin, colour or nationality
  • Sex
  • Sexual orientation

The following table provides a summary of the rating for each outcome.

Goal/Outcome / Rating / Evidence/Actions
Better Health Outcomes for All / Director of Public Health
Director of Commissioning and Transformation
Assistant Director of Quality & Patient Experience
1.1
Services are commissioned, designed and procured to meet the health needs of local communities, promote well-being, and reduce health inequalities. / Developing / Evidence
Scarborough and Ryedale CCG has detailed analysis about the health needs and outcomes for some of the protected characteristics. These are especially shown in the Joint Strategic Needs Assessment (JSNA) and Director of Public Health (DoPH) Annual Report 2011, NHS North Yorkshire and York for age (particularly vulnerable adults and children), disability, ethnicity, pregnancy and maternity. The DoPH Annual Report contains comparisons, especially related to disadvantage. This includes health inequalities, high smoking in pregnancy rates and low prevalence of breast feeding, lower life expectancy for men in Scarborough, bowel cancer.
Public Health programmes have focussed on a wide range of areas including:
  • Smoking Cessation – aimed at those who are pregnant.
  • Bowel Cancer – for people aged between 60 and 75
  • Children and adult healthy lifestyles
The North Yorkshire Health and Wellbeing Board allows health and local authority representatives to work much more closely together to address local needs and inequalities, and improve health and social care services for residents of North Yorkshire.The Clinical Chair of SR CCG is an active member of the Board which has considered joint health and social care priorities. Regular meetings bring together a wide range of public, local authority, Local Involvement Network (LINk) and NHS provider representatives who supported our priorities.
SRCCG actively reviewed the draft Joint Health and Wellbeing Strategy 2013-18 and provided comment to NYCC.
SRCCG continues to on an Integrated Commissioning Strategy across primary, secondary, social and voluntary care. Our priorities are agreed as:
  • Supporting healthy independent ageing
  • Reducing health inequalities
  • Promoting selfcare
Big Issues Road show events led by North Yorkshire County Council and supported by NHS NYY,took place during December 2011 and January 2012 where people including public, representatives of protected groups and GPs were asked to think about what the Big Issues were facing the North Yorkshire population. Representatives from SRCCG attended events and promoted inclusion to member practices. Specific issues raised for the Scarborough and Ryedale area included:
  • Advocacy
  • Affordable childcare
  • Equal access to services, including access to interpreters
  • Accommodation and housing and avoiding ghettos
  • Avoid short term funding and longer term planning
  • Obesogenic environment.
Issues raised that are shared by other regions of North Yorkshire included:
  • Access to services and transport
  • Isolation
  • Alcohol
  • Community based services
  • Information
  • Mental health
  • Partnership working
  • Carers
  • Implications of aging population.
The JSNA has identified key actions needed to improve these areas and these have been fed into the SRCCG objectives going forward.
Joint commissioning arrangements are in place with NYCCand we support the Joint Health and Wellbeing Strategy.
Our Integrated Commissioning Strategy supports the aim to provide care closer to home. We have particularly focussed on making services accessible to the elderly.
York Foundation Trust hospitals in Scarborough and York are our main providers of acute care and Malton is a Community Hospital which are all accessible and designed to meet the needs of people with a disability.
When undertaking service change or procuring new services, engagement and Equality Impact Analysis is planned to be undertaken in the future by the SR CCG as appropriate.
Actions
  • Undertake more detailed work to understand whether people from all protected groups are readily accessing services.
  • Strengthen the Customer Service Excellence (CSE) plans to document plans to engage with the hard to reach groups.
  • Embed the CSE model approach in all commissioning activities and service reviews.

1.2
Individual patients’ health needs are assessed, and resulting services provided, in appropriate and effective ways. / Developing / Evidence
SRCCG has detailed analysis about the health needs and outcomes for some of the protected characteristics. These are especially shown in the Joint Strategic Needs Assessment (JSNA) and Director of Public Health (DoPH) Annual Report 2011for age, disability, ethnicity, pregnancy and maternity. The DoPH Annual Report contains comparisons, especially related to disadvantage. This includes life expectancy between men and women, immunisation, bowel cancer, smoking cessation.
The JSNA is a key tool for informing aNorth Yorkshire Health and Wellbeing Strategy and the commissioning of local services. When originally developing our Joint Strategic Needs Assessment with the Local Authority in 2007/08, we gathered intelligence from many sources, including The Lifestyle Survey, Local Action Teams and the Local Authority information.The JSNA is reviewed annually and a stakeholder workshop involving representatives from the voluntary sector and diverse groupsis key to the process of refreshing the current assessment.
When undertaking service change or procuring new services, engagement and Equality Impact Analysis is undertaken as appropriate.
We have identified that there is a need to improve end of life care for elderly in Care Homes to ensure that their end of life wishes are respected. We are working to address this by working with local care homes, GPs and acute care providers in helping them to understand and respect end of life wishes.
We also have a range of policies aimed at meeting the needs of individuals such as:
  • Individual Funding Requests
  • Strategic Commissioning Group Policy
Actions
  • Identify which hard to reach groups in Scarborough and Ryedale should be targeted to help improve access to appropriate healthcare, in particular primary care, MIU and A&E

1.3
Changes across services for individual patients are discussed with them, and transitions are made smoothly. / Developing / Evidence
Patients and local residents will be better engaged with about service changes and clinical pathway development. Recent examples of how we are starting to do this include self-management of COPD, alcohol harm reduction services, MSK service delivery and outcomes.
Local views are also sought and used in the development of service specification. SRCCG has adopted the Customer Service Excellence Model which embraces a clear methodology for engaging with patients and public about service design and delivery. This is being used as a pilot on MSK service design.
All GP practices have a patient representative group or are in the process of establishing and a representative from each forms the SRCCG Practice Patient Representative Group, chaired by the lay member of the CCG Board and has a responsibility for patient engagement. The group will meetat least quarterly, but in its’ formative stage will meet more often.
The SRCCG Communication and Engagement Committee has a detailed engagement plan which includes working with the voluntary sector organisation and attends all Health and Social Care Forum meetings and has facilitated a “Showcase Event”
Many of the Voluntary sector organisations will assist us to reach the hard to reach and vulnerable groups, including carers.
Actions
  • Assess the success of the MSK service redesign pilot using the Customer Service Excellence Model
  • Embed the Customer Service Excellence Model in future service redesign.
  • Strengthen relationships with LINKs and Borough and District Council forums
  • Utilise the Voluntary Sector data base to help identify key contacts for groups
  • Identify contacts for minority groups.

1.4
The safety of patients is prioritised and assured. In particular, patients are free from abuse, harassment, bullying, violence from other patients and staff, with redress being open and fair to all. / Developing / Evidence
SRCCG takes the safety of all patients very seriously. Any serious concerns and incidents affecting patient safety are investigated thoroughly. Providers are required to report all serious incidents to us. As a commissioner, we performance manage providers to ensure that lessons learned are disseminated across the NHS as appropriate.
QIPP (Quality, Innovation, Productivity and Prevention) programme objectives are to improve efficiency and effectiveness of care, improve patient safety, improve patient access and experience and improve staff wellbeing. Commissioners are actively focussed on this, however, equality data and information is currently limited.
All providers are required to provide equality accounts about the services they provide and patient safety is a key feature. We also proactively monitor where systems are working well through quality monitoring information (e.g. eliminating mixed sex wards).
We work closely with the Scarborough and Ryedale Local Involvement Network (LINk) to resolve any concerns that have been brought to their attention by local residents.
We have Safeguarding Boards that are responsible for the safety of vulnerable adults and children.
Actions
  • Develop and strengthen partnership working with acute providers.
  • Ensure all services provided through SLA with Commissioning Support Unit embrace the Equality and Delivery system plan, and that the CCG receives assurance on delivery
  • Continue to work with the voluntary sector to develop and embed the outcomes framework that will provide commissioners with tools to measure impact and effectiveness of services across all groups including minority groups.

1.5
Public health, vaccination and screening programmes reach and benefit all local communities and groups. / Not Scored / Actions
  • We will work in partnership with the National Commissioning Board to promote national screening campaigns
Note – the National Commissioning Board is responsible for the commissioning of national screening programmes from 1 April 2013.
Goal/Outcome / Rating / Evidence/Actions
Improved Patient Access and Experience / Director of Commissioning and Transformation
Assistant Director of Quality & Patient Experience
Head of Communications and Engagement
2.1
Patients, carers and communities can readily access services, and should not be denied access on unreasonable grounds. / Developing / Evidence
All our services are commissioned to ensure they are accessible to all our residents. The Individual Funding Request Policy considers exceptional requests for treatment and the process is managed fairly.
Consultation and engagement with and involvement of the Community and Voluntary Sector are given a high priority when there are changes being planned.
A wide range of methods are used including the involvement of Scarborough and Ryedale LINk and attendance at the local Overviewand Scrutiny Committee to discuss local health issues and to update them on our service review programme.
During the last year we have:
  • Joined other stakeholders to a Working Together Event to discuss and agree a joint Health Strategy containing key health priorities for Scarborough and Ryedale.
  • Held a prioritisation focus group to assist in beginning the process of refreshing our current Joint Strategic Needs Assessment, which provides detailed information on the health needs of our population and informs our Joint Health Strategy.
  • Surveyed elderly patients with long term conditions to follow up and benchmark a national project aimed at improving the quality of care and quality of life of this group of patients.
We aim to collate a wide range of information ‘About you’ on all our engagement activities in order to monitor that all protected groups are included in these events.
Actions SRCCG needs to add something that we will do
Actions
  • Review translation and interpretation procedures and policies
  • Aim to collate a wide range of information ‘About you’ on all our engagement activities in order to monitor that all protected groups are represented in these events.
  • Ask diverse groups for their views on accessing the services we commission.
  • Review the information gathered at the public events about Your Health, Your Say to gain understanding about different groups views on accessing services and priorities.

2.2
Patients are informed and supported to be as involved as they wish to be in their diagnosis and decisions about their care, and to exercise choice about treatments and places of treatment. / Achieving / Evidence
In all our service specifications and commissioning intentions we make it clear that we expect patients are involved in decisions about their care. We are actively promoting ‘Choice’ and engage patients and the public during all service change programmes. We have a range of alternative providers for patients to access and are implementing Any Qualified Provider (AQP).
A range of evidence sources have been used to assess how involved Scarborough and Ryedale residents are in their care and whether they are able to exercise choice about treatments and where they are treated. This includes:
  • NHS GP Patient Survey
  • NHS Inpatient Questionnaire
  • Scarborough Hospital Patient Experience Group
  • Practice Patient Representative Group
  • Annual Survey
Actions
  • Encourage diverse membership of our patient participation groups.
  • Consider establishing a Forum of 1,000 members that is representative of our population.

2.3
Patients and carers report positive experiences of their treatment and care outcomes and of being listened to and respected and of how their privacy and dignity is prioritised. / Developing / Evidence
Trust Quality and Performance Reports are taken into consideration by the CCG when commissioning services and contract setting.
A range of evidence sources have been used to assess the quality of experiences patients have in relation to care and treatment. This includes:
  • NHS GP Patient Survey
  • NHS Inpatient Questionnaire
  • CQC Survey
  • Scarborough Hospital Patient Experience Group
  • Practice Patient Representative Group
Actions
  • We gather a range of patient experiences but recognise we need more information about specific diverse groups.
  • Develop a translation policy

2.4
Patients’ and carers’ complaints about services, and subsequent claims for redress, should be handled respectfully and efficiently. / Developing / Evidence
All complaints are managed in line with the NHS Complaints Regulations and every complainant is advised of their right to seek support from the Independent Complaints Advocacy Service or approach the Parliamentary Health Services Ombudsman for concerns or failure of the complaints service to resolve their concern.
Every complainant is dealt with as an individual and spoken to to agree what the outcome is that they are looking for and how we will maintain contact. Adjustments are made at this point based on individual needs.
We seek views of complainants at the end of the process for their input on whether the complaints process was followed to their satisfaction. An equality and diversity monitoring form accompanies the survey which is completed voluntarily.
The Quality and Performance Committee review complaints and serious incident reports from providers on a regular basis.
Actions
  • Analyse the complaints to better understand whether there are groups of people who experience greater difficulties in accessing services or their experience falls below the standard expected.

Goal/Outcome / Rating / Evidence/Actions
Empowered, engaged and well-supported staff / Head of Workforce Development
3.1
Recruitment and selection processes are fair, inclusive and transparent so that the workforce becomes as diverse as it can be within all occupations and grades. / Achieving / Evidence
SRCCG will work in line with the NHS North Yorkshire and YorkRecruitment and Selection Policy which is in place and staff are asked regularly if the PCT acts fairly when recruiting.