• Introduction to EDS2
The Equality Delivery System (EDS) framework was designed by the NHS to support NHS commissioners and providers to meet their duties under the Equality Act. The EDS has four goals, supported by 18 outcomes as detailed in the table (1) below. NHS North Derbyshire CCG has used the EDS as a tool kit to meet the requirements (Public Sector Equality Duty) under the Equality Act 2010 and in discussion with local partners including local populations, review and improve their performance for people with characteristics protected by the Equality Act 2010. Furthermore we have linked the EDS to Human Rights, table 2 lists the Articles.
From April 2015, EDS implementation by NHS organisations was made mandatory in the NHS standard provider contract. In addition, EDS implementation is explicitly cited within the CCG Assurance Framework, and will continue to be a key requirement for CCGs.


  • Map of North Derbyshire CCG region

  • Overview of North Derbyshire CCG population demographics (Census 2011)
Age (years) / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
0 to 4 / 57339 / 5.82% / 13756 / 5.06%
5 to 14 / 111313 / 11.30% / 29142 / 10.72%
15 to 24 / 120995 / 12.28% / 30718 / 11.30%
25 to 39 / 177231 / 17.99% / 43473 / 15.99%
40 to 64 / 342922 / 34.80% / 100461 / 36.95%
65 to 74 / 93812 / 9.52% / 29144 / 10.72%
75 and over / 81736 / 8.30% / 25171 / 9.26%
Total / 985348 / 100.00% / 271865 / 100.00%
Sex / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
Females / 499723 / 50.72% / 138494 / 50.94%
Males / 485625 / 49.28% / 133371 / 49.06%
Total / 985348 / 100.00% / 271865 / 100.00%
Disability / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
Day-to-day activities not limited / 787765 / 79.95% / 215281 / 79.19%
Day-to-day activities limited a little / 103808 / 10.54% / 29901 / 11.00%
Day-to-day activities limited a lot / 93775 / 9.52% / 26683 / 9.81%
Total / 985348 / 100.00% / 271865 / 100.00%
Religion / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
Christian / 599156 / 60.81% / 178063 / 65.50%
Buddhist / 2282 / 0.23% / 629 / 0.23%
Hindu / 3545 / 0.36% / 398 / 0.15%
Jewish / 462 / 0.05% / 133 / 0.05%
Muslim / 21144 / 2.15% / 1018 / 0.37%
Sikh / 11194 / 1.14% / 305 / 0.11%
Other religion / 3747 / 0.38% / 957 / 0.35%
No religion / 274909 / 27.90% / 70616 / 25.97%
Religion not stated / 68909 / 6.99% / 19746 / 7.26%
Total / 985348 / 100.00% / 271865 / 100.00%
Ethnicity / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
White English/Welsh/Scottish/Northern Irish/British / 892743 / 90.60% / 260716 / 95.90%
White Irish / 5231 / 0.53% / 1111 / 0.41%
White Gypsy or Irish Traveller / 604 / 0.06% / 70 / 0.03%
White Other White / 18995 / 1.93% / 3283 / 1.21%
Mixed/multiple ethnic group White and Black Caribbean / 6920 / 0.70% / 1012 / 0.37%
Mixed/multiple ethnic group White and Black African / 1152 / 0.12% / 270 / 0.10%
Mixed/multiple ethnic group White and Asian / 3726 / 0.38% / 754 / 0.28%
Mixed/multiple ethnic group Other Mixed / 2134 / 0.22% / 421 / 0.15%
Asian/Asian British Indian / 14969 / 1.52% / 854 / 0.31%
Asian/Asian British Pakistani / 15555 / 1.58% / 438 / 0.16%
Asian/Asian British Bangladeshi / 887 / 0.09% / 180 / 0.07%
Asian/Asian British Chinese / 2939 / 0.30% / 701 / 0.26%
Asian/Asian British Other Asian / 5270 / 0.53% / 623 / 0.23%
Black/African/Caribbean/Black British African / 4425 / 0.45% / 665 / 0.24%
Black/African/Caribbean/Black British Caribbean / 4508 / 0.46% / 351 / 0.13%
Black/African/Caribbean/Black British Other Black / 1067 / 0.11% / 108 / 0.04%
Other ethnic group Arab / 1098 / 0.11% / 109 / 0.04%
Other ethnic group Any other ethnic group / 3125 / 0.32% / 199 / 0.07%
Total / 985348 / 100.00% / 271865 / 100.00%
Marital status / Derbyshire Overall / NHS North Derbyshire
n / % / n / %
Single / 249010 / 30.96% / 65005 / 28.81%
Married / 394932 / 49.11% / 114325 / 50.67%
In a registered same-sex civil partnership / 1789 / 0.22% / 540 / 0.24%
Separated / 19855 / 2.47% / 5222 / 2.31%
Divorced or formerly in a same-sex civil partnership / 77609 / 9.65% / 22286 / 9.88%
Widowed or surviving partner / 61038 / 7.59% / 18233 / 8.08%
Total / 804233 / 100.00% / 225611 / 100.00%
The Census demographics highlighted above demonstrate the difference in the local community that the CCG serves and Derbyshire as a whole.
The 2011 Census collected information across 6 of the 9 protected characteristics, of those included the CCGs local population is generally representative of Derbyshire. There are some differences in relation to Race where the CCGs local geography has a lower representation of people identifying with an Asian or Asian (Mixed) heritage.
Of the 3 protected characteristics not covered by the 2011 Census, the CCG is working with partner stakeholder agencies such as Public Health and Local authorities to understand those communities within the CCGs geographical area.
  • Overview of North Derbyshire CCG health inequalities
The CCG’s population covers a mixed area with the largest urban centre being Chesterfield. Within the patch also lie significant areas of rural isolation such as High Peaks and Buxton. The CCG recognises that patients within these areas have found accessing services more difficult.
A legacy of mining and heavy industry has left its mark on the population with higher instances of COPD and other conditions in the older population as a result of these industries. An example of this is the Bolsover District in North East Derbyshire (partly within the CCG boundary) where a former mining area has now become one of the most deprived district authority area in Derbyshire.
In addition the proportion of persons over 65 is (19.9%) in North Derbyshire, higher than the County average (17.82%) with a consequential lower number of working age people. This is a challenge both economically and as a result of the increased demand on services.
With a spread out population the CCG’s focus on community based services is key to delivering quality accessible services where they are needed not necessarily in traditional hospital premises.
An overview of the Health Inequalities in Derbyshire are provided in the Joint Strategic Needs Assessment. Key issues for the area that North Derbyshire CCG covers are the highest level of premature mortality (Bolsover District, followed by Chesterfield and High Peaks). Premature mortality is a good indicator of general inequalities since life expectancy is higher in some parts of the County than others. The reasons for this are multiple but include the effects of deprivation, higher than average instances of Heart Disease, Stroke, COPD and lifestyle factors such as smoking, drinking and high fat diet. This combines to result in the figure shown below.
  • Statement of commitment from North Derbyshire CCG
Equality is centric to the CCG internally and externally, to ensure that all staff are considered in engagement. A staff engagement forum has been established within the CCG to inform policies and procedures, appraisal and performance, organizational development and health and wellbeing. The CCG is committed to engage with all relevant communities and demonstrate the work carried out to reduce health inequalities by improving health outcomes for seldom heard groups. The details of which are published via the CCG website to ensure accessibility to all interested parties, stakeholders, groups and members of the public.
  • North Derbyshire CCG Approach to equality
North Derbyshire CCG is committed to design and implement policies, procedures and commission services that meet the diverse needs of our local population and workforce, ensuring that none are placed at a disadvantage over others. The CCG takes into account current UK legislative requirements and best practice These include the Equality Act 2010, Human Rights Act 1998, Gender Recognition Act 2004, the NHS Constitution and guidelines on best practice from the Equality and Human Rights Commission and the Department of Health.
The CCG commits to promote Equality, Inclusion and Human Rights (EIHR) to ensure that the CCG’s activities ensure no-one receives less favourable treatment due to their personal circumstances. This includes, but is not limited to, the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity status.
The CCG commits to ensure that when making decisions, appropriate and proportionate consideration is given to; gender identity, socio-economic status, immigration status and the principles of Human Rights in the Human Rights Act 1998.
In carrying out its functions, North Derbyshire CCG is committed to having due regard to the Public Sector Equality Duty of the Equality Act 2010. This applies to all the activities for which the CCG is responsible, whether internal or where services are commissioned on its behalf, including policy development and review.
At the heart of this commitment is the requirement placed on ALL staffto ensure that robust and proportionate Equality Analysis and Due Regard is taken around any decision which the CCG takes and can be effectively demonstrated.
This is a Legal requirement, enshrined in:
  • The Equality Act 2010 (Public Sector Equality Duty, s149)
  • The Human Rights Act 1998.
  • The NHS Constitution.
  • Health and Social Care Act 2012 (Section 14)
In order to meet these requirements, the CCG ensures that before making any decision ithas proportionately considered the following:
  1. Who will be affected by the decision?
  2. Current / prospective / future service users
  3. Families, carers and dependants
  4. Staff
  1. Is the information available comprehensive or will more research be needed to gain acomplete understanding of the affects?
  1. What will the impact(s) be?
  2. Will it be positive or negative?
  3. Are some groups affected differently than others?
  4. Is action required to ensure an equitable outcome?
  1. If there is a negative impact, can this be mitigated?
  2. If so, what action is needed and is this proportionate?
  3. If not, why is this not possible
Historically, many NHS and public organisations have used an Equality Impact Assessmentform (EIA) to facilitate this process. With the introduction of the Equality Act 2010, an EIAform (while providing structure) proved inadequate to demonstrate the level of evidencerequired to meet the new legislative requirements in having Due Regard.It is important to remember that this is about far more than the need to assess policies. Arange of decisions can have an impact and if this is not identified in advance an inequalitymay be produced or sustained and the CCG placed at risk of challenge from the localcommunity they serve.
The CCG has published on its website a summary of its activities around Equality Inclusion and Human Rights annually both around its Equality Objectives annually in October and its activities against the NHS Equality Delivery System 2 (EDS2) annually in January. The twin overviews showcase the CCGs work and approach to deliver the best possible outcomes for all Derbyshire residents including those vulnerable groups who have historically experienced inequalities in healthcare.
  • Procurement
The CCG procurement service is provided by Arden & GEM CSU and works to ensure that in Designing and Procuring services, the CCG ensures that services are delivered inclusively and in line with the Public Sector Equality Duty. A key goal in doing so is to ensure that equality of access is provided to all patients and that services deliver equality of outcome. With the move towards Co Commissioning of GP Practice services with NHS England the CCG has a further role in using the procurement process to enhance services and ensure equality of access / outcome for all patients.
Each aspect of the procurement activity includes embedded EIHR considerations (where relevant) and includes comprehensive EIHR-related tender questions in both Pre-Qualifying Questionnaire (PQQ) and Invite to Tender (ITT) stages.
  • HR (including workforce information)
The CCG has strongly committed to embedding and Equality Inclusion and Human Rights across the organisation to ensure that the experience of staff is a positive one and that they feel supported and engaged. This approach is summarised through the CCG’s Equality commitment.
The CCG is supported with specialist HR expertise from Arden & GEM Commissioning Support Unit (CSU) which covers all aspects of HR activity including key areas where embedded EIHR considerations are necessary for the CCG to demonstrate the value its workforce provides. Through this collaboration with CSU specialist colleagues (from both HR and EIHR), North Derbyshire CCG is successfully maintaining its status as a Two Ticks for Disability employer.
North Derbyshire CCG has also committed to implementing the Living Wage standard. For example, all HR policy development and the recruitment, selection and appointment processes are fully assessed for their EIHR considerations to ensure a proactive approach is taken.
North Derbyshire CCG is also supporting the following initiatives to further support an inclusive working environment:
  • Future Focused Finance
  • ILM First Line Management
  • Medicines Management Awards
  • Staff Engagement Forum
  • Hello, my name is…
In terms of North Derbyshire CCGs workforce demographics (at March 2015), the CCG employs 97 WTE (whole-time equivalent) staff with the following diversity breakdown summary:
% Disabled / 3%
% Female / 75%
% Male / 25%
% Black, minority ethnic (BME) / 2%
This information is reviewed on a quarterly basis to enable the CCG to build an understanding of the diversity of it’s workforce compared to that of the local community it serves.
Based on the Census (2011) demographic information the following observations can be made when comparing the CCGs workforce with that of the local population:
The CCG workforce has:
  • a low % of staff identifying with a disability compared to the local population (20%).
  • has an over-representation of female staff compared to that of the local population (50%)
  • a lower % of staff identifying as BME than that of the local population (4%)

Equality Delivery System 2 (EDS2)
Evidence Portfolio /
1. Better health outcomes
The NHS should achieve improvements in patient health, patient safety and public health for all, based on comprehensive evidence of needs and results
1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities
How does the CCG design/procure/commission services which are appropriate to its local population?Please give examples
Protected characteristics / Equality objective / Human Rights / Evidence
(What has actually been done/achieved?) / Impact / Grading
[May 2016]
  • Age
  • Disability
  • Gender
  • Pregnancy and Maternity
  • Ethnicity
  • Religion and Belief
In addition the CCG has demonstrated consideration for Geographically isolated communities and Carers. / •Objective 1To focus on ways to increase access to service from local vulnerable groups and ensure that effective information is provided to allow service users to make informed choices.
•Objective 2To promote consideration for Carers in Primary Care and to encourage all providers to adopt the principles of the carers pledge.
•Objective 3To address Health Inequalities through the implementation of the 21st Century programme to deliver fair and equitable access for all groups.
•Objective 4To develop an enhanced understanding of the experiences of children and young families in health care and use this understanding to influence effective and inclusive commissioning of services for this section of the local community. / Article 2 | Right to life
Article 3 | Anti-torture and inhumane treatment
Article 5 | Right to liberty and security of the person
Article 8 | Right to private and family life
Considerations for Human Rights are embedded into the planning and delivery of services by the CCG. This is especially important since its area of work includes mental health services and regular use of the Deprivation of Liberty Standards (DoLS) and other actions which impact on an individual’s Human Rights. / The CCG in company with the other 3 Derbyshire CCGs works to ensure that the services that it commissions and are delivered on its behalf fully meet the needs of local communities including vulnerable / seldom heard groups.
Within the North Derbyshire area are some more geographically isolated communities such as High Peak and Buxton which require particular attention to ensure that services are meeting their needs as well as the rest of the Derbyshire population.
The CCG’s focus as illustrated in its Equality objectives has been to ensure that the design of services is inclusive of such groups as children and young families, elderly frail and disabled people – particularly in the 21st Century programme.
To do so the CCG has developed a diverse engagement strategy and worked with local vulnerable groups and the third sector to ensure that in designing services these groups can input and shape those services.
To ensure that services delivered on its behalf do meet the needs of those communities the CCG utilises clear service specifications and robust quality schedules.
1)Healthier Together programme
The CCG has worked to support the retention of Stockport FT hospital as a specialist centre since it is this site primarily which is used by North Derbyshire patients from the Buxton and High Peak areas.
In addition as shown in the engagement evidence the CCG has supported the inclusion of High Peak and Buxton residents in the consultation around the future of Manchester NHS services.
2)21st Century Programme Lay Reference Group
The CCG has ensured that patients have had the opportunity to comment and influence decisions for this programme.
3)Primary Care Co-Commissioning
As the CCG has now taken on a shared role in the commissioning of GP services the CCG has worked to engage with patients and understand the needs of each area. As an example the Have your say document shows how the views of patients were sought.
4)Children’s Take over day report
As shown in the previous year’s evidence the CCG has committed to engage strongly with young people in shaping health services. A key part of this has been Children’s take over days which allowed young people to be part of the CCG decision process. It also allowed the CCG to take a barometer of children’s experience in both primary and secondary care and identify areas for further work.
5)Diabetes stakeholder event
This event saw North Derbyshire and Hardwick CCGs discuss the current state of play of Diabetes services in North Derbyshire and identify area and identify future plans and challenges.
6)Contract monitoring
A key area for ensuring that services delivered on its behalf meet the needs of local communities is through effective contracts, robust measures and quality schedules. This ensures that the service is delivered as designed.
The evidence portfolio shows the following examples of such monitoring for the CCG’s Community Services Provider Derbyshire Community Health Services(DCHS):
  • CQINs
  • Quality schedule.
In addition it is pleasing to see that the provider has published service activity data broken down by protected characteristic, allowing the CCG to examine who is actually using services.


7)Voluntary grants
The CCG funds a range of the third sector groups to supplement NHS services and support patients in such areas as:
  • Age Concern
  • Shop mobility
  • Community Transport
8)Sample of Service Specifications and activity reports