Public Sector Equality Duty Report

April 2016

Public Sector Equality Duty Report April 2016

Contents / Page
Introduction / 3
Public Sector Equality Duty and the purpose of this document / 3
Profile of equality groups in B&NES / 5
Information about our employees / 12
Demonstrating how we consider equality in governance processes / 13
Equality in Commissioning / 14
Equality in Communication and Engagement / 17
Equality Delivery System 2 / 18
Equality Objectives 2016-2017 / 19

Introduction

About NHS Bath and North East Somerset Clinical Commissioning Group

NHS Bath and North East Somerset Clinical Commissioning Group (BaNESCCG) is a commissioning organisation;we commission (buy) health services for BaNES residents. We do not provide health services ourselves. We use our clinical knowledge to commission the best services to meet local people’s needs. You can see our Five Year Plan here

We publish our commissioning intentions each year. You can see the latest list here:

For more information on what health services we commission, please visit our web site BaNES CCG

Public Sector Equality Duty and the purpose of this document

BaNES CCG is subject to the legal obligations arising from the Equality Act 2010. Section 149 of the Equality Act 2010 places a Public Sector Equality Duty (PSED) on all statutory public authorities and those who act on their behalf. CCGs may not delegate these duties and are responsible for ensuring compliance by providers to whom the CCG commissions the delivery of services.

The general duty has three aims. Each CCG must in the exercise of their functions, have due regard to the need to:

1Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited under the Act.

2Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it.

3Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

The specific duties of the public sector equality duty require CCGs to publish, in a manner that is accessible to the public, information to demonstrate their compliance with the public sector equality duty at least annually. This information must include, in particular, information relating to people who share a protected characteristic who are its employees – (public authorities with fewer than 150 employees are exempt) and people affected by its policies and practices. We must also set equality objectives at least every four years.

During 2016-2017 the Clinical Commissioning Group will be reviewing and updating our equality and diversity action plan to show how the CCG plan to comply with our equality obligations: Our previous plan can be found at the following link:equality duty update

BaNES CCG has published this report as a requirement of the Public Sector Equality Duty (PSED) which is a specific duty placed on public authorities requiring us to publish equality information to demonstrate our compliance with the Equality Act 2010. This documenthighlights the workBaNES CCG has undertaken towards meetings the general PSED duty, gaps it has identified and actions it is going to take to improve quality outcomes.

We use the Joint Strategic Needs AssessmentJSNAto inform our commissioning intentions and decision making. The JSNA is a collection of research about the local people, places and communities that B&NES Local Authority and BaNES CCG deliver services to. This is much more detailed than just equality data. We use the JSNA to try to understand what needs to be done in collaboration with local knowledge and community feedback. It is a ‘wiki’ style resource which is continually updated with live information.This meets many of the Equality and Human Rights Commission’s recommendations on publishing annual equality information as the data is online, easily available, more up to date, cross referenced and more comprehensive than previously issued annual reports.

We know that we need to make full use of the JSNA in our commissioning practices; in 2015-2016, all staff including the Board receivedfurther equality and diversity training which will include information on evidence based commissioning.

Profile of equality groups in BaNES

We use a range of data and information when consulting on and commissioning services. We work closely with the Local Authority public health and research and intelligence teams to ensure we share the most up to date information available.Knowing our community and recognising its diversity is pivotal to the commissioning of modern, high quality health services.

Population

There were 182,021 residents of Bath and North East Somerset in 2014. This is lower than the GP registered population of 197,040. Bath and North East Somerset has a significantly higher proportion of residents (10.6%) aged 20-24 than nationally (7.9%), this can be attributed to the high student population

.

Age

Children and young people

The 2011 census shows that 16.7% of the population of Bath and North East Somerset are 15 years or under, and that 6.3% are 16-19 year olds.

Adults

There are projected to be large increases in the number of older people in B&NES in the coming years. For example, by 2021 the number of over 75's in the population is projected to increase by 20% (approximately 4,400 people) and the number of over 90's are projected to increase by 44%. We note that services for older people are likely to experience increases in demand.2014 estimates suggest that there are currently 11,807 people aged 65+ in B&NES who are unable to manage at least one self-care activity on their own. This is expected to increase to 16,408 by 2030.

Gender

The population’sgender balance is almost 50/50; women 51.1% men 48.9%.

In line with national trends, our local information shows us that life expectancy for women (84.5) is greater than for men(80.9), (2011-2013) although the gap is expected to narrow as the population ages.For men, this was higher than the South West (79 years) and England (78 years) averages. For women life expectancy is higher than the South West and England average of 83 years.

Ethnicity

Approximately 10% (17,500 people) of the BaNES population define as non-white-British.The second most common ethnicity is 'Other White' (6,600 people) and this population group is increasing.It is likely that a large proportion of these people will be from the EU accession states. There are also approximately 4,500 people of Asian or Asian British descent living in BaNES.

Our information shows we have a disproportionate number of children in care from Black and minority ethnic groupswith 12.5% of children in care from a black or minority background but only 10% of the population is BME.

Language use

In a commissioning exercise undertaken in 2014-2015 to find a single provider of Translation and Interpreting Services for the CCG and four partners organisations (Bath and North East Somerset Council; Avon and Wiltshire Mental Health Partnership; The Royal United Hospital; and Sirona Care and Health), the following languages were identified as being the most frequently requested in theBaNES area between 2013-14:

Face to face interpreting: Arabic, Bengali, Italian, Punjabi and Polish

Telephone interpreting: Polish, Cantonese, Italian, Bengali and Arabic

Religion & Belief

In the 2011 Census, 56.5% of people in Bath and North East Somerset identified as Christian; a large proportion (32.7%) stated they have no religion. B&NES has generally lower levels of other faith groups than the national average:Buddhist, Hindu, Jewish, Muslim and Sikh are each 0.5% of the population or less.

Ill Health and Disability

Ill health and disability refers mainly to people with long term conditions, which are those that experience illnesses which cannot currently be cured but can be controlled with the use of medication and/or other therapies.

Rates of long term conditions in Bath and North East Somerset are comparatively low, but rising in line with the rest of the country. Estimates suggest there are approximately 2,469 people aged 18-64 with a significant physical disability in B&NES. Almost half of people with long-term conditions surveyed in 2011 felt that they were able to manage their condition. People with long term conditions are more likely to be older people living in deprived areas.

7% of people with long term health condition or disability living in B&NES state theirday-to-day activities are limited a lot, 9.1% state they are limited a little and 83.9% state they are not limited by their ill health or disability.

GP Registered Conditions

The table below outlines the numbers of the registered GP population of Bath and North East Somerset that were recorded to haveone of the following long term conditions in 2012-2013:

Condition / Number
Hypertension* / 25,395
Asthma / 12,353
Diabetes Mellitus (Diabetes) Register (ages 17+) / 7,460
Hypothyroidism* / 6,093
Coronary Heart Disease Register (CHD) / 5,824
Heart Failure / 1,545
Heart Failure due to LVD (Left Ventricular Dysfunction) / 862
Cardiovascular Disease Primary Prevention / 4,522
Chronic Kidney Disease (ages 18+) / 5,232
Cancer / 4,338
Stroke or Transient Ischaemic Attacks (TIA)* / 3,488
Atrial Fibrillation / 3,396
Chronic Obstructive Pulmonary Disease (COPD)* / 2,693
Osteoporosis: Secondary prevention of fragility fractures / 267
Peripheral Arterial Disease (PAD) / 1,134
Epilepsy (ages 18+) / 1,162
Dementia / 1,140
Learning Disabilities (ages 18+) / 733
Mental ill Health / 1,595
Depression ages 18+ / 8,931
Palliative Care / 439
Obesity (ages 16+) / 13,446

Sexual orientation

There are likely to be approximately 9,000 adult residents of B&NESidentify as lesbian, gay or bisexual. Our data and research demonstrates that LGB people are more likely to be vulnerable to adverse health and wellbeing outcomes compared with the general population, including: hate crime, domestic violence, shorter life expectancy, higher rates of smoking, poorer sexual health, higher rates of self-harm and suicide, school absenteeism and homelessness.

Gender identity

There are an estimated 1760 people who identify as transgender in B&NES, this equates to 1% of the population.

Transgender people are vulnerable to prejudice and hate crime (including physical attacks) because of their gender identity. Trans and ‘other’ gendered people may face particular barriers to participation in physical activity.

Gypsy traveller & boat dwellers

The most recent study done locally into the Travellers and Gypsy Traveller communities has been The Bath and North East Somerset Gypsy, Traveller, Boater, Showman and Roma Health Survey, 2012. Significant information was gathered from all communities included in the sample in relation to access to services (including emergency care and experiences of A&E services), health needs, barriers to registration with GP and other primary care services; prevalence of particular conditions and preferences and experiences of terminal care for members of their communities. Data was also collected on the strength of community networks/availability to support from peers during times of illness. Needs are characterised by increased risk factors across a range of issues including mental ill-health, physical disabilities and lifestyle factors such as smoking. For example, Traveller and Gypsy Traveller women are more than twenty times more likely to experience the death of a child than the population as a whole. These needs are often coupled with a reluctance to engage with public services, although satisfaction with health services was considered reasonable.

Overall 32.5% of respondents to the Professional/Practitioner survey reported having had contact with Gypsy/Traveller/Boater communities in their practice but there is a general absence of recognition of the needs of these communities by health practitioners who in the main are reported as failing to monitor their health status and access to services. To address some of these issues, the CCG has supported the funding of a bespoke Health Visiting Service to work with these community groups

Information about our employees

At 31st December 2015, BaNESCCG had 64 employees in post. As this is below the threshold of 150, the CCG is not required to publish equality data about their staff as it is very difficult to publish some aspects of the data without compromising staff confidentiality.

A detailed work force profile is made available to the Executive team and data taken from a report as at 31st December 2015 is shown below. We have made sure that this data does not identify individuals.

Disability

3.1% of staff self identified as Disabled; 79.7% as not Disabled. 17.1% did not respond.

Ethnicity

89% declared themselves as White British; 4.6% of other ethnicity and 6% did not respond.

Gender

82% female; 17.1% male.

Sexual orientation

71% declared heterosexual; 4.6% LGBT; 23% did not respond.

Part time / full time employees

48.5% of employees hold full time posts. 51.5% hold part time posts.

Demonstrating how we consider equality in governance processes

NHS BaNES CCG Constitution’s principles of good governance include observing and working within the Equality Act 2010.

In 2015-2016 the CCG had delivered the key functions it had defined in order to meet the public sector equality duty by:

  • delegating responsibility for equality legislation to the Chief Officer –Tracey Cox and
  • designating an Equality and Human Rights operational lead –Dawn Clarke, (Director of Nursing and Quality).

We have established a robust governance and accountability reporting mechanism to the Board via the Quality Committee. Responsibility to seek assurance on the robustness of arrangements relating to equality and human rights stays with the CCG Board. An equality and diversity update was reported to the CCG Board in July 2015 and to Quality Committee. Updates are scheduled quarterly to the Quality Committee and annually to the Board. We have delegated responsibility for the review of arrangements relating to equality and human rights to the Quality Committee. This includesarranging mandatory equality and diversity training for all of its employees.

We have developed a clear specification for training staff in equality and diversity issues which includes public sector equality duty requirements; equality analysis; equality in decision making and how to scrutinise equality analysis; equality and health inequality aspects of BaNES JSNA; inclusive leadership and cultural competence.

In 2015-2016, we worked with the BaNES Independent Equality Advisory Group (comprising public services and cross-representation of voluntary sector organisations) for consultation, feedback and sharing good practice.

During 2015-2016 we committed to ensuring that equality & diversity is routinely included in job descriptions and job descriptions have been reviewed to confirm this.

Equality in Commissioning

Our aim is to commission modern, high quality health services that recognise and value the diversity of our communities and believe that meeting equality needs is pivotal to this aim. To turn this intention into a reality we carry out equality analysis (equality impact assessment) as an integral part of commissioning projects.

Equality analysisuses a process of systematically analysing a new or existing policy or service to identify what impact or likely impact it will have on people of differing groups within our community. It aims to identify any discriminatory or negative consequences for a particular group or sector of the community, and to prompt us to consider what positive actions we need to take in order to meet the needs of people with protected characteristics. Equality analysis can be carried out in relation to service delivery as well as employment policies and strategies.

As we commission jointly with the B&NES Council, equality analyses are published on the CCG website or on the Council website. BaNES equality analysis

We publish our annual commissioning intentions as well as making them available for public scrutiny at the BaNES Health and Wellbeing Board. The commissioning intentions documentation details our priorities and any re-commissioning / contract awards requiring on-going funding: Commissioning intentions 2016-2017 can be found at:

Examples of commissioned servicesduring 2015-2016

The following examples demonstrate that we have paid due regard to the need to promote equality as part of the public sector equality duty.

Your Care Your Way:

We believe that everyone in Bath and North East Somerset shouldbe able to accessthe best possible health and care services in their community and feel supported tolivehappy, healthy and independent lives.That's why, with B&NES Council welaunchedyour care, your way; an ambitious two year project to review, design and deliver integrated community services in partnership with localpeople. Phase Three, which aims to score and evaluate potential providers, began in February 2016. A team of volunteers who have a wide experience of community health and care services have been appointed as Community Champions to support us with this process to ensure that equitable, high quality services are commissioned for all

Our joint work with the Council to support people with learning disabilities is a specific example of how we strive to improve access to health services and reduce health inequalities for people with protected characteristics.

Identification and Referral to Improve Safety (IRIS)for people suffering from Domestic abuse.The IRIS team are commissioned by BaNES CCG to offera free training and advocacy package to all BaNES GP practices. The training is for all clinicians working within the practice- doctors, nurses, midwives, pharmacists and the Reception Admin team as well, equipping the entire practice team with the knowledge & skills to identify and respond to patients who are experiencing domestic abuse

With the Council, the CCG has committed recurring budget to the Alcohol Liaison Service at the RUH. This service has significantly increased its reach year on year since it started in 2013/14. Clients referred to the service have on average a 67% reduction in hospital spells 3 months post contact with the services

An Independent Domestic Violence Advisor at the RUH. Since April 2015, The IDVA has been providing advice and support to patients and staff, providing domestic abuse training, attends B&NES and Wiltshire MARAC and supports safeguarding supervision within the Trust. This one-year pilot, funded by BaNES CCG, has already begun to embed a coordinated domestic abuse response across the organisation

Wellbeing College:

The College provide courses, activities and groups to Bath & North East Somerset residents aged 16 or over, or those who are registered with a GP in the area. Courses cover a range of areas including physical and mental wellbeing, stress, nutrition, social support, IT and many more. These may be one-off workshops or longer courses and are provided across the locality in various community venues. Most courses, activities and groups are free.