Report on Erewash CCG S Progress Towards Its Equality Objectives September 2015

Report on Erewash CCG’s progress towards its Equality Objectives September 2015

Erewash Clinical Commissioning Group (CCG) set the following objectives in October 2013 and has made progress towards achieving them as outlined below and in the previous updates published on the CCG’s website.

This report details a final update on the progress made towards these objectives. The CCG will be publishing new objectives for the 2015–17 period on its website before the 13thOctober 2015. Further updates on the progress made towards these new objectives will then be published on this section of the website.

Objective 1: To continue to gather useful information on the diversity of the local communities in order to better understand their health needs. The year one goal is to build accurate and more detailed local profiles across protected characteristic groups of the population served.

Erewash CCG continues to use the diversity profile of the Derbyshire area, derived from the 2011 Census, provided by Arden GEM CSU Equality, Inclusion and Human Rights team to develop baseline data to use when carrying out Equality Analysis and Due Regard on decisions. The data provides an understanding of the diversity of the population served by Hardwick CCG. The CCG is now making regular use of this data and comparing it with that currently held on service users and data supplied by the Provider organisations. This data will continue to be highly useful since it will allow a baseline to be produced and clarity provided, for example the scale and requirement of translation services. The CCG also recognises the need to identify further information and data going forward and works with relevant Local Authorities and the public to ensure this is available.

• The CCG has utilised the full Diversity profile of the Erewash area derived from the 2011 Census data by the Equality, Inclusion and Human Rights team. The CCG will now build on this to work with other Commissioners and Public Health to ensure that the needs of the patients in Erewash are understood and met.
• The CCG’s Engagement Strategy for 2014-15 has seen the CCG use a range of events such as the World Café event and a feedback session as well as Stakeholder Group meetings to gather additional information from the community.

• Erewash CCG’s Stakeholder Group includes representatives from some third sector groups. The CCG utilises this group as a key part of its regular engagement programme.These groups include Campaign for Tackling Acquired Deafness (CAMTAD), Connexions Derby, a group providing information for young people and adults and Derbyshire Carers, Derbyshire Mind and Derbyshire Friend.
• The CCG identified in the last report examples of how baseline data had been collected and used. With this process now embedded the CCG will continue to target groups with known health inequalities such as Gypsy and Travellers. Where new services are commissioned, the CCG will continue to work to ensure that Erewash residents are full considered and that services are locally appropriate.
• An example of this work is the Dementia Dashboard commissioned by Hardwick CCG from Arden GEMCSU, which provides figures for Dementia hospital admissions. The Dashboard allows adverse consequences / variations to be identified, for example admission for UTI which are known to result in longer hospital stays.
• Developing Engagement Maps brings together what we know from the engagement activity so that we can effectively understand each population and inform commissioning intentions more effectively in the future.
• The development of the Healthy Voices Panel to include a more diverse membership will continue and support both engagement and an understanding of the population.
• During 2014 – 15, the CCG built additional links between the CCG and Public Health Funded community projects which have been useful in understanding the needs of local communities.

Objective 2: To identify and reduce health inequalities for vulnerable and/or protected groups in the local communities. This is tied to the CCG’s fourth strategic priority;Reducing local health inequalities. The year one goal is to identify what health inequalities exist within the local population with particular focus on protected groups.

The CCG has worked over the last 2 years to identify the key Health Inequalities in company with Public Health. Key concerns identified have been around the health outcomes for patients with a learning disability and those in lower economic outcome areas.

• Having identified specific issues for users of mental health services within the Erewash area, the CCG has worked with Hardwick CCG (the lead commissioners for mental health) to identify the inequalities that exist and look at ways to close the gap. This has resulted in a specific Erewash Mental Health service being established to meet these needs locally.
• The development of closer working relationships with public health has enabled the CCG to build more detailed community maps and increased our knowledge of the health needs of the wider community across all diversity strands. This in turn has led to more focused work in the communities where inequalities are more prolific.
• Examples include working with young people, (especially young women) in Cotmanhay to increase their confidence levels. It is intended that this will lead to greater employment potential and reduced health inequalities. Other work with young people has focused on how they access health services, a review of written information and a specific project to improve access to sexual health advice and support. The sexual health project also focused on older people using services, a group which has historically not accessed such services even where they have a need.

The CCG recognises the on-going need to remain focused in this area and will continue to work closely with Public Health in identifying and addressing local health inequalities.

Objective 3: To continue working with the seldom heard groups in the local area and further build good relationships with them. The year one goal is to work withthe seldom heard groups and begin the process of further relationship building.

The CCG has set out a clear plan in the 2014-15 Engagement Strategy to build on existing work in order to increase the number of third sector groups with whom Erewash CCG engages. The CCG utilises both the Stakeholder Group and the Patient Participation Network as a key route of engagement while also utilising targeted engagement with other relevant groups. In addition to the examples included in the previous update the CCG has carried out a range of other activities as detailed below.

• The CCG has developed Engagement Maps to bring together what we know from our engagement activity in order to understand each population and inform commissioning intentions more effectively in the future.
• Developed a Healthy Voices Panel membership to include more people with protected characteristics and seldom heard groups.
• The CCG has undertaken local outreach sessions at Children’s Centres with further work planned for the future.
• In recognition of the importance of engaging with young people within the Erewash area, the CCG has built a strong relationship with Erewash Borough Council Youth Forum. This allows the CCG to engage effectively on relevant issues
• As part of ensuring that the CCG’s commissioning intentions are designed inclusively including the views of relevant individuals or organisations, the CCG carried out a survey.This survey was disseminated to all known third sector groups in the area and the responses received included in the decision process.
• The CCG has used MCP Hubs as a new and diverse opportunity to focus on engagement of seldom heard groups and protected characteristics to ensure that services commissioned are accessible to all in the future.
• Relevant groups and individuals have been given an active involvement in review of Sexual Health Services. The resulting views are being used to shape the service.
• Further examples of groups and individual involvement in the design of programme include:
• Ripplez – Patients in Control programme for vulnerable first time teenage parents
• Campaign Development Insight Work with Younger People - June / July 2014

• The established Stakeholder Forum brings together representatives from seldom heard groups, partner organisations and patient/voluntary groups and organisations. The group has been used to set the context of the NHS locally and nationally and outline the challenges and health inequalities faced in Erewash, obtain feedback and share initial thoughts on commissioning services for the population of Erewash. The CCG will continue to ensure that the group is as representative as possible of the population served by Erewash CCG.
• The CCG will continue to work to ensurethat as many groups and individuals as possible are invited to join the CCG’s Health Panel, which will give them the opportunity to be kept informed and involved with the work of the CCG on an ongoing basis, without necessarily having to attend meetings or events.
• Over the last 2 years the CCG has followed its Engagement Plan ensuring that people who are less likely to be involved, for example those living in relatively deprived areas such as Cotmanhay, are included. Examples of the activities undertaken were included in the previous update.
• As part of the process of engaging with “hard to reach” groups, Erewash CCG has supported Hardwick CCG around a number of projects. For example, specific engagement with Gypsy and Traveller groups for the Dementia Engagement, where Gypsy and Traveller groups were specifically targeted. Derbyshire Friend were also invited to provide views as part of the “Suicide Prevention Strategy,” this was in response to the Stonewall report which showed that a high proportion of respondents had thought about harming themselves, indicating that a health inequality exists nationally for LGB patients with a mental health issue. Hardwick CCG has provided a £5000 p.a. grant to help Derbyshire Friend run an advice line and is working with Derby Hospitals Foundation Trust around support. This line will cover all four CCG areas and thus supports Erewash’s work. Support for Derbyshire Friend is crucial in maintaining engagement with the LGB&T community across Derbyshire.

The CCG has established very strong links with the local community and voluntary organisations who work closely with seldom heard groups. These organisations support people, and those who care for them, in their own homes and are well placed to understand their needs and health behaviours. This approach is sustainable because it is focused on a community model which enables the CCG to have conversations with local people on an on-going basis and understand where change is needed.

Objective 4: To support the work on integration of care focused on Frail and Older people and to identify the health needs across protected characteristics in relation to access to services and health outcomes, which links to CCG priority 5, Integration of Care (focusing on frail and older people). The year one goal is to identify the diversity of the older population and what this means when accessing services and their health outcomes.

In delivering this objective the CCG worked with the other Derbyshire Clinical Commissioning Groups and NHS providers to ensure that the needs of frail and older people within the Erewash area are met. A key ambition for the CCG has been to increase the number of patients receiving care in their own home rather than in hospital. With this achieved and successful alignment between GP practices and care homes this objective stands delivered with a need to continue the work for the future.

• Support for care home patients is particularly targeted on avoidable admissions to hospitals and is delivering positive results. Alignment of practices and homes has been completed but patients retain the choice of GP.
• The CCG has taken an opportunity to pilot a Tele Health service. This service, first pioneered by Airdale FT West Yorks, covers care homes across the country. Erewash and Hardwick CCGs are leading this pilot with an initial phase seeing 12 pieces of equipment for 12 homes. This gives access to specialist advice at short notice without the need for physical attendance by either patient or doctor. The result is a very effective additional resource that is also cost effective.
• During May-July 2015 the CCG has undertaken a detailed clinical and management review of the anticoagulation services provided by five providers (two pharmacists, three GP practices). The review demonstrated that the providers are working closely with their patients to ensure that compliance is achieved. This means that when appropriate the service is being delivered flexibly (location and time), and that the providers have developed a strong relationship with the patients to understand their particular circumstances.
• Following on from the previous objective report, responsibility for Emergency Ambulance Services within Derbyshire has been transferred to Hardwick CCG. With this change made further updates around this service will be provided by Hardwick CCG. .
• As with every aspect, Erewash CCG recognises that engagement lies at the heart of effective services. To engage with the Frail and Older population the CCG has arranged public events and collected data as part of the IAPT project and will look to increase and build on this work through the year.

Objective 5: To ensure work to support people with long term conditions includes consideration of any specific needs which may arise due to a protected characteristic or vulnerability. The year one goal is to identify how long term conditions can affect different people with protected characteristics.

High quality care for patients with a long term condition is a key focus for the CCG and over the last 2 years it has worked extensively to deliver this. Much of this work has seen the CCG partner with other Commissioners and NHS providers but the CCG takes a key lead on ensuring relevant accessible effective services for Erewash residents.

• Improvements to IAPT services agreed with Hardwick CCG will improve outcomes for those with long term conditions through more appropriate effective care. By improving patient experience through better coordinated care and avoiding Crisis situations these patient groups will see better outcomes and better quality of life. The use of single assessment and a reduction in inappropriate and unplanned admissions and Long Term residential placements will see improved outcomes and better life quality for those with Long Term Conditions. The reduction in LOS and Delayed Transfer of Care (DTOC) will also see better quality of care.
• The CCG has funded an Early Supportive Stroke Discharge service which will see extra support for patients being discharged from Nottingham hospitals. The CCG is currently running the pilot. This is an expansion of the service to encompass patients being discharged from Nottingham University hospitals. The funding was secured at the start of this financial year for the additional provision. Following the completion of the recruitment process, this will begin in September 2014.

Summary and future plans

The CCG has effectively met the equality objectives set for the period 2013–15, and it will need to maintain momentum in those areas to ensure that further progress is made in each of these areas. This will be supported by the Arden GEM CSU EIHR Team and by the newly created Derbyshire-Wide Equality and Inclusion Strategy Group which will be a forum to share information and good practice.

Successful engagement remains key and must always be linked to the Protected Characteristics of those consulted so that this can be mapped against the Census data and interpreted to identify and support key priority areas. All service areas will need to look at what information on the protected characteristics of service users they currently collect and/or have access to from providers.

The CCG will continue to embed the use of Equality Analysis and Due Regard, using the Census data as a baseline in analysing current service user profiles. This analysis will be used to identify whether health inequalities exist. Having identified the diversity with the CCG’s area and examined many of the inequalities that exist, the CCG will continue to work to identify and address such inequalities in the future.

In setting new objectives for the 2015–17 period the CCG will consider the progress made against these objectives and continue to deliver a best practice model around Equality Inclusion and Human Rights.

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David FaggEquality, Inclusion and Human Rights Team