Sutton and Merton Boroughs

Public Sector Equality Duty

Annual Report

January 2012 - January 2013

Author: Wasia Shahain, Equality and Diversity Lead

ContentPage Numbers

Preface3

  1. Introduction
  2. Background4
  3. Organisational context4
  4. Clinical Commissioning Group transition
  5. Operating plans5
  6. Equality and Diversity Schemes6
  7. CCG leadership7
  8. Quality InnovationProductivity and Prevention programme (QIPP)7
  9. Public Health
  10. Joint Strategic Needs Assessment (JSNA)8
  11. Health impact and needs assessments9
  12. Public Health initiatives11
  13. Partnerships
  14. Health and Wellbeing Boards11
  15. Health Diversity initiative11
  16. Consultation and Engagement
  17. Legal duties12
  18. Overview12
  19. Complaints / Patient Advice and Liaison Service (PALS)
  20. PALS and Complaints13
  21. Interpreting Service13
  22. Community Outreach14
  23. Serious Incidents14
  24. Safeguarding14
  25. Contracts, Tenders and Performance Monitoring15
  26. Community Commissioning15
  27. Equality and Diversity Progress in 2012/13
  28. Equality and Diversity Progress16
  29. Workforce information17
  30. Areas for development in Sutton and Merton CCGs17
  31. Appendices
  32. List of documents19
  33. Summary of Public Health evidence20

This report has been produced by the Equality and Diversity Manager for NHS Sutton and Merton Boroughs. If you would like more details on any of the contents, or extra copies of this document, please contact the lead at the address below:

NHS Sutton and Merton Boroughs

Equality and Diversity Lead

3rd Floor, Wimbledon Bridge House

London SW19 3RU

Tel: 020 8251 0510

Email:

Web:

Preface

We are delighted to present this report highlighting our progress on equalities in 2012.

This year has been one of significant change in the NHS, and we are keen to ensure that throughout this period we get to grips with the statutory requirements we will shortly be responsible for as a public body, an employer and a commissioner of services.

This report brings together information, evidence and recommendations which demonstrates how NHS Sutton and Merton Borough teams, working closely with both Clinical Commissioning Groups, are meeting statutory duties under the Equality Act 2010.

There is a clear demonstration of the steps already taken to improve performance in this area, and we are committed to both CCGs building on successes and addressing gaps, in recognition that:

  • People can experience inequalities, discrimination, harassment and other barriers;
  • Patients should be at the centre of our decision making, and in partnership we can deliver high quality, accessible services that tackle inequalities and respond to personal needs;
  • An environment where dignity, tolerance and mutual respect is experienced by patients, staff and members should be created and maintained.

The contents covered describes how key business functions have taken into account equalities requirements, evidenced by relevant documentation and supporting information where required. Key areas for development and recommendations are cited at the close of the report.

We will be looking carefully at how to integrate these findings into the strategic business and operational running of our organisations, using the Equality Delivery System as a tool to support us through the authorisation process, with preparations for handover and beyond.

Dr Brendan HudsonDr Howard Freeman

ChairChair

Sutton Clinical Commissioning GroupMerton Clinical Commissioning Group

Acknowledgement: Thanks go to all colleagues from NHS Sutton and Merton Boroughs and both Clinical Commissioning Groups who contributed to this report.

1)Introduction

1.1Background

The Equality Act 2010 provides a legal framework to strengthen and advance equality and human rights. The Act consists of general and specific duties:

The general duty requires public bodies to show due regard to:

-Eliminate unlawful discrimination

-Advance equality of opportunity

-Foster good relations

1.2There are nine ‘protected characteristics’ covered by the Equality Act: race, disability, sex (male/female), age, religion or belief, sexual orientation and gender reassign nment, marriage and civil partnership and pregnancy and maternity.

1.3The specific duties require public bodies to publish relevant, proportionate information showing how they meet the Equality Duty by 31 January each year, and to set specific measurable equality objectives by 6 April every four years starting in 2012.

1.4As a statutory public body, the NHS Sutton and Merton Borough team must ensure it meets these legal obligations and intends to do so by publishing information demonstrating how the organisation has used the Equality Duty as part of the process of decision making in the following areas:

  • Service delivery - evidence of equality impact analysis that has been undertaken
  • Information - details of information taken into account when assessing impact
  • Consultation - details of engagement activity that has taken place

1.5With the introduction of the Equality Act 2010, Equality Impact Assessments have been abolished. A new tool has been developed and adopted to assess the impact of documents and services known as ‘Equality Analysis’. There will be evidence of both assessments in this report.

1.6Organisational context

Since April 2011, NHS Sutton and Merton Borough team has been part of a cluster of five PCTs, known as NHS South West London. Since 1 October 2012, Borough teams have been operating in full shadow arrangements with both Sutton and Merton Clinical Commissioning Groups (CCGs) who will assume all statutory responsibilities from 1 April 2013.

1.7Throughout 2012-13 NHS Sutton and Merton has continued as a single PCT,with statutory responsibilities covering equalities. We have made progress in this transition year using the Department of Health’s tool the Equality Delivery System as a way of meeting our duties with local stakeholders. Progress with 2012/13 Equality Objectives is outlined on page 15 of this report.

1.8To support transition and transfer of responsibilities to clinical commissioning groups in 2013, NHS Sutton and Merton Borough team has been working closely with both CCGs to ensure requirements under legislation are implemented and support the mainstreaming of equalities in all core business functions, also providing assurance as part of the authorisation process.

1.9Both CCGs are purchasing a range of services from the newly formed South London Commissioning Support Unit, which will support CCGs to discharge their statutory responsibilities, including those within the Equality Act 2010.

1.10The NHS Commissioning Board will also provide strategic policy guidance and performance monitoring through its national Equality and Health Inequalities team.

1.11This report will focus on the period January 2012 - January 2013, covering the following core business areas:

  1. Clinical Commissioning Group transition
  2. Quality Innovation Productivity and Prevention (QIPP)
  3. Public Health
  4. Partnerships
  5. Consultation and Engagement
  6. Complaints / Patient Advice and Liaison Service (PALS)
  7. Serious Incidents
  8. Safeguarding
  9. Contracts, Tenders and Performance Monitoring
  10. Community Commissioning
  11. Equality and Diversity progress in 2012/13

2)Clinical Commissioning Group (CCG) transition

2.1Commissioning Plans

Commissioning Plans have been produced to support the development of CCGs in line with requirements of the authorisation process. Both Sutton and Merton CCGs have prepared plans which look carefully at population needs based on demographics, health inequalities and access to services. At the heart of these strategies is a key objective to improve outcomes for patients ensuring services are accessible and responsive to patient needs.

2.2The Sutton CCG (SCCG) Integrated Plan (IP) 2012/13 – 2014/15 is a key strategic document describing how clinical commissionersin Sutton are working to transform and improve health services through a wide range of initiatives in commissioning areas. SCCG also work closely with Local Authority colleagues and other stakeholders to align strategies and improve health outcomes for residents and patients through the Joint Health and Wellbeing board, the Joint Health and Wellbeing Strategy and other areas of partnership work, for example the joint post for Mental Health.

2.3The information used to develop the IP comes directly from the JSNA, including population demographics, key commissioning implications and substantial patient and public engagement. Overarching equality priorities and measures have been incorporated into the strategic overviews linked to each of the following commissioning areas: Community Services, Long Term Conditions, Acute Care, Urgent Care, Planned Care, Mental Health and End of Life Care.

2.4As a result, Sutton will be seeking to address the following issues in its commissioning of health services:

a) Stronger assurance that providers are meeting statutory duties on equalities as required by the Equality Act 2010.

b) Improved performance on data monitoring and analysis, to enable commissioners to assess equitable access to health services and health outcomes for people who share protected characteristics.

c) Clear performance indicators and targets for groups where specific problems have been identified in relation to health services access and health outcomes.

2.5The Merton CCG Integrated Strategy and Operating Plan (ISOP) 2012-2015 describes MCCGs strategic objectives and delivery plan in detail, using this opportunity to concentrate on the population of Merton and their specific needs at borough and practice levels. MCCG have built on past successes and strong partnership working arrangements to develop their current plans, with the aim to improve patient experiences and health outcomes by commissioning services differently in the future though strategic initiatives.

2.6Extensive demographic information highlighting health inequalities, public health priorities and patient engagement feedback have been used to develop a ‘case for change’. The ISOP includes a section on the Equality Delivery System and how MCCG plans to use this as a tool to embed equalities within its systems and processes.

2.7Equality and Diversity Strategies

Sutton and Merton CCGs have also developed Equality and Diversity strategies to support delivery of their legislative responsibilities as a future public body, an employer and a commissioner of services. These can be found in Appendix 1 (a) and (b).

2.8The implementation plans which underpin these strategies outline how each CCG proposes to meet their equality duties. Key objectives are focused around: putting appropriate governance arrangements in place, providing equality and diversity training, ensuring Equality Analysis assessments are conducted on all documents and services, developing patient participation groups to represent communities, utilising the JSNA and other data sources to identify gaps in service provision and ensuring Human Resources (HR) and employment policies are in line with the Equality Act 2010 and implementing the Equality Delivery System (EDS).

2.9Development of EDS objectives for years 2-4 will focus on the contents of these Equality Strategies and plans, ensuring that subsequent implementation is responsive and focused on priority areas for each CCG.

2.10CCG leadership

Merton CCG and Sutton CCG have both identified clinical equality leads that areactively supporting the development and delivery of equality work streams. Merton CCG has also identified responsibilities for a Director of Quality to lead the equality and diversity work programme, with progress to be fed in through the Clinical Quality Committee. Sutton CCG is in the process of identifying an operational lead to provide strategic direction, though assurance will be provided through the Quality Committee.

3)Quality Innovation Productivity and Prevention (QIPP) programme

3.1QIPP is a national programme for the NHS aiming to make efficiency savings while delivering Quality, Innovation, Productivity and Prevention outcomes.Two Equality Impact Assessments for the current 2012/ 2013 QIPP programme were undertaken, one for Sutton and one for Merton, highlighting key evidence-based commissioning implications that would need to be considered in the delivery of QIPP programmes, andproviding an overview of the potential impact of any service changes on diverse groups within each Borough. The full impact assessment can be found in Appendix 1 (c).

3.2General recommendations were identified across all work streams:

  • Each project should still undergo an EIA screening assessment, with a full EIA undertaken where indicated;
  • Rates of healthcare need and consultation vary within different groups, therefore QIPP programmes need to consider whether they may need to have pathways in place to care for specific minority groups which are known have disproportionately higher rates of some conditions;
  • Information must be given to patients is in a suitable format. This may include, for example, “Easy-read” leaflets, leaflets in large type or Braille, or written and oral information in the first language of patients who are not fluent in English;
  • Patients with learning disabilities or dementia may need longer appointments and involvement of their carers when making decisions about health care;
  • Ease of access to services must be ensured for people with mobility problems, including physical and sensory disability;
  • Judgments about lifestyle, attitudes or values must not be made and specifically not based on a patient's disability, marital status, ethnicity, religion or sexuality;
  • Additional support may be needed for patients not familiar with the health care system in England;
  • Consideration must be given to carers who may require support in addition to that given to the patient themselves;
  • Where patients are themselves carers for others, they may require additional support for defined periods of time while unwell;
  • Pregnancy is a period in life when women may have higher levels of medical and emotional need. Services should be tailored to meet these specific requirements;
  • As community settings for outpatient clinics have been shown to increase ease of access, plans to relocate services into the community should have a beneficial effect on equality;
  • As many plans aim to make cost savings, any monies released can be used for other plans within the boroughs, thus potentially reducing inequalities.

4)Public Health

4.1Joint Strategic Needs Assessment (JSNA)

The Joint Strategic Needs Assessment (JSNA) is a duty and describes a process of gathering information and evidence to enable local authorities, primary care trusts (PCTs) andclinical commissioning groups (CCGs) to commission services effectively and efficiently.

4.2The JSNA has been split this year to reflect changes in NHS structures, as we move into individual borough-aligned CCGs. 2012 updates for the JSNAfor Sutton and Merton provides a wealth of evidence on local health needs, inequalities within our populations and includes detailed key commissioning implications to address these inequalities. It focuses on a number of the protected groups covering age, disability, ethnicity, gender, religion and sexual orientation.

  • The 2012 JSNA update for Sutton can be accessed here.(
  • The 2012 JSNA update for Merton can be accessed here. (

4.3NHS Sutton and Merton Public Health Directorate have been leading the process in partnership with key senior personnel from Local Authorities and CCGs, working together closely to increase support and input to strengthen data sources and analysis to describe the changing needs of our local communities and to plan for future needs.It encompasses both the health and social care needs of the population and includes the wider determinants of health and wellbeing.

4.4Strong partnerships and innovative ways of working are important in order to reduce health inequalities. The assessment provides information about Sutton and Merton thatwill support the local authorities and CCGs as they prepare to take on new responsibilities – PH responsibilities are moving to local authorities – to improve the health of the wholelocal population, including seldom heard communities.

4.5Developing the Joint Strategic Needs Assessment is an on-going process. The core data set will be updated again in 2013 once further information is published from the 2011 census. We will continue to add other findings from more detailed pieces of work to enhance our understanding of the health and well-being of our local population, including a closer look at evidence identifying need of communities from the protected groups.

4.6Health impact and needs assessments

A range of health and equality impact assessments have been undertaken to identify the needs of different sections of the population.

4.7‘LiveWell’ programme

A new programme of health improvement called LiveWell has been commissioned to support our strategic vision to promote health and wellbeing and reduce health inequalities in Sutton and Merton, enabling the organisation to tailor and target any future service planning.

4.8An external agency was commissioned to undertake a public and stakeholder programme of engagement to identify the needs, barriers and facilitators for local citizens to choose to lead a healthy lifestyle. ‘Healthy lifestyle’ was defined as: Physical activity, anti-smoking, food choices, sexual health, alcohol consumption and positive mental well being. This was supported by the completion of afull Equality Impact Assessment (EIA) which identified a focus for the researchers in order to target diverse groups and communities in the study.

4.9The programme became operational in October 2011. It has engaged 402 clients from January 1st 2012 to date (as of November 6th). The service has seen a marked increase in uptake resulting from GP referrals via the Health Checks Programme.

4.10Since the service mobilised, two further EIAs have been completed by St Mary’s in accordance with the contract. These indicate that the service actively considers equality of access for a range of groups including men and women, different age groups and faith groups, people with disabilities and ethnic minority groups.For copies of the full EIAs, please see Appendix 1(d).

4.11The findings of the EIAs indicate that the service has actively seen a greater proportion of individuals from black or ethnic minority groups within Merton and a similar proportion of individuals in comparison to JSNA data in Sutton. A major observation previously highlighted in the 2010 Insight Report completed by ICE, a social marketing company, was that there is a greater incidence and prevalence of diabetes and hypertension in local Black and Asian minority groups. As a result, NHS South West London has incorporated into the key performance indicators, a need to target specific wards to help reduce health inequalities and target these specific groups. In addition, a handful of multilingual health advisors have been trained to deliver the service in different languages and are able to act as an interpreter.

4.12While there are fewer male than female clients, since October 2012, the number of males accessing the service has increased and the rate of follow through from referral to uptake of service is equal for men and women.