11/06/2016 Line Manager Development: Confident & competent around Diversity Julia Allen E&IBP Equality & Inclusion team, Corporate Affairs 1 hour 30 mins annual session supporting middle managers & line manager

2 Midlands and Lancashire CSU OVERVIEW Understanding Equality Diversity & Inclusion in the workplace – fair access to information / services / premises / employment & training opportunities Who are the 9 protected characteristic groups? EI&RA awareness / training for all commissioners EDS v2 Managers having discussions about staff needs Reasonable Adjustments in the workplace - (All staff Briefing) NHS focus on Dignity & Respect New Accessibility Standard – NHS England Prohibited discrimination types Health inequalities Local demographics Religion or Belief & using diversity calendars Prayer or Quiet room – inclusive working Can line managers identify 1 thing they would want the organisation to deliver for E&I? Outcome: Line managers have an enhanced sense of ED&I insight, awareness & appropriate challenge. Also relevance between line manager role to wider CCG ED&I responsibilities

Understanding Equality Diversity & Inclusion in the workplace: fair access to information / services / premises / employment & training opportunities

4 Midlands and Lancashire CSU What is equality? Equality: is about fair treatment of people It means everyone having the same chances to do what they can. Some people may need extra help to get the same chances and equality of outcomes eg disabled people

5 Midlands and Lancashire CSU What is diversity? Diversity: literally means difference and is about recognising individual as well as group differences, treating people as individuals and placing positive value on diversity in the community and in the workplace. Being aware of how differences mean that simply doing the same for everyone does not produce equality of outcome Diversity is also about business efficiency & reaching out to all parts of our local community through recruitment of diverse teams for example. Representing at all levels within the CCG, all sections of our local communities eg representative Boards reflected within the WRES or workplace Race Equality Standard from NHS England Recognising & valuing difference & deriving business benefits from the added value diversity brings Reaching all parts of our local communities Developing a more representative workforce Improving our business performance. Diversity is about more than remaining within the law. It’s widely agreed to be positive for business.

6 Midlands and Lancashire CSU What are Human Rights? Human rights are about our basic needs as human beings. They capture the core rights we are all entitled to so that we may develop our potential and live our lives in dignity and respect. Human rights are embedded in the NHS Constitution and are everyone’s responsibility in all their planning and decision making processes. Remember the FREDA Principles: Fairness Respect Equality of opportunity Dignity Autonomy

7 Midlands and Lancashire CSU How is E&I and Human Rights relevant to your job role responsibilities? The bottom line for delivering EDHR inclusive services is how confident are we, working with the added value that ‘difference’ can bring and can vulnerable local people gain fair access to information, services, premises & employment opportunities? How are we able to evidence inclusive working for workforce and service delivery issues? Outcome: E&I checks and balances in place eg (1) Brown Principles applied (2) FREDA (Human Rights scrutiny in our planning & decision making) See u tube video

8 Midlands and Lancashire CSU Pointers – evidencing taking ‘due regard’ see Brown Principles Service Delivery issues FAIR ACCESS: EDS – Equality Delivery System 2 RISK: Equality Analysis & Risk Assessment process to manage business risk Annual E&I Report Board Development E&I Awareness Workshops Qtly progress reports for assurance of legal compliance Workforce issues FAIR REPRESENTATION AT ALL LEVELS: WRES – Workplace Race Equality Standard Annual E&I Report Equality Analysis scrutiny of strategies and policy Fair / Inclusive Recruitment training for inclusive ways of working eg competency based scoring

Your E&I responsibilities You have a duty not to discriminate against patients or staff (discrimination types Briefing) Evidence giving due regard eg when reviewing services or making financial decisions Be aware of our processes and information supporting this responsibility eg Equality Analysis & Risk Assessment (EI&RA) Recognise & address health inequalities for vulnerable groups Employers are liable for the actions of their employees, done in the course on their employment

Statutory Duties: what do staff need to be aware of? Public Sector Equality Duty (General): General – CCG must have due regard: eliminate discrimination, harassment, victimisation and other unlawful acts –e.g. preventing things happening in the first place advance equality of opportunity between people who share a protected characteristic and those who don’t share it –e.g. take steps to meet the needs of people with certain protected characteristics where these are different from the needs of other people foster good relations between people who share a protected characteristic and those who don’t share it –e.g. encourage people with certain protected characteristics to participate in public life or in other activities where their participation is disproportionately low i.e. ‘seldom heard groups’ Public Sector Equality Duty (Specific): Publish information to demonstrate compliance with the General Duty at least annually 31 st January Set Equality Objectives at least every 4 years agreed with local people, patients and staff Deliver on those Objectives & report publicly on progress Human Rights Anybody carrying out functions on behalf of the CCGs including the CSU needs to Promote & Protect Human Rights Avoid actions that would lead to a breach of a person's Human Rights Take active steps to protect a person’s Human Rights Remember ‘FREDA Principles in all our planning & decision making processes

Who are the 9 protected groups? In workforce & service delivery

Protected Groups (Equality Act 2010) How many Protected Groups are there?

Protected Groups (Equality Act 2010) AgeDisabilitySexRace Religion or Belief Sexual Orientation Marriage and Civil Partnership Pregnancy and Maternity Gender Reassignment

11/06/2016 Who are protected? New: Protected Characteristic Groups Age Gender (M/F) Gender Reassignment Disability Race Religion or belief Sexual orientation Marriage and civil partnership (employment & training only) Pregnancy maternity & breastfeeding mums Carers * Military veterans * * Recommended that CCG include in scrutiny for inclusion, as good practice

EI&RA awareness / training Evidencing due regard to the PSED for legal compliance assurances to CCG

16 Midlands and Lancashire CSU Equality Impact & Risk Assessment: audit trail of CCG evidence What do line managers need to know about ‘due regard’? Your EI&RA related staff should all attend Workshop training eg commissioners & policy or strategy developers EI&RA scrutiny should be carried out by CCG at earliest stages of consideration Timely engagement with reps from the 9 local protected groups – CCG require feedback Mitigate where possible in response to feedback received Focus on achieving any improved outcomes for local protected groups CCG and local communities of interest re-shaping healthcare services to be more inclusive Board members should routinely ask when Papers presented for a decision / approval: Has an Equality Impact & Risk Assessment been completed? If not, why not? What in essence did feedback received say? How did CCG mitigate in response? What improved outcomes resulted for local protected groups? This is along the lines of ‘You said. We did’

17 Midlands and Lancashire CSU Equality Impact & Risk Assessment process Rationale The EI&RA process has been designed to prompt thinking & deliberate consideration of local protected groups in all our planning & decision making processes. Also to support our CCGs in ensuring all commissioning decisions, Project Initiation Documents (PIDs) and any other business plans / strategies / policies are evaluated for their impact on Privacy, Equality, Human Rights and the NHS Constitution. Look at the impact on those PGs most likely to be impacted by key healthcare changes..

Equality Delivery System 2 – NHS equality performance framework How do local people from PGs fare compared to people overall in healthcare?

19 Midlands and Lancashire CSU EDS: The NHS equality performance framework 4 Goals; 18 required Outcomes; over a 4 year delivery cycle Mandated by NHS England from April 2014 Applies to all commissioning organisations & ‘larger providers’ Applies to all organisations which provide NHS funded healthcare services are subject to requirements of the NHS Standard Contract (not primary care) Applies to all NHS providers and non NHS providers (including private & voluntary sector) Asks for annual evidence from CCG (and providers) – how do local people from protected groups fare compared to people in general [in healthcare]? Annual public grading of evidence by volunteer local stakeholder reps from local protected groups & local communities of interest Public grading should be representative of locality & protected group reps Transparent grading dashboard displayed annually on CCG website & NHS England The vulnerable patient voice helping CCG to shape services to be more inclusive

20 Midlands and Lancashire CSU How do local people from protected groups fare compared to people in general [in healthcare]? GradingUnderdevelopedDevelopingAchievingExcelling People from all protected groups fare poorly compared with people overall OR evidence is not available People from only some (2 or less) protected groups fare as well as people overall People from most (3 to 5) protected groups fare as well as people overall People from all (9) protected groups fare as well as people overall

Managers having discussions about staff needs

22 Midlands and Lancashire CSU Line manager responsibilities: workforce issues Include having discussions about staff support needs Processes: 1:1s – regular; no surprises; include wellbeing discussion Annual performance review Suite of HR support policies eg Flexible working; Grievance & disciplinary; Confidentiality; Flexi time working – accessible via HR Business Partner at CSU / intranet All recruiting managers are likely to receive fair recruitment practices training including unconscious bias awareness (NSCCG & SOTCCG) Support available from HRBP workforce issues / E&IBP equality related issues

Unconscious Bias What is Unconscious Bias? –Life experiences – whether positive, negative or neutral – heavily influence how we view and evaluate others. –Our actions are directly informed by these experiences, which can lead to un-objective and unconsciously biased decision- making. –An 'Unconscious Bias' is an association or assumption held by an individual which affects their attitudes and behaviours. Also known as 'implicit stereotypes', these biases are often displayed subtly and without pre-meditation or intention: through body language, mannerisms and conversation. What are the effects of Unconscious Bias? –In decision making it can influence the persons objectivity e.g. when undertaking the Equality Analysis section in the Pre- PEAR assessment or when deciding whether to fund a service or decommission a service. What can be done to address Unconscious Bias? –we all have biases and we need to be aware of those when considering equality in decision making and determining risk. Transgender people decide to change their gender so why do we need to support them with facial hair removal Security Bulletin: Gypsy Travellers have illegally set up on the waste ground next door please ensure all cars, windows and doors are locked We have a universal service which offers interpreters so why do deaf people need a dedicated BSL service? The normal mechanism for making babies is ….. If you can’t show infertility through ‘normal mechanisms’ then you can’t have IVF funding

Reasonable Adjustments in the workplace All staff Briefing available An anticipatory duty

25 Midlands and Lancashire CSU Reasonable adjustments Service Delivery issues EI&RA scrutiny through feedback from local protected group reps CCG considering feedback and mitigating / re- shaping services to be more inclusive for people from protected groups Service specs (commissioners) Assurance of legal compliance to Governing Body / CCG Provider Monitoring Schedule embedded into larger contracts by Procurement team CSU Workforce issues The duty to make reasonable adjustments aims to make sure that, as far as is reasonable, a disabled worker has the same access to everything that is involved in doing and keeping a job as a non-disabled person. When the duty arises, you are under a positive and proactive duty to take steps to remove or reduce or prevent the obstacles a disabled worker or job applicant faces. You only have to make adjustments where you are aware – or should reasonably be aware – that a worker has a disability. Many of the adjustments you can make will not be particularly expensive, and you are not required to do more than what is reasonable for you to do. What is reasonable for you to do depends, among other factors, on the size and nature of your organisation. An anticipatory responsibility Caution: Failure of duty to make reasonable adjustments is a form of ‘prohibited discrimination’ Action: See Reasonable Adjustments Briefing (workforce settings) for all staff

NHS focus on dignity & Respect Human Rights Act 1998

27 Midlands and Lancashire CSU Respect and dignity in action What the Equality Act 2010 means for you The Equality Act 2010The Equality Act 2010 gives the NHS opportunities to work towards eliminating discrimination and reducing inequalities in care. The NHS already has clear values and principles about equality and fairness, as set out in the NHS Constitution, and the laws under the Equality Act 2010 reinforce many of these both in service delivery and workforce settings.the NHS Constitution What does this mean for you? Most of us need to visit a doctor or dentist from time to time, and may need hospital treatment on occasions. Others may rely on the NHS and social care services for help with long-term health conditions or disabilities. Whenever you need healthcare, medical treatment or social care, you have the right to be treated fairly and not to be discriminated against, regardless of your ‘protected characteristics'. The law under the Equality Act set out that every patient should be treated as an individual and with respect and dignity.visit a doctordentistsocial care services The laws mean that all NHS organisations will be required to make sure health and social care services are fair and meet the needs of everyone, whatever their background or circumstances.

28 Midlands and Lancashire CSU Which NHS services are covered? Health and social care services covered by law under the Equality Act 2010 include: all NHS providers (e.g. hospitals; GP services; dental services) all NHS commissioners (e.g. GP practices) those supporting older and disabled people in their homes care in day centres, and residential or nursing homes those caring for children who cannot live with their parents. It doesn’t matter whether the service is provided by a public body or an independent provider. You also have rights under the European Convention on Human Rights (included in the Human Rights Act 1998 in the UK), which are relevant to health and social care. These rights include:European Convention on Human Rights the right to life the right not to be subjected to torture, inhuman or degrading treatment or punishment the right to liberty the right to respect for private and family life

29 Midlands and Lancashire CSU What is prohibited discrimination? Discrimination can be direct or indirect. Direct discrimination is when one person receives less favourable treatment than another person because of a protected characteristic. For example, if a clinic refuses to offer fertility services to a lesbian couple because they are not heterosexual, this constitutes direct discrimination on grounds of sexual orientation. Indirect discrimination is when there is a condition, rule, policy or practice that applies to everyone, but which particularly disadvantages people who share a protected characteristic. For example, a social care provider that runs a day centre decides to apply a ‘no hats or other headgear’ rule to its service users. If this rule is applied to every service user, then Sikhs, Jews, Muslims and Rastafarians, who may cover their heads as part of their religion, will not be allowed to use the drop-in centre. Unless the social care provider can objectively justify using the rule, this is indirect discrimination. The Equality and Human Rights Commission has developed guidance for users of health and social care. Follow the links below to find out more about health issues relevant to these groups: black health south Asian health gay and lesbian health transgender health living with a disability children with a learning disability pregnancy and baby guide carers men's health 60-plus women's health 60-plus

30 Midlands and Lancashire CSU Why address health inequalities? CCG have duties to: Have regard to the need to reduce inequalities between patients in access to health services & the outcomes achieved Exercise their functions with a view to securing that health services are provided in an integrated way Include in an annual commissioning plan an explanation of how they propose to discharge their duty to have regard to the need to reduce inequalities Include in an annual report an assessment of how effectively they discharged their duty to have regard to the need to reduce inequalities Health & Social Care Act 2012 Lawyers advise that having due regard to the need to reduce means health inequalities must be properly and seriously taken into account when making decision or exercising functions, including balancing that need against any countervailing factors Having due regard includes accurate record keeping of how the need to reduce health inequalities has been taken in to account in CCG planning & decision making The duty must be exercised with rigour & an open mind and should not materialise as an afterthought in the process of reaching a decision.

31 Midlands and Lancashire CSU Health inequalities improvements focus on local protected groups  Short on-line film: An inclusive patient journey (9 mins)An inclusive patient journey public-sector-equality-duty/essential-information/an-inclusive-patient-journey-short- film/articles/an-inclusive-patient-journey-short-film  Indirect links & correlations – how much do you know about PGs? (look at local demographics interactive quiz)

Thank you