Next Steps for Improving Equality Across Healthcare Ruth Passman Deputy Director, Equality and Health Inequalities June 2014

NHS England Strategic Priorities - Context Set within the context of the Equality Act 2010 and the Health and Social Care Act 2012 Reflective of the NHS Constitution values and pledges Approved by NHS England Board, December 2013 The 9 strategic priorities reflect the different roles of NHS England:  NHS England’s role as a system leader  NHS England as a commissioner  NHS England as an employer of ~6500 staff - Equality, Diversity and Inclusion in the workplace strategy 2

What are the priorities? As a system leader, re-launch and support the Equality and Diversity Council Support NHS Organisations to improve equality performance and meet the public sector Equality Duty (EDS2 implementation) Robust Data to measure equality and health inequalities, determine priorities and drive improvement Creating an NHS Workforce and leadership that is reflective of the communities we serve and that are free from discrimination Resource allocation supports duties around inequalities 3

The Strategic Priorities (cont’d) Incentivise and prioritise improvements in primary care towards communities and groups who experience inequalities in healthcare and outcomes Embed equality and tackling health inequalities into CCG assurance regime Remove derogations which permit geographic variations in care standards Support the reduction of mental illness inequalities through the parity of esteem programme Programme Board for Equality and Health Inequalities under development 4

Equality and Diversity Council Formed in 2009, with members from DH, NHS and other partner organisations NHS reforms and transition – transferred to NHS England and refreshed Scope covers equality and tackling health inequalities Chaired by the CEO of NHS England with diverse membership from system leaders, NHS, patient representation, staff and staff side, local authority, academia, think tanks, community and voluntary sector Values and principles of the NHS Constitution – NHS Values Summits an enabler for meaningful engagement

EDC work priorities 1.Equality Delivery System – EDS2 Supporting implementation and effective use 2.System alignment Embedding equality and tackling health inequalities within the key policy levers for the NHS 3.Leadership and workforce Values based recruitment / talent management 4.Data measurement Equality and health inequality monitoring / disaggregation 5.Communications

Equality Delivery System for the NHS Organisations analyse and grade their equality performance against 18 EDS outcomes grouped into 4 EDS goals:  Better health outcomes for all  Improved patient access and experience  Representative and supportive workforce  Inclusive leadership

System data to measure equality and health inequalities Expand and improve data available to measure equality and health inequalities A National Equality and Health Inequalities data group is being established to determine data collection, monitoring and dissemination requirements and drive delivery within NHS England and the wider system

Workforce Equality Issues: Leadership Diversity The lack of diversity in boardrooms needs addressing as a priority in order to bring the best resources to leadership, culture, innovation, ethics and behaviour; In 2012, just 1% of NHS chief executives came from a BME background, whilst there was just one non-white face in the 2012 Health Service Journal list of the one hundred most influential people in healthcare; A snapshot of CCG leadership on governing bodies shows that 12% are from BME, and 37% are women. However this masks significant variation, with over 40 CCGs without any female GP leadership on their governing bodies. 9

BME Staff engagement and satisfaction An established link between the treatment of BME staff and the care patients receive; “Research suggests that the experience of black and minority ethnic (BME) NHS staff is a good barometer of the climate of respect and care for all within the NHS” “Put simply, if BME staff feel engaged, motivated, valued and part of a team with a sense of belonging, patients were more likely to be satisfied with the service they received” NHS Staff Survey and Related Data West, M et al,(2012) 10

NHS Staff survey data and ethnicity The 2011 NHS Staff Survey found that harassment, bullying or abuse was experienced more by Black staff (25% rising to 26%) and for mixed race staff in acute trusts than by white British staff (13%) NHS Health and Wellbeing, Benefit Evaluation Model, 2008 The 2012 NHS Staff Survey found bullying and harassment (including that linked to a ‘protected characteristic’ in equality law) from colleagues and managers was reported by 24% of staff, a much higher level than that reported outside the NHS 11

…Workforce representation Link between representative workforce and better health outcomes for patients is well-known Under-representation of BME staff at senior and leadership levels within NHS organisations exists This is a priority area for the EDC going forward – Simon Stevens speech at Kings Fund Leadership event in May EDC-led ‘expert group’ to produce strategic approach for July EDC meeting Commitment to make a meaningful and sustainable difference on this issue 12

Next steps… NHS England has: Published EDS2 on its website from 4 November 2013 Agreed shared governance with Equality and Diversity Council Continued to play in the NTDA, CQC, HEE, Monitor, community voluntary sector, and NHS colleagues Developments underway: Embedding equality within key policy levers Equality Hub and the EDS Dashboard

Embedding equality within key policy levers CCG Assurance Framework – building upon equality (EDS uptake) lines that featured in CCG authorisation CQC inspection regime – building upon existing collaborative work with CQC (Essential Standards) and ensuring that inspectors are equipped to identify equality performance evidence Corporate Governance Statement – mandated annual response from NHS organisations (work just beginning on this) NHS England14

Equality Hub and the EDS Dashboard Tools, guidance, good practice examples, news and events, links and contacts, interactive communication – all located in one online ‘hub’ Proposal to host a national EDS Dashboard on the ‘hub’ Dashboard to facilitate sharing of good EDS implementation across the country and ascertain EDS uptake levels across the NHS NHS England15

Finally…people not processes Keep the EDS under review so that it is a force for good High quality care for all, now and for future generations Values and principles of the NHS Constitution: ‘making sure everyone counts’ ‘Flexing’ our services and arrangements to meet needs