Working Together with the Race Equality Guide Robert Mitchell North Central London Strategic Health Authority Ila Gocoldas Camden Primary Care Trust

NCL SHA Strategy  Provide Leadership  Develop the SHA as a model  Provide feedback and guidance  Keep race equality on the agenda  Support Networking

Racial Equality Network  RRAA + Race Equality Schemes  Refugees and Asylum Seekers  Language Support  Equalities training  Ethnic monitoring  Employment + recruitment  BME health & demographics  Sickle Cell & Thalassaemia

SHA Race Equality Guide 2004 To support NHS organisations:  Be systematic as they promote race equality and good race relations and reduce discrimination  Set realistic goals and milestones  Assess their own progress  Incorporate race equality into performance management arrangements  Keep the law

The Performance Framework  For performance management and self- assessment  Specific to race equality but complements other requirements e.g. in IWL  Three stages of development  Assess progress and prioritise action in each area  Include action in corporate plans and the next RES  Agree timescales for progress

The eight performance areas  Leadership and corporate commitment  Strategy and services  Patient and public involvement & consultation  Health  Workforce  Partnership  Finance & procurement  Information & communication technology

Recommendations from the review: Leadership & Performance  All NCL trusts engaged but many still have a long way to go  The SHA must continue to support networking to assist organisations in preparing robust second Race Equality Schemes for  Trusts asked to address issues identified through the review, demonstrate how their organisation will reach level three of the framework.  Performance review meetings following the publication of the NHS Staff Survey should ask how trusts interpret any differences in experience and perceptions related to staff ethnicity and outline the action they will be taking in response to any anomalies.

Recommendations from the review: Workforce  Existing patterns of disadvantage and discrimination experienced by many BME staff and communities are likely to continue without a concerted effort sustained over a number of years the  The SHA, through the work of its Workforce Development Directorate, is already encouraging positive action initiatives by trusts targeted at those black and minority ethnic communities that are under-represented in the workforce – particularly at senior levels. However, current positive action workforce initiatives in the sector are judged to be too small in scale to deliver significant progress.  NCL trusts should be challenged to increase the scale and impact of such initiatives. The WDD should facilitate shared approaches between trusts, partnerships with external bodies (e.g. Learning and Skills Councils) share information on those initiatives that have proved successful and encourage innovation.

Recommendations from the review: Health, Inequalities & Access  NCL trusts to be challenged to identify specific initiatives designed to ensure services are reaching and addressing the specific health issues/concerns of black and minority ethnic communities  Increased NHS involvement in Local Strategic Partnerships (trusts as well as PCTS) in order to link race equality initiatives with broader measures to tackle deprivation and disadvantage and health inequalities.  All trusts in the sector to have reached the 95% target figure set for the completeness of ethnic monitoring data of their patients in 2004/05.  Performance review meetings shift their focus to the use being made of ethnicity data - whether any anomalies related to race/ethnicity have been identified and if so how have these been investigated, and any action consulted upon or taken

Race Equality in the Mainstream  Race Equality Schemes provide an opportunity to get it right this time round  The NHS KSF & Improving Working Lives include Equality & Diversity  Choosing Health commitment to reducing health inequalities  Health & Social Care Standards include Equality and Diversity

Approach to promoting race equality in the PCT LEADERSHIP LINKS: policies & Joint working SUSTAINING CHANGES: cycle of planning

Approach to promoting race equality in a PCT Leadership : Internal (individual or group) External (e.g. SHA or the Healthcare Commission) Links and joint working : Race equality and NSF Race equality and The NHS Implementation Plan Race equality and nGMS Race equality and IWL Sustaining change:cycle of planning Planning & delivery e.g. LDP Commissioning and review e.g. SLAs Performance management/corporate & clinical governance Staff employment & development

Using Maslow’s Hierarchy-of-needs to motivate healthcare development Developing basics: interpreting, translation, diet, multi-faith facilities. Planning and providing targeted services for specific high prevalence diseases or conditions such as Diabetes, CHD. Developing other services: replicate and systematically transfer learning and good practice to generic services. The Guide is a very helpful tool. Growth: less need for targeted services; race equality being mainstreamed and integrated in planning, commissioning and performance management, & in functions (e. g. employment)

Structure we used for self assessment of progress Commissioning Public HealthServices Voluntary sector Nursing Primary Care RES Steering Group Training & DevelopmentHRCommunication User & Community InvolvementClinical Governance

Highlights Commitment of Steering Group members essential. The Guide and Framework: Provided legitimacy Put race equality on organisational map Provoked dialogue and discussion Was comprehensive and rigorous Self-assessment Process provoked further rethinking & resulted in: Health Equity audits of smoking cessation and podiatry Race equality embedded in annual work plan of clinical governance & clinical audit Review of uptake of clinical training and development opportunities Integration of equality questions in job interviews

In the context of today, what will help to further promote race equality? Performance Management discussions Race equality must be a regular agenda item e.g. appraisals, targets, SHA reviews Healthcare Commission 68 (approx) proposed prompts to assess equality & human rights Link these to the ‘Guide-Performance Framework’