(Big) Health & (In)Equality Shakirah Ullah Diversity & Access Coordinator January 20 th, 2011

Introduction Greater Manchester Voluntary Sector Support –Diversity Steering Group –Equalities and Human Rights Parliament –Pan equality / human rights-based approach to inequality GMCVO –3 core values: Locality, Equality and Collaboration –Predisposed towards people / communities who are disadvantaged –Equal treatment / equal worth

Changing landscape… Health inequalities –Marmot review: Fair Society, Healthy Lives –National Equality Panel: An Anatomy of Economic Inequality in the UK –The Spirit Level: Why More Equal Societies Almost Always Do Better Restructuring the NHS –Radical shift: regulated industry (Ofhealth / Ofsick…?) –Secretary of State “no powers to intervene” –Health providers to stand or fall on their own –Wider implications of this Will ‘non-profitable’ services continue to be delivered?

Equality Law Specific Duties – anti-discrimination legislation –Race Relations (Amendment) Act –Gender Equality Duty (GED) –Disability Discrimination Act All had strong specific duties - (EqIA) & duty to consult, etc. Southall Black Sisters (SBS) –Used the RRA to challenge Ealing local authority

Equality Act 2010 October 2010 –90% provisions enacted –9 ‘protected characteristics’ + Carers Extending discrimination law –Direct, Indirect, Associative, Discrimination by perception, Harassment, Harassment by 3 rd party, Victimization Disability duty –Extends discrimination grounds –Extends ‘reasonable’ adjustments

Equality Act 2010 General Duties –Public authorities must have ‘due regard’ for: Elimination of unlawful discrimination, harassment, victimisation Advancement of equality of opportunity between people from different groups Foster good relations between people from different groups Specific Duties –April 6, 2011 – Schedule 19 Race, Disability and Gender specific duties rescinded Underpins the general duties (framework) / help to meet GD Requires SMART ‘equality objectives’ Publication of information (July 31, 2011) to show how the general duties have been met – ‘transparency’ EqIAs will stay but not a legal requirement

EA - Continued Procurement –£220 billion + pa –Extended ‘equality’ considerations Sub-contracted organisations would / might be required to meet equality obligations set out in the GD dependant on the ‘service’ –But no additional ‘duties’ – ‘light touch’ / reducing the burden Enforcement –Equality & Human Rights Commission Assessing compliance Enforcing general and specific duties Can apply for compliance orders / judicial review –EHRC or group of ‘people with an interest’

Public Law –Set of principles that public bodies must adhere to when making & communicating decisions Public bodies MUST act fairly, lawfully, reasonably (maladministration) –Southall Black Sisters RRA ‘specific duties’ & Public Law –Interim remedy / injunction If challenged a PA cannot withdraw or stop funding until the matter is resolved – no loss in service Can also be used to challenge PAs over ‘value for money’ (Thurrock VCS)

Human Rights Act 1998 European Convention on Human Rights –Political and civil rights –UK HRA ‘enshrines’ the ECHR in domestic law Public authorities must respect Convention rights –Must act compatibly with Convention rights unless statutory provision prevents it –Human Rights must be part of all policy making –Provide a benchmark (in theory…) PAs must have human rights principles in mind when making decisions British Institute of Human Rights:

What are the challenges? Assumptions: –Individual self-sustainability – ‘empowered communities’ –Existing health inequalities Tesco-isation of service delivery –‘pile ‘em high, sell ‘em cheap’ –Generic services / cessation of specialist services Responsibility and accountability –Transparency agenda – one form of accountability –Where does the buck stop? Prime contractor models –Specialist providers left with ‘crumbs’ but opportunity for ‘niche’ services –Merlin standard – fair shares policy

Q1: what are the challenges faced by? Commissioners –Understanding (EA duties) –Pressure to get services right – general duties –Avoiding challenges – Equality Act / Public Law –Saving money Service Providers –Strict criteria in place –Capacity for small providers to compete in a competitive market –Mission drift for voluntary organisations / collaboration (good and bad) Service users –Unmet needs –Inequity / ‘fairness’ – voice and influence : what about the ‘poor, powerless & marginalised’?

Q. 2: Procurement: How do we ensure equality needs are met? How will this address equality in real terms? –How much will ‘fairness’ overshadow equality? How can we ensure that procurement ‘enshrines’ equality & diversity? –Anti-discrimination law – ‘superficial’: How can an equality culture be established? –What about diversity? Co-design / co-production –Role of the voluntary sector reaching the so-called ‘hard to reach’ –How can the co-design /production model be best promoted? –What should the specification look like?

Shakirah Ullah Diversity & Access Coordinator Phone: