1. Diversity Counts! Tools for tackling ethnic inequalities in health Diversity Counts! Tackling ethnic differentials in Health Implementing the Race Relations (Amendment) Act Robert Mitchell Associate Director, Equalities and Health Improvement North Central London Strategic Health Authority

2. Diversity Counts! Tools for tackling ethnic inequalities in health THE GENERAL DUTY What it requires n Listed public authorities in carrying out their functions shall have due regard to the need to: –eliminate unlawful racial discrimination –promote equality of opportunity –promote good race relations between people of different racial groups What it means n A proactive approach - mainstreaming n Due regard n Weight proportionate to relevance to a particular function n Consider and balance all three parts of the general duty n Series of specific duties n Specific duties are the steps that will help deliver the General Duty n When you tackle a specific duty you must link back to the general duty

3. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES: PREPARE AND PUBLISH A RACE EQUALITY SCHEME (RES) What it Requires n Prepare and publish a Race Equality Scheme n The RES to set out how they will meet their obligations under the general and specific duties Good Practice n Cover how authority will meet the general and each specific duty n Set out values, principles and standards n Action points and timescales n Other relevant measures e.g. aims, targets, indicators, positive action n Other relevant requirements e.g. equalities performance indicators n Provision for community consultation n Arrangements to ensure awareness amongst staff n Relation of RES to other/strategies n Timetable for review of the scheme

4. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES: ASSESS FUNCTIONS AND POLICIES FOR RELEVANCE What it requires n Assess functions and policies for relevance to the general duty, and carry out subsequent reviews Good Practice n Identify assessment method and conduct assessment n Determine degree of relevance of functions and policies n Use results to prioritise issues to receive attention n Mainstream Race Equality in prioritised functions n Cover all functions in time n Undertake subsequent review within 3 years

5. Diversity Counts! Tools for tackling ethnic inequalities in health What it Requires n Set out arrangements for monitoring for any adverse impact on the promotion of race equality of its policies. Good Practice n Establish monitoring systems - methods n Monitor effect on different groups n Identify any differences n Assess whether differences constitute an adverse impact n Investigate causes - reasons n If any causes constitute unjustifiable discrimination, then policy may need to be considered for revision SPECIFIC DUTIES: ARRANGEMENTS FOR MONITORING THE IMPACT OF ITS POLICIES

6. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES: ARRANGEMENTS FOR ASSESSING AND CONSULTING ON PROPOSED POLICIES What it requires n Set out arrangements for assessing and consulting on the impact on the promotion of race equality of policies they are proposing to adopt Practice n Establish assessment methods n Establish consultation methods involving relevant stakeholders n Analyse data and results n Produce impact assessment statement - include how intend to proceed and monitoring of policy in practice n Establish a procedure for revising proposed policies in light of assessment and consultation

7. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES - ARRANGEMENTS FOR PUBLISHING ASSESSMENT, CONSULTATION AND MONITORING RESULTS What it requires n Set out arrangements for publishing results of assessments, consultations and monitoring for any adverse impact on the promotion of race equality of policies. Good Practice n Publication increases transparency, demonstrates commitment and should increase confidence n Specific report to be made on each assessment, consultation and monitoring exercise n Summaries of results should be widely available. n Consider using existing publications/methods

8. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES: ARRANGEMENTS TO ENSURE ACCESS TO INFORMATION AND SERVICES (1) What it requires n Set out arrangements for ensuring public access to information and services which it provides Good Practice Information 1. Identify information needs of ethnic minorities 2. Monitor patterns of use 3. Identify and remove barriers to access to information 4. Alter the way information is provided

9. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES: ACCESS TO INFORMATION AND SERVICES (2) Access to services 1. Consultation on delivery styles 2. Ensure accessible and community locations 3. Conduct community outreach 4. Provide staff training 5. Address e enablement in e government, 6. Interpretation and translation service 7. Staff profile 8. Positive Action, Section 35

10. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES : ARRANGEMENTS FOR TRAINING STAFF ON RELEVANT ISSUES What it requires n Set out arrangements for training staff on issues relevant to the general and specific duties to promote Race Equality Good Practice n A specific focus - delegated staff to have ability to carry out specific tasks to ensure meet the general duty n Identify key tasks n Identify knowledge and skills required n Assess extent to which staff have knowledge and skills n Identify any gaps n Design, and deliver training n Monitor and evaluate training

11. Diversity Counts! Tools for tackling ethnic inequalities in health SPECIFIC DUTIES IN EMPLOYMENT What it requires 1.Arrangements in place to ethnically monitor staff in post and applicants for jobs, promotion and training 2. Ethnically monitor and analyse grievances, disciplinary action, performance appraisal, training and dismissals and other reasons for leaving (150 or more staff) 3. Publish results annually Good Practice n Establish ethnic monitoring systems n Integrate with personnel information system n Analyse data for patterns of inequality n Where unjustifiable patterns revealed, take action n Taking Action enables compliance with the general duty n Produce annual results

12. Diversity Counts! Tools for tackling ethnic inequalities in health THE LOCAL CONTEXT IN APRIL 2002 n Major Structural and Personnel Changes n London Ethnicity and Health Project n Joint CRE/DOH Race Equality & Health Project n Commitment of SHA Chair and Chief Executive n Substantial, but rarely evaluated, past work on race and health issues led by old Health Authorities n Need to facilitate continuity and ensure consistency n Need to apply learning from the past and share best practice across organisations n Need to ensure all NHS organisations respond to the new RRAA legislation n Need to integrate Race Equality into broader change strategies for the NHS

13. Diversity Counts! Tools for tackling ethnic inequalities in health FACILITATING ACTION 2002/03 n Publication of SHA Race Equality Scheme n Prompting of NHS Trusts to produce RESs n Inauguration of NCL NHS Racial Equality Network n Independent Review of London NHS Race Equality Schemes commissioned & published n NCL Trust Race Equality Leads Group Established n Evaluation of “Achieving Equality – Respecting Diversity” (Enfield & Haringey strategy) published n London targets set for improving NHS trust ethnic monitoring coverage and its extension into Primary Care, Outpatients and A&E n Incorporating Race Equality into NCL NHS Planning processes for 2003/06

14. Diversity Counts! Tools for tackling ethnic inequalities in health NCL RACIAL EQUALITY NETWORK SHARING BEST PRACTICE ON: n Developing a compliant Race Equality Scheme n Black and Minority Ethnic Health Inequalities n Refugees and Asylum seekers n Language and Advocacy Services n Positive Action for black and minority ethnic employees n Encouraging BME communities to work for the NHS n Training on Racism Awareness and Cultural Diversity n Training on improving ethnic coding data

15. Diversity Counts! Tools for tackling ethnic inequalities in health SHA/WDC PRIORITIES FOR 2003/04 n RES Annual progress report published n New corporate policies adopted plus IWL/IIP accreditation, induction training & positive action n SHA/WDC RES revised and updated n SHA/WDC Equalities Group established n Performance management framework developed n Review of NCL Trust annual reports n Ethnic monitoring progress n Ethnic data utilised to inform decisions/planning/action n Workforce initiatives n Black and minority ethnic health initiatives

16. Diversity Counts! Tools for tackling ethnic inequalities in health WHAT INEQUALITIES? n Average life expectancy n Cancer n Care of elderly n Child protection n Coronary Heart Disease n Dental caries n Diabetes, Type 2 n Haemoglobinopathies n HIV/AIDS n Infant mortality rate

17. Diversity Counts! Tools for tackling ethnic inequalities in health WHAT INEQUALITIES? n Long term limiting illness / disability n Maternal and Child Health n Mental health n Renal health n Smoking n Social deprivation n Stroke n Substance misuse n Teenage pregnancy & conception n Tuberculosis

18. Diversity Counts! Tools for tackling ethnic inequalities in health WHAT INEQUALITIES? n Breakfast clubs n Breast screening services n Cervical screening services n Dental services (general) n Food n General health services n Health promotion, health development & leisure services n Language services n Linkworker / Advocacy / Community development / Outreach n Primary care n Sexual health promotion n Specialised health services

19. Diversity Counts! Tools for tackling ethnic inequalities in health RRAA - A TOOL FOR TACKLING ETHNIC INEQUALITIES IN HEALTH? n Make ethnicity data as complete, accurate and sensitive as possible and track changes over time n Analyse the data to profile how different ethnic groups are using or not using services n Investigate anomalies and seek explanations n Undertake further investigation and/or consultation to confirm or refute hypotheses n Identify possible remedies n Make changes to mainstream services or introduce targeted initiatives n Monitor impact

20. Diversity Counts! Tools for tackling ethnic inequalities in health SOME PRACTICAL PROBLEMS n Overcoming fear, ignorance and resistance from staff and some users n Defending positive action n Those collecting the data not using the data n Competing priorities n Identifying the time and resources n Skills and knowledge deficits n Sustaining the effort long enough to change the culture n Population mobility n Extent of diversity

21. Diversity Counts! Tools for tackling ethnic inequalities in health SOME SOLUTIONS n Top level and corporate commitment n A Race Equality Scheme which is strategic and action orientated n Invest in high quality staff training n Develop and utilise in-house expertise n Clinical, managerial, board and community champions for equalities issues n Integrate race equality objectives into other NHS change programmes n Form partnerships with other organisations n Provide feedback and acknowledge success as well as highlighting failure

22. Diversity Counts! Tools for tackling ethnic inequalities in health CONTACT DETAILS North Central London Strategic Health Authority Website address: www.nclha.nhs.uk Robert Mitchell’s E-mail address: robert.mitchell@nclha.nhs.uk