Annual Public Sector Equality Duty Data Publication

Annual Public Sector Equality Duty Data Publication

Annual Public Sector Equality Duty Data Publication

31 Jan 2014

Contents Page

  1. Introduction 2
  2. Trafford Borough 2
  3. Health and the Trafford Population 3
  1. Commissioner Landscape 4
  1. Equality Data 8
  2. Equality Act 2010 8
  3. Public Sector Duty 9
  1. Human Rights 10
  1. What this means for health care commissioning 11
  1. EDHR Achievements. 12
  2. Equality Objectives Working 13
  1. Trafford Provider Equality Monitoring Data Schedule Returns 18
  2. Central Manchester University Hospital NHS Foundation Trust ( Acute Provider) 19
  3. University Hospital South Manchester NHS FT( Acute Provider) 26
  4. Greater Manchester West Mental Health NHS FT (Mental Health Provider) 32

d.Pennine Care NHS FT Trafford Division (Community Services Provider) 37

  1. TCCG Work Force Profile 45
  2. Conclusion 48

  1. Introduction

This document is the first annual public sector duty report for Trafford Clinical Commissioning Group(TCCG) . It has been complied by Greater Manchester Commissioning Support Unit to provide an overview of Equality Diversity and Human Rights work that has contributed and supported the delivery of continuous improvement required by the Equality Act 2010. Trafford Clinical Commissioning Group is a new NHS organisation, which was formed on 1st April 2013 when PCTs were abolished in England. Clinical Commissioning Groups took over some of the commissioning responsibilities from the former PCTs. TCCG buys, or commissions, health services for the people of Trafford and is responsible for making sure that people have the health services they need, that the services are safe and deliver high quality care. This is delivered within the budget allocated to us by a government agency called NHS England while making sure we take into account the different needs of all our diverse communities. At TCCG we are passionate about Equality Diversity and Human Rights andthis is fully embeddedin our values and ways of working. As commissioners of health services we aim to meet the health needs of our ever changing community whilst ensuring we consider and remove potential barriers and inequities faced by vulnerable groups.

  1. Trafford Borough

Trafford was conceived as a metropolitan borough of Greater Manchester in 1974, with parts of its area bordering Manchester city centre and neighbouring Salford. Like the rest of the UK, Trafford’s population is growing and ageing. The resident population of Trafford is 230,000. Trafford is an area of 40 square miles, made up of 21 electoral wards, 63 councillors (3 members per ward) and has a population of broadly:

  • 49% of the population are male and 51% are female
  • 21.7% of the population are over 60
  • 19.6% of the population are from Black and Minority Ethnic groups
  • 7.2% of the population were born outside of the European Union
  • In 2001 the average life expectancy was 76.4 years for males and 80.3 years for females. Between 2008-2010 the average life expectancy increased to 79.2 for males and 83.4 for females

The borough has disparate socio-economic factors with some of the most affluent areas of the country situated alongside areas that are in the worst 5% nationally for deprivation. The population residing within Trafford’s boundaries is diverse, varying from areas of high deprivation in the north to areas of relative affluence in the south.

  1. Health and the Trafford Population

The registered population of Trafford is 236,000. This represents all patients registered with a Trafford GP practice regardless of where they reside. The resident population of Trafford is 230,000. This represents all residents of Trafford regardless of who their GP practice is. The borough also has 37 GP practices, 33 dental practices, 62 pharmacies and 30 opticians.The number of households in Trafford is 94,500. 51% of Trafford residents consider their health to be “Very Good”.

Life expectancy in these areas varies greatly. A major challenge for improving the health of the borough lies in tackling the 80% of deaths in Trafford which are as a result of three types of disease: cardio-vascular disease (CVD), cancer and respiratory disease. This trend is consistent throughout the Trafford population and mortality rates for these disease areas are consistently above the national average.

Overall, the health of Trafford is better, or similar to, the national average. This ‘average’ picture however, can be misleading, particularly in Trafford when there are many lifestyle inequalities in relation to deprivation, gender and ethnicity. People in the more deprived parts of the borough live shorter lives than those in the more affluent areas – as much as eleven years less for men and six years less for women, as indicated in the 2011 Health Profile for Trafford. Also, those with mental health problems and learning disabilities suffer much poorer physical health than the rest of the population. Importantly, there is a widely acknowledged recognition that healthcare costs relating to mental health are likely to double over the next 20 years.

In addition, life expectancy is increasing in men and women, although people are still dying earlier than necessary. Some specific health indicators in Trafford are significantly worse than the national average, including deaths caused by smoking, binge drinking in adults and the number of physically inactive children. The most economically and socially deprived neighbourhoods in Trafford have the greatest levels of health deprivation, with the worst being north of the borough within the ward of Clifford but also within pockets of Bucklow St-Martins and St Mary’s.

4.Commissioner Landscape

Trafford is unusual in that its patients have access to multiple providers within the economy, rather than the usual 1:1 relationship between commissioners and providers. In health, the population of Trafford have choice in providers but the flow of patients is also influenced as to the location of where they live. Patients in South Trafford predominantly go to University Hospital of South Manchester (UHSM). Patients in the North access Central Manchester Foundation Trust (CMFT) both on their main site and the Trafford General Hospital (TGH) site. The TGH site is being developed in line with theTrafford New Health Deal.Trafford has developed an integrated care model which will continue to offer patients choice but the model will have a great emphasis on primary and community care; intervention and support.

Within Trafford there are three significant healthcare / hospital sites:

  • Trafford General -where accident and emergency was based which now has a new Urgent Care Centre
  • Altrincham General - which has a minor injuries unit (new build)
  • Stretford Memorial - which has outpatient services and a in-patient rehabilitation unit (new build)

A large proportion of residents from the borough also receive care and treatment from the larger acute hospitals just over our borders at Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children’s Hospital, University Hospital of South Manchester NHS Foundation Trust and Salford Royal NHS Foundation Trust, as well as specialist care from The Christie NHS Foundation Trust and others.

Table 1: 2012-13 Activity by Provider (Trafford registered population) - Hospital Spells

Provider / Spells / % of Total
Central Manchester (Trafford Site) / 22,187 / 31%
Central Manchester (Other Sites) / 16,324 / 23%
University Hospital of South Manchester / 24,166 / 33%
Salford Royal / 5,439 / 8%
Christie / 1,247 / 2%
GMW Mental Health / 486 / 1%
Pennine Acute / 307 / <1%
Stockport / 237 / <1%
All Other providers / 1747 / 2%
Total / 72,140

Community Services

Following Transforming Community Services, Trafford Primary Care Trust’s (PCT) decision was to not vertically integrate the Trafford Community Services with an acute trust, but rather to undertake a comprehensive procurement of all community services. Following completion of this process and contract award, from 1st April 2013, Pennine Care NHS Foundation Trust is responsible for the delivery of the majority of Trafford’s community services; which have remained together as a Trafford Division within the Pennine Care organisation. Pennine Care also has experience of providing community services to other sectors within Greater Manchester.

Mental Health

Trafford has over the past 7 years designed, developed and delivered an innovative approach to integrated care in mental health. Commissioning and provider organisations are now collaborating to provide integrated physical and mental health provision which spans historical organisational boundaries, whilst maximising the potential of joint working between secondary, primary and social care.The focus of the approach is to improve patient’s mental and physical health, continuing the reduced reliance on secondary and inpatient care where unnecessary and promoting primary and self-care.

Across the national mental health performance priorities, delivery of Improving Access to Psychological Therapies (IAPT) continues to be a challenge with increasing rises in referrals for both low and high intensity talking therapies support. However, the significant improvement in both access and recovery rates over the past 2 years suggest that further improvement is possible in terms of positive outcomes in terms of the defined national indicators such as provision of service against local prevalence rates for common mental health problems.

The impact of more people living into very old age has huge implications for mental health services in Trafford. As people get older, the likelihood of developing dementia increases. Local figures would seem to indicate that Trafford reflects the national situation, in that there are currently high numbers of people with dementia with unmet needs and remaining undiagnosed. Of those diagnosed, most people with dementia live at home, supported by neighbours, communities and mainstream services. Also, dementia patients are disproportionately represented in acute and residential care settings. One in four adult hospital beds is occupied by a patient with dementia. Two thirds of people with dementia live in the community. Two-thirds of all people living in care homes have a form of dementia, and the remaining third live in care homes and are usually at a more advanced stage of the illness.

As part of the systematic and integrated care strategy developments initiated in Trafford in line with the Health and Well Being Strategy, we expect to clearly improve the experience and outcomes for those with and without mental health problems (and their carers) and would also reduce emergency admissions, re-admissions and length of stay, especially in over 65s, and delay or reduce admissions into residential care through the RAID programme.

The majority of mental health issues are dealt with and managed at primary care level, by GPs, who respond with a range of strategies to deal with the 90% of common mental health problems such as anxiety, depression and post-traumatic stress reactions.

A comprehensive range of specialist Community Mental Health Services are commissioned in line with the responsible commissioner guidance whereby for the majority of those registered with Trafford GPs who reside in Trafford – services are commissioned from Greater Manchester West NHS Foundation Trust (currently the best performing Mental Health trust in the North of England) and for those resident in Manchester from Manchester Mental Health and Community NHS Trust, and where necessary additional services are secured from other specialist service providers in the North West (e.g. Learning Disability and Community Eating Disorders services are commissioned from Cheshire and Wirral Partnership NHS Foundation Trust).

Trafford patients are alsoable to access a wide range of support from jointly commissioned health and social care services targeting common mental health difficulties through a number of third sector organisations (including BlueSCI, Self Help Services, Age UK, Carers Centre, 42nd Street, Relate and Trafford Rape Crisis). These are important partnerships that enable preventative and effective support for a range of difficulties (such as coping with depression, anxiety management, alcohol and substance misuse problems, enhancing self esteem, stress management, assertiveness development, anger management, obesity, coping with loss and bereavement, managing pain and carer support programmes) and work to reduce stigma and strengthen the emotional health and well being of the Trafford population.

  1. Equality Data

The equality data included within this report refers largely to secondary care equality data from TCCG main providers of acute, community and mental health providers of Trafford health care services. The evidence represents a snap shot of data that has been scrutinised to provide assurance to TCCG of providers legal compliance with the Equality Act 2010 public sector equality duties and provider performance against the contractual equality requirements . TCCG have included a detailed equality monitoring schedule within all its major provider contracts. The monitoring schedule is used to regularly assess provider performance against the requirements of the Equality Act 2010 and forms a significant part of the reporting within this document. Each of the main providers have the responsibility to produce an annual public sector duty annual report, which will have additional information found on each of the providers web sites under each organisations own annual publication by the 31st January 2014.

TCCG is no longer responsible for the reporting of primary care data e.g. GP Practice patient data summary reporting. Most of primary care equality diversity and human rights (EDHR) legal assurance reporting is now under the responsibility of NHS England following the April 2013 re-structure of NHS services.

  1. Equality Act 2010

The Equality Act (2010) is the UK’s discrimination law, which protects individuals from unfair treatment and promotes a fairer and equal society. It protects people from discrimination, harassment and victimisation in work, education and when accessing services like healthcare.

The Equality Act protects anyone who falls into a ‘protected characteristic’.

  • age,
  • disability,
  • gender reassignment,
  • marriage and civil partnership,
  • pregnancy and maternity
  • race,
  • religion or belief,
  • sex,
  • sexual orientation
  1. The Public Sector Duty

The General Duty ensures that Public Bodies such as TCCG in the exercise of their functions, have due regard to the need to:

  • Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.(This involves removing or minimising disadvantages suffered by people due to their protected characteristics.)
  • Advance equality of opportunity between people who share a protected characteristic and those who do not. ( Which involvesmeeting the needs of people with protected characteristics andencourage people with protected characteristics to participate in public life or in other activities where their participation is low.)
  • Foster good relations between people who share a protected characteristic and those who do not.(Involves tackling prejudice and promoting understanding between people who share a protected characteristic and others.)

The Specific Duties

In addition to the general duties, public sector organisations have specific duties to fulfil which are legal requirements that ensure the delivery of the general duty. Under the DoH revised timeframes for reporting of these duties CCGs are required to publish in a manner that is accessible to the public the following:

  • Information to demonstrate its compliance with the public sector Equality Duty at least annually, starting by 31 January 2014. This information must include, in particular, information relating to people who share a protected characteristic who are its employees – (public authorities with fewer than 150 employees are exempt) and people affected by its policies and practices.
  • Equality objectives at least every four years starting by 13 October 2013. All such objectives must be specific and measurable.

Having due regardmeans consciously thinking about the three aims of the Equality Duty as part of the process of decision-making. This means that consideration of equality issues must influence the decisions reached by public bodies for example how they act as employers; how they develop, evaluate and review policy; how they design, deliver and evaluate services, and how they commission and procure from others.

  1. Human Rights

TCCG is fully committed to working with members of the public, patients, carers and partners to build a culture through which we treat everyone with fairness, respect, equality and dignity, and respect their autonomy (the FREDA principles).

We ensure that our Human Resources policies including recruitment policies, exit interviews and restructures are fair and transparent and take account of reasonable adjustments, engagement with staff and any adverse impacts upon local protected groups resulting from key changes or reviews. We also regularly review complaints/PALS issues, patient stories and Serious Untoward Interviews to ensure that no breaches of Human rights have occurred; we also ensure that these are scrutinised for discrimination by protected characteristic (including violent discrimination or hate crime) and that we have procedures in place to record and report such discrimination through our quality governance structures. Human Rights will be an additional reporting requirements which has been built into the commissioning intentions of the CCG. We will be focusing on improving Human Rights working and reporting in 2014.

  1. What this means for health care commissioning

We aim to commission services that give all our vulnerable groups the same opportunities to access healthcare as the general population and to have the same health outcomes. This means that we pay due regard to:

  • Reducing inequalities in health outcomes and experience between patients. We do this by planning our strategic aims and working in partnership with Trafford Council, our health care providers and others to address the needs of vulnerable groups as shown in the JSNA.
  • Removing any barriers or inequalities faced by more vulnerable protected groups in accessing healthcare.
  • Removing or minimising disadvantages suffered by people due to their protected characteristics.
  • Encouraging people who are less likely to access our services to use them
  • Promoting the involvement of patients and their carers in decisions about provision of the health services to them
  • Enabling patients to make choices with respect to aspects of health services provided to them

The need to make “reasonable adjustments” is an anticipatory duty – in other words, we need to find out what the barriers for protected groups might be in advance (as far as possible) and put arrangements in place to remove them. One way of doing this is by Equality Analysis delivered by both members of TCCG staff and through GM CSU commissioned services.

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