January 2015

Annual Equality Data Publication

Trafford CCG

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CONTENTS PAGE 1.0 Executive Summary 3 2.0 Introduction 4 3.0 What is ‘due regard’? 5 4.0 Trafford local context 6 4.1 Public Health 8 4.2 Local protected characteristic groups and health inequalities 10 5.0 Compliance with Equality Legislation and the Public Sector 11 Equality Duty – legal obligations 6.0 4 year (delivery of) Equality Objectives 12 6.1 Outcomes from our Equality Objectives 14 7.0 What have we been doing to meet equality legislation 16 requirements? 8.0 Equality Delivery System – 17 NHS equality performance framework 9.0 Meeting statutory Human Rights requirements 19 10.0 Engagement in action with local people 20 10.1 Appendix 1: 28 List of community groups and organisations CCG engage with 11.0 Monitoring Equality Outcomes with our providers 31 12.0 Governance arrangements for equality diversity and human 32 rights 13.0 Way forward 32 14.0 Conclusions and Recommendations 34 15.0 Equalities 36 Tables Page 1 Ethnicity estimate (%) 6 2 Aims of the Public Sector Equality Duty 11 3 EDS(2) Grading explanation 17 4 EDS Goal 4: Inclusive Leadership at all levels – 18 summary of grading June 2014

Separate Appendices Page 1 Provider perspective of service delivery 1 2 Key Health Inequalities and Demographic Profiles by 2 Protected Groups for Trafford 3 Sexual Orientation Trafford 20

1 Executive Summary

This is the Clinical Commissioning Group’s (CCG’s) second Annual Equality Data Publication. It shows Trafford CCG’s commitment to promoting equality and reducing health inequalities, and sets out the way in which the CCG fulfils its responsibilities arising from the Equality Act 2010. This Act requires public bodies to publish relevant, proportionate information showing compliance with the Equality Duty on or before 31 January each year.

This information includes overviews of the CCG’s aims, and of Trafford’s diverse population and health challenges. It sets out the legal responsibilities of the CCG in demonstrating ‘due regard’ to the public sector equality duty’s three aims and will provide evidence for meeting the specific equality duty. It will set out the way in which the CCG strives to commission for inclusion. It shows progress on delivering the CCG’s Equality Objectives and explains how we monitor the equalities performance of our commissioned providers.

The CCG needs to be assured that the organisations that provide the services we commission can effectively collect and analyse data to improve service provision and give better health outcomes for vulnerable groups in Trafford. This report is best read in conjunction with the equivalent reports published by our providers, which also must be published by 31 January.

The report gives examples of work undertaken by the CCG to take account of the needs of our vulnerable communities, looks at the plans that we are making to improve the way we commission services and identifies future areas for development. It also shows the equality progress the CCG has made since our first Publication in January 2014.

The report will also show any significant equality data gaps we have identified. We aim to use our equality data for information and service improvements, and to deliver the equality objectives set out in our Equality Diversity and Human Rights Strategy 2014 to 2018.

2 Introduction

The annual Publication will set out how the CCG has been demonstrating ‘due regard’ to the public sector equality duty’s three aims and will provide evidence for meeting the specific equality duty, which requires all public sector organisations to publish their equality information annually. The report will also include Equality Objectives (including equality data) progress made during 2014 and since out first Publication in January 2014. In addition the Publication will set out what equality data we currently work with (mainly from provider partners and Public Health), any significant gaps in data and how they will be linked to our Equality Objectives and addressed during the coming year.

3 What is ‘due regard’?

Due regard means that the Clinical Commissioning Group has given advanced consideration to issues of equality and prohibited discrimination before making any strategy, programme, policy or ‘key healthcare change’ decision that may potentially impact negatively on local protected groups. That is a valuable requirement that is seen as an integral and important part of the mechanisms for ensuring the fulfilment of the aims of anti-discrimination legislation set out in the Equality Act 2010.

The CCG continues to work to show due regard to the aims of the Public Sector General Equality duty as set out in the Equality Act and as detailed below:

Eliminate unlawful discrimination, harassment and victimisation

Aims

Advance Foster good equality of relations opportunity between between different groups different groups

Through the adoption of the NHS Equality Delivery System the CCG aims to demonstrate to the people we serve how we are meeting the three aims of the Equality Duty.

Equality Analysis is a further key process used by CCG to evidence ‘due regard’ or consideration of the 9 protected groups in CCG’s planning and decision making around significant healthcare changes.

4 Trafford Local Context

Trafford is a Metropolitan borough in the North West region with a population of 226,578 (Census 2011). The area is made up of 21 wards. The ward with the largest population is Broadheath, representing 5.53% of the total resident population of the area, or 12,538 residents. The population density across Trafford is 21.40 persons per hectare. Within Trafford this varies from Clifford with the highest population density of 81.80 persons per hectare, and Bowdon with the lowest population density of 4.00 persons per hectare. The mean age of the population is 39 years. This compares with a mean age of 40 years for the North West region, and 39 years for England.

Healthy Life Expectancy

The life expectancy at birth for people living in Trafford is 79.4 years for males, and 83.5 years for females. This compares with the England life expectancy at birth for males at 78.3 years and 82.3 years for females for the same period (2006-10). Within Trafford, Bucklow-St Martins has the lowest life expectancy at birth for males at 75.1 years. Hale Central has the highest life expectancy at birth for males at 82.7 years. Urmston has the lowest life expectancy at birth for females at 80.9 years. Hale Barns has the highest life expectancy at birth for females at 88.8 years.

Ethnicity

14.5% of the population is from a black or minority ethnic (BME) population. This compares with a BME population of 9.8% for the North West region, and 14.6% for England.

Table 1: Ethnicity estimate Trafford (Source: 2011 Census)

Ethnicity % Trafford NW England White British 80.4 182200 6141069 42279236 White Irish 2.2 5098 64930 517001 White Other 2.8 6496 151570 2430010 White Gypsy 0.02 40 4147 54895 Traveller Mixed: White 1.2 2658 39204 415616 and Black Caribbean Mixed: White 0.3 669 18392 161550 and Black African Mixed: White 0.7 1535 30529 332708 and Asian Other Mixed 0.5 1169 22766 283005 Asian British 2.7 6306 107353 1395702 (Indian) Asian British 3.1 7027 189436 1112282 (Pakistani) Asian British 0.2 457 45897 436514 (Bangladeshi)

Other Asian 0.9 1951 46750 819402 Black British: 0.8 1807 59278 977741 African Black British: 1.6 3802 23131 591016 Caribbean Black British: 0.4 931 15460 277857 Other Chinese 1 2232 48049 379503 Other – Arab 0.5 1259 24528 220985 Other any other 0.4 941 19688 327433 ethnic group

The ethnic composition of the Trafford population is also changing, with the current Census (2011) showing that 14.5% of the population is from a black or minority ethnic (BME) population. This compares with a BME population of 9.8% for the North West region, and 14.6% for England.

4.1 Public Health

Health of local protected groups - Public Health actions

The nine characteristics protected by the Equality Act 2010 are as follows:

• Age • Disability • Gender re-assignment • Marriage and civil partnership • Pregnancy and maternity • Race including nationality and ethnic origin • Religion or belief • Gender • Sexual orientation

The following Public Health interventions have been undertaken in 2014/15 to improve the health or access to healthcare in these groups:

Age

Funding has been agreed from the public health grant for breastfeeding support work aiming to increase the uptake and continuation of breastfeeding.

As part of the National Child Measurement Programme all children are weighed in school during reception and year 6, and written results are sent to their parents or carers. Funding has been agreed from the public health grant for the provision of a specialist weight management service for children. Previously this has only been available for adults.

HENRY is a national initiative that provides training for health and early years practitioners who wish to develop their skills in supporting parents, carers and their children who are at risk of obesity. It combines prevention and targeted early intervention to tackle child obesity. A specialist young person’s sexual health clinic is provided.

Flu vaccination is offered to everyone aged 65 and over due to their increased risk of adverse outcomes from flu infection. All people aged 65 and over receive a written invitation from their GP to attend the surgery for a flu vaccination.

Wellbeing Wednesdays is a project in Sale West that addresses the 5 ways to wellbeing through a variety of activities for all ages. It is particularly well attended by older people on a regular basis. Improved outcomes have been achieved in respect of their fitness, core strength and mobility and have developed new skills, reduced isolation and enhanced emotional wellbeing.

Digging Sale is an intergenerational project in Sale Moor that encourages younger and older people to learn from one another and not only improves their fitness but addresses food poverty and healthy eating issues.

Disability

The national priority target group for uptake of flu vaccination this year people under 65 who at risk due to a long-term health condition. Vaccination for this group is available from pharmacies as well as from GP practices is order to give maximum flexibility to encourage uptake. Wellbeing Wednesdays is attended by a number of adults with Downs syndrome as part of their weekly programme. It is also attended by a number of older people with a variety of physical disabilities including mobility issues and those suffering from stroke or cancer.

Pregnancy and maternity

The young bumps project provides support for pregnant women under the age of 18 helping them prepare for parenthood and their future with education and support covering a range of topics; healthy eating diet, personal health and wellbeing, sexual health and contraception, education, training and employment, self-esteem and personal resilience, parenting skills and child development.

The Family Nurse Partnership is being implemented, taking referrals from December for young expectant parents to help them prepare for parenthood.

Race including nationality and ethnic origin

In Old Trafford mental health counselling is available for BME groups through Skype because it was found that the Old Trafford Asian community were more comfortable using Skype technology.

The specialist community services for domestic violence and abuse (currently being tendered) will be required to provide a specialist support for BME groups to address under-reporting by this group.

Gender (male / female)

The specialist community services for domestic violence and abuse (currently being tendered) will be required to provide a specialist support to males to address the under-reporting by this group.

A community engagement plan has been implemented to encourage uptake of cervical screening by women aged 25-64 years.

Sexual orientation

A campaign to increase awareness and encourage testing is being led by the Lesbian and Gay Foundation during HIV Awareness Week in November.

Public Health is about helping people to stay healthy, and protecting them from threats to their health. Trafford council wants everyone to be able to make healthier choices, regardless of their circumstances, and to minimise the risk and impact of illness.

4.2 Local protected characteristic groups and health inequalities

(Formerly known as Equality Target Groups, protected by previous equality legislation i.e. race, disability & gender)

1. Age 2. Gender (M/F) 3. Gender Reassignment (Trans) 4. Disability 5. Race 6. Religion or belief 7. Sexual orientation (LGB) 8. Marriage and civil partnership 9. Pregnancy maternity & breastfeeding mums  Carers *  Military veterans *

Note: * Good practice to include these groups as if protected groups when scrutinising for any adverse impacts from key healthcare changes e.g. within the Equality Analysis process.

See Section 15 ‘Equalities’ and Appendix 2 ‘Health Inequalities by protected groups’ for more information.

5 Compliance with Equality Legislation and the Public Sector Equality Duty

The CCG became the statutory organisation in relation to the Equality Act 2010 as of the 1st April 2013. During this time the CCG governing body and senior management team have worked with the Equality Diversity and Human Rights lead at North West Commissioning Support Unit (NWCSU) for the CCG to show ‘due regard’ to the aims of the Public Sector General Equality Duty included in the Equality Act as set out below:

Table 2: Aims of the Public Sector Equality Duty

Aim 1 Eliminate unlawful discrimination, harassment and victimisation Aim 2 Advance equality of opportunity between different groups Aim 3 Foster good relations between different groups

The CCG adopted the NHS Equality Delivery System version 2 as a performance framework to help the CCG demonstrate to the people of Trafford how it is meeting the three aims of the Equality Duty. The outcomes of the annual EDS public grading by local communities of interest can be found on page 13 of this Publication.

The Specific Equality Duty

The CCG has met the Specific Equality Duty by publishing equality information in accordance with section 149 of the Equality Act 2010, this information has included the CCGs performance against the four goals (over a 4 year delivery cycle 2013 to 2017) set out in the NHS Equality Delivery System demonstrating how all our patients, carers and family members have a say in how the CCG is performing in:

. Making health care services more accessible to everyone. . Improving people’s health regardless of their; race, gender, age, sexual orientation, religious and philosophical beliefs, gender status, disability or ability, pregnancy, maternity status or their marriage and civil partnership status. . Ensuring our employees are trained and supported to ensure they are able to help the CCG to meet the Equality Duties and can make decisions that are fair, objective and legal. . Ensuring that the CCG board and leaders understand their responsibilities and accountability in meeting the public sector equality duties and make fair, equitable and objective decisions and promote best practice in everything they do.

6 Four Year Equality Objectives

Implementation of our four year Equality Objectives will support the range of CCG strategies such as the 5 Year Strategic Commissioning Plan, and the Equality Diversity and Human Rights Strategy, to be delivered equitably and fairly. It is important that EDHR becomes embedded in principle within all strategies and policies developed by CCG.

CCG had retained the Objectives set by the former PCT (Primary Care Trust) initially in shadow form, in April 2012.

3 Equality Objectives were identified to be delivered over the remaining 4 year period October 2013 to 2017:

Objective 1: Improve equality data collection, analysis, and usage to inform commissioning decisions and improve health inequalities for all protected groups.

Objective 2: Ensure on-going effective senior leadership and awareness of equality agenda for Trafford CCG and their membership practices.

Objective 3: Ensure patient and public communication and engagement is inclusive of people from all protected groups.

These refreshed objectives were originally agreed in consultation with local communities of interest patient and carer reps, and the Executive team in advance of 13 October 2013 deadline for all CCGs to make any changes.

These Equality Objectives were developed in partnership with Trafford patients, staff and communities. Every four years or less CCG will consult widely and agree new Equality Objectives with local communities of interest, including protected group patient and carer representatives. CCG Executive team will annually review these Objectives to ensure they are ‘fit for purpose’ against a backdrop of changing delivery of health and social care to all sections of our local communities.

However, the CCG have developed a new EDHR Strategy during 2014, and three new Equality Objectives have been agreed, following consultation with local communities of interest.

New Equality Objectives (November 2014):

Objective 1: Embed equality, diversity and human rights considerations into our commissioning decisions and the culture of the CCG.

Objective 2: Ensure senior leadership is fully understanding of equality, diversity and human rights and effective in ensuring awareness and delivery of the EDHR agenda across the CCG and its membership practices.

Objective 3: Ensure that health inequalities as they affect protected groups are measurably reduced.

NHS Trafford Clinical Commissioning Group will procure, monitor and evaluate the services that we commission and deliver in line with the inclusion agenda to improve patient access, experience and health outcomes for all the people in Trafford, specifically those who identify with protected characteristics and Inclusion Health groups.

Section 6 identifies progress against our previous Equality Objectives. Future reports will highlight progress against the revised objectives.

6.1 Outcomes from our Equality Objectives

Equality Objective 1:

Improve equality data collection, analysis, and usage to inform commissioning decisions and improve health inequalities for all protected groups.

Progress in 2014

 Equality monitoring is now effectively embedded as part of contract quality reporting.  All CCG commissioning managers team have been trained and adopted Equality Analysis tools  Equality Analysis is a compulsory aspect of all commissioning decisions through the use of the Commissioning Approvals Policy  Trafford specific health inequalities document is required to be effectively used in all commissioning considerations  EDHR Schedule document has been scrutinised by NWCSU EDHR Leads and refreshed for inclusion in 2015 provider contracts. The Schedule requires annual evidence from providers on legal compliance and good practice requirements under the Equality Act 2010; Public Sector Equality Duty; Equality Delivery System (2).  A new Health Inequalities document has been developed for CCG commissioners from research on protected groups and health inequalities both locally and nationally. This document is available to be used by commissioners when reviewing commissioning priorities and writing service specifications for provider partners.  CCG continue to encourage declaration of protected group status by staff onto our internal ESR system for workforce profile monitoring, scrutiny and reporting purposes.

Equality Objective 2: Ensure on-going effective senior leadership and awareness of equality agenda for Trafford CCG and their membership practices.

Progress in 2014

 EDS grading at amber ( developing ) for Goal 4, Inclusive Leadership at all levels  EDS (Equality Delivery System) annual public grading carried by trained Stakeholder Group in July 2014, focusing on Goal 4: Inclusive Leadership at all levels  Chief Clinical Officer address to AGM or VBMET  VBMET sessions to GP’s and Practice staff  Governing Body development at November strategy session.

Equality Objective 3: Ensure patient and public communication and engagement is inclusive of people from all protected groups.

Progress in 2014

CCG governance and delivery:

 PRAP formation and recruitment  Integrated Care Reference Group  New Health Deal implementation  Healthier Together consultation

Local communities:

 Trafford CCGs information leaflet is now being printed in Guajarati, Arabic and Urdu to meet the needs of the local BME population in Old Trafford  Highlighted cultural issues with regards pharmaceutical ingredients in the nasal spray which we are now able to make people aware of when we are promoting this.  When originally attending the BME Service Improvement Partnership (BME SIP) to present on winter planning, this has now led onto currently discussing holding cultural awareness training sessions for all CCG staff  BME SIP have presented at the GP clinical learning event in Trafford and have met since with the Director of Public Health for Trafford and one of Trafford CCG Clinical Directors to discuss a further programme of work within primary care.  Diabetes focus groups have highlighted issues within the South Asian community and risks to being diagnosed with diabetes. We are now able to target this group  Trafford CCG has worked closely with the Trafford Deaf Partnership during the consultation for Healthier Together which has resulted in significantly improved relationships and appreciation by the CCG of the issues affected deaf people and their access to healthcare services  Decision to co-fund the ‘Saving Lives’ programme  Revitalisation of the Trafford Talks health network  Henshaws Society for the blind are kindly putting information sent through to the stakeholder distribution list into the appropriate format for their service users so local health information and opportunities are able to be sent to a wider audience.  CCG staff being aware of events, training and projects relating to the protected characteristics they can link in with to work in partnership and further promote.  Community being made aware of opportunities to be involved in Trafford CCG projects and focus groups. Many of those who attended our MSK and Diabetes focus groups found out about the focus groups through the Trafford Talks Health Network and organisations on our Stakeholder distribution list they are involved in.  We have currently consulted on our EDHR strategy and the majority of feedback received came through from TTH and our stakeholder distribution list.

7 What have we been doing to meet equality legislation?

 The Health & Social Care Act 2012 requires CCGs to: Reduce inequalities between patients with respect to their ability to access health services; reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.

 A Health Inequalities document for Trafford locality - looking at local and national Health Inequalities from research, specifically for each of the 9 protected groups as well as deprivation is being promoted to CCG commissioners for use alongside their planning and decision making processes (as well as the Trafford JSNA). This Health Inequalities document has been quality assurance checked by Trafford City Council (Public Health).

 Promote the involvement of patients and their carers in decisions about provision of the health services to them. Enable patients to make choices with respect to aspects of health services provided to them.

 CCG have developed a Communication and Engagement Strategy, to ensure that people from protected groups are engaged effectively regarding key changes in healthcare. Their feedback is considered by CCG and mitigation is applied wherever possible to evidence the local patient voice working with CCG to shape local services.

 Consultation and engagement work has taken place with local communities of interest about key changes in healthcare such as the PCCC. Vulnerable local groups are asked to provide feedback on any adverse impacts arising, on any protected groups they represent. CCG’s approach is to ask for feedback in terms of ‘You said. We did.’ with evidence from CCG of good outcomes for protected groups.

 The Equality Analysis process provides support to CCG of our audit trail for how staff give ‘due regard’ to local protected characteristic groups in all our planning and decision making processes. EAs are carried out where there is likely risk of adverse impact on people likely to be impacted by the key healthcare change. CCG staff have attended Equality Analysis Workshops during 2014 and these are planned quarterly for new staff and re-fresh purposes.

 Patient experience, complaints, comments, compliments and concerns will be monitored for all patient and staff protected groups and scrutinised for any element of prohibited discrimination. The ‘option to declare’ this information, is provided by CCG.

 Raising staff awareness of what does discrimination look like? An All Staff Briefing: Prohibited Discrimination has been developed for CCG staff. This is one Briefing in a set of 5 core Briefings for all staff to sign off with line manager their awareness and understanding by 31/3/15.

8 Equality Delivery System – The NHS equality performance Framework

The Equality Delivery System (EDS) has been designed to be a tool for NHS organisations and their contracted provider partners, through involvement of stakeholders, to assess how we are performing in respect of equality and diversity and to help identify future priorities and objectives. A refreshed EDS(2) framework was launched by NHS England to all NHS commissioner organisations (and their provider partners) on 4 November 2013.

CCG carried out an annual public grading event and training event for EDS Stakeholder group during June 2014. Evidence in year one of the four year delivery cycle (2013 to 2017 equality performance) focused on Goal 4: Inclusive Leadership. A detailed report and scoring dashboard can be found on CCG website EDS(2) page. Follow the link for more information.

The NHS Equality and Diversity Council decided on 30 October 2014 to support mandating the Equality Delivery System (EDS2) from April 2015 and to support a programme of work to support these proposals. Consultation is still underway at this time (November 2014). This decision is likely to make a significant difference to improving equality in the NHS. Each of Trafford CCG’s provider partners are currently on target to deliver EDS during 2014 to 2015, looking at 2013 to2014 equality performance across 18 required Outcomes over a 4 year delivery cycle of 2013 to 2017. CCG proactively encourage patient and carer representatives from each of the local protected groups to become part of the EDS Stakeholder Group who carry out an annual public grading of CCG’s equality performance.

EDS(2) equality performance framework asks for evidence of: how do people from local protected groups fare compared to people in general re healthcare?

Table 3: EDS (2) Grading explanation

Score Number of protected Explanation  groups affected  Underdeveloped 0-2 care pathways/groups Insufficient data available

 Developing 3-5 care pathways/groups Improved outcomes.  Achieving 6-8 care pathways/groups Improved outcomes. Level 1 Have significantly improved on developing but still have actions to complete, clear future achievable plans in place  Achieving 6-8 care pathways/groups Improved outcomes. Level 2 Can demonstrate they have achieved significant actions & clear future achievable plans in place  Excelling 9 care pathways/groups Improved outcomes.

Table 4: Goal 4: Inclusive Leadership at all levels – Summary of public grading June 2014

EDS(2) required Outcome Public grading Action plan for equality grading uplift performance score by June 2015 4.1 Boards and senior leaders routinely  demonstrate their commitment to promoting equality within and beyond their organisations. Developing

4.2 Papers that come before the Board and  other major Committees identify equality Developing related impacts including risks, and say how these are being managed. 4.3 Middle managers and other line managers  support their staff to work in culturally competent ways within a work environment Developing free from discrimination.

We have developed a 1 year action plan to move their Goal 4 public grading up to the next level in May 2015, with additional evidence to be presented and with the approval of the EDS Stakeholder group.

9 Meeting statutory Human Rights requirements

The Human Rights Act 1998 sets out a range of rights which have implications for the way the CCG commissions services and manages their workforce. In practice this means that we must:

. Act compatibly with the rights contained in the Human Rights Act in everything we do . Recognise that anyone who is a ‘victim’ under the Human Rights Act can bring a claim against the CCG (in a UK court, tribunal, hearing or complaints procedure) . Wherever possible existing laws that the CCG as a public body deals with, must be interpreted and applied in a way that fits with the rights in the Human Rights Act 1998.

All staff are required to evidence their awareness and understanding, through line manager and team discussions, of an All Staff Briefing (and human rights ‘due regard’ flowchart) What are Human Rights?

10 Engagement in action with local people

Purpose of Engagement:

As stated by the Department of Health1, clinical commissioning groups have the following responsibilities with respect to communications and engagement:  To secure public involvement in the planning of commissioning arrangements and in developing, considering and making decisions on any proposals for changes in commissioning arrangements  To co-operate with relevant local authorities and participate in their health and wellbeing boards and other NHS bodies.  To commission health services that are provided in a way that promotes the NHS Constitution, and promote awareness of the NHS Constitution amongst patients, staff and the public.  To promote the involvement of individual patients, their carers and representatives where relevant, in decisions relating to the prevention or diagnosis of illness in them or their care and treatment.  To enable patients to make choices about aspects of health services provided to them.  To consult patients, the public and partners in developing, or making significant revisions to, the commissioning plan.  To publish an annual report on how the CCG discharged its functions in the previous financial year, with particular reference to how it discharged its duties in relation to quality improvement, reducing inequalities and public involvement, and contributed to the delivery of joint health and wellbeing strategies.  To hold a meeting to present the annual report to the public.  To have a published constitution that sets out the arrangements made by the CCG for the discharge of functions and: o How the CCG will make decisions, how it will deal with conflicts and potential conflicts of interest of members, employees, governing body members and members of CCG or governing body committees and sub-committees, how it will ensure transparency for its decisions and how it will ensure effective participation of all its members. o Public involvement in planning commissioning arrangements, and in proposals and decisions concerning changes to those arrangements that would have an impact on services delivered, and a statement of the principles, which the CCG will follow in implementing the arrangements.

The health profile of Trafford’s population has helped to shape the CCG’s clinical priorities, which in turn has helped to inform the strategic objectives that are outlined in the organisation’s operating plan and framework.

To achieve these priorities and objectives, the CCG has an overarching vision to create a health and social care system in the borough that delivers true integration for patients.

1 The functions of clinical commissioning groups, 12 June 2012, of Health

Commissioning Engagement Cycle:

Trafford CCG’s values as developed by staff are:

 Compassion, respect and dignity; we will treat everyone as we would expect to be treated.  Commitment to quality care to improve lives; we are committed to ensuring our patients receive the best quality, co-ordinated care possible. To continually monitor and improve our services and how we commission them.  Working together to meet the healthcare needs of Trafford; we will give patients, families and the public opportunities to be involved and have a voice. We will work together to make improvements for our population.  Valuing each other; we support each other to be the best we can.  Honour, integrity and openness; we will be transparent in all our actions and decision making.  Objectivity and accountability; we will commission services that meet established and identified needs. The services we commission will be equitable, cost effective and our decisions will be open to scrutiny.

The CCG aims to apply these values to all work and is embedding a culture that has engagement at its heart, adhering to one of its key values and communications and engagement principles that ‘everyone counts’.

Commissioning processes, as detailed in the integrated plan, uses a ‘commissioning engagement cycle’ to ensure robust patient and public involvement in CCG decision-making.

The commissioning engagement cycle (see above) translates to a ‘local method’ for Trafford CCG, which will ensure that commissioned services provide increased responsiveness, a culture of personalisation, patient reported outcome measures, and a link between the population conversation and the service contract. Patient and public involvement will be deliberative, and the outcomes of conversations, discussions and insights will be incorporated into the CCG’s planning and delivery.

Engagement Mechanisms in place:

Integrated Care Reference Group (ICRG):

The main focus of the Integrated Care Public Reference Group is to test the success of integrated care. The ICRG was originally called the ‘Public Reference Group’ was initially established to scrutinise the communications and engagement activities relating to the New Health Deal for Trafford consultation. Membership includes representatives from:

 Trafford Healthwatch  Trafford Council’s Young Persons Engagement Officers,  Trafford Diverse Communities Board  Members of the public from different localities around Trafford

Now proposals have been implemented for the Trafford New Health Deal the groups have moved to become a key role in monitoring the effectiveness of the integrated care programme.

Public Reference and Advisory Panel (PRAP):

The Public Reference and Advisory Panel (PRAP) has been established in 2014 to represent the views of the Trafford population in respect of clinical and commissioning decisions, policy and performance. The Public Reference and Advisory Panel is authorised by the Governing Body to challenge any activity within its terms of reference and has varied representation from different sectors of the community.

The purpose of the PRAP is to provide a view of the Trafford public and its representative groups on the following areas:

Clinical Policy

The Panel reviews existing and proposed clinical policies to ensure they meet the requirements of the Trafford population. These reviews combine planned and reactive activity.

Clinical Redesign

The Panel reviews and comments on clinical redesign plans and pathways.

Clinical Commissioning

PRAP inputs a Trafford population perspective into commissioning intentions and business case development and in this context, receives, critically appraises and makes recommendations on all commissioning, joint-commissioning and neighbourhood based commissioning strategies and proposals to ensure they are robust in their need to meet the requirements of the Trafford population.

Prioritisation

PRAP advises the Governing Body of areas for review and redesign, making recommendations based on rigorous assessment of the health benefit to the Trafford population.

Performance

PRAP considers the delivery of commissioned services from the perspective of value for money and contribution to the health of the Trafford population.

Public Engagement

Where required, provide advice to the CCG regarding the most appropriate way to communicate and engage with individuals, those to whom their organisation works with and communities.

Culture and Values

PRAP acts as key contributor to the assessment and evaluation of the CCG’s performance in respect of its desired culture and values

Community:

Trafford CCG Commissioners and communications and engagement team engage regularly with local groups and organisations representing the 9 protected characteristics through holding Trafford CCG’s own focus groups, attending regular community interest forums and holding their own meetings relating to partnership working with commissioning projects.

Trafford CCG focus groups have recently been held for diabetes and MSK service re-design to make sure patients are involved in developing the services to meet their needs. These groups were advertised widely through the current services, our website and twitter account, Trafford Talks Health Network and Stakeholder distribution list (see below for more information) who have service users from the 9 protected characteristics and local media to make the wider population aware. Another example is Trafford CCG has a personalisation co-production group with wide representation of the protected characteristics involved which looks at the implementation of the personal health budget agenda. The group is currently reviewing its membership to make sure we can get even more representation of the protected characteristics and mapping current members networks to see which other groups they link into and can disseminate the information to more people.

Members of the engagement team have focused on going out and attending local community groups this year to discuss current projects and wider consultations the CCG is involved in such as Healthier Together, as well as presenting information which is relevant to these groups. The engagement team have recently attended a variety of groups to share key messages about staying well this winter especially to those most vulnerable people in the community.

Outcomes and key learning:

 Trafford CCGs information leaflet is now being printed in Guajarati, Arabic and Urdu to meet the needs of the local BME population in Old Trafford  Highlighted cultural issues with regards pharmaceutical ingredients in the nasal spray which we are now able to make people aware of when we are promoting this.  When originally attending the BME Service Improvement Partnership (BME SIP) to present on winter planning, this has now led onto currently discussing holding cultural awareness training sessions for all CCG staff  BME SIP have presented at the GP clinical learning event in Trafford and have met since with the Director of Public Health for Trafford and one of Trafford CCG Clinical Directors to discuss a further programme of work within primary care.  Diabetes focus groups have highlighted issues within the South Asian community and risks to being diagnosed with diabetes. We are now able to target this group  Trafford CCG has worked closely with the Trafford Deaf Partnership during the consultation for Healthier Together which involved the exchange of the Deaf partnership formal consultation feedback and Healthier Together’s response, having interpreters at Trafford CCG Healthier Together events, discussing Healthier Together at service user drop in sessions with another organisation who support deaf and hard of hearing people which has also led onto other pieces of work. This includes investigating current provision for BSL interpretation services within primary care, 2 CCG staff training sessions for deaf awareness are booked for January 2015 and we are looking to hold a deaf partnership session at one of the quarterly clinical education events in 2015. The deaf partnership have educated CCG staff around communication with deaf people and we have found this extremely valuable  Decision to co-fund the ‘Saving Lives’ programme

Trafford CCG is keen to work more closely with young people and the Transgender and the lesbian and Gay community and is currently looking at ways to involve and have more representation from this group within the CCG.

Trafford Talks Health Network (TTH) and Stakeholder distribution list:

Trafford Talks Health Network is a database which is managed by a member of the communication and engagement team, that members of the public sign up to receive information about local healthcare and can get involved in work of Trafford CCG.

Having set up the ‘Trafford Talks Health network’ in January 2010, it holds a membership of 564 local people to keep updated with development in health care, Trafford CCG have revitalised current methods to sign people up to the network. By using the new online tool ‘My NHS’ the CCG aims to increase membership to ensure they have a wide representation of views, opinions and feedback on areas of health provision which are of interest to them. The new tool is an online form attached to our website, or if an individual does not have the internet can phone us and we will fill the form in on their behalf. This form is more detailed in the demographic information we collect, giving us more understanding of our membership that we can break down this information and help us target different groups of people from the information they have given.

People can become involved in a number of ways including attending meetings and events, sharing views through focus groups or online surveys or simply subscribing to receive the latest CCG news and updates. Membership of the Trafford Talks Health Network is completely free, without obligation and people can cancel their registration at any time. Personal details will be kept confidentially and will not be shared with third party organisations.

When the Trafford Talks Health network was originally set up members of the public could list organisations they either represented or were involved in, these have been included in appendix 1 below.

Separate to this Trafford CCG have a Stakeholder distribution list which has been built on by members of the communication and engagement team meeting with a variety of organisations, which mirrors the purpose of the Trafford Talks Health Network using this to disseminate information about local health care and sharing opportunities to become involved in each other’s work. Organisations on the distribution list have areas of the 9 protected characteristics registered next to their information so again we can target and understand the needs of the organisations we are working with (groups included in appendix 1 below). This is separate to the Trafford Talks Network as the new tool had not developed a stakeholder function when it was agreed to use My NHS and by keeping organisations and the public on separate distribution lists this helps us identify gaps in stakeholder relations and monitor demographics of our TTH.

Online platforms

Trafford CCG has the following online platforms:  Public website: www.traffordccg.nhs.uk  Trafford CCG staff intranet: intranet.traffordccg.nhs.uk  Trafford GP Extranet: extranet.traffordccg.nhs.uk  Twitter: www.twitter.com/traffordccg

The public website and Twitter feed is open and accessible to all members of the public but has content aimed at the Trafford population. The staff intranet is password protected and accessible only by Trafford CCG staff and the GP Extranet is password protected, accessible only by Trafford GP’s and practice staff.

There is an accessibility statement across all three CCG sites that state our commitment to providing access to as many visitors to the CCG site’s as possible, within the scope of their intended audiences. The statement is below in full:

Accessibility

Trafford CCG is committed to providing access to as many visitors to our website as possible. To meet this commitment, our website is authored in accordance with worldwide accessibility standards published by the W3C. To the best of our knowledge, in periodically updated tests, our site meets the Priority 1 and 2 checkpoints of the Web Content Accessibility Guidelines (WCAG 1.0). If you have trouble using this site, please contact us.

For more information on making the web easier to use, please visit the BBC’s accessibility website, My Web My Way. The site explains the many ways you can change your browser, computer, keyboard and mouse settings to make the web more accessible for you.

All three Trafford CCG sites have been created within the 2014-15 financial year and are all mobile optimised to ensure full access can be gained by all audiences on any mobile or tablet device. The website, staff intranet and GP extranet have news and events sections that as well as being used to promote specific CCG meetings and events, are utilised to promote Trafford-wide stakeholder, community and third sector news and events. A variety of which are targeted at specific groups within the nine protected characteristics such as:  Free fitness for body and mind classes targeted at people with any physical and/or mental disability  The Royal British Legion’s new face-to-face welfare service in Trafford and central Manchester to help serving members of the Army, Royal Navy, Royal Marines and the Royal Air Force, Reservists and veterans, and their families  Sale West and Ashton Partnership Christmas Lunch 2014, a free lunch for people who might be on their own at Christmas time

In addition to being promoted in the news and events sections of the CCG sites, all events that would have any relevance to the protected characteristic groups are widely promoted on the official organisation Twitter feed.

The CCG’s website and Twitter feed are a key mechanism for engaging with a younger audience who may not be engaged with fully without them. For example, 27.5 per cent of website visitors (as at 7 December 2014) were within the 18-24 age range, followed by 33.5 per cent aged 25-34 and 15.5 per cent aged 35-44.

Future Plans for engaging with the protected characteristics

As said previously we recognise and are keen to build on our relationships with the Transgender, lesbian and gay community and young people, we are currently looking at ways this can be done.

To build on educating and raising awareness with CCG staff arounf needs of the different protected characteristics we will continue to look for training opportunities. We are currently planning for representative groups of the 9 protected characteristics to present in internal meetings, hold lunch time learning sessions for groups to come in and talk to staff about their work.

The engagement team will continue to work with our Clinical education Lead to involve different community groups presenting at the quarterly education events for local GPs and Practice Managers to help improve local GP services.

Trafford CCG held their EDS2 annual public grading earlier this year. From this we are developing a ‘you said, we did’ briefing that will go out to those who attended representing the protected characteristics to show how we have built on their comments and feedback from our evidence of goal 4, and show how we are working towards goal 2 for next year’s grading. Our engagement team are currently working with commissioners to gather evidence and embed EDS2 into the commissioning cycle. Members of the engagement team are also developing a time table of liaison meetings with representatives of the protected characteristics who are interested in being more involved in the work of the CCG.

The communications and engagement team are currently developing a programme of work for the CCG to get involved in events and projects locally and nationally to help build our reputation, continue learning and understanding the needs of the protected characteristics to inform our commissioning decisions, as well as build on our relationships and partnership working.

Table 5: List of community groups and organisations CCG engage with

Age UK BHA Black Health Agency Blue Sci BME SIP/ LMCP Care Link British Red Cross Carers Centre Christies CMFT (Customer Care) Culture In Trafford CwDP Disability Advisory Group, Deaf Partnership, Diverse Communities Board (Trafford Council) Diabetes Support Group Equality (Trafford Council) Genie Networks George House Trust Greater Manchester West Hard of Hearing Group Healthwatch Trafford Henshaws Society for blind people LD SIP Lesbian & Gay Foundation Mastercall Mastercall Penine Care Trust Personalisation (Trafford Council) Psychosexual counselling Public Health Redeeming our communities Stroke Association Stronger Communities (Trafford Council) Talkshop Thrive Thrive Trafford CIL Trafford Council Trafford Council (Partnerships & Performance Trafford Housing Trust

Trafford Mental Health Advocacy Service Trafford Parent Partnership Trafford Partnership Trafford Sound VBMET VCAT Wai Yin Society Young Person's counselling service Youth Parliament (Trafford Council) Trafford Council (Sport Relationship/ Partnership communities) Public Health (Health improvement team) NHS England (Greater Manchester Local Area Team) Department of Health Care Quality Commission Trafford Health Centres North Manchester CCG Central Manchester CCG South Manchester CCG Pennine Care Salford Royal Foundation Trust Central Manchester Foundation Trust University Hospitals South Manchester FT North West Ambulance Service Care UK (NHS CATS) Care Fertility Age Concern Alzheimers UK Care Homes (nursing and residential) Home Instead Senior Care Trafford Youth Cabinet Partington Parish Council CYPS Greater Manchester Fire and Rescue Trafford Police ACE Women’s Group Altrincham and Bowden Civic Society Alzheimers Society (Trafford) Arthritis Care, Altrincham and District Broadheath Partnership Broomwood Partnership

Butterflies young parents group Cancer Aid and Listening Line (CALL) Citizens Advice Trafford Empowering Muslim Youth Project Epilepsy Action South Manchester Family Support Network Trafford (FASNET) Flixton Heart and Stroke Group Friends of Altrincham General Hospital G Force Greater Manchester coalition of disabled people Lions Club of Urmston Longsight & Moss side Community Project Lostock Community Partnership Lostock Residents Association New Way Forward Old Trafford Partnership Parkinsons Disease Society Partington EngAGE Positive Partington Sale West & Ashton Partnership Special Educational Needs Family Support Group (SENFSG) St Francis Church The Counselling and Family Centre Trafford Cancer Patient User Participation Group Trafford Care and Repair Trafford CVS & Volunteer Centre Trafford Mental Health Advocacy Service Trafford Tenants and Residents Federation Urmston Partnership Voluntary Transport Group Woodsend Community Group Woodsend Interest Groups

11 Monitoring Equality Outcomes with our providers

The CCG through its contracts with providers ensures that those provider organisations are compliant with Equality legislation. All the NHS providers and private providers which the CCG contracts with undertake the annual equality performance review using the NHS Equality Delivery System (EDS). They are also required to annually submit evidence electronically to the CCG in support of their equality, diversity and human rights compliance via their EDHR Schedule within their contract. Face to face meetings are provided with providers to support them in meeting required EDHR evidence standards. Any variance in required performance is raised for discussion within cyclical Quality / Contract meetings to ensure year on year progress is evidenced throughout the year and assurances of compliance are provided to CCG

NHS or other Equality Published Undertaken providers Objectives Equality EDS grading (Trafford CCG is agreed & information re 2013-14 Associate published in 2014 performance Commissioner) Greater Manchester West MH NHS FT Pennine Care FT Community Healthcare Services CMFT By March 2015

UHSM By March 2015

12 Governance arrangements for equality diversity and Human rights

CCG Equality Lead reports into the Assistant Director of Corporate Services and Organisational Development. EDHR reporting arrangements are set out within the EDHR Strategy.

13 Way forward

The CCG want to place equality and inclusion at the heart of commissioning services for local people from vulnerable protected groups. The CCG has made clear progress in transparently embedding Equality Diversity and Human Rights into its decision making processes and this will be increasingly reflected in the redesign of existing services and the commissioning of all services.

The diagram below illustrates the key components of mainstreaming equality and inclusion into the commissioning cycle:

EDHR at the heart of commissioning

 Patient centred performance management e.g. using the EDS equality performance framework and delivery system.  Ensure all CCG staff and providers have received training in how to embed EDHR into day to day practices.  Ensure providers monitor access to services by protected groups and differential satisfaction levels. Build equality returns into contract reviews.  Build in EDHR criteria into all contracts e.g. EDHR Schedule of evidence, and EDS performance framework.  Involve all protected groups in service design and re-design.  Show ‘due regard’ – undertake Equality Analysis and Human Rights screening on early stage decisions, priorities re Commissioning Intentions; programmes; strategies; policies.  Specify required equality Outcomes within service specifications.  Engaging local protected groups to identify health needs and any negative impacts on protected groups from healthcare changes under consideration.

In addition, for our workforce data, CCG will begin gathering EDS evidence for Goal 3 this year onwards ie A representative and supported workforce, with a focus at our public grading event during 2016. CCG continue to monitor workforce data and fair employment practices which are full inclusive of each of the local protected groups.

14 Conclusions and Recommendations

The prevailing theme with all of our provider services is a lack of data on protected characteristics. As a result, the views of different community groups about current service provision cannot be fully understood.

Local engagement is working to identify and improve the patient experience for some protected groups in terms of ‘how do local protected groups fare compared to people in general re healthcare?’ – this is the EDS annual evidence requirement over a 4 year delivery cycle, for each of the local protected groups.

CCG will not be publishing workforce data within this publication due to numbers being low and this could potentially lead to an individual. However, we will continue to internally scrutinise data routinely for any trends or hot spots.

 Baseline patient information communicated from GPs to providers: protected group information should be collected by GP surgeries and (where declared by the patient) routinely communicated at referral point to the provider service  Disability: issues were raised with access to emergency appointments for the deaf community due to a lack of trained signers / BSL interpreters  Health Inequalities awareness: CCG to provide evidence that information from the Health Inequalities document and JSNA sub sections are being used in CCG decision- making.  Provider impact on protected groups: Provide evidence to show outcomes from the Equality Strategy / Health Inequalities document / EDHR Schedule of evidence submission and show how these have influenced better analysis of equality information leading to service improvements from provider organisations.  Inclusive Leadership at Board level: Provide ‘due regard’ evidence for EDS Stakeholder group i.e. Board Papers discussing protected groups and giving 'due regard'.

Recommendations:

Over the coming years the CCG should ask all service providers to disaggregate patient satisfaction levels by protected characteristics to provide assurance that no community group is experiencing a worse service than others.

The EDHR Schedule of annual required evidence should include a focus on: (1) full provider analysis of this equality data to show year on year improvements for protected groups (2) up to date website compliance to achieve fair access and public transparency of information (3) assurance by providers of all staff awareness of the anticipatory duty to consider reasonable adjustments in service delivery and workforce issues (3) commissioner to clarifying what does equality compliance look like for providers.

The CCG Equality Lead should ensure a robust approach to contract management for provider contracts, with; 4 monthly face to face visits with provider Equality Lead staff to support compliance requirements throughout the year; an EDHR compliance action plan is developed by providers as a result of these face to face meetings to ensure full compliance is achieved and maintained within a reasonable timescale; any variances are raised by CCG Equality Lead as a timely agenda item at the next Quality / Contract meeting with NWCSU to resolve any issues and provide assurances to CCG of required progress.

 CCG should set out how the Equality Strategy; Health Inequalities document; and annual provider EDHR Schedule each show how these have influenced inclusive decision making by commissioners and have provided better summary analysis of equality information leading to service improvements from provider organisations.

 CCG to actively promote commissioner use of the current Health Inequalities support document when planning and reviewing services.

 The CCG should ensure commissioners refer to equality requirements within service specifications, as appropriate to each service (See EA support toolkit Appendix 4)

 The CCG should provide evidence of Board Papers routinely discussing protected groups and giving 'due regard'. Board agenda items onto U Tube should be investigated as one potential way forward.

 The CCG should demonstrate that staff (including governing body members) have engaged with local groups to learn more about a particular community and understand their healthcare needs and how best to promote provision of fair access for that community.

 The CCG (Primary Care Development Lead) should look into online provision of access to signers / BSL interpreters (trained to at least Level 6) for emergency healthcare appointments.

 Demographic data on complaints is gathered by CCG to aim to ensure that:

The complaints process is fair and accessible to all sections of our local communities, including protected groups

CCG gather data on differential satisfaction levels across the 9 protected groups, regarding their experience of the complaints process. Data gathered is used for service improvement purposes.

15 Equalities

The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society. It replaced previous anti-discrimination laws with a single Act, making the law easier to understand and strengthening protection in some situations. It sets out the different ways in which it is unlawful to treat someone.

Trafford CCG believes that equality and diversity includes addressing health inequalities and should be embedded into the earliest stages of all commissioning activity. Using the Equality Analysis process we request local communities of interest to feedback on any negative impacts from healthcare changes under early stage consideration by CCG. This complies with our duty to evidence ‘due regard’ towards each of the protected groups in all our planning and decision making processes.

Our EDHR Strategy 2014 to 2018 will enable the CCG (and our provider partners) to evidence how we are meeting the Equality Act 2010 and the Public Sector Equality Duty (PSED). Our strategy includes providing equality of opportunity to all our patients, their families and carers and proactively recognising and eliminating direct or indirect discrimination of any kind, within workforce and service delivery issues.

Through the adoption of the NHS Equality Delivery System and through developing an Annual Equality Data Publication we aim to demonstrate to our communities how we are meeting the three aims of the General Equality Duty

The CCG is keen to Involve local people in the continuing development and monitoring of our Equality Objectives and strategy to ensure that we commission (buy) the right health care services, provide well trained staff to deliver them, ensure our providers meet the equality duties set out in the Equality Act 2010 and promote people’s rights.

The CCG produced its first Annual Equality Data Publication in January 2014, which set out how the CCG has demonstrated ‘due regard’ to the public sector equality duty’s three aims since 1 April 2013.

The governing body approved Annual Equality Data Publication is published on the CCG website showing our 2014 to 2015 equality activity. CCG also provides this publication in Easy Read format available to download from the website, following approval of this Publication by the governing body. CCG want to give ‘due regard’ to protected group by evidencing how we are providing fair access to information, services, premises and any employment opportunities.

Under the Equality Act 2010, the NHS and other statutory bodies must show ‘due regard’ to eliminating discrimination. CCG have applied this ‘due regard’ principle in the form of an Equality Analysis tool to help us make fair, robust and transparent decisions based upon a sound understanding of the needs and rights of the population, and to ensure our priorities demonstrate meaningful and sustainable outcomes for ‘protected groups’. These are groups of people with specific characteristics who are protected against discrimination by the Equality Act 2010 together with Inclusion Health groups, such as people who are homeless. The Act sets out protected characteristic groups as: age, gender, gender reassignment, disability, race, sexual orientation, religion or belief, marriage and civil partnership, pregnancy

maternity and breastfeeding mums. Trafford CCG also include carers and military veterans as if protected groups in any scrutiny for fair access to information, services, premises and employment opportunities.

The CCG buys a range of health care to meet the needs of the people of Trafford CCG. The CCG develops plans every year setting out what it will buy - these are called the Commissioning Intentions or Strategy.

We aim to commission accessible, preventative, inclusive services for all sections of our local communities that improve the health outcomes of our patients and carers. We know that different groups experience and take up service differently. There will be a strong focus on patient experience and the delivery of effective and efficient health care services which assure patient safety and fair access to information, services, premises and any employment opportunities, across each of the local protected characteristic groups.

Commissioning intentions form part of the annual Planning cycle which commences development in the summer and finishes with agreed and signed contracts with providers by the 31st March of the following year. The major part of the planning cycle is the development of the integrated plan which responds to the requirements of the NHS Operating Framework which is published in October or November of each year.

The CCG considers equality information, including data from public health on health inequalities (see the latest Joint Strategic Needs Assessment – JSNA) when developing its commissioning plans, undertaking service design and redesign, equality analysis and strategic developments.

Report author: Julia Allen EDHR Consultant North West Commissioning Support Unit

Date: 30 January 2015