Equality and Diversity Strategy

Aston, Handsworth, Quarter, , , Newtown, , , Soho, Oldbury, , , , , Handsworth, , Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich C5206 GUJARATI

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إذا ﻛﻨﺖ ﺗﺮﯾﺪ ھﺬه اﻟﻮﺛﯿﻘﺔ ﺑﻮﺳﯿﻠﺔ أﺧﺮى ﺑﻤﺎ ﻓﻲ ذﻟﻚ ﻋﻠﻰ ﺷﺮﯾﻂ ﺻﻮﺗﻲ، ﺑﺄﺣﺮف ﻛﺒﯿﺮة، ﺑﻠﻐﺔ ﺑﺮﯾﻞ أو ﻣﺘﺮﺟﻤﺔ، ﻧﺮﺟﻮ أن ﺗﺘﺼﻞ 件，如录音版、大字体版、凸ﺑﺎﻟﺮﻗﻢ أﻋﻼه. 如果你想要用别的版式制作的这份文 Translation文版或其它语言的翻译版，请打下面的电话号码。 2C

jy qusIN ies prcy nMU iksy hor bxqr, v`fI CpweI, bryl, suxn vwlI Translationtyp/sIfI 2C jW iksy hor bolI iv`c lYxw cwhuMdy ho qW ikrpw krky hyTW id`qy nMbr

إذا ﻛﻨﺖ ﺗﺮﯾﺪ ھﺬه اﻟﻮﺛﯿﻘﺔ ﺑﻮﺳﯿﻠﺔ أﺧﺮى ﺑﻤﺎ ﻓﻲ ذﻟﻚ ﻋﻠﻰ ﺷﺮﯾﻂ ﺻﻮﺗﻲ، ﺑﺄﺣﺮف ]Pon kroﻛﺒﯿﺮة، ﺑﻠﻐﺔau~qy ﺑﺮﯾﻞ أو ﻣﺘﺮﺟﻤﺔ، ﻧﺮﺟﻮ أن ﺗﺘﺼﻞ ﺑﺎﻟﺮﻗﻢ أدﻧﺎه.

Sandwell and West Birmingham CCG Equality & Diversity Plan 3

Inclusion Matters: A Transitional Strategy for Equality, Diversity and Human Rights

This is the first in a series of documents outlining Sandwell and West Birmingham Clinical Commissioning Groups (CCG) plans for equality, diversity and human rights. The CCG recognises that to meet the challenges ahead and to attain its vision of ‘Healthcare without Boundaries’, it has to radically change the way people think and act, and the way services are commissioned and provided. The CCG will aim to embed an inclusive approach that ensures equality, diversity and respect for human rights are everyone’s business and are integral to everything they do.

This transitional strategy sets out our vision and plans for embedding this inclusive approach within our organisations culture, commissioning systems and practices. It provides an accountable governance structure within which our progress can be scrutinised and assurance provided. In this strategy, we will also set out our plans for using the national Equality Delivery System framework to assess and monitor our ongoing equality performance and to comply with the requirements of the Equality Act 2010. 4 Sandwell and West Birmingham CCG Equality & Diversity Plan

Contents

1. Foreword page 5

2. Purpose of this Strategy page 6

3. Duties and Responsibilities page 8

4. An Inclusive Approach page 11

5. Governance Arrangements page 13

6. Understanding our Communities page 15

7. Achieving Inclusion: getting to where we want to be page 19

8. Transitional Action Plan page 24

9. Appendices page 25 Sandwell and West Birmingham CCG Equality & Diversity Plan 5

Foreword

We have an immense challenge ahead of us, and one that we do not underestimate.

Our populations are diverse, with a richness of backgrounds, culture and language and that makes Sandwell and West Birmingham a very vibrant place to live. Equally, we have high levels of poverty and deprivation that can make everyday life for some of our populations very difficult and affect their health. Yet it is some of these very groups that face barriers to healthcare, which is simply not acceptable.

It is apparent that if we do what has been previously done, things are unlikely to change. A one-size fits all approach simply will not do, but neither can we resource individual services for every patient. We will focus our attention on making sure that every service we commission is inclusive and remove barriers that prevent access. Where this is not possible, we will work with those groups affected to commission appropriate and sensitive services.

This is why we have committed to embedding an inclusive approach that will bring about a cultural change in the way that we commission services and behave as an employer. This approach will ensure that our patients, especially those that are most vulnerable and in greatest need, see a noticeable difference in their health outcomes, experiences and interactions with health and social care services and staff.

We are not constrained by the past, and as a new organisation can, from the outset, ensure that everyone who works in partnership with or for us is clear and committed to our vision and the pace of change ahead. Change will not be easy, or happen overnight, but through this strategy we have started to introduce the building blocks that will make our vision a reality.

Together with our partners and stakeholders, we are excited about the road ahead.

Nick Harding Chair Sandwell and West Birmingham CCG 6 Sandwell and West Birmingham CCG Equality & Diversity Plan

Purpose of this strategy

This is the first in a series of documents outlining 2.2. Inclusion Strategy Sandwell and West Birmingham Clinical Commissioning Groups (CCG) plans for equality. We will publish our four-year inclusion strategy The CCG recognises that to meet the challenges in April 2013. The strategy will demonstrate ahead and to attain its vision of ‘Healthcare how we have worked in partnership with a wide without Boundaries’, it needs to radically change range of stakeholders (collectively called local the way people think and act, and the way services Interests) to assess our equality performance are commissioned and provided. The CCG will aim and to jointly agree our priorities, objectives to do this by embedding an inclusive approach, and desired outcomes for equality, diversity and whereby equality, diversity and respect for human human rights over the next four years. It will set rights are no longer an afterthought; but are out the variations in health outcomes and health integral to the business of the CCG, and more experiences between and within, different groups importantly, become everyone’s responsibility. contained within our population area; and the actions we will take to address gaps in evidence, This transitional strategy sets out our vision and outcomes and experiences. In developing our plans for embedding our inclusive approach priorities, will use the four goals and 18 outcomes within the organisations culture, commissioning of the EDS framework to assess the extent to systems and practices. It provides an accountable which existing commissioning activity is delivering governance structure through which our progress intended outcomes for diverse groups and grade will be demonstrated and legal compliance with our performance accordingly. the Equality Act 2010 assured. The strategy also sets out our plans for using the national Equality Delivery System framework to assess and monitor our on-going equality performance.

The CCG will establish its plans for addressing equality, diversity and human rights, through the development of three inter-related documents:

2.1. ‘Inclusion Matters: A transitional strategy for equality, diversity and human rights’

This will represent the CCGs transitional equality strategy for 2012/13, introducing the CCGs vision for equality, diversity and human rights; detailing how compliance with the public sector equality duty (PSED) of the Equality Act 2010 will be achieved and performance measured. The transitional strategy will set out the governance arrangements for equality and the work the CCG will undertake during the first year of its assurance, to develop a robust four-year inclusion strategy, underpinned by the national framework of the Equality Delivery System (EDS). Sandwell and West Birmingham CCG Equality & Diversity Plan 7

2.3. Inclusion Action Plan

In addition to the strategy, we will develop an Inclusion Action Plan that sets out the outcomes to be achieved between the financial years 2013/14. The Action Plan will incorporate our annual equality and diversity strategy (EDS) objectives and outcomes. Subsequent action plans will be updated and published annually, to share the progress the CCG has made, and to ensure transparency in the assessment of our performance against the EDS framework, by local interests.

2.4. Inter-Dependencies

Equality for our patients, staff and communities will be achieved when our Inclusive values and principles are woven through every aspect of the organisation and its business; shaping and developing an organisational and workforce culture whereby living by these values and principles becomes the norm and anything less is deemed unacceptable. To achieve this goal, we have embedded our inclusive approach, throughout all of our key organisational strategies.

This strategy therefore should be read alongside the following SWB CCG documents:

• CCG constitution • Organisational Development Strategy • Communication and Engagement Strategy • Integrated Plan. 8 Sandwell and West Birmingham CCG Equality & Diversity Plan

Duties and responsibilities

The CCG, upon its authorisation, will have responsibility for the commissioning of health services for all its local populations and as a public sector organisation, have responsibility for evidencing its compliance with statutory legislation. For the purposes of this strategy, this includes compliance with the Equality Act 2010, Human Rights Act 1998 and relevant sections of the Health and Social Care Act 2012.

3.1. Equality Act 2010

The Equality Act was introduced to harmonise the raft of existing equality legislations, making it easier for people and organisations to understand discrimination law. The Act provides protection to groups of people who may be discriminated against because of certain characteristics they share. It provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. The groups protected by the Act include:

Protected Characteristic Protection is afforded to:

Age People of different ages including children, young and older people. People with a long term condition, or with mental, physical, sensory, Disability learning disability or impairments; or a combination of these. Gender Reassignment People who have or are in the process of changing their sex.

Marriage and Civil Partnership People who are married or in a civil partnership.

Race People characterised by shared ethnicity, language or culture.

Religion or Belief People with or without a religion or belief.

Sex Men and women.

Sexual Orientation People who identify as Lesbian, Gay, Bi-sexual or Trans.

Pregnancy and Maternity Women who are having or have just had a baby.

The Equality Act sets out the responsibilities of public bodies, in the Public Sector Equality Duty. This duty requires public bodies to consider all individuals when carrying out their day to day work – in shaping policy, in commissioning and delivering services and in relation to their own employees. It requires the CCG, when carrying out its duties, to have due regard to the need to:

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. • Advance equality of opportunity between people who share a protected characteristic and those who do not i.e: • Remove or minimise disadvantages suffered by people due to their protected characteristics. • Meet the needs of people with protected characteristics; and • Encourage people with protected characteristics to participate in public life or in other activities where their participation is low. Sandwell and West Birmingham CCG Equality & Diversity Plan 9

• Foster good relations between people who 3.3. Human Rights Act (1998) share a protected characteristic and those who do not. The CCG has obligations under the Human • Tackling prejudice and promoting Rights Act 1998, that as a public body, it must understanding between people from at all times act in a manner compatible with the different groups. rights protected in this Act and safeguard these for patient and staff in its care and employment. The Equality Duty supports good decision making Human Rights are underpinned by a set of common – it encourages us to understand how different values and have been adopted by the NHS under people will be affected by our activities, so that the acronym FREDA. The FREDA principles our policies and services are appropriate and represent: accessible to all and meet different people’s needs. By understanding the effect of our activities on • Fairness e.g. fair and transparent grievance and different people, and how inclusive public services complaints procedures. can support and open up people’s opportunities, • R espect e.g. respect for same sex couples, we can be more efficient and effective. teenage parents, older people. • Equality e.g. not being denied treatment due to 3.2. The Equality Act 2010 (Specific age, sex, race, etc. Duties) Regulations 2011 • Dignity e.g. sufficient staff to change soiled sheets, help patient to eat / drink. The Equality Act also sets out specific duties to help • Autonomy e.g. involving people in decisions us perform the Equality Duty better. It does this by about their treatment and care. requiring us to be transparent about how we are responding to the Equality Duty. The Government The Equality and Human Rights Commission has believes that the CCG should be accountable to stated that putting human rights principles into its service users and be open to public scrutiny. public service practice is in the public interest. The duties therefore provide the public with the Evidence shows that public bodies taking information they need to challenge and hold us human rights seriously treat people better. We to account for our performance on equality. The will endeavour to embed a human rights based specific duties require us to: approach in the way that we commission services and in our role as an employer. This approach • Publish sufficient information to show that we is not new, and we will learn from the work have considered the three aims of the general undertaken by Heart of Birmingham PCT to embed duty when making decisions; and the equality a human rights based approach, and through data that underpins those decisions. the implementation of NHS policy initiatives such • Publish Information related to persons who as Dignity in Care, Essence of Care, Standards share protected characteristics who are of Better Health and the Knowledge and Skills employees or others affected, such as service Framework. users. • To publish the information in a manner that is Appendix 1 provides a summary of the Human accessible to the public Rights Articles and their relevance to the NHS.

To actions we will implement to comply with the requirements of the Equality Act 2010, are set out within our transitional action plan. 10 Sandwell and West Birmingham CCG Equality & Diversity Plan

3.4. Health and Social Care Act 2012

The CCG has a legal duty under the Health and Social Care Act 2012 to reduce inequalities between patients regarding their ability to access health services, and with respect to health outcomes; as well as to ensure that services are provided in an integrated (joined up) way. The Act also places duties on us to promote the NHS Constitution, to enable choice and to promote patient, carer and public involvement. To discharge this responsibility effectively we will work with our partners to reduce health inequalities amongst those groups in greatest need and embed this requirement into our joint health and well being strategies. We will also consider how we can provide more culturally sensitive services and ensure all patients can exercise choice and be involved in our decision making.

The Act also requires CCGs to work with its local Healthwatch organisations, to provide information to the CQC and Health and Well Being Governing Body about essential levels of safety and quality of its providers.

Our Communication and Engagement strategy sets out in greater detail how we will work with emerging Healthwatch organisations and their predecessor bodies to achieve this aim. Sandwell and West Birmingham CCG Equality & Diversity Plan 11

An inclusive approach

4.1. Why Inclusion? or belief. It has a duty to each and every individual that it services and must respect Inclusion is an overarching term that encompasses their human rights. equality, diversity and human rights. Equality is concerned with fairness, Diversity with valuing “At the same time, it has a wider social duty difference and human rights with ensuring respect to promote equality through the services for the FREDA principles. Inclusion helps to focus it provides and to pay particular attention attention on the adoption of a person centred to groups or sections of society where approach, and to consider how or why people improvements in health and life expectancy may feel, or are excluded, from the services and are not keeping pace with the rest of the employment opportunities provided by NHS population.” (NHS Constitution:2009) organisations. 4.2. Inclusion is good business sense This approach does not limit the extent of our work to the protected groups stipulated within Adopting an inclusive approach makes good equality legislation, and enables us to consider the business sense. The NHS is facing exceptional variations of need and groups that make up our challenges, including the requirement to maintain local communities. This approach enables us to and improve quality, innovation, productivity consider the impact of our work for example, on and performance levels, whilst achieving huge homeless people, migrant communities, gypsy and efficiency savings, and all within an environment of travellers, offenders, disaffected youth and single unprecedented organisational transformation. parents. This depth of change can easily lead to We know from evidence that people enjoy life retrenchment and a culture whereby we continue more if they are treated with dignity, respect and to do things the way we have always done them. fairness. Such behaviour enriches our society We know that such a position is untenable within because each and every person can do what they the current climate. are best at, and achieve their full potential; and it is easier for people to live side-by-side and get “Austerity need not lead to retrenchment in on with each other. We recognise that Inclusion the welfare state. Indeed, the opposite may should be at the heart of our business, not only be necessary: the welfare state in , because it helps us to comply with equality the NHS itself, was born in the most austere legislation, but because it makes good moral post-war conditions. This required both sense to target health services where they are courage and imagination. Today we call for most needed, to groups that are most vulnerable courage and imagination again, to ensure in our communities and to those whose voices we equal health and well-being for future seldom hear. generations” (Marmot, 2010a; p12)

Equality is also one of the principles upon which We recognise that keeping people out of the NHS was founded and Inclusion supports the hospital when they don’t really need to be there; first principle of the NHS Constitution: helping patients with long term conditions such as Diabetes and COPD to better manage “The NHS provides a comprehensive service their conditions at home; making better use of available to all irrespective of gender, race community services and of new technology, can all disability, age, sexual orientation, religion help to improve a patients quality of life and aid 12 Sandwell and West Birmingham CCG Equality & Diversity Plan

their recovery. These actions can also help to 4.4. Our Inclusive Approach reduce the financial burden on us and the wider health economy, and help us to allocate more of Our intention is to ensure that we achieve our vision our limited resources to where they are needed of ‘Healthcare without boundaries’ and our mission: most; at the frontline, saving lives. “To value diversity and tackle inequality. An inclusive approach will help us to appreciate the We will improve the health and wellbeing needs of our communities, and through listening to of all communities in Sandwell and West and learning from what they (patients, communities Birmingham, reducing inequalities as we do and the public) have to say, be better placed to so.” exercise some difficult decisions. This approach will enable us to target our commissioning activity We will do this by embedding an inclusive approach and resources to where they are most needed and and set of values that: will have the greatest impact; helping us to reduce health inequalities, deliver quality services and • Is driven by a strong and committed leadership achieve improvements in health outcomes. with empowered and engaged staff. • Nurtures autonomy, ensuring that everyone has 4.3. Quality and Inclusion a choice in the care they receive and where and how they are treated. Promoting equality and inclusion is closely related • Commissions services that are fair to all and to the pursuit of quality and actions to address and personal to each. reduce gaps in health inequalities. A quality service • L istens to and understands the needs and is one that recognises the needs and circumstances experiences of all our communities and service of each patient, carer, community and staff users, and learns from the past. member, and ensures that services are accessible, • Understands and values the differences between appropriate, safe and effective for all, and that individuals, groups and communities. workplaces are free from discrimination where staff • S hares its vision with, and is accountable to, its can thrive and deliver. A service cannot be described communities, member practices, partners and as a quality service if only some patients achieve stakeholders. good outcomes while others do not. • I mproves health outcomes and reduces health inequalities through designing and improving The needs and circumstances for patients, carers, services that will remove barriers. communities and staff from protected and other • Values our service users, staff, member practices disadvantaged groups can be distinct and specific. and stakeholders and treats all with fairness, In providing quality services and workforce dignity and respect. environments that are appropriate and effective • Ensures that everyone has a voice and the for all, organisations should prioritise and promote opportunity to participate in decisions made equality. This makes sense on many levels as the about their health and well-being. majority of patients, carers and staff will have one or more characteristic protected by the Equality Act. Sandwell and West Birmingham CCG Equality & Diversity Plan 13

Governance arrangements

The CCG will ensure that appropriate governance • 5.1.5. Each Locality Commissioning Group arrangements are in place to discharge its legal Board, and relevant Committees, including requirements. the Partnership Committee, Strategic Commissioning and Service Redesign; and 5.1. Responsibility for compliance Organisational Development Committee will against the Public Sector Equality Duty report to the Executive Lead for Equality and Diversity against their Equality and Diversity of the Equality Act 2010 will rest with Action Plans. the CCG Governing Body:

• 5.1.1. The Governing Body are directly accountable for all actions and omissions in relation to equality and human rights legislation and this accountability cannot be delegated. • 5.1.2. The Governing Body will delegate responsibility for providing compliance assurance, to its Quality and Safety Committee. • 5.1.3. The Quality and Safety Committee will monitor progress, performance and delivery of the CCGs Inclusion Strategy(s) and Action Plan (s) and provide assurance to the Governing Body of compliance with the Public Sector Equality Duty. • 5.1.4. The Executive lead for Equality and Diversity will ensure the CCG fully discharges its Equality Duty; this responsibility will sit with the CCG’s Accountable Officer.

14 Sandwell and West Birmingham CCG Equality & Diversity Plan

5.2. Governance Structure

The CCG governance and accountability structure for equality, diversity and human rights is set out in the diagram below:

CCG Governance of Equality, Diversity and Human Rights:

Clinical Commissioning Group Governing Body

Quality and Safety Committee Local Interests

Executive Lead for Equality and Diversity

Local Commissioning Organisational Group Boards Development Committee

Partnership Strategic Commissioning Committee and Redesign Committee

CSS Equality and Diversity Lead

The responsibilities of each level are set out in Appendix 2 with a summary of the mechanisms by which assurance and transparency will be achieved. Sandwell and West Birmingham CCG Equality & Diversity Plan 15

Understanding our Communities

To effectively commission high quality services that published in April 2013. will meet the health needs of all diverse population groups, the CCG will need to understand who its 6.2. Patient Populations communities are, how the profile of communities has changed and will change in the future; and The CCG has 115 practices and a registered the impact of these changes will have on the patient population of 527,810, but this does not commissioning of health services. account for service users that may not be registered with a general practice. A breakdown of the Sandwell and West Birmingham CCG embrace population by Age, Sex, Ethnicity (estimated) and a densely populated and exceptionally diverse deprivation is provided below. More detailed section of West Birmingham and the analysis of our patient populations within the new conurbation. The CCG patients are spread across CCG boundaries will be provided in our Inclusion four local authority areas, with the largest majority Strategy to be published in April 2013. of patients (56%) within the Sandwell local authority area. The CCG area transcends historical PCT and Local Authority boundaries to encompass 6.2.1. Population by Age and Sex: the urban Sandwell towns of Blackheath, Cradley Total population of Sandwell and West Heath, Oldbury, Rowley Regis, Smethwick, Tipton, Birmingham CCG bt gender and age as at , , and West Bromwich; and January 2012 the West Birmingham wards of , Aston, Nechells, Lozells, Handsworth and Soho. Age groups Female Male Grand total

6.1. Data and Information 0-17 56,109 59,237 115,346 18-64 146,550 160,499 307,049 Achieving our aspiration for ‘healthcare without boundaries’ has created some interesting challenges 65+ 32,748 26,644 59,392 and exciting opportunities for us to consider. Information about our communities will be Grand total 235,407 246,380 481,787 crucially important to enabling us to commission effective and efficient health services. But before we can begin, we have a huge task ahead of us, to rationalise and make sense of the different approaches and systems used by NHS organisations and our partners to collect equality data about our patients. We also have an exciting opportunity to lead the development of integrated approaches and systems, to improve equality data collection and completion rates across the CCG area.

Much of this work is currently under-way in partnership with our public health colleagues and local authorities; and therefore whilst some data is provided below, a more detailed analysis of our diverse communities and health outcomes, will be presented within the Inclusion Strategy to be 16 Sandwell and West Birmingham CCG Equality & Diversity Plan

6.2.2. Population by Ethnicity (estimates of CCG area)

70

60

50

40

30

20 Percentage of total population Percentage 10

0 White Mixed Asian Black Other Sandwell and West Birmingham Ethnicity Estimates Source: ONS ethnic population estimates for PCTs applied to CCG population.

6.2.3. Population by Deprivation:

Patients registered with the CCG practices are likely to come from some of the most deprived areas of the country. The figure below shows the location of the CCG practices and deprivation by small area (lower super output area). Each GP practice in the country has had a deprivation score calculated for it with the average for all England practices at 24 (the higher the number the more deprivation). Sandwell and West Birmingham CCG average deprivation score has been calculated at for being 40.7, almost twice the England average. Sandwell and West Birmingham CCG Equality & Diversity Plan 17

6.3. Joint Strategic Needs Assessment • Newly Migrant Communities (Birmingham) (JSNA) • Priority Neighbourhood profiles (Birmingham)

The Government’s health reforms present an JSNAs help us to understand more about the opportunity for us to work more closely with both health of our local populations, for example, JSNAs the Sandwell, and the Birmingham Health and undertaken across our patch inform us that: Well Being Partnerships, to build on existing good practice and develop more culturally sensitive • Handsworth has a higher proportion of years JSNAs. A joint partnership has been agreed to of life lost from chronic liver disease including cover the CCG area, which will enable the CCG to cirrhosis, suicide, injury undetermined and influence the partnership agendas. than other parts of Birmingham. • Within Birmingham, Nechells ward has the JSNAs represent a continual process of gathering highest proportion of children living in poverty. and analysing information to provide a • Lozells has a higher proportion of years of comprehensive picture of the current and future life lost from accidents, suicide and injury health & wellbeing needs of the population undetermined and stroke. Mortality rates are in the CCG area. This is then used to inform higher than Birmingham average, with smoking- commissioning decisions to achieve better attributable diseases and alcohol-attributable outcomes and reduce inequalities. diseases contribute the most to this. • Within Sandwell, life expectancy is a postcode The CCG has developed JSNAs of each of its lottery and can vary between 10 years for men localities by practice. This information will help and 5-9 years for women, across the borough. the CCG to understand the needs of its practice • Smoking related deaths and hospital stays for populations and will complement the existing alcohol related harm are higher in Sandwell data and information the CCG has access to, from than the national average. JSNAs conducted by both Sandwell and Heart of Birmingham PCTs; that incorporate within them analysis by age, gender and race. We will use 6.4. Health Inequalities this information to help us analyse our equality performance and to set robust and evidence based Health inequality is a term often used to describe equality objectives. the differences, variations and disparities in the health outcomes of individuals and groups. The PCT assessments can be accessed on the An inclusive approach will help us to reduce Birmingham Health and Well Being Partnership unintended variations in health outcomes that result website: www.bhwp.nhs.uk and for Sandwell on in health inequalities across our catchment area. www.sandwelltrends.info website. We haves a responsibility under equality, health and social care legislation to try to understand what Some of the issues and topics covered in the PCT these differences are for their local populations and JSNAs include: to consider the actions that are needed to address them. • Alcohol (Sandwell) • Coronary Heart Disease (Sandwell) We recognise that we cannot change social and • Cancer (Sandwell) economic inequality and health outcomes in • Children and Young People (Sandwell) isolation of the wider health economy. • Black and Minority Ethnic groups.(Sandwell) 18 Sandwell and West Birmingham CCG Equality & Diversity Plan

This is why our strategies for commissioning, for communications and engagement, and for equality, stress the importance of working with our partners in local government, public health, and across the voluntary and community sectors, as well as with our provider organisations, to adopt a comprehensive approach towards these issues with shared goals and plans which link strongly with each other, rather than each of us acting independently.

“A central message of this Review... is that action is required across all these social determinants of health and needs to involve all central and local government departments as well as the third and private sectors. Action taken by the Department of Health and the NHS alone will not reduce health inequalities”. (Marmot, 2010a p12)

We believe that the biggest health challenge for us will be closing the inequalities gap in Sandwell and West Birmingham between deprived and more affluent communities. To do this we will need to:

• Make better use of the NHS resources we have • Improve patient experience and quality of life • Tackle deep seated inequalities and get to the real issues of why there is poor health and • Join up services. Sandwell and West Birmingham CCG Equality & Diversity Plan 19

Achieving inclusion: Getting to where we want to be

In anticipation of acquiring the statutory public The EDS will help us to meet: sector equality duty following authorisation, the CCG jointly agreed with the Black Country Cluster • The requirements of the public sector Equality of PCTs a set of interim equality objectives in April Duty 2012. These interim objectives represent our action • Equality aspects of the NHS Constitution plan for delivering this, our transitional strategy • Equality aspects of the NHS Outcomes for equality, diversity and human rights. The Framework transitional action plan is cited in Appendix 6. • Equality aspects of CQC’s Essential Standards • Equality aspects of the Human Resources The Action Plan sets out our priorities over the next Transition Framework. 12 months to: The EDS will also help us to commission better • Ensure statutory compliance outcomes for patients and communities and better • Implement the EDS and set equality objectives working environments for our staff, which are and outcomes personal, fair and diverse. It will provide us with • Develop our organisation and leadership the tools to work in partnership with patients, competencies in equality, diversity and human the public, member practices, staff and staff-side rights organisations to review our equality performance • Develop our staff to have the right knowledge and to identify equality priorities, objectives and and skills to carry out their roles more effectively actions. • Develop our Inclusion Strategy and Action Plan • Engage and involve local interests in our At the heart of the EDS is a set of 18 outcomes decision making grouped into four goals. These outcomes focus • Commission equality expertise from the on the issues of most concern to patients, carers, Birmingham, Solihull and Black Country communities, NHS staff and Governing Bodies. The Commissioning Support Service. four EDS goals are:

We will harness both local and national good • Better health outcomes for all practice to help us achieve our vision for an • Improved patient access and experience inclusive commissioning organisation and employer. • Empowered, engaged and included staff The tools we will use include: • Inclusive leadership at all levels. It is against these outcomes that we will analyse 7.1. National Equality Delivery System and grade our performance and determine collectively the action to be taken. The EDS grades (EDS) are set out below: We agreed in April 2012, to adopt the EDS as 1. Excelling Purple our equality performance and quality assurance 2. Achieving Green framework. The EDS will help us to drive up 3. Developing Amber equality performance and embed equality into our 4. Undeveloped Red mainstream business. 20 Sandwell and West Birmingham CCG Equality & Diversity Plan

The grades have been designed to reflect and development programme. promote: 7.2. Commissioning for Equality • The delivery of positive outcomes for protected groups, and to encourage continuous Our inclusive approach underpins the actions we improvement. will take to ensure that equality, diversity and • The recognition of inequalities between human rights are embedded throughout each stage protected groups and patients or staff as a of the CCGs commissioning cycle. The nature of whole, and how gaps can be reduced while commissioning activity necessitates our making maintaining or improving overall outcomes. decisions about health services and health care on • Good engagement with patients, carers, behalf of the public. At each stage of this process, communities and staff from protected groups. or commissioning cycle, we make decisions that • The use of best available evidence and good will affect our communities, staff and service practice examples to inform service and users. These decisions shape what we commission, workforce developments. who we commission services for, what the service • Tackling health inequalities for disadvantaged will look like and how they will be delivered and groups at the same time as inequalities for monitored; they shape how much resources we protected groups are addressed. allocate and who we involve to help us arrive at • Dealing with, and reporting on equality as part our decisions. of mainstream business and in particular relating work designed to promote equality to work Our inclusive approach ensures that at each stage, focused on the imperatives of QIPP, as reported our decision making processes pay due regard to in NHS integrated Plans where appropriate or in equality, diversity and human rights. other ways Appendix 5 presents the types of decisions we Appendix 3 sets out the EDS goals and outcomes make at each stage of our commissioning cycle and for NHS organisations. provides an indication of the approaches we will use to demonstrate due regard for equality and 7.1.1. EDS implementation respect for human rights at each stage.

We will build on the EDS implementation plan 7.3. Equality Impact Analysis (EqIA) already agreed with the Black Country Cluster PCTs to embed the EDS into the work of the CCG. We will use robust EqIAs to support our decision making. An EqIA is essentially a risk assessment Details of this plan can be found in Appendix 4. tool for equality and will ask questions of those We are aware that Implementation of the EDS developing policies or plans, to consider the impact tool itself will not satisfy the requirements of the of their proposals on groups protected by equality Equality duty, or change the way we commission legislation, or on vulnerable and seldom heard and act as an employer, therefore, we will: groups. Our EqIA policy will require developers to provide evidence to support their decision making, • Ensure that the implementation of the including evidence of whom they have engaged EDS is supported by a robust learning and and consulted with to mitigate any adverse impact development programme for the CCG and to justify positive impact. Governing Body, its staff and member practices and is included within the our organisational Sandwell and West Birmingham CCG Equality & Diversity Plan 21

The EqIAs undertaken will be proportionate to 7.4. Equality Monitoring the proposals being considered to ensure that our staff use their time effectively, focussing more time The CCG recognises that information is the key to and attention on decisions that have the greatest improving health outcomes for our communities impact. and staff.

The Governing Body will seek assurance that all 7.4.1. Workforce Monitoring proposals and plans presented before it include a robust EqIA and will consider the findings of the We will ensure that we undertake robust EqIA when arriving at their decisions. To comply monitoring of our workforce across all protected with the requirements of the equality duty, the characteristics to enable us to analyse the data and Governing Body will need to demonstrate that: be assured that our policies and practices comply with the requirements of the Equality Act 2010. • The duty was complied with before and at the We have learned from our predecessors, that it is time a proposal is under consideration and a simply not good enough to collect data, it must decision is taken. serve a purpose. We will ensure that the data • Decisions taken have considered the need to we collect about our staff is analysed to identify advance equality as an integral part of the any trends or patterns of behaviour that may decision-making process. indicate that our policies, procedures or practices • The duty must be exercised in such a way that it are not being implemented fairly. We will take influences the final decision. proportionate action to address any issues identified and publish our workforce data and action plans 7.3.1. Provider EqIA annually, in line with the requirements of the Public Sector Equality Duty. The CCG will also embed the requirement for NHS providers to conduct EqIAs within an agreed 7.4.2. Service user Equality Monitoring time-period, as a quality assurance clause within service specifications. The EqIA will inform the As a commissioner of NHS services, we will work CCGs contract and performance review processes. with our NHS service providers to ensure they We will set out the requirements for service undertake equality monitoring of their staff and providers to undertake an EqIA, but will not be service users. Our greatest task will not be to prescriptive in the methods they use. The EqIAs convince them to do so, as this requirement is will provide the CCG with valuable insight into placed upon them by the public sector equality the groups and patients that use the services we duty; but to agree with them a standardised have commissioned and those that do not; as set of equality monitoring categories. We know well as their experiences of the service and its that equality data collection and completeness staff. The outcomes of provider EqIAs will be used vary between and within primary, secondary and alongside other quality assurance evidence to community services providers; this is an area we will support the establishment of developmental action need to consider carefully with our partners, when plans or remedial action where there is evidence developing our equality priorities and action plans. of persistent non-compliance with our contract requirements and /or equality and human rights legislation. 22 Sandwell and West Birmingham CCG Equality & Diversity Plan

7.5. Engagement and Involvement Police and Fire Service. We have agreed a joint health and well being partnership As local clinical commissioners and leaders, we are approach across Sandwell and West Birmingham, in a unique position to drive service change and and will use this and other partnership mechanisms bring practice clinical insights to the forefront of to jointly address issues of discrimination and service redesign. To achieve this, both the CCG equality that necessitate an integrated approach. and its constituent Locality Commissioning Groups will need to work very successfully with a wide 7.7. Inclusive Leadership and an and diverse range of communities, local patients, Empowered Workforce partners and stakeholders to ensure local services are transformed. The EDS also places a requirement upon us to work with local interests, and emerging 7.7.1. Governing Body and leadership bodies such as Healthwatch, to ensure patients and development service user voices inform the development of our equality strategies and objectives; and are at the The success of our vision for an inclusive CCG will forefront of assessing our equality performance. succeed or fail on the strength of our commitment, and subsequent actions to foster a leadership We will build on the excellent track record of culture that not only understands, but can our award winning patient involvement and demonstrate through its actions, the value it places engagement approaches in the region to ensure on diversity and inclusion. that diverse groups continue to be involved and engaged in our work. Our EqIA process will help us To achieve our vision we will: to target our engagement activity at those groups upon which our policies, plans and proposals have • Embed within our organisational development the greatest impact, especially on groups for whom plans for the Governing Body and our leadership there may be a negative impact. In this way, we will teams; training and development opportunities ensure that our engagement activity is focussed, to equip them with the appropriate knowledge efficient and effective. More information about our and skills to successfully lead this agenda and plans can be found within our Communication and fulfil their roles and responsibilities effectively. Engagement strategy. The first of these will take place in June 2012. • Implement the Leadership Competency 7.6. Partnership Working Framework for Equality and Diversity. • Ensure that our Locality Commissioning Groups Successful approaches to equality require different are fully conversant with the duties placed upon public sector organisations to work together on them and have action plans in place to support eliminating discrimination and promoting equality the delivery of this agenda. in society. Key to achieving this will be the co- • To ensure our member practices understand the ordinated approach we take with our partners. This breadth of the equalities agenda, and their role will include our working across organisational and in helping to attain our desired outcomes. As geographical boundaries to maintain and develop well as understanding their role in challenging partnerships with other NHS Trusts, Metropolitan our equality performance. Borough Councils, Community and Voluntary Services, Healthwatch and Practice Patient Groups, within both Sandwell and Birmingham; as well as our partnerships with organisations such as the Sandwell and West Birmingham CCG Equality & Diversity Plan 23

7.7.2. Workforce Development rights. This will include training on conducting equality impact analysis, identifying and “Evidence shows that giving staff clear challenging inappropriate behaviours and on direction, good support and treating them using the EDS to drive up equality performance. fairly and supportively leads to higher quality • We will publish our workforce information of care, more satisfied patients and lower in compliance with the requirements of the patient mortality. By creating environments Equality Act 2010. where staff can give their best, it will improve patient satisfaction and save lives.” Our Organisational Development Strategy sets West and Dawson 2010: NHS staff Management out in greater detail our plans for developing an and Health Service Quality. inclusive leadership and empowered workforce.

To ensure that we empower and engage our staff, 7.8. Commissioning Equality Expertise we will: We acknowledge that as an emerging organisation, • Train our staff, to make certain that they, and we do not necessarily have all the expertise in particular managers, are conversant with ‘in-house’ to deliver our vision for an inclusive the requirements of the Public Sector Equality CCG. We will therefore, commission equality, Duty. Recognising that compliance involves diversity and human rights skills and expertise “a conscious approach and state of mind” [R from the Birmingham and Black Country Cluster (Brown) v Sec of State for Work and Pensions Commissioning Support Service to support us in [2008]]. achieving our aims. • Develop HR and workforce development policies that embody our inclusive values and have In anticipation of authorisation, we have already been supported in their development by robust secured the support of the Black Country Cluster equality impact analysis. PCTs Equality and Inclusion team to guide us in the • Monitor staff access to different aspects of development of our equality and diversity strategy, the work environment (across the protected associated action plan(s) and to implement the EDS characteristics where possible.) including: framework. We have also secured the involvement • Applicants for employment, training and of equality and diversity expertise on our development Organisational Development Committee, to ensure • Staff who receive training that our organisational development plans are • Staff who benefit or experience detriment as underpinned by inclusive values and approaches. a result of performance assessment • Applications for flexible working • Return to work rates after maternity leave • Pay gap information • Grievances and disciplinary procedures. • Staff ceasing employment • Develop Staff profile analysis to identify the composition of our workforce compared to population being served. • Implement robust induction and training programmes to develop staff skills and competencies in equality, diversity and human 24 Sandwell and West Birmingham CCG Equality & Diversity Plan

Transitional Action Plan

In anticipation of acquiring the statutory public sector equality duty following authorisation, the CCG jointly agreed with the Black Country Cluster of PCTs a set of interim equality objectives in April 2012. These interim objectives represent our action plan for delivering this, our transitional strategy for equality, diversity and human rights. The transitional action plan is cited in Appendix 6.

The Action Plan sets out our priorities over the next 12 months to:

• Ensure statutory compliance. • Implement the EDS and set equality objectives and outcomes. • Develop our organisation and leadership competencies in equality, diversity and human rights. • Develop our staff to have the right knowledge and skills to carry out their roles more effectively. • Develop our Inclusion Strategy and Action Plan. • Engage and involve local interests in our decision making. • Commission equality expertise from the Birmingham, Solihull and Black Country Commissioning Support Service. Sandwell and West Birmingham CCG Equality & Diversity Plan 25

Appendices

9.1. Appendix 1:

Human Rights Act 1998 Summary of Human Rights Articles and their relevance to NHS

Article Relevance Article 2: The Right to Life • Service provider policies e.g. DNR, consent, medical research, living wills etc • Deprivation of liberty safeguards • Mental Capacity Act • Palliative and End of Life Care policies • Equality and Diversity Policies • Individual Funding Requests Article 3: Prohibition of Torture • Mixed Sex accommodation • Child and Adult protection • Privacy and Dignity standards • Bullying, harassment and victimisation • Zero Tolerance policies

Article 4: Prohibition of Slavery • Forced Marriage policies and procedures and Forced Labour • Domestic Violence Policies • Adult and Child Safeguarding • Child / Sex Trafficking • Employment policies Article 5: Right to Liberty and • Mental Health Act Security • Deprivation of liberty safeguards • Interpreting and Communication services • Child and Adult Protection • Health and Safety policies Article 6: Right to a Fair Trial • Employment procedures and policies • Disciplinary and Grievance procedures • Interpreting and Communication services • Child and Adult protection • Prisoner Health Article 8: Right to Respect for • Service Provider policies Private and Family Life • Governance policies • Mixed Sex Accommodation • Privacy and Dignity Standards • Employment Policies • Child and Adult Protection 26 Sandwell and West Birmingham CCG Equality & Diversity Plan

Article Relevance Article 9: Freedom of Thought, • Freedom of exemption – conscientious objections Conscience and Religion • Employment policies • Food and Diet • Dress code and uniform policies • Consent policies Article 10: Freedom of Expression • Complaints policies and procedures • Patient and public engagement policies • Membership of political parties • Whistle Blowing policies • Confidentiality policies Article 11: Freedom of Assembly • Union Membership Rights and Association • Membership of extreme political groups Article 12: Right to Marry (and to • Maternity services – teenage pregnancy, single parents found a family) • Learning disability services • Fertility Treatment Article 14: Prohibition of • Equality and Diversity legislation and policies Discrimination • Employment policies and practices Sandwell and West Birmingham CCG Equality & Diversity Plan 27

9.2. Appendix 2:

CCG Governance and Accountability Structure

Sandwell and West Birmingham CCG Governing Body

Accountability Assurance Transparency Corporate responsibility • Governing Body sets outs its • Approval and Publication of for statutory compliance plans for compliance within its transitional inclusion strategy and with equality and human Inclusion Strategy and related action plan 2012/13 rights. action plans • Consultation, Approval and • Governing body approves Publication of Inclusion Strategy adoption of the inclusion strategy 2013-17 and associated action and EDS framework to monitor plan(s) equality performance and • Annual publication of data, progress information and evidence of • Accountability for compliance compliance with requirements of discharged to Quality and Safety the Public Sector Equality Duty. Committee with 6 monthly • Publication of Reports and reports against performance decisions related to equality and • Executive Lead for Equality and diversity. Diversity identified • Approval of information to comply with the specific duties of the Equality Act 2010 • Equality and Inclusion are regular agenda items. Ensure that an inclusive • Strategic Commissioning and • Publication of Equality Impact approach is embedded Service Re-design Committee Analysis reports at the core of the CCGs assurance • Publication of Reporting templates strategic decision making. • All reports received include • Publication of Governing body assurance that equality impact Agenda, Minutes and Reports. analysis has been undertaken • All proposals received embed the outcomes of EqIA and specify how this has shaped the proposal • Reporting templates specify that the Governing body have reviewed the EqIA before reaching a decision. 28 Sandwell and West Birmingham CCG Equality & Diversity Plan

Sandwell and West Birmingham CCG Governing Body

Accountability Assurance Transparency Ensure that it is Receives regular reports on statutory • Regular reports the from quality accountable to its compliance and the Equality and Safety committee. membership, the NHS performance of the: • Publication of information about: and social care regulatory • CCG • CCG workforce bodies and other • Its NHS providers • Service users enforcement agencies. Provides assurance to: • Engagement and involvement • NHS Commissioning board activity of compliance with equality • Equality Impact Analysis legislation • Progress with implementing • Midlands and East Strategic Inclusion Strategy and Action Health Authority of progress plans against EDS and statutory • Progress with implementing compliance EDS • Healthwatch (local Interests) • Grading of CCG performance. of performance against EDS objectives and outcomes • OSC of evidence of Equality Impact Analysis and public involvement in service developments and re-design • LGG and member practices of compliance against Equality legislation. Ensure the CCG has • OD strategy to embed use of • Reports from each Committee competent Inclusive the ‘Competency Framework for on performance against Equality leadership within its Equality and Diversity Leadership’; Action plans and EDS structure. to recruit, develop and support • Publication of information to strategic leaders to advance include data about leadership equality outcomes recruitment, development and • An executive lead for equality training and diversity has been identified • Publication of performance • Each Locality Commissioning against the Competency Group has identified a lead for Framework for Equality and Equality and Diversity. Diversity Leadership’. Ensure that all staff are • Approval of CCG organisational • Publication of data and empowered, engaged and development strategy information on numbers accessing well supported. • Leadership and staff training and and benefitting from leadership, development needs identified staff and members training and and programme delivered development programme • Staff and LCG engagement • Staff experience surveys / mechanisms established. feedback. Sandwell and West Birmingham CCG Equality & Diversity Plan 29

Quality and Safety Committee

Accountability Assurance Transparency To provide assurance • Quarterly Assurance reports from • Publication of annual equality data to the Governing Body Executive Lead for Equality and and information in compliance of compliance with the Diversity on: with the equality act Equality Act 2010 and • Progress against the Inclusion • Publishing equality objectives and implementation of EDS. Strategy and Action Plan (s). annually reporting on outcomes • Performance and progress against these against the EDS equality • Publication and communication of objectives and outcomes Good practice. • Performance against Committee ED action plans. • Reviews and approves information and data for publication • Reviews the involvement of local interests • Identifies gaps in equality performance, data and user involvement across the CCG and its providers/contractors • Makes recommendations to the governing body to support the review and development of equality priorities, objectives and outcomes • Reviews exception reports and remedial action plans on CCG, CSS, Public health and other provider performance • Shares good practice. 30 Sandwell and West Birmingham CCG Equality & Diversity Plan

Organisational Development Committee

Accountability Assurance Transparency To provide assurance • OD committee structure includes • CCG OD committee to include of progress against the Equality and Diversity expertise representation from: OD elements of the • OD committee terms of reference • CCG Executive lead for CCG inclusion Strategy include requirement to monitor equality and diversity, and and action plans and performance against the OD • CSS lead for equality and compliance with the Equality Action Plan diversity. Equality Act 2010. • To agree OD Equality and • Publication of Inclusion strategy Diversity Action Plan and Action plan to include • To agree CCG priorities against equality priorities for EDS goals 3 EDS goals 3 and 4 + 4 • To monitor and report on • Annual publication of performance against the ED OD performance against EDS goals action plan 3+4 • To review and produce exception • Reports to Executive Lead for reports against OD equality Equality and Diversity performance and EDS goals 3 • Communication and publication and 4 of good practice. • Raise Equality Issues and concerns • To share good practice and learning. Sandwell and West Birmingham CCG Equality & Diversity Plan 31

Locality Commissioning Group Boards

Accountability Assurance Transparency To provide assurance Each LCG will: • Have a named lead for Equality of progress against the • Identify a lead for Equality and and Diversity CCG inclusion Strategy Diversity • Publish its Equality Action Plan and action plans, and • Set out how it will meet the and progress against it compliance with the CCGs priorities for Equality and • Publish its progress against the Equality Act 2010. Diversity Equality Action Plan • Develop and monitor its • Communicate good practice performance against its LCG • Has Involved and engaged Equality and Diversity Action plan local interests including diverse • Equality and Diversity progress is patients, public and carers. a regular board agenda item • Produce reports to the Executive Lead for Equality and Diversity : • Outlining its equality performance and progress. • Raise equality issues and concerns • Identify how it has involved diverse local interests in its decision making • Identify intelligence and insight from patients and local interests • Exception reports against its performance and progress. • Share good practice and learning with its member practices and the CCG. 32 Sandwell and West Birmingham CCG Equality & Diversity Plan

Partnership Committee

Accountability Assurance Transparency To provide assurance • Identify a lead for Equality and • Have a named lead for Equality of progress against the Diversity and Diversity Partnership elements of • Set out how the committee will • Reports on progress against its the CCG inclusion Strategy meet the CCGs priorities for Equality Action Plan and action plans, and Equality and Diversity • Communicates and shares good compliance with the • Develops and monitors practice. Equality Act 2010. performance against its Partnership Equality and Diversity Action plan • Produces reports to the Executive Lead for Equality and Diversity to: • Outline its equality performance and progress • Raise equality issues and concerns • Identify how it has involved diverse local interests in its decision making • Identify intelligence and insight from patients and local interests • Exception reports against its performance and that of partners. • Share good practice and learning with the CCG, LCG, its member practices and partners. Sandwell and West Birmingham CCG Equality & Diversity Plan 33

Strategic Commissioning and Service Re-design Committee

Accountability Assurance Transparency To provide assurance • Identify a lead for Equality and • Have a named lead for Equality of progress against the Diversity and Diversity relevant elements of the • Set out how the committee will • Reports on progress against its CCG inclusion Strategy meet the CCGs priorities for Equality Action Plan and progress and action plans, and Equality and Diversity against it compliance with the • Develops and monitor • Communicates and shares good Equality Act 2010. performance against its Equality practice. and Diversity Action plan • Produce reports to the Executive Lead for Equality and Diversity : • Outlining its equality performance and progress. • Raise equality issues and concerns • Identify how it has involved diverse local interests in its decision making • Identify intelligence and insight from patients and local interests • Exception reports against its performance and that of providers. • Shares good practice and learning to the CCG,its member practices and partners. 34 Sandwell and West Birmingham CCG Equality & Diversity Plan

Executive Lead / Accountable Officer

Accountability Assurance Transparency Accountable officer for the • Executive lead for equality and • Reports to quality and Safety organisation’s ED&HR risk diversity identified committee on compliance Management and • Appropriate and robust systems with Equality Act 2010 and compliance status. and processes are developed and implementation of EDS implemented to minimise risk • CSS SLA in place. and ensure compliance • Champions equality, diversity and human rights within and outside the organisation • Ensures appropriate SLA is in place for commissioning Equality Expertise from the CSS.

CSS Equality and Diversity Lead (S)

Accountability Assurance Transparency To provide the CCG with • Deliver the outcomes set out in • Outcomes delivered in line with equality and inclusion the SLA for CSS Equality and service specification. expertise in line with the Inclusion support. Service level agreement. Sandwell and West Birmingham CCG Equality & Diversity Plan 35

9.3. Appendix 3:

NHS Equality Delivery System EDS Objectives and Outcomes The analysis of each outcomes must cover each protected group, and be based on comprehensive engagement, using reliable evidence.

Goal Outcome 1. Better health 1.1 Services are commissioned, designed and procured to meet the health needs of outcomes for all local communities, promote wellbeing, and reduce health inequalities

1.2 Patients’ health needs are assessed, and resulting services provided, in appropriate and effective ways

1.3 Changes across services are discussed with patients, and transitions are made smoothly

1.4 The safety of patients is prioritised and assured

1.5 Public health, vaccination and screening programmes reach and benefit all local communities and groups.

2. Improved 2.1 Patients, carers and communities can readily access services, and should not be patient access and denied access on unreasonable grounds experience 2.2 Patients are informed and supported so that they can understand their diagnoses, consent to their treatments, and choose their places of treatment

2.3 Patients and carers report positive experiences of the NHS, where they are listened to and respected and their privacy and dignity is prioritised

2.4 Patients’ and carers’ complaints about services, and subsequent claims for redress, should be handled respectfully and efficiently. 3. Empowered, 3.1 Recruitment and selection processes are fair, inclusive and transparent so that the engaged and well workforce becomes as diverse as it can be within all occupations and grades supported staff 3.2 Levels of pay and related terms and conditions are fairly determined for all posts, with staff doing the same work in the same job being remunerated equally

3.3 Through support, training, personal development and performance appraisal, staff are confident and competent to do their work, so that services are commissioned or provided appropriately 36 Sandwell and West Birmingham CCG Equality & Diversity Plan

Goal Outcome 3. Empowered, 3.4 Staff are free from abuse, harassment, bullying, violence from both patients and engaged and well their relatives and colleagues, with redress being open and fair to all supported staff (continued) 3.5 Flexible working options are made available to all staff, consistent with the needs of patients, and the way that people lead their lives

3.6 The workforce is supported to remain healthy, with a focus on addressing major health and lifestyle issues that affect individual staff and the wider population.

4. Inclusive 4.1 Governing Bodys and senior leaders conduct and plan their business so that leadership at all equality is advanced, and good relations fostered, within their organisations and levels beyond

4.2 Middle managers and other line managers support and motivate their staff to work in culturally competent ways within a work environment free from discrimination

4.3 The organisation uses the NHS Equality & Diversity Competency Framework to recruit, develop and support strategic leaders to advance equality outcomes. Sandwell and West Birmingham CCG Equality & Diversity Plan 37

9.4. Appendix 4:

EDS Implementation Plan Proposed objectives mapped to EDS Goals and Outcomes

Interim Black Country PCT EDS Goals and Outcomes Objectives 2012/13 NHS Goal Outcome to be achieved Analyse local, national and regional 1. Better health 1.1 Services are commissioned, designed and evidence to support the CCGs in the outcomes for all procured to meet the health needs of local Black Country to identify and prioritise communities, promote wellbeing, and reduce work with groups protected by health inequalities legislation, where difference in health outcomes and need is the greatest. 1.2 Patients’ health needs are assessed, and resulting services provided, in appropriate and Measure: effective ways • 100% CCGs have analysed and prioritised the equality issues for 1.3 Changes across services are discussed with their patient populations patients, and transitions are made smoothly • 100% of CCGs have set objectives to improve the health outcomes 1.4 The safety of patients is prioritised and for at least one protected or assured vulnerable group • Publish analysis by December 2012 1.5 Public health, vaccination and screening • Publish CCG equality objectives by programmes reach and benefit all local April 2013. communities and groups.

Undertake an analysis of the major 2. Improved 2.1 Patients, carers and communities can barriers to improved patient access patient access readily access services, and should not be and experience within the Black and experience denied access on unreasonable grounds Country for groups protected by legislation. 2.2 Patients are informed and supported so that they can understand their diagnoses, Measure: consent to their treatments, and choose their • Pilot an equality survey in one CCG places of treatment • 100% of CCGs have analysed the major barriers for their patient 2.3 Patients and carers report positive population groups experiences of the NHS, where they are • 100% CCGs utilise the analysis to listened to and respected and their privacy and set their equality objectives dignity is prioritised • Publish analysis by December 2012. 2.4 Patients’ and carers’ complaints about services, and subsequent claims for redress, should be handled respectfully and efficiently 38 Sandwell and West Birmingham CCG Equality & Diversity Plan

Interim Black Country PCT EDS Goals and Outcomes Objectives 2012/13 NHS Goal Outcome to be achieved Support and advise the Black 3. Empowered, 3.1 Recruitment and selection processes are fair, Country CCG to embed inclusive engaged and inclusive and transparent so that the workforce leadership throughout its well-supported becomes as diverse as it can be within all organisational and workforce staff occupations and grades development programmes. AND 3.2 Levels of pay and related terms and conditions Measure: are fairly determined for all posts, with staff doing • Workforce equality analysis 4. Inclusive the same work in the same job being remunerated completed for locality based leadership at all equally receiver organisations (CCGs levels and CSS) as part of legacy 3.3 Through support, training, personal handover development and performance appraisal, staff are • Pilot inclusive leadership confident and competent to do their work, so that training within one CCG services are commissioned or provided appropriately • ED training programme developed and implemented 3.4 Staff are free from abuse, harassment, bullying, for CCG senior managers violence from both patients and their relatives and • All CCGs to have established colleagues, with redress being open and fair to all mechanisms for assessing their equality performance and 3.5 Flexible working options are made available to demonstrating compliance all staff, consistent with the needs of patients, and with the requirements of the the way that people lead their lives Equality Act 2010. 3.6 The workforce is supported to remain healthy, with a focus on addressing major health and lifestyle issues that affect individual staff and the wider population

4.1 Governing Bodys and senior leaders conduct and plan their business so that equality is advanced, and good relations fostered, within their organisations and beyond

4.2 Middle managers and other line managers support and motivate their staff to work in culturally competent ways within a work environment free from discrimination

4.3 The organisation uses the NHS Equality & Diversity Competency Framework to recruit, develop and support strategic leaders to advance equality outcomes. Sandwell and West Birmingham CCG Equality & Diversity Plan 39

9.5. Appendix 5:

Commissioning for Equality

Nature of Decisions Equality will be evidenced through: Statutory Compliance • Compliance with the requirements of the Equality Act 2010, Human Rights Act 1998 • Ensuring that the Governing Body is aware of its duties and responsibilities • The Governing Body has identified an executive lead for equality / inclusion • The Governing Body has received training on using the NHS equality Competency framework for leadership • Appropriate governance arrangements for equality and diversity have been agreed by the Governing Body. Strategic Analysis: • Assess population • Assessment of the health needs of the local populations across all protected, health needs vulnerable and seldom heard groups. Development of culturally sensitive JSNAs.

• Review current • Analyse how effective existing commissioned services are at addressing the Service Provision needs of protected and vulnerable groups in comparison to the general population.

• Resource Analysis • Analyse whether there is an equitable distribution of available resources against need, and whether any groups may be put at a disadvantage. Strategic Planning: • • Establish • Equality, diversity and human rights should be explicitly considered when Commissioning establishing commissioning priorities with the commissioning strategy Priorities and plan setting out how the needs and views of protected groups have informed and shaped the decisions reached.

• Agree priorities for • Consider the impact of investment and disinvestment proposals on protected investment and and vulnerable groups, to inform strategic decision making. disinvestment

• Gap Analysis • Assess whether monitoring data is comprehensive and robust. This data will be required for publication and to support priorities and decisions.

• Service Design / • Ensuring that robust equality impact analysis support the design/re-design of Re-design services. Technical Decisions: • Procurement and • Ensure that the tenders for service provision explicitly set out the Tendering requirements to address health inequalities amongst protected groups; and how equality performance will be measured through contracts. 40 Sandwell and West Birmingham CCG Equality & Diversity Plan

Nature of Decisions Equality will be evidenced through: Technical Decisions (continued): • Ensure that all contracts have robust equality clauses and that service • Market and supplier specifications clearly set out the providers’ contract obligations for equality Management including the requirement to provide data on all protected groups and to provide evidence of equality impact analysis against their performance.

• Capacity Building • Support providers where necessary to understand the requirements of equality legislation, this may include the development and distribution of guidance and good practice. Evaluation and Review: • Contract Monitoring • The inclusion of robust equality monitoring as part of the contract review process.

• Quality Assurance • Quality assurance of its commissioning decisions and EqIAs, to ensure that they comply with the CCGs Inclusion strategy.

• Review strategy and • Review the impact of the CCGs Inclusion strategy and annual performance market performance against the action plan, identifying areas of good practice as well as improvement and development. Sandwell and West Birmingham CCG Equality & Diversity Plan 41

9.6. Appendix 6:

Transitional Inclusion Strategy Action Plan 2012/13 Lead CCG Executive lead for Equality and Diversity, supported by the CSS lead for Equality and Diversity. be To confirmed. Workforce Workforce policies developed. Robust equality monitoring built into workforce policies and procedures. Equality analysis of workforce policies undertaken and published. Expected Outcomes The CCG has assessed its performance and identified the main issues and barriers to patient improved outcomes, experience, choice and access across each Locality Commissioning area. Group • • • EDS Reference Goals 1+2 Goals 3+4 Assurance Q&S Committee / Governing Body Approval Organisational Development Committee Date Completion September 2012 To be To confirmed Activity Needs assessment Patient involvement in service change Patient safety Public health Access Choice Patient experience Complaints Equality Delivery System implementation Analysis of the equality issues and barriers to: relating • • • • • • • • for CCG patient populations and within each LCG area. Inclusive Workforce Inclusive Workforce policies have been developed and informed by robust EQIA Ref 1.1 1.2 1.0 42 Sandwell and West Birmingham CCG Equality & Diversity Plan Lead CCG Equality and Diversity Executive lead. CCG Equality and Diversity lead. CSS Equality and Diversity lead. CSS Equality lead. CCG Equality lead. CSS ED lead for Equality and Diversity. Outcomes Expected Consultation initiated on Inclusion Strategy. CCG publishes information to comply with the requirements of the PSED. Inclusive Commissioning training and development programme implemented for Governing Body and senior staff. Lay interests have been Lay interests involved in assessing and grading EDS performance. EDS objectives and for outcomes agreed priority goals and outcomes. CCG has RAG rated its performance against its analyses of performance (EDS goals and outcomes). EDS Reference EDS Goals 1-4 EDS Goals Goals 3+4 Goals 1-4 Goals 1-4 Goals 1-4 Q&S Committee Quarterly reporting Assurance OD Committee OD Committee Q&S Committee • • Date Completion December 2012 - February 2013 December 2012 June 2012 - October 2012 October 2012 November 2012 October 2012 Activity CCG consults on its equality priorities, objectives and outcomes (set out within its Inclusion Strategy). CCG publishes its analysis 1.1 and 1.2 to underpin from its decision making. EDS awareness session EDS awareness to Governing delivered Body, LCG, Committee members and leadership team.. CCG has involved local in the grading of its interests equality performance and the setting of equality priorities. CCG has set objectives to health outcomes for improve and at least one protected vulnerable group. The CCG has graded its the 18 performance across outcomes and four goals of the EDS (using performance 1.1) analysis from Ref 1.8 1.7 1.6 1.5 1.4 1.3 Sandwell and West Birmingham CCG Equality & Diversity Plan 43 Lead CCG Executive lead for Equality and Diversity. CCG Executive Lead for Equality and Diversity. CCG Equality and Diversity Executive lead. Transitional strategy Transitional published CCG four year Inclusion Strategy and annual action plan published. Outcomes of consultation inform strategy Strategy and Action plan published on PCT web site and in version Easy read Copies of strategy made available in alternative format. Outcomes Expected • • and Workforce Service user data and information published. Public consultation undertaken to inform objectives and strategy, action plan. • • • EDS grading shows across improvement the EDS objectives and outcomes set out within the Inclusion strategy. EDS Reference EDS Goals 1-4 EDS Goals 1-4 Assurance Q&S Committee strategy, approve objectives and action plan Q&S Committee approval Q&S Committee approval Governing Body approval Quarterly assurance to Q&S Committee Date Completion June 2012 (transitional) April 2013 (finalised) December 2012 December 2012 - February 20123 April 2013 April 2014 and annually Activity Statutory Compliance Publish an equality strategy, objectives and annual action plan. and service Publish workforce user information. Consult on equality strategy, Consult on equality strategy, objectives and action plan. CCG Inclusion Strategy and Action Plan published. on year improvement Year against EDS objectives and outcomes (inclusion strategy action plan). Ref 2.0 2.1 2.2 2.3 1.10 1.9 44 Sandwell and West Birmingham CCG Equality & Diversity Plan Lead CCG Executive Lead for Equality and Diversity. CSS ED lead. CSS Lead for Equality and Diversity. Terms of Reference of Reference Terms developed and agreed ED leads represented on OD Committee. EDS Embedding equality into commissioning activity Statutory compliance requirements. Outcomes Expected OD strategy produced. • • Increased knowledge of: Increased • • • ED Action plan developed. Performance reports produced. Equality performance EDS goals graded across and outcomes. EDS Reference EDS Goal 3+4 EDS Goal 3+4 Engagement and Involvement of Lay interests Assurance OD Committee Quarterly to Q&S report Committee OD Committee approval Date Completion June 2012 June 2012 September 2012 March 2013 March September 2012 June 2012 Activity Organisational Committee set out role of Reference Terms diversity to equality, in relation and human rights. Organisational Development is inclusive approach Ensure embedded into OD strategy and plans. Develop ED Action plan for OD Committee. Involve LCG and member practices in assessing equality performance. Implement ED Action plan. Engagement and Involvement Involve LINkS and other local to analyse equality interests performance. Commissioning for Equality event for Host Awareness LCG boards Governing body, and leadership team. Ref 4.2 4.0 4.1 4.3 5.2 4.4 5.0 5.1 3.1 3.0 Sandwell and West Birmingham CCG Equality & Diversity Plan 45 Lead CCG Executive Lead for Equality and Diversity. CSS Lead for Equality and Diversity. Outcomes Expected ED expertise in place to support CCG to develop and implement its ED Strategy and action plan. Patient and clinical engagement in analysing and grading performance EDS Reference EDS Goals 3+4 Engagement and Involvement of Lay interests Assurance Q&S Committee Quarterly to Q&S report Committee Date Completion September 2012 December 2012 April 2012 October 2012 Activity CSS Equality and Inclusion expertise commissioned. Involve local interests to Involve local interests develop CCG Equality strategy, objectives and action plans. Commissioning Expertise CSS Equality and Inclusion expertise identified. Utilise Black Country Lay Assessors to assess and grade Equality performance. Ref 6.2 5.4 6.0 6.1 5.3 Address 1 Address 2 Address 3 Postcode

Tel: Email: Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich Aston, Handsworth, Jewellery Quarter, Lozells, Nechells, Newtown, Oscott, Perry Barr, Soho, Oldbury, Rowley Regis, Tipton, Smethwick, West Bromwich