NHS HUMBER CLUSTER (A Joint Board for East Riding of Yorkshire, Hull, North Lincolnshire Primary Care Trusts and North East Lincolnshire Care Trust Plus)

EQUALITY PLAN AND OBJECTIVES 2012-2016

Date: March 2012

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The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 2 of 49

NHS HUMBER CLUSTER (A Joint Board for East Riding of Yorkshire, Hull, North Lincolnshire Primary Care Trusts and North East Lincolnshire Care Trust Plus)

EQUALITY PLAN AND OBJECTIVES 2012-2016

CONTENTS PAGE

1 Welcome 3

2 Introduction 4

3 The Equality Act 2010 6

4 The Human Rights Act 1998 9

5 NHS Equality Delivery System 10

6 Our Staff 11

7 Area Equality Plans and Objectives 12

7.1 NHS East Riding of Yorkshire 12

7.2 NHS Hull 23

7.3 NHS North Lincolnshire 34

7.4 NHS North East Lincolnshire 41

8 MONITORING AND EVALUATION 46

Appendix 1 - Summary of the Human Rights Act 1998 47

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 3 of 49

NHS HUMBER CLUSTER (A Joint Board for East Riding of Yorkshire, Hull, North Lincolnshire Primary Care Trusts and North East Lincolnshire Care Trust Plus)

EQUALITY PLAN AND OBJECTIVES 2012-2016

1 WELCOME

Welcome to our Equality Plan and objectives for 2012-16. Our equality plan and objectives focus specifically on how we will positively contribute to a fairer society and good relations in the way we work across NHS Humber Cluster. NHS Humber Cluster is a joint Board accountable for the statutory duties of East Riding of Yorkshire Primary Care Trust, Hull Primary Care Trust, North Lincolnshire Primary Care Trust and North East Lincolnshire Care Trust Plus.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 4 of 49 2 INTRODUCTION

Our Equality Plan and objectives for 2012-16 are linked to local Health Strategies and describe how NHS Humber Cluster and the four local Clinical Commissioning Groups, covering the East Riding of Yorkshire, Hull, North Lincolnshire and North East Lincolnshire will lead and deliver our equality commitment.

This plan builds on the previous work of our local Primary Care Trusts/Care Trust Plus and brings together our statutory duties and covers our commitment to equality issues and Human Rights following the introduction of the Equality Act 2010.

Developing this plan has been led across our four geographical areas via the emerging Clinical Commissioning Groups listed above and through the engagement of local people, service leads within the NHS, diverse groups, wider public sector organisations including Local Authorities and the voluntary/community sectors.

The Clinical Commissioning Group Committees for East Riding of Yorkshire, Hull, North Lincolnshire and North East Lincolnshire have committed to:

• Identifying a clinical and lay lead for equality and diversity. • Providing equality training to ensure that the clinical, Human Resources, Commissioning and Public Health leads are trained in Equality Impact Analysis. • Contributing to the publication of equality information required at PCT/Humber Cluster level. • Continuing to actively seek views from diverse groups within their area to inform decisions made by them.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 5 of 49 The Equality Plan includes separate chapters for each geographic area in the Humber Cluster, providing more detail about each area‟s specific plans and objectives for the period 2012-2016.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 6 of 49 3 THE EQUALITY ACT 2010

The Equality Act 2010 came into force on 1 October 2010. The Act brings together and replaces the previous anti-discrimination laws with a single Act, which aims to simplify and strengthen the law, removing inconsistencies and making it easier for people to understand and comply with it. The Act covers the following protected characteristics:

 Age.  Disability.  Gender reassignment.  Marriage and civil partnership (only in relation to the requirement to have due regard to the need to eliminate discrimination).  Pregnancy and maternity.  Religion or belief (or lack of belief).  Race, including ethnic or national origin, colour or nationality.  Sex.  Sexual orientation.

3.1 General Duty The Act also includes a new general equality duty that replaces previous separate duties on race, disability and gender equality. This came into force on 5 April 2011.

The NHS Humber Cluster Board (acting on behalf of the four PCTs in our area) is covered by the general equality duty. The aim of the general equality duty is to ensure that public authorities, and those carrying out public functions, consider how they can positively contribute to a fairer society through advancing equality and fostering good relations in their day to day activities. The duty ensures that equality considerations are built in to the

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 7 of 49 design of policies and the delivery of services and that they are kept under review.

We are required to have due regard of the need to:

 Eliminate unlawful discrimination, harassment and victimisation and other conduct that is prohibited by the Act.  Advance equality of opportunity between people who share a relevant characteristic and those who do not.  Foster good relations between people who share a relevant characteristic and those who do not.

To make sure we comply with the Act we must:

 Remove or minimise disadvantages experienced people due to their protected characteristics.  Take steps to meet the needs of people from protected groups where these are different from the needs of other people.  Encourage people with protected characteristics to take part in public life or in other activities where their participation is disproportionately low.

3.2 Specific Duties Specific duties set out in the Equality Act 2010 promote better performance of the equality duty by requiring the publication of:

 Equality objectives, at least every four years.  Information to demonstrate compliance with the equality duty, at least annually.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 8 of 49 These tell us the steps we need to take to demonstrate we are paying due regard to the general duty.

To make sure we comply with both the general and specific duties we will:

 Prepare and publish our equality objectives, in our Equality Plan, by 6 April 2012. This will include information on the actions we intend to take to meet the objectives, how we will measure our progress and how long we expect to take to meet our objectives.  Make arrangements to monitor our progress against objectives and evaluate the effectiveness of the actions taken.  Give consideration to the equality information we hold when considering and reviewing our equality objectives.  Review our equality objectives at least once every 4 years.  Involve a broad range of people in setting our equality objectives, reviewing our equality plan and identifying how our work can contribute to the general equality duty.  Carry out equality impact analysis on policies, strategies and decisions about services.  Collect and publish relevant equalities information about our staff on an annual basis (where we have 150 staff or more).  Produce an equality progress report on an annual basis ensuring it is made available in accessible formats.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 9 of 49 4 THE HUMAN RIGHTS ACT 1998

The Human Rights Act (HRA) 1998 details how the UK complies with and implements the rights and freedoms guaranteed under the European Convention on Human Rights. All public bodies have an obligation to ensure respect for Human Rights, acting in ways that positively reinforce the principles of the HRA 1998.

The HRA 1998 came into force in October 2000 and enabled people to enforce the European Convention on Human Rights in the UK courts. Article 14 of the Human Rights Act 1998 refers to the prohibition of discrimination, and states that the enjoyment of the rights and freedoms set out in the European Convention on Human Rights shall be secured without discrimination on the grounds of sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.

A summary of the HRA Convention Rights is attached at Appendix 1.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 10 of 49 5 NHS EQUALITY DELIVERY SYSTEM

The NHS has introduced an Equality Delivery System (EDS) designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse. The EDS aims to assist organisations to achieve compliance with the Public Sector Equality Duty in a way that also helps deliver on the NHS Outcomes Framework, the NHS Constitution and the Human Resources Transition Framework. It will help providers to continue to meet the Care Quality Commission‟s “Essential standards of quality and safety”.

At the heart of the EDS is a set of 18 outcomes grouped into four objectives. These outcomes focus on the issues of most concern to patients, carers, communities, NHS staff and Boards. It is against these outcomes that performance is analysed, graded and action determined.

The four EDS objectives are:

1. Better health outcomes for all 2. Improved patient access and experience 3. Empowered, engaged and included staff 4. Inclusive leadership at all levels

The objectives of the EDS have driven the development of our local objectives and each area chapter demonstrates how their local objectives meet the requirements of the EDS. Full assessments against the EDS will be undertaken by Clinical Commissioning Groups as they work towards authorisation to become statutory bodies.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 11 of 49 6 OUR STAFF

Each PCT/CTP in the NHS Humber Cluster is committed to publishing information on an annual basis which demonstrates its commitment to, and compliance with, the Public Sector Equality Duty which came into force in April 2011.

An Equality and Diversity Workforce Report is published annually, and can be viewed on each PCT/CTP website. These reports contain details of the analysis of the workforce data for each organisation by ethnicity, gender, disability, sexual orientation, religious belief, and age.

Each PCT/CTP has a range policies and procedures in place to support Equality and Diversity and to support the PCTs/CTP in achieving their aim, all new and reviewed policies, strategies, specifications, contracts, plans and proposals are subject to an Equality Impact Analysis.

Each PCT/CTP is committed to providing specialised Equality and Diversity training to its workforce.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 12 of 49 7 AREA EQUALITY PLANS AND OBJECTIVES

The following sections describe the equality plans and objectives for our four geographical areas.

7.1 NHS EAST RIDING OF YORKSHIRE

ABOUT THE EAST RIDING OF YORKSHIRE AREA East Riding of Yorkshire covers an extensive rural area of approximately 1,000 square miles which includes the coastal strip from Spurn Point to Bridlington across Holderness, Haltemprice and Goole & Howdenshire. The area has diverse communities ranging from villages in the Wolds and on the outskirts of Hull, rural farming areas, market towns in Driffield, Goole, Beverley, Hessle, Market Weighton and Pocklington to the coastal towns of Bridlington, Hornsea and Withernsea. There is a general population of around 335,000 people.

Age - There is a growing population of people aged over 65, which results in higher levels of age related challenges including Long Term Conditions, general frailty associated with ageing and deteriorating cognitive functions (dementia). There is a lower than average birth rate. The population of children and working age groups is projected to decline whilst a rise in the number of elderly people with chronic conditions will be a major challenge.

Disability - It is estimated that approximately 48% of the East Riding population lives with a disability including physical disabilities, hearing impairments, poor mental health and autism. (Source: Projecting Older People Population Information System and Projecting Adult Needs and Service Information)

Gender - The gender split in the East Riding is approximately 50% men and women. Whilst life expectancy continues to increase in the East Riding, there is still a gap between life expectancy of males (79.2) and females (82.5) with people living longer in some parts of the East Riding than others.

Race - Compared with the East Riding 2001 Census, the 2007 midyear estimate shows that the Black and Minority Ethnic population has risen from 2.4% to 4.9%. In 2005/06

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 13 of 49 approximately 1500 new National Insurance Numbers were issued to overseas nationals living in the East Riding and there is an increase of new migrants from Poland, Latvia and Lithuania, particularly in Goole.

Religion & Belief - According to the 2001 Census, almost 80% of the population have identified themselves as Christian and 1.2% of the population is made up of other religions. The remainder of the population did not state anything or stated „no religion‟.

Sexual Orientation - There are no local statistics for how many Lesbian, Gay or Bisexual (LGB) people live within the East Riding however, nationally, the Government estimates that 5% of the population are lesbian, gay, bi and transgender communities.

Transgender - There are no official statistics nationally or regionally regarding transgender populations, however, GIRES (Gender Identity Research and Education Society) estimate that 1% of the population are gender variant to some degree (i.e. seeking or receiving treatment or undergoing or undergone transition).

Marriage and Civil Partnership - This protected characteristic generally only applies in the workplace.

PARTNERSHIP WORKING We are committed to working in partnership across the range of public, private and voluntary agencies to promote equality, diversity and human rights. To this end, we are active partners in the Joint East Riding of Yorkshire Equality and Diversity Board which includes East Riding of Yorkshire Council, Humber NHS Foundation Trust, Humberside Police Authority, Humberside Police Force and Humberside Fire and Rescue Service. The purpose of the Board is to provide a partnership approach for inward and outward facing strategic direction and leadership for the promotion of equality and diversity throughout the East Riding, working towards shared outcomes.

We are also committed to working in partnership in the development and implementation of our objectives with East Riding of Yorkshire Council and will actively support the local authority in implementing their equality objectives.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 14 of 49 Table 1 identifies the equality objectives for NHS East Riding of Yorkshire and East Riding of Yorkshire Council and how they link into our shared EDS outcomes.

DEVELOPING OUR OBJECTIVES In developing our objectives, we considered knowledge from a range of sources including:

 The East Riding of Yorkshire Joint Strategic Needs Assessment.  Previous engagement with diverse groups such as the Disability Advisory Group, migrant and gypsy and traveller communities and the Hearing Impaired and Visually Impaired Forums.  The East Riding of Yorkshire Knowledge Management Toolkit.  National publications and research, for example, from the Department of Health, Equality and Human Rights Commission and Professional Lobbying Group Stonewall.

The following proposed objectives were considered by the NHS East Riding of Yorkshire Clinical Commissioning Group (CCG) in January 2012:

1. Improve access and information on well-being through Primary Health Care Services for BME Populations and men.

2. Improve access to preventative services for ‘hard to reach’ groups specifically: a. Cervical Screening b. Bowel Cancer Screening c. Health Checks 3. Improve experience for ‘hard to reach’ groups living with: a. Chronic Obstructive Pulmonary Disease b. Learning Difficulties c. Mental Health

These were subsequently presented for comment to diverse groups through a questionnaire and attendance at meetings such as the Lesbian, Gay, Bisexual and Transgender Forum, Migrant Support Group, the Gypsy and Traveller Forum, the Disability Advisory and Monitoring Group, East Riding of Yorkshire Health and Well-being Overview and Scrutiny Committee and the East Riding of Yorkshire Local Involvement Network.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 15 of 49 A Working Together event held on 15 February 2012 also provided a wide range of stakeholders (65 people attended from organisations including Yorkshire Ambulance Services, NHS Humber Cluster, Hull and East Yorkshire Hospitals NHS Trust, Scarborough and North East Yorkshire Healthcare NHS Trust) with the opportunity to have their say on, and help prioritise, the draft objectives.

As a result of engagement so far, we received the following comments/suggestions:

 Develop a joint, shared approach with East Riding of Yorkshire Council.  General support for prioritisation for access to primary care, screening and health checks.  COPD and Mental Health (Dementia in particular) to be incorporated into improved access to primary care in relation to protected characteristics e.g. men, migrant communities and age (due to an aging population).  It was identified that there is specific work ongoing in relation to Learning Difficulties Health Checks and the focus should be on other protected groups in relation to general health checks.  Many ideas were put forward for action as well which will be carefully considered as each objective plans and outcomes are determined.

Following the engagement so far our final objectives have been refined (see below) and are attached in more detail at Table 2, along with Rationale and Key Delivery Actions.

Objective 1

Improve Access and Information on Services and Wellbeing through Primary Health Care and Community Services for Migrant Communities and Men.

Objective 2

Improve access to preventative services for ‘hard to reach’ groups specifically: a. Cervical Screening b. Bowel Cancer Screening

c. Health Checks

We will continue to engage groups in relation to the objectives and organisational leads have been identified who will work with appropriate members of staff and partners to deliver key actions to ensure our objectives are met.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 16 of 49 OUR PROGRESS SO FAR Our former Single Equality Scheme 2008-2011 set out a range of actions and, working closely with other organisations and diverse groups, we have made good progress in implementing these. Progress reports have been published annually and some key achievements include:

 Development of a British Sign Language (BSL) DVD in partnership with East Riding of Yorkshire Council, Humberside Fire and Rescue Service and Humberside Police Authority to raise awareness of the services that are available.

 Introduction of an Equality and Diversity Knowledge Management Toolkit in partnership with East Riding of Yorkshire Council, Humberside Police Authority and Humberside Fire and Rescue Services to provide a source of information to assist staff when undertaking Equality Impact Analysis. The toolkit includes quantitative and qualitative information on age, gender, disability, race, religion and belief, sexual orientation, transgender and marriage and civil partnership. It also includes information on key issues for staff to consider and details of local groups which can be approached for further information and engagement.

 Four Disability Fayres organised in partnership with East Riding of Yorkshire Council at Withernsea, Hessle, Driffield and Goole. Events were attended by a wide range of organisations including Remploy, Mind, Stroke Association, East Riding of Yorkshire Council Disability Resource Team and over 150 people attended each event.

OUR STRATEGY FOR THE EAST RIDING The CCG is operating in a vastly changing environment, facing challenges in aiming to commission services of the highest standards to meet patient needs, whilst operating within limited resources and alongside major reforms.

Our vision is:

Better Care – by meeting the greatest challenges in our health care system and providing as integrated a health and care system as we can.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 17 of 49 More locally – through providing services as close to patients as possible within our recognised financial constraints and enabling patients to confidently self manage and remain independent for as long as possible.

Within Budget – recognising the financial constraints within our health system due to increasing demands and lower funding growth we need to ensure value for money in all our commissioned activity. Our aim is to provide the best value and quality for every £1 spent.

Through Transformation – working with our patients and partners in true partnership to transform the way we deliver and receive healthcare. Our belief is that to truly transform the health system everyone in the system needs to work differently.

Looking forward, the key areas of focus are to:

 Support our patients and population to achieve healthy independent aging.

 Reduce health inequalities across the East Riding.

 To improve the physical and mental health and wellbeing of children.

 To work within our financial allocation to ensure delivery of value for money in all our commissioned services.

 To meet our commitment to deliver improving outcomes in line with national and local drivers for change.

This Equality Plan will support the delivery of our vision, strategic aims and commissioning intentions.

ENGAGING LOCAL GROUPS Working in partnership, we are committed to maintaining and strengthening links with a range of diverse groups including:

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 18 of 49  Disability and Advisory Monitoring Group – established jointly during 2010/2011 with East Riding of Yorkshire Council, Humberside Fire and Rescue Service and Humberside Police Authority and brings together around 50 residents from across the East Riding with a range of disabilities. During 2010/2011 the group provided advice on how accessible some of our main services are to people with disabilities. NHS services assessed included Abdominal Aortic Aneurysm Screening, Bowel Cancer Screening, Breast Screening, Expert Patient Programme, Tele Medicine and Neighbourhood Care Teams. The group has also given their comments on key consultations such as the Patient Transport Survey and Public Health White Paper consultation.

 Independent Living Group, Deaf and Hearing Impaired and Visually Impaired Forums – NHS East Riding has attended regular forum meetings with the deaf and hearing impaired community, visually impaired community and the Independent Living Group. As a result projects have been completed such as the BSL DVD, we have promoted fax numbers as a form of communicating with us as it is a favoured method by the deaf and hearing impaired. Work is also ongoing with the hospital trusts to communicate with the visually and hearing impaired in an appropriate method. As the majority of service concerns have been addressed, these forums have now been merged with the Disability Advisory and Monitoring Group.

 Black Minority and Ethnic (BME) Communities – NHS East Riding of Yorkshire and East Riding of Yorkshire Council are currently working in partnership to improve and strengthen links with BME communities by working with Migrant Project activities in Goole and improving links with the Hull and East Riding Interfaith Forum.

 Lesbian, Gay, Bisexual and Trans (LGBT) Communities – NHS East Riding of Yorkshire is working in partnership with key contacts within the LGBT community to discuss the best way of engaging with the section of the population.

 Equality and Diversity Newsletter – introduced to ensure communities are kept informed of public sector activity with regard to equalities, capturing latest news, updates, upcoming events and consultations from all partners. The newsletter is circulated to over 300 community groups and individual contacts across the East Riding. The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 19 of 49 MONITORING The NHS East Riding of Yorkshire CCG Committee will receive progress reports every 6 months and progress will be published annually in May as part of Year End Reporting.

Table 1 – Partnership Objectives and Joint Outcomes

Outcome 1: Outcome 2: Outcome 3: Outcome 4: Better service Improved Empowers and Inclusive Organisational Objective outcomes for access and supported staff leadership and Lead all experience management at all levels Improve Access and Information on Services and Wellbeing through NHS East Primary Health Care and Riding of Community Services for Yorkshire     Migrant Communities and Men. Improve access to preventative services for „hard to reach‟ groups NHS East specifically - Cervical Riding of Screening, Bowel Cancer Yorkshire     Screening and Health Checks Ensure the council has a consistent approach to considering and managing East Riding of the impact on protected Yorkshire groups when making key Council     decisions

Improve the use of service user profiles to ensure equal access to and East Riding of encourage take up of Yorkshire services by members of Council   protected groups

Identify and address East Riding of under-representation of Yorkshire younger people in the Council   Council‟s workforce Ensuring access to services for economic East Riding of migrants and Gypsy and Yorkshire Travellers, and particularly Council   vulnerable families Develop and implement a East Riding of partnership approach to Yorkshire minimise the impact of Council    hate crime

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 20 of 49 Table 2 – Objectives, Rationale and Key Delivery Actions

Improve Access and Information on Services and Wellbeing through Primary Health Care and Community Services for OBJECTIVE 1 Migrant Communities and Men The Black and Minority Ethnic (BME) population for East Riding of Yorkshire has increased from 2.4% to 4.9% since the 2001 Census and there are particularly high levels of migrants in the Goole area. There is a need to work with migrants and GPs in the Goole area in particular to find effective ways to address the issues faced by the growing BME population accessing Primary and Community Care in the area.

We know that men are less likely to access primary care services. A focus group held in March 2010 found that men thought approaching a GP was a sign of weakness also working hours for full time workers make it difficult to access services during opening hours. RATIONALE

Particular health issues for these groups are:  Chronic obstructive pulmonary disease (COPD) – There is an increased likelihood that men and Middle Eastern populations will smoke and these groups have been identified as less likely to access health care at an earlier stage and therefore develop higher needs with COPD.

 Mental Health – There are higher levels of depression for both men and women in middle age than any other age groups and in many BME communities, mental health issues are regarded as taboo subjects.  Migrant Communities PROTECTED  Men GROUP AFFECTED  Age  Disability

Key Delivery Action Completion Date Lead Year 1 Year 2 Year 3 Year 4 Identify key Outcomes to create a sustainable Health and Social Care model in Assistant Director of Design and Goole  Innovation Identify key Outcomes to improve the health of men in the most deprived areas of Director of Public Health the East Riding  Reduce inappropriate attendances and Do Not Attends (DNAs) of migrants at the Goole GP Practices and Minor Injuries Unit (MIU): Assistant Director of Design and  Monitor migrant DNA rates     Innovation  Audit reasons for migrant attendance (or non attendance)

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 21 of 49

Improve Access and Information on Services and Wellbeing through Primary Health Care and Community Services for OBJECTIVE 1 (cont) Migrant Communities and Men

Key Delivery Action (cont) Completion Date Lead Year 1 Year 2 Year 3 Year 4 Support migrants to access health and social care appropriately:  Understand migrant requirements  Monitor migrant registration rates for GPs Assistant Director of Design and  Monitor services – 2 GP practices, MIU     Innovation  Signpost correct services  Access to support groups Develop and implement appropriate social marketing campaigns:  Understand what migrants want Assistant Director of Design and  Proactively encourage migrants to use GPs appropriately  Innovation  Evaluate campaigns and their success Promote key Public Health issues which, for male and BME communities, are:  COPD Assistant Director of Design and  Mental Health     Innovation  Sexual Health  Infectious Diseases (e.g. Hepatitis B, Tuberculosis) Improve appropriate attendance of men at GP surgeries where the male life expectancy is lowest:  Bridlington South   Director of Public Health  Goole South  South East Holderness Introduce Health Checks for men in the most deprived areas of the East Riding which have been identified as:  Goole  Assistant Director - Service Planning  Bridlington  Withernsea Work with the Local Strategic Partnership in developing an approach to tackling alcohol issues in men: Head of Emergency Planning &  Identify key issues  Community Cohesion  Identify key areas to target in the East Riding Develop campaign work on early lung cancer diagnosis in men:  Identify barriers for men  Director of Public Health  Identify key areas to target in the East Riding The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 22 of 49

Improve access to preventative services for ‘hard to reach’ groups specifically Cervical Screening, Bowel OBJECTIVE 2 Cancer Screening and Health Checks A report by the Department of Health – Reducing Cancer Inequality: Evidence, Progress, and Making it Happen identifies that awareness of cancer is lower amongst some BME groups, men and the lesbian, gay, bisexual and transgender (LGBT) community. This appears to be reflected in a lower uptake of screening services in these groups of people. RATIONALE Actions will look at how we can increase awareness of cancer and the importance of screening, to these groups of people, specifically looking at cervical and bowel cancer screening.

Health Checks appear to be less well attended by vulnerable groups and addressing this should be a priority.  BME Groups PROTECTED GROUP AFFECTED  Men  LGBT

Key Delivery Action Year Lead Year 1 Year 2 Year 3 Year 4 Identify key Outcomes  Nurse Consultant - Public Health Identify which hard to reach groups in the East Riding should be Assistant Director - Service Planning targeted as a priority for Health Checks  Develop and implement appropriate social marketing campaigns for screening and health checks targeted at affected groups and key areas:  Goole (migrants) Nurse Consultant - Public Health /  Bridlington/Cottingham (G&T)  Assistant Director - Service Planning  Driffield Rural/Bridlington South/Goole South/South East Holderness (Men) Ensure that key messages and facts are delivered in the most appropriate and accessible way for the group being targeted. Promotion of alternative locations/times for screening rather than Nurse Consultant - Public Health visiting GP surgeries (i.e. evening clinics etc)  Promotion that measures are in place to ensure that screening Nurse Consultant - Public Health services are accessible to all diverse groups (e.g. female nurses)  Deliver general training to staff so they are aware that reasonable adjustments must be made to ensure screening services are  Nurse Consultant - Public Health accessible for all Deliver specialist training to staff with regards to screening services Nurse Consultant - Public Health for LGBT communities. 

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 23 of 49 7.2 NHS HULL

HULL’S GEOGRAPHICAL AREA Hull covers an area of 7,154 hectares, and as a city has relatively tight geographical boundaries with most of the „leafy suburb‟ areas outside Hull‟s boundaries in East Riding of Yorkshire. As a result, Hull has a relatively high deprivation score, as measured by the Index of Multiple Deprivation 2010, with Hull ranked as the 10th most deprived local authority out of 326 (bottom 4%).

The resident population of Hull is 262,400 based on estimates from the Office for National Statistics (ONS) for 2009, and 265,369 residents based on estimates from the local GP registration file as at October 2011. This equates to approximately 37 residents per hectare.

Compared to England, Hull has lower percentages of residents aged 10-19 years and 55+ years, but slightly higher percentages aged under 5, 20-34 years and 45-54 years. There is a relatively large difference between Hull and England for the age group 20-34 years, due to Hull‟s colleges and Universities.

There were 2,869 live births occurring to Hull residents in 2001, but this has increased steadily to 3,771 for 2010. The number of deaths occurring to Hull residents has decreased from 2,571 to 2,310 between 2001 and 2010. ONS estimated the resident population to be 243,596 in 2001 compared to 260,424 residents based on the GP registration file, with the difference between these estimates narrowing over time. So, whilst it is difficult to quantify the exact increase in Hull‟s population, it has increased over recent years. Between 2010 and 2030, ONS estimate that Hull‟s population will increase from 266,100 to 311,900 residents, an increase of 17%.

The percentage of the population from Black and Minority Ethnic (BME) groups has increased substantially since 2001. For the 2001 Census, it was estimated that 3.3% of Hull‟s population was not White British or White Irish, whereas ONS estimate that this figure increased to 10.5% for 2009. There is no single BME group in Hull with much higher percentages compared to other groups. ONS estimates that 2.2% of Hull‟s population is Other White, 2.1% Indian, 1.0% Chinese, 0.9% Black African, 0.8% Other Asian, 0.8% other ethnic groups and 0.7% Pakistani. The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 24 of 49 Survey responders in Hull‟s 2011-12 Health and Lifestyle Survey, which involved over 13,500 residents, were asked about their religion, sexual orientation, as well as general health. In terms of self-reported health, 28% reported that their health was fair or poor and 29% reported that they had long-term illness or disability that affected their daily living. The main religions were Christian (59%), Muslim (1.2%), Buddhist (0.4%), Hindu (0.14%), Jewish (0.11%) with 1.1% stating other religions and 1.5% stating that they would rather not say. The distribution of religions is probably not surprising given that 93.4% of survey responders were White British. Of the 13,029 survey responders who provided an answer to the sexual orientation question, 93.2% stated they were straight/heterosexual, 0.87% bisexual, 0.50% lesbian or gay woman, 0.89% gay man and 0.15% transgender with a further 2.9% stating none of these and a further 1.5% who preferred not to say.

For 2008-2010, life expectancy in Hull was 75.7 years for men and 80.2 years for women compared to 78.6 years and 82.6 years for men and women respectively in England.

The Joint Strategic Needs Assessment (JSNA) identifies considerable inequalities in health between Hull and England, and between populations within Hull.

NHS HULL’S EQUALITIES PROGRESS SO FAR

Support for Veterans Joint working with, and for, the veterans community has been a strategic priority for NHS Hull for a number of years. NHS Hull has, for example, hosted two major national conferences, produced a guide for the Armed Forces for use by GPs and developed a post-trauma service in partnership with Humber NHS Foundation Trust. As joint signatories to the local Armed Forces Military Covenant, this work will continue.

Minerva Project NHS Hull works with Hull Prison, Hull City Council‟s Citysafe and the Humberside Probation Trust. Minerva is a not-for-profit Social Enterprise Community Interest Company, which aims to help people coming out of prison and reduce the likelihood of re- offending. 80% of people are actively engaged with the project, with some in full-time employment with the company. From the 596 people involved in the project, only 82 have since returned to prison.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 25 of 49 The Warren NHS Hull, through joint commissioning with Hull City Council, is working with The Warren in providing access and information for disengaged young people aged between 14 and 25 years old. Assistance offered includes advice regarding teenage pregnancy, parenting, healthy eating, health education, counselling services and the provision of a crèche.

Wilberforce Youth Development Programme Working alongside One Hull, our Local Strategic Partnership, NHS Hull agreed to invest in a training vessel as part of a project to help local disadvantaged young people aged 17 to 19 secure employment, education and training. The Wilberforce Youth Development Programme is now run by Hull-based charity Cat Zero, having initially been delivered through Hull City Council‟s Children and Young People‟s Services. NHS Hull continues to offer health education and training as part of the classroom-based modules of the 12 week programme.

Mindful Employer NHS Hull is proud to be a Mindful Employer, aiming to increase awareness of mental ill health. It provides information and support for employers in the recruitment and retention of staff. It also enables employers to build on current good practice and put further initiatives in place to help ensure employees and job applicants who declare mental health issues receive the right level of support.

Through a working group in partnership with „Positive Assets‟, being positive about mental health has been promoted in the Trust. Some examples are:

 Job advertisements (changes in templates)  Staff Surveys regarding staff wellbeing and the workplace  Offering availability for complementary therapies  Signposting managers to resources on mental health and distributing information such as the „SHiFT Line Managers‟ guide.

Online Engagement Guide NHS Hull‟s online Engagement Guide has been compiled to help staff understand more about patient and public involvement and how to undertake formal, statutory engagement and consultation activities. This will allow us to build up a wealth of knowledge and The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 26 of 49 expertise about our local communities and their health needs so the Trust can be truly centred on what matters to patients and make a real difference to people‟s health and lives.

Equality Impact Analyses (EqIA) The NHS Humber Cluster has recently developed a joint process to undertake Equality Impact Analyses. NHS Hull has also implemented a Policy to help staff understand the importance of undertaking them and has requested that an EqIA be undertaken at procurement and approval stages and included with relevant Committee reports.

This process has been circulated to staff and training has been given and continues to be rolled out to staff across the CCGs and the Humber Cluster. Completed Equality Impact Analyses will be published on our website.

HOW WE ENGAGE WITH LOCAL DIVERSE GROUPS

Membership Scheme In April 2008, NHS Hull became one of the first Primary Care Trusts in the country to set up a Membership Scheme. Usually a feature of hospital or other care Trusts, this was NHS Hull‟s way of inviting more people in to see what we do, understand how we work and then help us to design and deliver the types of services local people want.

NHS Hull currently has over 8,000 Members, some of which became Ambassadors. Ambassadors work with NHS Hull on a voluntary basis and the focus of their activity is to help the Trust engage effectively with the people of Hull through agreed structures and processes.

Over the past three years the Membership has grown steadily with numbers standing at 8190 individual members and 94 groups at the end of August 2011. Members receive regular newsletters and are offered the opportunity get involved in NHS Hull engagement activities.

‘We’re All Ears’ Listening Exercise NHS Hull‟s „We‟re All Ears‟ listening exercise was one of Hull‟s largest public consultations with the overall aim to consult with the people of Hull to find out their aspirations and

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 27 of 49 expectations for both their own and their family‟s personal health. 1,500 telephone interviews took place followed by 10,000 face to face surveys with Hull residents.

Residents identified their top three priorities as:  Services to support older people to stay in their own homes  Training to help people gain skills they need for work, and  A regular, free health and well-being MOT.

These, along with other key themes identified, were built into 2010/11 work plans and the benefits are now coming to fruition. Examples of this include:

 Over 400 telehealth systems have been introduced enabling remote monitoring of various long term conditions and allowing patients to remain at home  Support for a number of training initiatives. including the Cat Zero Project which has already enabled 416 young people, who were not in education, employment or training to gain valuable new skills and confidence to better equip them for employment  The introduction of a free, easily accessible health check for people aged over 40, along with a targeted promotional campaign to encourage those people who do not regularly access health services to take up the check. 3616 people have undertaken the check since its introduction in November 2011.

Patient Participation Groups (PPGs) NHS Hull, with support from Ambassador Members, has been active in supporting GP practices to set up and develop Patient Participation Groups (PPGs). During 2010/11, 53 practices were supported to improve their engagement with their patients, including in some cases, developing their PPGs, 27 of which now have established groups. The remaining GP practices are still in the process of taking their Patient Groups forward. Whilst the development of a PPG is not obligatory, it is regarded as good practice and there are many benefits to having a PPG.

Other Examples A number of commissioning groups have been established in areas such as Chronic Heart Disease, Stroke, Chronic Obstructive Pulmonary Disease (COPD), Diabetes and Cancer. Each group has patient representation on it to enable patients‟ views to be paramount in The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 28 of 49 all aspects of commissioning the services that they use. Patient representatives have been actively involved in strategy development, service reviews and redesign of services.

PARTNERSHIP WORKING Examples of organisations working in partnership with NHS Hull are as follows:

 Hull City Council  The Warren  Humber All Nations Alliance (HANA)  Local Armed Forces Military Covenant  Humberside Probation Trust  Cat Zero

NHS Hull works in partnership with neighbouring Trusts such as Humber NHS Foundation Trust, who provide a variety of services for people with mental health problems, learning disabilities, addictions and community services. Various departments work with the local authority, Hull City Council, on different projects and activities, which address inequalities.

NHS Hull also works in partnership with the Spice Trust and Citycare to secure the future of some learning disability services in the community. This work continues today.

JOURNEY TO EQUALITY OBJECTIVES AND HOW THEY HAVE BEEN PRIORITISED An information gathering exercise was undertaken to help NHS Hull produce Equality Objectives and to demonstrate our compliance with the Public Sector Equality Duty.

NHS Hull engaged with the following groups for this piece of work and their feedback (through the representatives) was collated into an information gathering document:

 The Warren – Young people‟s services  Choices and Rights – Disability Coalition  Age Concern  The Youth Enterprise Centre  Disability Rights Advisory Services  Crisis Pregnancy Services

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 29 of 49  Gypsy and Travellers Project  Cornerhouse – Sexual Health  Conifer House – Sexual Health  LINk (Local Involvement Network)  HANA (Humber All Nations Alliance) – BME Communities

From this information, the most common themes identified related to Mental Health, in particular for young people and BME communities regarding lack of knowledge about how to access services. Other themes included health service staff‟s lack of knowledge in relation to the needs of patients, in particular BME communities, and their failure to recognise and address communication barriers.

Nationally, there is a wealth of national data which highlights inequalities and backs up the common themes arising from the patient and public engagement carried out.

The most up-to-date is a document published by Mencap in February 2012 entitled “Death by indifference: 74 deaths and counting – A progress report 5 years on”. This publication follows the “Death by indifference” report published in 2007 and considers the steps that have been taken; the progress made as a consequence, and what Mencap believes still remains to be done.

NHS Hull‟s Learning Disability and Mental Health Team‟s objectives and action plan cover the majority of issues raised in the Mencap report but one area which can be improved on is that of the number of eligible GPs who are signed up to the Annual Health Care for People with Learning Disabilities Direct Enhanced Service. Only 36 out of Hull‟s 57 practices are currently signed up to the DES, which made this an ideal area on which to build an Equality Objective.

The routine collection of equality data on local service users is not yet embedded in the Humber region, which made the identification of equality gaps quite difficult. The collection of equality data by both the Trust and its providers will, therefore, be addressed within our action plans.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 30 of 49 OBJECTIVES AND ACTION PLAN From our findings, and the evidence we have to support them, the following Equality Objectives have been approved by Hull‟s Clinical Commissioning Group Committee (CCGC):

Objective 1

To increase GP practices’ sign up to the Annual Health Check for People with Learning Disabilities Directed Enhanced Services (DES) to 100% of those eligible by 2014.

Objective 2

To improve the information we provide on mental health services available in the city, in particular for BME Communities and younger people.

Both of the Equality Objectives help NHS Hull meet the aims of the Equality Duty and links to the following Goals and Outcomes of the EDS:

Objectives Objective 1 Objective 2 EDS Goals Outcome Outcome Goal 1 1.1, 1.2, 1.4 1.1 Goal 2 2.1,2.3 2.1, 2.3 Goal 3 3.3 3.3 Goal 4 4.1 4.1

Further engagement has taken place on NHS Hull‟s Equality Objectives. This has included re-engagement with equality/voluntary organisations such as The Warren and LINk and seeking the views of NHS Hull‟s Membership.

MONITORING The NHS Hull CCG Committee will receive progress reports quarterly and progress will be published annually.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 31 of 49 Table 3 – Objectives and Action Plan

To increase GP practices’ sign up to the Annual Health Check for OBJECTIVE 1 People with Learning Disabilities DES to 100% of those eligible by 2014.

 Feedback from engagement with local groups.  Death by indifference: 74 deaths and counting – A progress report 5 years on” (Mencap – February 2012). RATIONALE  National data and publications highlight the problems Learning Disability Patients face in relation to accessing health care.  Learning Disability Patients are only offered a health check if practices are signed up to the DES, which is optional.

Date for Completion Action Monitoring Lead 2012/13 2014 Advise all GP Practices of the approved CCG Equality Newsletter/mail-out Associate Director Objectives of Corporate  Affairs Identify which eligible practices are not signed up to the DES Keep a register of practices Director of   and review quarterly Commissioning Seek support and co-operation of the DES from those Will be identified by take up Director of practices eligible but not signed up increase Commissioning  Ensure LD training is provided to, and undertaken by, front Register of training held by Director of line staff including new starters practice, assurance annually Commissioning   reported to CCG Remind non-participating practices quarterly of the DES and Keep a register of practices Director of check eligibility updating the spreadsheet accordingly and review quarterly Commissioning   Investigate the possibility of obtaining information relating to Annual collation of Director of the types of learning disabilities patients have information Commissioning  Investigate the possibility of obtaining equality and diversity Annual collation of Director of monitoring information of patients with learning disabilities information Commissioning  

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 32 of 49

To improve the information we provide on mental health services OBJECTIVE 2 available in the city, particularly for BME Communities and younger people.

 Feedback from engagement with local groups.  Evidence shows the prevalence of childhood mental health problems is generally increasing, (e.g. 20% of children and adolescents have mental health problems at some point). RATIONALE  Research shows that people from black and ethnic communities may face increased difficulties including higher rates of mental illness in some communities and subsequent problems with access to the right care and treatment.

Date for Completion Action Monitoring Lead 2012/13 2014 2015 2016 Identify mental health services already available Evidenced by Assistant Director – documentation Learning Disability  and Mental Health Identify current information available on how to access Researched evidence Assistant Director – mental health services specifically for younger people and Learning Disability  BME communities and Mental Health Engage with BME communities and younger people in a Recorded variety of ways to understand what services are required and engagement Associate Director of   what communication tools would be useful in accessing Corporate Affairs information about those services Review current communication tools giving information on Recorded Assistant Director – mental health services, e.g. website, leaflets, posters, etc. to engagement in review Learning Disability ensure up to date and relevant of documents and Mental     Health/Associate Director of Corporate Affairs Develop partnership working with external organisations, e.g. Recorded Hull City Council, to increase the opportunity to display engagement and Associate Director of  information, e.g. local libraries evidence of Corporate Affairs partnership approach

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 33 of 49 Date for Completion Action Monitoring Lead 2012/13 2014 2015 2016 Provide general information to be displayed in public areas, Evidence of Assistant Director – e.g. walk-in centres etc. informational Learning Disability materials being and Mental     developed and Health/Director of distributed Commissioning Improve access to information, e.g. websites, posters, Surveys, comments Associate Director of leaflets, etc, specifically for younger people and BME and feedback  Corporate Affairs communities and identify any gaps Increase information in primary care services regarding Record regular mail- different languages, translators and interpreters. This will outs Associate Director of  help break some barriers in communication when seeking Corporate Affairs information about services Collect Equality and Diversity monitoring information on Annual services currently accessed to identify a baseline for each collation/published protected group, then annually thereafter to enable information, Director of     monitoring. Questionnaires and Commissioning Surveys

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 34 of 49 7.3 NHS NORTH LINCOLNSHIRE

THE NORTH LINCOLNSHIRE AREA North Lincolnshire sits on the south side of the Humber estuary and covers an area of 85,000 hectares. North Lincolnshire encompasses the major population centre of Scunthorpe, where almost half of our resident population of 160,300 people live. It also includes a number of growing market towns and rural areas which have more scattered populations.

Age - Although birth rates have increased recently, our population remains slightly older than the national and regional average, and this trend looks set to continue for the next 20 years. Between now and 2015 our population is projected to rise by a further 8% and our older population by 26%. This compares with 5.5% and 17% respectively across the country as a whole.

Disability – In 2001, 19.2% of North Lincolnshire residents stated that they had a long term illness or disability, (LLI), which “limited their daily activities”. This was slightly above the national figure of 17.9% and represented just under 30,000 people in that year. More than half of those reporting a limiting long term illness were aged 60+, with the percentage increasing with age. It is generally agreed that the number of older people with disabilities is likely to increase by at least 40% over the next 20 years, including an increasing number of adults with profound and complex disabilities surviving into older age.

Gender - There is a 11.6 year gap in life expectancy between our richest and poorest 10% males and a 7.9 year gap between our richest and poorest 10% females in North Lincolnshire.

Race - People from Black and Minority Ethnic (BME) communities currently make up 3.5% of our population, compared with 2.5% in 2001. The largest groups are people of Pakistani, Indian and Bangladeshi heritage. By 2030, our BME communities are projected to grow by a further 30%. The number of economic migrants settling in the area from Eastern Europe has also grown. Yet we know very little about the health needs of these populations.

Religion & Belief – Christianity is the most common religion in North Lincolnshire (2001 Census), identified by 79% of the local population. The next most common is the Muslim The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 35 of 49 faith, identified by 1% (1,740) of the resident population. Just over 1 in 10 North Lincolnshire residents stated they had no religion, whilst 7% did not state their religion or belief.

Sexual Orientation - There are no accurate statistics available regarding the profile of the lesbian, gay, and bisexual (LGB) population in North Lincolnshire, the region, or indeed, across England as a whole. Sexuality is not incorporated into the census or most other official statistics. Using research estimates that LGB and transgender people comprise 5% of the total population, we can estimate the numbers in North Lincolnshire to be in the region of 8,000 people.

Transgender - There are no official statistics nationally or regionally regarding transgender populations, however, GIRES (Gender Identity Research and Education Society) estimate that 1% of the population are gender variant to some degree (i.e. seeking or receiving treatment or undergoing or undergone transition).

Marriage & Civil Partnership – This protected characteristic generally only applies in the workplace.

PARTNERSHIP WORKING Key to reducing inequalities in health is the development of the newly emerging Health & Wellbeing Board and its Health and Wellbeing Strategy, in line with the national reorganisation. The strategic leadership provided will ensure that evidence based best practices continues to support an ongoing vision for success.. This will be achieved by using the Joint Strategic Needs Assessment and joint Health and Wellbeing Strategy to guide local commissioning and delivery of services, embedding change in line with the needs of the local population and approaching the tackling of inequalities by empowering local communities to utilise what works locally and build upon the current strengths of their local area to maximise health and wellbeing outcomes and strengthen communities.

This approach builds on the work of the former Wellbeing and Health Improvement Partnership (WHIP), a sub group of the Local Strategic Partnership (LSP), who‟s overall aim was to improve health and wellbeing and reduce inequalities for people in North Lincolnshire, and ensure that the LSP priorities for health and wellbeing were reflected in commissioning decisions.. The WHIP did this through a system of partnership working

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 36 of 49 which involved wide membership from health, council, voluntary organisations, business and communities.

The Council and NHS North Lincolnshire have a strong and practical approach to partnership working. We have good links with the voluntary sector and see this as being particularly important in improving health and well being. Similarly we are committed to working with our Local Involvement Network, Who Cares, to support their work in influencing the design and delivery of health services and adult social care.

Specifically in relation to Equalities Matters the North Lincolnshire Equalities Network, a group formed with lead E&D representatives from Health, Local Authority, Police, Fire and Rescue, North Lincolnshire Homes and JobCentre Plus meets with the objective of ensuring the Equalities agenda is consistently mainstreamed across North Lincolnshire promoting best practice and local needs and priorities.

Following changes to the local NHS, we are now working with the NHS organisations across the Humber Cluster.

PROGRESS WE HAVE MADE SO FAR We have taken action in a number of areas to address equality and diversity, for example:

National Mental Health Strategy In response the National Mental Health Strategy, “No Health without Mental Health”, we developed a Mental Health Partnership throughout 2010 to deliver the required objectives. One of the outcomes of the strategy is to improve the physical health of people who experience mental illness. It is well acknowledged that historically people who have experienced mental ill health have not had their physical health needs addressed and in some cases with particular conditions e.g. psychosis, shorter life expectancy has been recorded. On a population wide level, the benefits of physical activity and good diet on poor mental health are well acknowledged.

As a result of this information, a recommendation was put forward to develop an existing Health Trainer, with a Special Interest in Mental Health to work alongside Primary Mental Health care. Since December 2011, the Health Trainer has worked within the Primary Mental Health care team for one day per week. 26 referrals have been received to date for

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 37 of 49 a variety of physical activity/diet/nutrition related interventions. This provides effective inter- disciplinary delivery as the Trainer can advise Mental Health professionals on physical health issues and can also receive information on Mental Health for the individuals supported. It is also a safe practice; being integrated with the team ensures that the Trainer receives effective supervision particularly around complex cases.

Winter Influenza Vaccine Programme The winter influenza vaccine programme was specifically targeted at over 65s, pregnant women and long term conditions. A local media campaign was undertaken and the PCT utilised nine local newsletters for publication as well as internal publications. In addition awareness raising sessions were arranged for staff to be able to promote vaccine uptake amongst their patients and the hospital added a section regarding flu to their maternity check list to target pregnant woman.

HOW WE ENGAGE DIVERSE GROUPS We utilise a wide variety of techniques to encourage and engage diverse groups to share their views. For example, we commissioned Apna Sahara (which means “our support”) a North Lincolnshire based community charity group that is committed to supporting all of North Lincolnshire‟s BME groups to obtain equitable access to services, to undertake a local mental health engagement exercise, the purpose being to inform a more comprehensive health and social needs assessment of this population. Apne Sahara delivered four focus groups with members from BME groups resident in North Lincolnshire. The purpose of these focus groups was to identify attitudes and opinions towards mental health and mental health services. A task group is in place to take forward the recommendations in the final report.

DEVELOPING OUR OBJECTIVES In considering objectives to take forward, a number of options were discussed at the North Lincolnshire Diversity Steering Group, which is made up of local managers from across our organisation, including executive and non-executive leads as well as external representation from Who Cares and the Local Involvement Network. Objectives considered but rejected as they were already being addressed in other ways included:

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 38 of 49  To ensure equitable and sustainable services are delivered across North Lincolnshire. This was considered too wide an objective in terms of measurable equality data, and plans are underway for a full clinical review in this area.  Improve access and information for Unplanned Care. Again this was considered too wide an equality objective, but is being taken forward in another way.  Improve information and access for men with symptoms or higher prevalence to heart disease, stroke, and some cancers, with a view to addressing inequalities in premature deaths. This was discounted as a separate initiative has already been proposed which will address this.

All the potential objectives were also discussed with the CCG Chair and Chief Operating Officer and, following agreement, our final objective is below and attached in more detail at Table 4, along with summary rational and key delivery action.

Our Equality Objective

Improve access and services addressing sexual health for: a. Over 40’s b. Lesbian, Gay, Bisexual and Transgender c. Black and Minority Ethnic d. Vulnerable Groups, e.g. sex workers

We plan to take this forward through further collation of data and local insight and consultation, to enable the design and commissioning of new sexual health services.

Sexual health is fundamental to the physical and emotional health and wellbeing of individuals, couples and families and to the social and economic development of communities. When viewed affirmatively, sexual health encompasses the rights of all to have the knowledge and opportunity to pursue safe and pleasurable sexual life. However the ability of men and women to achieve sexual health and well-being depends on their access to comprehensive information about sexuality, knowledge about the risks they face, their vulnerability to the adverse consequences of sexual activity, their access to good quality sexual health care, and an environment that affirms and promotes sexual health (Developing sexual health programmes; a framework for action, WHO, 2010).

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 39 of 49 Our chosen objective and associated actions span all four EDS goals as follows:

1. Better health outcomes for all The objective to target sexual health for the over 40‟s is addressing a known national increase of Sexually Transmitted Infections (STIs) among this age group, albeit actual data for North Lincolnshire is unknown. We currently have no commissioned services specific to LGBT, BME, or vulnerable groups, thus the individual access and health needs of these protected characteristics are not being addressed. Overall the objective is looking to ensure that „Services are commissioned, designed and procured to meet the health needs of local communities, promote well-being, and reduce health inequalities‟.

2. Improved patient access and experience Services will be commissioned with a view to improving accessibility and information, and delivering the right services that are targeted, useful, useable and used in order to improve patient experience delivered to the 4 groups identified (over 40‟s, LGBT, BME, and Vulnerable Groups, e.g. sex workers).

3. Empowered, engaged and well-supported staff Staff training in supporting the different protected groups will be identified and provided, thus supporting staff to better respond to patients‟ and communities‟.

4. Inclusive leadership at all levels We, as part of the Humber Cluster, are committed to ensuring that equality is everyone‟s business, and everyone is expected to take an active part, supported by the work of specialist equality leaders and champions.

MONITORING NHS North Lincolnshire CCG Committee will receive progress reports every 6 months and progress will be published annually in May as part of Year End Reporting.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 40 of 49 Table 4 – Objectives, Rationale and Key Delivery Actions

OBJECTIVE Improve access and services addressing sexual health for over 40s, LGBT, BME and Vulnerable Groups (e.g. sex workers) As is common in many areas of the country, work in this area has been very focussed on the under 25‟s. In North Lincolnshire, a full breakdown of activity data for the last 24 months is unavailable, so the performance of the Service in terms of the equality duty is difficult to assess at this time. What we do know is:

 Attendance is rising year on year. RATIONALE  There has been nationally reported rises in sexually transmitted infection in the older age groups.  Termination and repeat termination rates are rising in the over 40‟s.  We have no commissioned services specific to LGBT, BME, or vulnerable groups, however these groups may have different access and service requirements.  Commissioned services for sexual health and HIV are generic, with a whole population approach, albeit with a requirement that they meet the diverse population needs of North Lincolnshire.

 Over 40‟s PROTECTED  BME Groups GROUP  LGBT AFFECTED  Vulnerable groups, e.g. sex workers

Key Delivery Action Year Lead Year 1 Year 2 Year 3 Year 4 Identify and collate current data, understand audience and any gap in data.  Prepare for insight work – use knowledge collated to clearly identify what we need to find out from our population.  Develop and undertake insight work to identify our population needs and preferences, targeting key areas.  Utilise data obtained to design and consult on new service specifications and find suitable service providers.  Overall Lead - Commissioning Manager – Implementation and promotion of services to all groups.  Sexual Health

Target specific changes to further improve access and services for the protected groups.  Deliver specialist training to staff with regards to needs of different protected groups.  Collate benchmark data from services, Identify KPI‟s and performance targets.  Measure targets, and continue to promote to protected groups. 

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BACKGROUND TO THE GEOGRAPHICAL AREA North East Lincolnshire sits on the South Bank of the Humber estuary. The most recent Joint Strategic Needs Assessment (JSNA) information shows some recent encouraging improvements in a range of quality of life outcomes within North East Lincolnshire. These include death rates, however, progress is not keeping pace with all other areas and the inequalities between this area and the rest of the country remain profound as do the inequalities between the poorest and the most affluent within the area. Indeed these inequalities appear to be increasing, particularly for life expectancy and circulatory disease. There has been significant progress in educational attainment/ qualification levels, and some narrowing of the inequalities gap. Crime information in the Joint Strategic Intelligence Assessment shows improvements in crime rates, but again the area remains a high crime area compared to other areas nationally as shown by crime indicators included in this overview. Other improvements include teenage pregnancy rates, participation in sport and recreation and smoking quits. Immunisation rates compare favourably with other areas but breast screening coverage has been comparatively poor.

There remain significant issues of concern, including low wages and worklessness, particularly in the current climate of job cuts and low economic growth. Poor housing remains an issue as do lifestyle behaviour issues (smoking prevalence, alcohol consumption, drug misuse, physical inactivity, poor diet, obesity prevalence, etc).

The most recent needs assessments undertaken for people with disability, children and young people, and cancer show considerable unmet need and there is much still to be done in implementing other recent needs assessment findings and ensuring strategies and action plans are in place.

THE LOCAL POPULATION The mid-2010 population estimates suggest that North East Lincolnshire has 157,300 residents1. This indicates a decrease from the population counted in the 2001 census which was recorded as 157,979.2 We have a lower proportion of people aged 25-39 compared to England, and a higher proportion in the 60 and over age groups.

1 Mid-2010 Population Estimates, Office for National Statistics © Crown Copyright 2011 2 Usual Resident Population, 2001 Census Office for National Statistics © Crown Copyright 2003 The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 42 of 49

The most recent population projections produced by the Office for National Statistics are based on the 2008 mid-year population estimates. They project that the population of North East Lincolnshire will increase by 5.79 per cent by 2033. There are notable differences in the projections for each age group, with the greatest reduction in population projected to be in the 55-59 age group (-15.63 per cent), and the greatest increase projected to be in the 85+ age group (+218.18 per cent)3.

75.7 per cent of people in North East Lincolnshire stated their religion to be Christian; this is slightly higher than the regional and national results. 14.6 per cent of people stated that they had no religion which is in line with both regional and national averages.4 At the time of the 2001 census 97.52 per cent of the population in North East Lincolnshire stated they were White British5. The mid-2009 population estimates by ethnic group estimate that 94 per cent of the population in North East Lincolnshire are White British, compared to 86.8 per cent in the Yorkshire and the Humber region and 82.8 per cent in England.6

DEVELOPING AND PRIORITISING OUR OBJECTIVES We have a community engagement model which utilises a community membership (Accord) of over 2500 citizens that focuses specifically on ideas/proposals for service change. This ensures public involvement at each stage of the commissioning cycle.

To lead reviews into service change we use a triangle basis of approach that consists of a lead commissioning clinical representative, a managerial representative and a public representative

Public Rep Clinical Rep

Managerial Rep

3 Mid-2008 Population Projections, Office for National Statistics © Crown Copyright 2010 4 2001 Census, KS07 Office for National Statistics, www.ons.gov.uk, © Crown Copyright 2003 5 2001 Census, KS06, Office for National Statistics, www.ons.gov.uk, © Crown Copyright 2003 6 Mid 2009 population estimates by ethnic group, Office for National Statistics, www.ons.gov.uk, © Crown Copyright 2011 The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 43 of 49 The public representatives‟ responsibilities are to ensure that there has been public involvement in each stage of the commissioning cycle and to challenge any proposals that do not appear to fulfill that requirement. This also applies to equality and diversity considerations where the public representative will ensure that the protected groups are considered. There is a lay member that leads on Equality and Diversity and offers support and advice to community members and clinicians.

We retain a list of representative groups including those with protected characteristics throughout the community and service plans and changes are tested through these groups as appropriate.

Recently we invited representatives from the Accord community membership to be involved in setting priorities for both health and social care for the forthcoming financial year. An event was then held based on the famous „Dragon‟s den‟ approach involving clinicians and public representatives pitching proposals which were judged against the agreed health and social care priorities. From this event it was clear that access to services for dementia, together with treatment, are a real issue for those with learning disabilities. The following objective was therefore proposed and agreed:

Our Equality Objective

To improve dementia care to people with protected characteristics whilst recognising and respecting a person’s individual history, in particular:

 The experience of dementia for an older person may be very different to the experience of a younger person.  The experience of dementia may be different for individuals who are approaching the end of their life: o Who have a learning disability o Who are from a black or minority ethnic background o Who are lesbian, gay, bisexual or transgender o Gender

This objective is in line with our Dementia Strategy which demonstrates that the operation of service will affect the over 65 years group of the population in North East Lincolnshire. This is expected to increase by 38% from 2008 to 2025 with an increase of 52% in the incidence of dementia. There are around 800 individuals currently registered with their GP as having dementia compared with the expected total of around 2000, based on national incidences.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 44 of 49

Full consideration has been given the human rights of people considering the equality, dignity, respect, autonomy and fairness through equality impact analysis.

Fundamental to a person centered approach are the concepts of equality, diversity and inclusion. It is important to understand that each person‟s experience of dementia is unique. It is essential to recognise and respect a person‟s individual history, and our objective reflects this. Our action plan is attached at Table 5.

Our Equality Objective and associated actions help us meet the aims of the Equality Duty and links to the following Goals and Outcomes of the EDS:

Objective Objective 1 EDS Goals Outcome Goal 1 1.1, 1.2, 1.3, 1.4 Goal 2 2.1, 2.2, 2.3 Goal 3 3.3 Goal 4 4.1, 4.2

MONITORING NHS North East Lincolnshire CCG Committee will receive progress reports every 6 months and progress will be published annually in May as part of Year End Reporting.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 45 of 49 Table 5 – Objective and Action Plan

To improve dementia care to people with protected characteristics whilst recognising and respecting a person‟s individual history, in particular:

 The experience of dementia for a younger person may be very different to the experience of an older person OBJECTIVE  The experience of dementia may be different for individuals who are approaching the end of their life: o who have a learning disability o who are from a black or minority ethnic background o who are lesbian, gay, bisexual or transgendered o gender

Key Delivery Action Year Lead Year 1 Year 2 Year 3 Year 4 Identify and collate current data, understand audience and any Older People Service Lead / Engagement JG √ gap in data Prepare for insight work – identify the equality data on the Older People Service Lead / Engagement JG existing 800 patients registered with their GP as having √ dementia Identify the relevant protected groups in North East Engagement officer JG √ Lincolnshire. Undertake insight work to identify our population needs and Older People Service Lead √ preferences Target specific changes to further improve access and services Older People Service Lead / Engagement JG √ for the protected groups mentioned above Get agreement from CCG on setting a strategy for the group √ Older People Service Lead / Engagement JG Identify ways we communicate changes to services to patients Older People Service Lead / Engagement JG √ with protected characteristics and carers. Workshop/ training for clinicians regarding changes to Older People Service Lead / Engagement JG √ prescribing drugs

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 46 of 49 8 MONITORING AND EVALUATION

Clinical Commissioning Groups will lead on the implementation of the objectives and their monitoring arrangements are included in earlier chapters.

The Humber Cluster Board will receive an annual report on progress for the year 2012-13 on behalf of its constituent Primary Care Trusts.

Each of the Clinical Commissioning Groups intend to be authorised as statutory bodies from April 2013 at which time full responsibility for these equality plans and objectives will transfer to them.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 47 of 49 APPENDIX 1 SUMMARY OF THE HUMAN RIGHTS ACT 1998 Article 1 THE CONVENTION Article 2 RIGHT TO LIFE Article 3 PROHIBITION OF TORTURE Article 4 PROHIBITION OF SLAVERY AND FORCED LABOUR Exclusions from meaning of “forced labour” defined (military service, penal sentence etc). Article 5 RIGHT TO LIBERTY AND SECURITY No deprivation of liberty except in the cases specified in accordance with law. e.g. of those of unsound mind. Right to damages for unlawful arrest/detention Article 6 RIGHT TO A FAIR TRIAL Provides for a fair, timely, and public hearing except in the interests of morals, public order, national security, juveniles or the protection of the private life of the parties. Article 7 NO PUNISHMENT WITHOUT LAW Article 8 RIGHT TO RESPECT FOR PRIVATE AND FAMILY LIFE No interference except in accordance with the law or in the interests of national security, public safety, the economic well being of the country, the prevention of disorder or crime, the protection of health or morals, or for the protection of the rights and freedoms of others. Article 9 FREEDOM OF THOUGHT, CONSCIENCE AND RELIGION Includes freedom to change religion or beliefs and to manifest these in worship, teaching, practice and observance. Article 10 FREEDOM OF EXPRESSION Includes freedom to hold opinions and to receive and pass on information and ideas. Exclusions include the rights of others and disclosure of information received in confidence, or for maintaining the authority and impartiality of the judiciary. Article 11 FREEDOM OF ASSEMBLY AND ASSOCIATION Includes the right to form and join trade unions, or refuse membership of a union. Article 12 RIGHT TO MARRY Article 14 PROHIBITION OF DISCRIMINATION The enjoyment of Convention rights and freedoms irrespective of sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status. Article 16 RESTRICTIONS ON POLITICAL ACTIVITY OF ALIENS Nothing in Articles 10, 11 and 14 shall be regarded as preventing the High Contracting Parties from imposing restrictions on the political activity of aliens. Article 17 PROHIBITION OF ABUSE OF RIGHTS The Convention does not authorise any activity aimed at the destruction of any of the rights and freedoms it contains. Article 18 LIMITATION ON USE OF RESTRICTIONS ON RIGHTS Restrictions permitted under the Convention on rights and freedoms shall not be applied for any purpose other than those for which they have been prescribed.

The NHS Humber Cluster comprises NHS Hull, NHS East Riding of Yorkshire, NHS North Lincolnshire and North East Lincolnshire Care Trust Plus Page 48 of 49 The First Protocol Article 1 PROTECTION OF PROPERTY Entitlement to peaceful enjoyment of possessions subject to the securing of payment of taxes or other contributions or penalties. Article 2 RIGHT TO EDUCATION No person shall be denied the right to education. Where the State assumes functions in relation to education and teaching, it shall respect the right of parents to ensure such education and teaching conform with their own religious and philosophical convictions. Article 3 RIGHT TO FREE ELECTIONS Free elections at reasonable intervals by secret ballot.

The Sixth Protocol Article 1 ABOLITION OF THE DEATH PENALTY Article 2 DEATH PENALTY IN TIME OF WAR A government may derogate from its Convention obligations during war or other public emergency.

Source: Human Rights Unit (2002) Study Guide Human Rights Act 1998, Lord Chancellor‟s Department.

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