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NHS Equality Delivery System 1. Introduction and Background This is clearly a time of radical change and uncertainty for staff working at NHS Kirklees. Against this backdrop, we must continue to meet our statutory equality duties at the same time as supporting the new successor organisations to embed equality and diversity into their business activities and structures. In April 2011, a new public sector equality duty will come into force. This will extend our existing promotional duties for race, sex and disability to include age, sexual orientation, religion and belief, gender reassignment and pregnancy and maternity. As a public sector organisation, we have a legal duty to demonstrate that promoting equality and tackling unlawful discrimination across all the protected groups are central planks of our policy making, the commissioning and delivery of our services and our employment practices. A key accountability for NHS Kirklees during the transition to new structures is to ensure that equality and diversity is not lost. The PCT will need to ensure that the good work that has been carried out in equality and diversity is integrated into the new structures of the NHS and that standards are retained during the transition process. The Equality Act 2010 provides the legislative impetus to move the agenda forward. The Equality Delivery System (EDS) is a quality assurance tool designed to help us meet our new statutory duties and embed equality and diversity into our core business.

2. Equality Delivery System for the NHS 2.1 The EDS has been developed by the Equality and Diversity Council (EDC),

which was established by the Department of Health and is chaired by Sir David Nicholson, Chief Executive of the NHS in England. The EDS is intended to drive up the equality performance of the NHS and embed equality into mainstream business activities. It requires NHS organisations, in collaboration with local interests, to analyse and grade their performance and set defined equality objectives, supported by an action plan. These processes should be integrated into mainstream business planning.

At the heart of the EDS are the objectives and outcomes (see Appendix 1). NHS organisations will need to analyse their equality performance against 12 outcomes grouped under the following four headings:

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

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2.2 The EDS is referenced in the NHS Operating Framework 2011/12 with the expectation that NHS commissioners and providers use the EDS to routinely report on local equality, diversity and human rights work. The PCT cluster implementation guidance also states that SHAs must ensure that clusters are able to take on the requirements for promoting the Equality Delivery System. The guidance adds that SHAs and clusters should ensure that all statutory duties, including equality and diversity, are handled clearly, explicitly and effectively through the new arrangements. This includes paying due regard to the provisions of the Equality Act 2010, which aims to ensure that all public bodies within the health service comply with the principles of equality.

2.3 The Equality and Diversity Council believes that the unique selling points of the EDS are that it will:

help the NHS deliver on the Government’s commitment to fairness and

personalisation, including the equality pledges of the NHS Constitution. deliver improved and more consistent performance on equality. help organisations to meet the new equality duty – something we will need to

do in any event. support commissioners to develop commissioning plans that meet the needs

of their communities, and help providers to respond better to CQC registration requirements.

improve efficiency and bring economies of scale by providing a national equalities framework for local adaptation.

retain a focus on fairness, personalisation and equality during transition

2.4 The EDS applies to PCTs and to the GP commissioning consortia that will take over the commissioning work of PCTs from 1 April 2013. It also applies to NHS providers including Foundation Trusts, all of whom are registered to provide services by the CQC. It may also be applied to all those healthcare organisations that are not a part of the NHS, but which may work to contracts issued by NHS commissioners.

2.5 Chief Executives will shortly be asked to sign up to implementing the EDS. It is

anticipated that organisations implementing the EDS will be able to deliver on the requirements of the Equality Act and will put themselves in a good position to deliver positive outcomes for patients, communities and staff in line with White Paper proposals and the Government’s priorities for the NHS. Implementing the EDS will help the NHS to deliver on the Equality Act and effectively build equality processes into the new NHS architecture.

3. Migrating from Equality Schemes to Equality Objectives The process and content of the EDS map directly onto the general and public sector duties of the Equality Act 2010. Hence, implementation of the EDS will help organisations respond more effectively to the requirements of the Equality Act 2010.

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During 2011/12, organisations will need to decide on the best way to migrate from equality schemes under the previous equality legislation to the equality objectives required by the Equality Act and the EDS. By April 2012, the migration should be complete. A suggested approach is to review the action plans of current schemes using the EDS objectives and outcomes, and narrow down the existing actions into a smaller set of critical priorities. In this way, organisations will remain compliant while moving from the old to the new equality duties. Engagement and evidence used to support the development of current schemes can, if still fit for purpose, continue to be used to support the new process. EDS guidance on these matters can help organisations to improve the transparency and evidence base of their planning, as required by the White Paper and the Equality Act. 4. Financial implications There are no direct financial implications arising from this new framework. However, there will be ongoing resource implications in terms of :

Developing and implementing an ongoing community engagement exercise to inform the equality objectives and actions and assess organisational performance against these.

Participating in a regional cluster of NHS Trusts to share good practice and peer support – this has already started.

It should be noted that because organisations are required to meet the new equality duty anyway, the above resource implications would still be incurred. 5. Risk Assessment What are some of the risks?

Loss of focus on equality and diversity due to transitional issues.

Failure to embed equality and diversity into the new commissioning and provider organisations.

Loss of significant progress made to date in relation to equality and diversity.

Loss of the Strategic Health Authority.

Weak links with Public Health as it moves out of the NHS to Local Authorities.

Who would be at risk? Existing and future NHS organisations will be at risk of legal challenge if they fail to meet their statutory obligations. Apart from the financial risk this presents, there is also the reputational risk and the potential loss of public confidence. How can the risks be managed?

Adopt the EDS as a framework to help us fulfil our statutory obligations and ensure that equality is not lost during the transition.

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Communicate the new equality duty and the EDS to GP consortia, the new provider organisation and public health.

Engage with local interests at the early stages of development.

Take part in regional EDS clusters to facilitate shared learning and support.

6. Legal Issues The EDS will support NHS Kirklees and successor organisations to meet with their legal duties under the Equality Act 2010. 7. Recommendation The Board is recommended to adopt the Equality Delivery System for the NHS.

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Appendix 1: EDS Objectives ad Outcomes (draft)

Objective Narrative Outcome

1. Better health outcomes for all

The NHS should achieve improvements in patient health, public health and patient safety for all, based on comprehensive evidence of needs and results

1.1 Services are commissioned, designed and procured to meet the health needs of local communities, promote well-being, 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 patient access and experience

The NHS should improve accessibility and information, and deliver the right services that are targeted, useful, useable and used in order to improve patient experience

2.1 Patients, carers and communities can readily access services, and should not be denied access on unreasonable grounds

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, engaged and well-supported staff

The NHS should Increase the diversity and quality of the working lives of the paid and non-paid workforce, supporting all staff to better respond to patients’ and communities’ needs

3.1 Recruitment and selection processes are fair, inclusive and transparent so that the workforce becomes as diverse as it can be within all occupations and grades

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

3.4 Staff are free from abuse, harassment, bullying, violence from both patients and their relatives and colleagues, with redress being open and fair to all

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 leadership at all levels

NHS organisations should ensure 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

4.1 Boards 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