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Equality and Human Rights

Public Sector Equality Duty

Compliance Report

January 2014

Chair: Dr Amr Zeineldine Chief Officer: Andrew Bland The best possible health outcomes for Southwark people

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1. Introduction

Enhancing equality, protecting human rights and driving up quality and compassionate care are

integral to NHS Southwark Clinical Commissioning Group’s (CCG) core business and reflected

throughout our Business and Operating Plans 2013/14. To this end, the CCG’s Mission,

Values, Goals and Priorities are all grounded in the human rights principles known as the

“FREDA Principles”. This means that commissioning decisions about care pathways for

Southwark people are subject to:

Fairness

Respect

Equality

Dignity

Autonomy

Having made equality and human rights ‘everyone’s business’, our commissioning principles

and processes are also underpinned by a “human rights based approach” as the key to

delivering quality and compassionate care pathways that are equitable and sustainable for

Southwark people.

2. The Equality Act 2010

The Equality Act 2010 came into force in October 2010. The Equality Act 2010 (‘The Act”) came

into force on 1 October 2010. The Act simplifies all previous anti-discrimination legislation to

make the law easier to understand and comply with. The Act brings about comprehensive

protection against unlawful discrimination in the workplace, public functions such as housing,

education, transport and in the provision services, goods and facilities.

The Act prohibits unlawful treatment on the grounds of nine “protected characteristics”.

These are:

Age

Disability

Gender Reassignment

Marriage and Civil Partnership

Pregnancy and Maternity

Race

Religion or Belief

Sex


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Sexual orientation

3. The Public Sector Equality Duty (PSED)

The Equality Act 2010 also introduced a Public Sector Equality Duty (PSED) that is made up of

a “general duty” which is the overarching requirement and the “specific duties” which are

intended to help performance of the general duty. The general duty has three aims and it

applies to most public authorities, including the NHS Commissioning Board and CCGs (and

bodies exercising public functions such as private healthcare providers), who must, in the

exercise of their functions, have due regard to the need to:

Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited under the Act.

Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it.

Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

The specific duties of the public sector Equality Duty: Revised timeframes for CCGs

Under the specific duties of the public sector Equality Duty, CCGs are required to publish in a

manner that is accessible to the public:

Information to demonstrate its compliance with the public sector Equality Duty at least annually, starting by 31 January 2014. This information must include, in particular, information relating to people who share a protected characteristic who are:

Its employees – (public authorities with fewer than 150 employees are exempt)

People affected by its policies and practices

Equality objectives must be produced at least every four years from 13 October 2013. All such objectives must be specific and measurable.


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4. Equality legislation update – review of the PSED

On 6 September 2013, the government published the outcome of the review of the PSED

(specific duties) following the Red Tape Challenge spotlight on equalities. The PSED was

introduced through the Equality Act 2010 to ensure that public bodies take account of equality

when carrying out their day-to-day work – in shaping policy, in delivering services and in relation

to their own employees – and to address the bureaucracy associated with the previous duties

on race, disability and gender. The review was established to examine whether the PSED is

operating as intended.

The review has not considered repeal of the PSED, but a full evaluation is being considered to

be undertaken in 2016 when the Duty will have been in force for five years. In the interim period,

the Equality and Human Right’s Commission has been asked to draw-up further best practice

guidance on implementing the PSED. The review also reaffirmed that public bodies must pay

due regard to equality outcomes and must be transparent about their objectives and

performance on equality, and it is vital that the specific duties support this aim.

5. Scope of this Report

This report is a snapshot of the progress we have made on our 4-year (2012/16) Equality

Objectives within a much wider Equality, Human Rights, Health Inequalities and Inclusion

project undertaken by the CCG, Southwark Council, Stakeholders and the Voluntary Sector.

The Dulwich Health Services Consultation, for example, shows the length and breadth of

community engagement that we facilitated across the protected characteristics with ‘reasonable

adjustments’ identified going forward to need the needs of the Dulwich and surrounding

communities. As part of our annual review, between March and May 2014 we are conducting an

in-depth equality impact analysis of our achievements over the past 12 months and aspirations

for the future in relation to our Operating and Organisational Development Plans and our

Engagements and Consultation Strategy. The outcome of our Annual Equality, Human Rights

and Health Inequalities Review will inform the future direction of our Inclusion strategy and

interventions.


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6. Equality Objectives for 2012/2016

In alignment with the CCG’s Operating and Business Plan, Public Health and the priorities set

by Southwark HealthWatch, Southwark CCG’s Equality Objectives for 2012/16 were:

1. Engagement and Patient Experience – consulting, engaging and involving patients, carers and stakeholder organisations to develop and improve service access/delivery for Southwark’s diverse population

2. Mental Health – focusing on equality in recovery, prevention and high quality accessible support, care and treatment services – particularly in relation to Black and Minority Ethnic (BME) communities

3. Learning Disability – continue to improve quality of outcomes and autonomy with a particular focus on the Winterbourne View recommendations

4. Contracts – ensuring that contracts, SLAs and Commissioning specifications are compliant with the Equality Act 2010 and the Human Rights Act 1998

5. Care Homes in Southwark - improving quality and compassionate care (Additional Equality Objective for 2013/14) - The CCG and Southwark council in partnership with Care Home Providers have set out a series of challenges to improve the support framework and services that are provided to people that live in Care Homes in Southwark including those with dementia and nursing needs.


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7. Key progress on our Equality Objectives and wider inclusion initiatives

Southwark CCG is ambitious to ensure the best possible health and wellbeing outcomes for the

diverse population it serves. Below are some of the key highlights of our progress on our

Equality Objectives and the wider inclusion initiatives. Our Annual Equality, Human Rights and

Health Inequalities Review (2013/14), which will be available later in the year, provides a

system-wide evidence-based analysis on the progress we have made on priorities set in the

Operating Plan 2013/14, the Communications and Engagement Strategy and the Organisational

Development Plan.

1. Engagement and Patient Experience

Dulwich Health Services Consultation – Setting the Benchmark

We wanted to raise the bar on engaging our local people with a particular focus on the 9

“Protected Characteristics” as defined by the Equality Act 2010. An independent Equality Impact

Assessment (EIA) review was conducted before and after the consultation on the proposed

Dulwich Health Services redevelopment. For over three month, the consultation team engaged

and consulted with a wide range of diverse communities across Southwark. The EIA clearly

demonstrated the length and breadth of community engagement across the protected

characteristics with ‘reasonable adjustments’ identified going forward.

The significance of the Dulwich Health Services Consultation

The Dulwich Health Services Consultation represents the first of a series of reviews, which will

be completed across other key localities in the Borough over the course of the next 5 years, and

this bodes well in terms of building on the high standard that has been set on embedding

equality and human rights.by this process. The objective of the EIA was to identify potential

positive and negative impacts that may result as a consequence of the proposals which were

outlined in the Southwark Clinical Commissioning Group (Southwark CCG) consultation

document entitled: ‘Improving health services in Dulwich and the surrounding areas - A

consultation about local services’, with a particular emphasis on enhancing the local fulfilment of

the PSED. The focus of the report was on assessing the potential impact of these proposals on

individual patients and relatives/carers who share one or more of the nine protected

characteristics


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The EIA process sought to align outcomes with the vision of the Southwark CCG as identified in

local commissioning plans. The local commissioning plans (the Integrated Plan) were

developed to deliver the CCG’s vision to secure the ‘best possible health outcomes for

Southwark people’ by ensuring that:

People live longer, healthier, happier lives no matter what their situation in life

The gap in life expectancy between the richest and the poorest in the population continues to narrow

The care local people receive is high quality, safe and accessible

The services we commission are responsive and comprehensive, integrated and innovative, and delivered in a thriving and financially viable local health economy

We make effective use of resources available to us and always act to secure the best deal for Southwark.

Methods and outcome of research, involvement and consultation The initial Equality Impact Assessment drew insight from a range of sources including but not

limited to national and regional research led by relevant organisations and public bodies such

as:

Age UK

Better Health UK

Department of Health

Equality & Human Rights Commission.

Joseph Rowntree Foundation

Men’s Health Forum

MENCAP

NHS Southwark / Southwark Clinical Commissioning Group

Princess Royal Trust for Carers

Stonewall

Women’s Resource Centre

Local demographic data relevant to the proposals to improve health services in Dulwich and the

surrounding areas was utilised, as well as local key documentation.

Engagement activities included:

✓ Surveys distributed in paper and online formats ✓ Community road shows ✓ Drop-in sessions in the locality for informal one-to-one discussions ✓ Discussions with existing patient and public participation groups ✓ Presentations to the Community Councils of Dulwich, Camberwell, Peckham and

Nunhead


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✓ Semi-structured discussions with community groups ✓ Semi-structured discussions with service users individually and in groups ✓ Briefings to partner organisations, local Members of Parliament and Councillors ✓ Direct work with local media and specifically those publications that are delivered to every

household locally. This was consistent with and has subsequently informed on-going developments of the ‘SCCG

Communications and Engagement Strategy’ and was also significant in the development of

Southwark’s Primary and Community Care and Redesigning Primary Care Counselling Services

Strategies (see below)

Primary and Community Care (P&CC) Strategy - Engagement

‘Improving out of Hospital Services’ - Engagement event on developing NHS Southwark

CCG’s Primary and Community Strategy

An event was held on the 10 April 2013 by the CCG to seek input into developing the CCG’s

primary and community care strategy. The event sought to co-produce with stakeholders the

CCG’s priorities for improving primary and community care, and to develop some strategic

options for delivering care out of hospital within Southwark. Approximately 70 people attended

the event held at Avonmouth House; and these included patients and local residents, clinical

leads, CCG staff, primary care staff, members of the Local Pharmaceutical Committee,

community health services staff from Guy’s and St Thomas’ NHS Trust.

The Participants were first asked:

1. What does good primary and community care look like?

2. How should care be delivered in Southwark in future?

The key themes from the responses were:

Patients want to have an extended range of services available at GP practices and pharmacies

Services should be conveniently located and accessible

Patients should know how to access services and get information to support self-management

GPs needn’t be the only gatekeeper to services

There should be stronger links with other types of care /more integrated services

Services should be patient-centred

Not all enhanced or out of hospital services can be offered in every practice or locality, service models need to take into account efficiency and best use of resources


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Workforce and IT are key enablers

The participants were then asked to think about services for distinct groups of patients

and to consider the following questions:

1. What does a good service look like for this group?

2. What is important to patients when accessing this service?

3. How do we know if the service is good?

Participants were asked to record their views and to comment on as many patient groups

as they wished to. The patient groups were:

Patients who are well and want to stay healthy

Families and patients with young children

People with Long Term conditions (e.g. diabetes, heart failure)

People with Mental Health Problems

Frail older people

People with disabilities

People with social problems (e.g. housing, language, immigration)

P&CC Strategy Responses to the consultations

The Key Strategic Principles and Clinical Priorities underpinned by the 7 key Themes in the

P&CC Strategy document, clearly and closely reflect the areas prioritised in both these

consultations, which in themselves employed methodologies that were inclusive, diverse and

rigorous.

Strategic Principles:

All Southwark patients should have consistent access to high quality care, including

enhanced services, regardless of where in the borough they live.

Services should be safe, evidence-based and focused on improving outcomes for patients.

Services should target health inequalities.

Services should be patient centred, seamless and accessible.

Where services can be effectively provided out of hospital and closer to patients’ homes,

they should be.


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Clinical Priorities:

Long Term conditions

Cancer and End of life

Mental Health

Children and Early years

It should be noted, that the commitment to develop more accessible, locality based, integrated

local hubs with enhanced/extended services contained in this strategy, will not only greatly

improve the Health Outcomes and Quality of Life of significantly more of Southwark’s residents

than is currently the case (see analysis below), but will also enable the CCG to engage with a

wider cross-section of the local population in future consultations regarding areas such as

Patient Experiences, Diverse needs, Health Outcomes and potential Service Developments.

The open, honest and reasonable approach of this strategy in terms of what can and cannot be

achieved over a certain time-frame and within projected future resource restrictions is both

refreshing and important with reference to managing expectations arising from consultations,

ensuring fairness and proportionality, and sustaining and building public involvement in

supporting the CCG’s commitment to positive change and development of Southwark’s P&CC

Services going forward.

2. Mental Health and Wellbeing In June 2013 Southwark Council’s Health, Adult Social Care, Communities and Citizenship

Scrutiny Sub-Committee called for evidence on psychosis and access to services for Black and

Minority Ethnic (BME) communities.

One of the key developments areas in relation to the prevalence of psychosis amongst the BME

community has been the work with Black Majority Churches (BMCs) in Southwark and

surrounding boroughs. Southwark has seen a huge surge in the number of new churches,

particularly BMCs, many of which are Pentecostal with a largely Caribbean or African

membership. An estimated 20,000 people gather to worship in around 240 different churches

across Southwark each week. South London and Maudsley NHS Trust (SLaM), through its

Charitable Trust has piloted a “Faith and Mental Health Training” project (‘the project”) with a

number of BME Churches in 4 London Boroughs including Southwark. SLaM’s project trained

faith leaders to promote mental health awareness within community groups often described as

hard to reach and to facilitate engagement with SLaM services. The CCG with its partners is

considering further such evidence-based interventions as part of the Joint Mental Health

Strategy.


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Primary Care Counselling Services

For some years, Southwark has been providing access to free primary care counselling from

around 40 of its GP Practices. Several small studies have indicated that a primary care-based

counselling (PBC) service can address the needs of a substantial group of patients for whom

psychiatric care is inappropriate. The CCG recognised that PBC had expanded piece-meal, due

to the available funding, and previously had little overall strategic direction. Due to the different

service arrangements for counselling services found in Southwark, historically there have been

differing contractual procedures (documentation, monitoring and management), with no single

reporting structure or management oversight of the service or commissioning arrangements.

During this time, however, PBC had developed into a good local service supporting practice

populations. Following the analysis of the data returns, from Southwark’s practice based

counsellors particularly for the period 2011-2012, the CCG’s set about to enhance and improve

PBC with a new development specification. In addition, `n EIA was conducted to inform forward

planning.

The EIA is not only a qualitative and quantitative analysis on the rationale behind the provision

of Practice Based Counselling (PBC), but also part of Southwark CCG’s prevention and early

intervention strategy for the mental wellbeing of Southwark people. To that end the EIA is to

assure that the proposed redesign of the Primary Care Counselling Service:

Is consistent with the vision and values and goals in Southwark’s Integrated Plan

Is consistent with Southwark’s Primary & Community Care Strategy for 2013/2014 –

2017/2018

Has a positive impact on equality and human rights for Southwark People

Helps in reducing health inequalities and improves access for different patient groups

Contributes to the prevention and early intervention for the mental wellbeing of Southwark’s

population

Meets all the statutory governance requirements

Identifies equality and human rights gaps to inform detailed implementation plans and future

commissioning intentions

Is consistent with the Rights and Pledges contained in the NHS Constitution

Is fit for purpose to meet the needs of Southwark’s diverse population in an equitable and

sustainable way


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Recommended “Reasonable Adjustments” for Practice Based Counselling Key recommendations for ‘reasonable adjustments’ on the PBC service going forward include:

Desktop survey on how schools and further education institutions in Southwark promote mental health and wellbeing support, particularly counselling services to students by gender

It is also crucial to consider the roles and needs of carers and it would useful if this could be scoped into the redesigned PBC specs e.g. counselling support and advice for those in a caring role. There are a number of practical issues that need to be taken into account such as visual/hearing impairment, complex needs and people with learning disabilities (1.5 million in England and 2.5 % higher health problems and unmet needs). Generally access for people with disabilities was good. Most therapy spaces were accessible via ground floor entrances and therapy rooms were of a good standard

PBC presents a real opportunity to promote a better understanding of transgender issues

through GP practice awareness training and working with the local transgender groups.

Ensure specifically in terms of practice staff/GPs, that they are being made aware of the equal legal rights of those who are married and those same sex couples who have a civil partnership (e.g. information sharing, visiting, involvement in care planning etc.).

Useful to do a desktop exercise on practices’ knowledge and understanding of Mental Health Stigma within BME communities and how this information is effectively fed back to GPs?

Further promotion of IAPT with and within the BME community via third sector and

community groups and faith organisations esp. Black Majority Churches.

All of Southwark people have access to PBC regardless of sex. How can we be assured that there is not a conscious or unconscious bias within some GPs to refer women to counselling but not men with the same diagnosis?

Given Southwark’s BME population, PBC might present a real opportunity to address unmet needs for the BME LGBT community with better mapping and signposting.


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3. Learning Disability

The CCG with its partners has continued to make good progress on Learning Disability with

further positive achievements including:

The rolling out of Personal Health Budgets (PHB) for NHS Fully funded clients with learning

disabilities

The establishments of the Winterbourne View Steering Group established ‐ key focus areas

for the group include; development/refresh of strategies for challenging behaviour and

autism, quality assurance, review and development of care pathways including crisis

intervention, personalisation, advocacy and access, workforce and commissioning

A Joint health & social care review has been undertaken of all out of borough and in patient

placements in progress. This includes multi‐disciplinary review of cases at the

Winterbourne View Working Group

Monthly managers meeting between SCCG and the local authority have been on-going

regarding Learning Disability Safeguarding & Quality Improvement, with a focus on

monitoring the quality of care commissioned for people with learning disabilities.

A Named Lead for maintaining register of all health funded people with learning disabilities

has been established

4. Contracts

We want to ensure that our contracts, SLAs and commissioning specifications are compliant with the Equality Act 2010, the Human Rights Act 1998 and The NHS Constitution. In this respect, we will continue to act as ‘critical friends’ to our providers and stakeholders, that compliance is reflected in across our QIPP plans as well as use incentives and contractual frameworks to support further development.


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5. Southwark’s Care Home Improvement Project

Southwark CCG has developed a joint vision for Care Homes in Southwark and is undertaking a comprehensive review of the approach and provision of Home Care services to the community, including nursing provision and care for those with dementia. The pilot project “My Home Life Southwark” has been implemented and aims to:

Develop standard care professional personal and skillset specifications

Develop and support Transformational Leadership skills (embedding Human Rights,

Compassionate Care and the Francis and Winterbourne View recommendations)

Deliver critical improvement and outcomes with a wide range of members providing a whole system wealth of experience

8. Other Developments - Launch of version 2 of the Equality Delivery System (EDS2)

On 4 November 2013 at an NHS England event a revised EDS NHS equalities framework was launched. Following an evaluation and further engagement, the original EDS has been refreshed so that it is slimmer and more flexible to use and implement at local level. Critics of the original EDS pointed out that whilst it did keep the equalities agenda on the table, some of the processes were bureaucratic and maintain the “tick box” culture, the grading system was too complex and some of the language of outcomes was difficult to understand. EDS2 is a streamlined and more flexible model but is not mandatory, and NHS organisations are free not to use the framework and/or adapt it for local use.

9. Risk factors

There is no discernible risk to the CCG in this area. Southwark CCG is able to demonstrate a

strong track record in continuously embedding equality and human rights outcomes into its

commissioning processes as well as compliance with statutory equality duties and governance.

The next statutory requirement is for the CCG to publish evidence by 31 January 2015 on

progress being made on its 4-year Equality Objectives.

10. Conclusions and Recommendations

NHS Southwark CCG continues to make good progress in the way it is enhancing equality and

protecting human rights for Southwark people. Both the Mid Staff and Winterbourne View

enquiry reports raised fundamental issues of humanity – fairness, dignity, equality, respect and


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autonomy – all key human rights principles at the heart of high quality care. With this in mind,

protecting human rights and enhancing quality and compassionate care are integral to the

CCG’s core business and reflected throughout our Operating Plan

As part of our annual review, between March and May 2014 we are conducting an in-depth

equality impact analysis of our achievements over the past 12 months and aspirations for the

future in relation to our Operating and Organisational Development Plans and our Engagements

and Consultation Strategy. The outcome of our Annual Equality, Human Rights and Health

Inequalities Review will inform the future direction of our Inclusion strategy, interventions and

refinement of the Equality Objectives.

equality and human rights public sector equality …...equality and human rights.by this process....

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