Annual Equality, Diversity and Inclusion Report 2017/18 Published 31 January 2018

Transcription

1 Annual Equality, Diversity and Inclusion Report 2017/18 Published 31 January 2018 Page 1

2 Better health outcomes for all Inclusive leadership Equality Fairness Respect Improved patient access and experience Empowered, engaged and included staff Page 2

3 Contents Section Title Page 1 Executive Summary 4 2 Introduction 6 CCG Equality Statement 6 The Equality Duty 6 What we mean by Equality 7 Protected characteristics 7 3 The Equality Delivery System version 2 (EDS2) 7 Local context 8 Targeted Communities 10 4 Progress against equality objectives Actions undertaken by the CCG in relation to its equality duty 14 Leadership 14 Workforce 15 Recruitment and Selection 17 Learning and Development 20 Collaboration and Inclusion 20 Key Staff Engagement Indicators 21 Arrangements for Patient and Public Engagement 21 Monitoring of Provider Equality Standards 22 Accessible Information Standards 22 Workforce Race Equality Standard (WRES) 23 Commissioning and Redesign of Services 23 Equality Analysis 25 Embedding Equality into Project Design 25 Quarterly Review of Equality 26 Joint/Collaborative Review Programme Design and Delivery 26 6 Recommendations 26 Objectives for Page 3

4 1 Executive Summary NHS North West Surrey CCG (NWS CCG) is pleased to present its first Annual Equality, Diversity and Inclusion Report delivered in this format. Historically, this report has been delivered within the CCG s Annual Report and Accounts, which is normally published in September of each year. However, it has been decided to now publish the report every January, to align with the practises of our partner organisations. The NHS Constitution enshrines public ownership of the NHS as a fundamental value, stating The NHS belongs to the people. The Annual Equality, Diversity and Inclusion Report describes how North West Surrey CCG is helping to meet this value in terms of equality by meeting its Public Sector Equality Duty and by showing the progress that has been made against equality and diversity objectives set by the organisation in 2017, those being: to understand the health needs of our local people and ensure that services commissioned reference the Joint Strategic Needs Assessment and reduce health inequalities; to ensure that equality is at the heart of the commissioning process, ensuring services are commissioned, procured, designed and delivered to meet the health needs of local communities; and to provide a working environment where staff feel valued and are supported in their training and development needs. The report specifically highlights our successes in these areas has seen closer working between the three CCGs that comprise the Surrey Heartlands Health & Care Partnership, those being North West Surrey, Guildford and Waverley and Surrey Downs CCGs. This has given us all an opportunity to share information and best practice in this important area. To all CCGs within the partnership, ensuring that people with different equality characteristics are able to benefit from the clinical commissioning that each CCG carries out is a key priority, as is having a diverse, supported workforce. With that, I look forward to seeing how closer partnership working will continue to support these aspirations, with collaborative working in mind. A key assurance activity this year was carried out by NHS England to assess CCGs compliance with statutory guidance on patient and public participation in commissioning health and care. The ten key actions that the CCG was assessed on included how it advances equality and reduces health inequality; how it provides support for effective engagement; and how it involves the public in governance. The CCG has received an indicative outcome and will continue to focus on ensuring all protected groups are able to fully participate in the commissioning of health and care. We expect these outcomes to be published in the summer of 2018 by NHSE. The CCG s Patient & Public Engagement Forum, comprising of members who represent our population with a wide range of different equality characteristics, continues to hold the CCG to account for patient experience and how its plans consider the needs of different equality groups and vulnerable people. This is strengthened by the Chairs of the Patient Participation Groups in North West Surrey s CCG s member practices. I want to thank all the committed members of these two groups for their unique insight and offering their time so generously to improve health outcomes for all of our population. Dr Charlotte Canniff Clinical Chair Page 4

5 If you would like any further information, please contact the CCG as follows: Tel: SMS text phone: Post: NHS North West Surrey Clinical Commissioning Group, 58 Church Street, Weybridge, Surrey KT13 8DP Page 5

6 2 Introduction This report sets out how NHS North West Surrey Clinical Commissioning Group (CCG) meets its statutory duties under the Equality Act 2010 and how it ensures the services it commissions addresses health inequalities. Equality Statement NHS North West Surrey CCG aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. We take into account the Human Rights Act 1998 and the Equality Act 2010 and promote equal opportunities for all. Through the development of policies and procedures, the CCG: gives due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who have shared a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and gives regard to the need to reduce inequalities between patients in access to, and outcomes from, healthcare services and in securing that services are provided in an integrated way where this might reduce health inequalities. We also embrace the staff pledges within the NHS Constitution. As an equal opportunities employer, the intention of the organisation is to ensure that the talents and resources of all members of staff are utilised to the full, and that no job applicant or employee receives less favourable treatment on the grounds of disability, colour, race, gender, marital status, sexual orientation, ethnic origin, nationality, religious belief or age. The CCG is committed to equality of opportunity in employment and to protecting its staff from circumstances that compromise their dignity and respect whether it originates in the workplace or from the CCG s clients or customers or where an individuals actions detrimentally affects the CCG or another CCG employee. Central to the CCG s policy is the prevention of discrimination, victimisation and harassment against service users and employees on any grounds, but particularly in relation to: sex, gender identity, race, disability, religion or belief, marital status, civil partnership status, age, language, social origin, employment status, sexual orientation, political belief, trade union membership or activity and responsibility for dependents. The Equality Duty NHS North West Surrey CCG is a membership organisation, comprised of practices that provide primary medical services to the population within the geographic boundaries of the CCG. The CCG now has 41 member practices working across three localities: Thames Medical (Runnymede and West of Elmbridge); Stanwell, Ashford, Staines, Shepperton and Egham (SASSE); and Woking. This structure allows us to commission the services that our patients need at a local level, develop services that are tailored to the specific needs of each of our diverse communities, and provides a rich understanding of how our initiatives improve patients experiences of health services. The CCG has met the Specific Equality Duty by publishing equality information in accordance with section 149 of the Equality Act Progress has been made against the following Public Sector Equality Duties (PSED): Page 6

7 eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; and foster good relations between persons who share a relevant protected characteristic and persons who do not share it. Having due regard for advancing equality involves: removing or minimising disadvantages suffered by people due to their protected characteristics; and taking steps to meet the needs of people from protected groups where these are different from the needs of other people Through the work that the CCG has carried out it has fulfilled its statutory responsibilities, namely to: reduce inequalities between patients with respect to their ability to access health services; and reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services. What we mean by equality Within the context of health care services, promoting equality means that every individual has the right to access services and enjoy improved health outcomes, regardless of any particular characteristic that is protected under the Equality Act The CCG shows due regard to reduce inequalities by ensuring that all decisions regarding service development have been assessed for their impact on different equality groups. As an employer it must promote equality and diversity through its employment practices. Protected characteristics The general equality duty covers the following protected characteristics: Age Disability Ethnic group Gender Gender reassignment Marriage or civil partnership Pregnancy and maternity Religion or belief Sexual orientation 3 The Equality Delivery System (EDS2) The EDS2 is a framework to help organisations to review and improve their performance for people with protected characteristics. The goals of the EDS2 framework are as follows: Better health outcomes; Improving patients access and experience; A representative and supported workforce; and Inclusive leadership This report presents a high level review of how the CCG has progressed these goals. Page 7

8 Local Context The Place-Based Profiles produced by Public Health in October 2107 provides local data for commissioners to incorporate into programme development plans. The 2015 resident population of North West Surrey CCG was estimated at 343,000 while the GP registered population was higher at 362,662 (April 2015). In 2017 the GP registered population has risen to 370,000 (2017). When constraints relating to projected housing availability are taken into account for projecting population increases, it is estimated the population will increase to 364,600 by The number of those aged 65 and over is projected to rise by 21% from 62,500 in 2017 to 75,600 in The population in the North West Surrey CCG area is the most diverse of all the Surrey CCGs with 12.5% of the population from a non-white ethnic background as follows; Indian (2.7%), Mixed/multiple ethic group (2.4%), Pakistani (2.1%) and other Asian (3.1%). There are around 544 Gypsy Roma Travellers in North West Surrey residing in 136 pitches spread across 25 sites. Due to the way the data is collected live births are always reported 18 months in retrospect; with gestation periods of 9 months from conception and then validation of data needed. This is collected nationally by Public Health England and is the same for all localities hence the dates being show relate to With that, there were 4,484 live births in A third was to mothers over 35 years of age. The North West Surrey CCG birth rate for women aged years (70/1,000) is higher than the Surrey average (63/1,000). The older age profile of mothers in North West Surrey may increase the proportion of pregnancies and births that experience complications compared with national rates. Access to GPs or hospitals for households without a car can be problematic. Only 36.2% of such households are within reasonable travel time if using public transport or walking to get to their GP practice and the corresponding figure for hospital access is as low as 6.8%. Learning disability prevalence in North West Surrey is estimated at fewer than 2.4% (6,683) of the population in This is projected to increase by 3.6% to 6,920 over the next 5 years (2022). North West Surrey is largely affluent with 105 out of 214 (49%) (Local Super Output Area) LSOAs in the least deprived 20% in England. The most deprived small area (LSOA) in North West Surrey CCG is in Maybury and Sheerwater. It is ranked within the most deprived 20% of all LSOAs in England. People living in more deprived areas typically experience poor health outcomes. Residents of North West Surrey can expect below average life expectancy (LE) compared to their counterparts in Surrey. LE is 80.6 years for men and 83.9 for women in North West Surrey CCG compared to 81.3 and 84.5 for men and women in Surrey respectively ( ). Women can expect to live an additional 3.3 years more than men. At age 65 men and women in North West Surrey can expect to live an additional 19.3 years and 21.6 years respectively. This is more than the England average for both men (18.6) and women (21.1) but is lower than the Surrey average. There is a considerable variation in both male and female life expectancy at ward level. LE at birth for men ranges from 74.8 in Weybridge North to 87.6 years in Ashford. For women, LE at birth ranges from 79.8 in Weybridge North to 92.5 in Walton Ambleside. Page 8

9 Men and women in North West Surrey live 84.3% and 82.2% of their lives in good health respectively. Men could therefore expect to live 12.7 years of their lives in not good health. Although women (83.9 years) live slightly longer than men (80.6 years), women spend an average of 14.9 years in not good health which is 2.2 years more than men. Similar to all of the Surrey CCGs, North West Surrey has the highest rate of Potential years of life lost (PYLL) for Cancer compared to other conditions. North West Surrey has the highest standardised mortality ratio for cancer (94.9) within Surrey when compared to England. Mortality among the under 75s from cancer is also higher in North West Surrey compared with other CCG areas in Surrey. Significant variation exists at ward level; for example, all age cancer mortality is high in Kingfield and Westfield (124.4) and low in St Georges Hill, Horsell East and Woodham and Ashford Town (68.4) when compared to nationally. There are more than 6,000 people receiving social care support in North West Surrey. Around 18.5% (1,801) of people aged 85 and over currently receive support. Just fewer than 2,000 carers currently receive support in North West Surrey and 1% of them are of working age (between years of age). Around 1.3% of people aged 85 and over are carers receiving Adult Social Care support. The actual number of carers in North West Surrey is likely to be higher as many will not be known to social care. Smoking prevalence in the district & boroughs within North West Surrey show a variation from 12.2% (in Elmbridge) to 18.6% (in Spelthorne). Also, there are significant variations between wards, ranging from 9 % in Pyrford, to 23% in Maybury and Sheerwater and 24% in Stanwell North. Smoking prevalence has gradually declined year on year. However, smoking rates are much higher among the more deprived communities, having a significant impact on increasing health inequalities by reducing life expectancy in these groups. The rate of alcohol related mortality is 40 per 100,000 population in Elmbridge, 40.5 in Runnymede and 36.5 in Spelthorne compared to 46 per 1,000,000 population in England (2016). Men experienced a higher rate of alcohol related mortality compared to women. The number of alcohol-related deaths is usually higher in more deprived groups. The rate of hospital admissions episodes for alcohol related conditions (broad definition) in Elmbridge is 1,412 per 100,000, Runnymede is 1,412 per 100,000 and Spelthorne is 2,010 per 100,000 compared to England 2,179 per 100,000. In Spelthorne, the proportion of adults estimated to be doing 150+minutes of physical activity per week is 54% which is significantly lower compared with Surrey (62%) and the lowest out of all the District and Boroughs in Surrey. The percentage of adults who do any walking for at least 10 minutes a day 5 times per week in Spelthorne is 37.7%, which is significantly lower than England (50.6%) and Surrey (49.8%). The percentage of adults classified as having excess weight in North West Surrey is the highest in Spelthorne (63%) and Runnymede (60.3%) and the lowest in Elmbridge (54.5%). These percentages are slightly less than that for England (61.3%). There are 18.2 % (2,037) of children in reception year and 29.6 % (2,658) of children in year 6 in North West Surrey that are classified as overweight or obese. Those children who are overweight or obese are putting their current and future health at risk. Page 9

10 The standardised hospital emergency admission ratios (adjusted for age) for stroke, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD) and myocardial infarction (MI) are significantly lower in North West Surrey compared to nationally. However, amongst the Surrey CCGs, North West Surrey also shows the highest emergency admission ratio for stroke (93.6), myocardial infarction (87) and COPD (67). Overall common mental health needs in North West Surrey are relatively low compared to England. Hersham North (0.10) has the highest level of common mental illness, and St George s Hill (-1.18) the lowest. The recorded prevalence of mental health disorders in children is lower in North West Surrey CCG than in England. The estimated prevalence of any mental health disorder for GP registered population aged 5 to 16 is 7.9%. This is significantly lower than the national average of 9.2%. The rate of people detained under the mental health act, is 24.7 per 100,000, which is significantly lower than the England average (58.7). The rate of contact with specialist mental health service for adults in North West Surrey was 2,665 per 100,000 which is significantly higher than the England average of 2,441. The discharge rate from mental health hospitals for North West Surrey registered patients (39.5 per 100,000 population) is lower than that for England (69.8). The demand for mental health advice through NHS 111 was significantly more in North West Surrey CCG (262.4 per 100,000 population) compared to the National average (235.6). In general there has been a downward trend in suicides in the UK, although rates in England have been slowly increasing since , and in Surrey since Surrey has historically had a lower rate of suicide compared to England. The latest three year average data for North West Surrey shows there were 100 deaths from suicide and undetermined injury, a rate of 11.1 per persons, which is higher than the rate for Surrey (9.1 per ) and England (10.1 per 100,000). The rate for women in North West Surrey (7.4) is higher compared to that for Surrey (5.6) and significantly higher than for England (4.7). The estimated dementia diagnosis rate for those aged 65 years or older in North West Surrey is 65%. This is not significantly different to the national target of 67.9%. The estimated rate describes the rate of recorded diagnoses per person estimated to have dementia; therefore approximately 35% of people with dementia in North West Surrey are thought to be undiagnosed. Reducing dementia diagnosis prevalence gap was a local indicator for the Better Care Fund. Currently 2,794 residents have been diagnosed with dementia. Estimates of expected levels of dementia in the population indicate that 35% of the residents with dementia remain undiagnosed compared to the National average of 32.1%. Targeted Communities Working with our public health, social care and wider colleagues we continue to progress a number of key initiatives including: Working with young carers to provide support, advice and guidance to improve the health and wellbeing of those caring for others through the Surrey Carers Strategy. Page 10

11 Prevention action joint work with the CCG, local boroughs and Surrey County Council Public Health to deliver the Prevention Plan aiming to improve health and reduce health inequalities for people living in North West Surrey. This has included: o o o o o o o o o o o o o to increase the provision of Stop Smoking Services in primary care; to increase Stop Smoking Services in priority groups; COPD - systematic case finding of patients in specific general practice cohort; Physical Activity - to Increase physical activity levels amongst groups identified as inactive or with a condition that would benefit from exercise; improve adoption of a Workforce Wellbeing Charter which encourages physical activity and healthy eating as part of a healthier workforce; Healthy Weight - Raising the issue of weight; increasing the number of people referred to diabetes prevention programme; improving early identification of alcohol misuse among the general population; improving effective management of people who misuse alcohol; increase the number of General Practices that offer NHS Health Checks; increase the number of pharmacies that offer NHS Health Checks; People with Learning Disabilities - on-going dialogue with primary care to identify and address training and development priorities that will enable more GP Practices to offer people with learning disabilities annual health checks; and to identify and support patients at risk of developing long term health conditions and co-morbidities, such as diabetes and hypertension. The Prevention Plan sits as part of the Joint Operational Group that reports to the Local Joint Commissioning Group for North West Surrey. This group involves representatives from all partner organisations. Through the latter part of 2016/17 the priorities for the Prevention Plan have been refined and now reflect the following high-level priorities: Preventing disease and promoting wellbeing - to include the promotion of healthy lifestyles across the life-course such as smoking, alcohol, healthy weight and emotional wellbeing; Earlier diagnosis of Long term conditions linked to QIPP priorities and Surrey Heartlands Strategic Transformation Partnership with a focus on hypertension, diabetes and cancer; and Promoting Independence including action to reduce social isolation, to promote winter wellbeing and prevent falls. The CCG is working in partnership with Surrey County Council Public Health, Adult Social Care, and the borough and district councils on an action plan to address these priorities. 4 Progress Against Equality Objectives 2017 Following completion of the EDS2 assessment the CCG developed three Equality Objectives dated Objective 1. To understand the health needs of our local population and ensure that services commissioned reference the Joint Strategic Needs Assessment and reduce health inequalities. Status and actions Met Equality Impact Assessment (EIA) completed on Quality Strategy Action plan developed. EIA Completed on Operational Plan and Sustainability Transformation Partnership (STP) in Page 11

12 1. (Cont d) Surrey County Council (SCC) Public Health (PH) team have confirmed that an equality analysis has been completed on all Surrey County Council/Public Health commissioned services. We have supported the recommendations in the SCC PH Gypsy, Roma and Traveller (GRT) Children and Young People strategy PH Health is supporting the Surrey wide work on Brighter Futures for GRT. An in house electronic library has been developed with links to Joint Strategic Needs Assessment (JSNA) chapters, local and national organisations to enable staff to access information on all protected characteristic groups. An EIA tool and guidance has been developed. EIA training sessions are delivered regularly as part of CCG training programme. We have focused on wider patient involvement and engagement through a range of mechanisms around particular programmes of work and we have focused issues on groups, as appropriate, for the particular programme. Patient and Public Engagement Forum and stakeholder locality meetings have been refreshed. We continue to develop positive engagement in our procurement programmes, with up to date information on our website. A review of all correspondence/information sent out by the CCG to patients and members of the public have been completed as part of Accessible Information Standard (AIS) work. 2. To ensure that equality is core to the commissioning process and services will be commissioned designed and delivered to meet the health needs of local communities. A statement is included in printed communication advising that information can be provided in alternative formats. Met Equality and Quality review sessions are offered to all programme leads on a quarterly basis. The outputs are collected through each programmes update and reported to the Programme Delivery Group where leads are accountable for highlighting any areas of risk or assuring the programme is not adversely impacting on service users from an equality or quality perspective. Regular 1-1s are held with Programme Managers and Programme leads to ensure the Equality and Quality impact review is incorporated into each programme and proposed service change process. EIA training has been delivered to programme managers and leads to support this work. Equality analysis completed on the programme to improve stroke services across West Surrey - January Page 12

13 3. To provide a working environment where staff are valued and are supported in their training and development needs Awareness raising sessions have been delivered for staff on the needs and issues relating to the protected characteristic groups: Carers, Lesbian, Gay, Bisexual, and Transgender and GRT. Met Equality and diversity in the workplace training forms part of the organisations statutory and mandatory framework. Compliance against this training is regularly monitored and reported on to the Governing Body quarterly. At the time of publication, the organisation reported 97% compliance in this area. Non-compliant individuals are reminded monthly of their requirement in this area. Line managers and the Executive team are also routinely kept informed on compliance. Presentation slides and assessment based on the Skills for Health UK Core Skills Framework have been created for 1-1 delivery or for NWS CCG to use as part of their own e-learning package in future if required. Whole team refresher on equality, diversity and inclusion was delivered on 30th June An EIA tool and guidance has been developed. EIA training sessions are delivered regularly as part of CCG training programme. Completion of performance appraisals are regularly monitored with targets set. Staff are having regular 1:1 discussions with their managers. Issues raised by the staff survey have been addressed via management action, whole team meetings, action planning and staff forum. Display Screen Equipment self-assessments taken place. Mental health and well-being workshops are offered to staff. Monthly lunchtime walks have been arranged via Surrey County Council. Regular lunchtime Pilates sessions are open to staff. Specialist chairs and ergonomic devices have been purchased for use of staff where a need is identified. Collection of data on our workforce relating to protected characteristic. This includes both workforce data and staff survey data. The CCG reviewed the data against the NHS Workforce Race Equality Standard metrics. Page 13

14 5 Actions Undertaken by the CCG in Relation to its Equality Duty Leadership One of the main four goals within the EDS is Inclusive Leadership. Within the EDS2, under the Inclusive Leadership goal, there are key outcomes which focus on the following areas: Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations; papers that come before the Board and other major Committees identify equalityrelated impacts including risks, and say how these risks are to be managed; and middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination. The CCG is committed to the following, to promote achievement of this goal and the stated outcomes: in January 2018, the Executive Team and Governing Body members renewed its commitment to actively act to promote equality and diversity agendas, acting as organisational champions in this area. They will also be mindful of equality and diversity agendas as part of their dealings with organisations they work with, challenging where needs be where they feel or think these agendas are not being addressed adequately; the Executive Team and Governing Body will undertake appropriately commissioned equality awareness training in 2018 as part of their seminar programme, in order to ensure that they are current in their thinking in this area; the Executive Team and Governing Body will satisfy themselves that all papers presented to them identify equality related issues where necessary, initially scrutinising front summary sheets which highlight areas around Equality Analysis as well as commenting where appropriate on equality related issues within content; the CCG will continue to work with appointed lay members and patient representatives within the Patient and Public Engagement Forum and the Quality Committee, who are able to reflect any concerns and viewpoints of patients and the public in relation to the issue of Equality and Diversity; all staff and managers will continue to undertake Equality and Diversity training as part of the CCGs mandatory training programme. Compliance against this training is measured and reported to the Governing Body with staff being sent reminders by the workforce team to ensure that they comply with the requirement. In addition, staff that are involved in making decisions that have a direct impact on people when dealing with activities such as procurement and commissioning undertake Equality Impact Assessment training, commissioned by the CCG and delivered by external specialist trainers; the Executive Team and Governing Body will review responses made by staff in the annual staff survey, which focus on discriminatory behaviours; acting on any feedback presented and seeking to improve scores where necessary through positive intervention; and Page 14

15 the CCG will continue to engage with a dedicated Equality and Diversity specialist who not only leads in this area for the CCG, but also provides training, subject matter expertise, advice and guidance in this subject area. This specialist will also act as the lead for equality being routinely considered at various points in the development of clinical commissioning plans. Workforce There are 115 individuals currently on the CCG s payroll, in a diversity of roles. As part of our commitment to ensure quality and equality of access across the range of services our workforce support, the equality, diversity and inclusion agenda is well embedded throughout our employment practices. In order to gain the greatest benefit from a diverse workforce, we monitor our people data on an ongoing basis to understand the profile of the workforce as well as how well we are supporting it as a whole. Further information on our demographic is below: Gender diversity Page 15

16 Age diversity Ethnic diversity Page 16

17 Religious diversity Data on religion is limited due to it not having been consistently collected prior to We know that we have 6 religions represented amongst our workforce, with Christianity being the most prevalent. Sexual orientation diversity As with data relating to religion, data relating to sexual orientation was not consistently collected prior to As at 1 January 2018, all staff reported heterosexual orientation. Disability diversity As at 1 January 2018, 4 members of the workforce are known to have a disability. Recruitment and Selection Equality data is collected where provided for any individual applying for a role through NHS Jobs and monitored from that point through to shortlisting and appointment. The tables below illustrate the comparative journeys of a range of demographic groups from application to appointment: Comparative Data: Male/Female Applications % of applicants shortlisted % of applicants appointed Male Female Page 17

18 Comparative Data: Disability/No Disability Applications % of applicants shortlisted % of applicants appointed Disability No disability Comparative Data: Ethnic Mix Applications % of applicants shortlisted % of applicants appointed White Asian Mixed Black Other Comparative Data: Age Mix Applications % of applicants shortlisted % of applicants appointed Under and above Page 18

19 Comparative Data: Religious Mix Applications % of applicants shortlisted % of applicants appointed Atheism Buddhism Christianity Hinduism Islam Sikhism Undisclosed % 5.6% We remain assured that our recruitment and selection activity generally supports equality and diversity. However, we are aware of some areas for improvement, in particular around less favourable outcomes during shortlisting for BME individuals, less favourable outcomes for black minorities at interview, and less favourable outcomes for over 60s at interview. We are delivering training around interviewing techniques in order to support managers to conduct exploratory and balanced interviews, and have also developed a question bank tool to support a consistent and transparent approach to selection, based on behavioural competencies and technical competencies, equally applicable and accessible across diverse groups of applicants. Post-appointment, we have continued to deliver a local induction and on-boarding programme for new starters, which starts from the perspective of supporting individuals to understand and harness the unique strengths they bring to the organisation and to their role. Our detailed corporate induction familiarises new starters with the wider organisation, the context of the system around it, and provides staff with an opportunity to identify their role in it. The induction is set up to take place within their first week and is accompanied by a starter pack, which includes information of the organisations values and behaviours, our annual review process, office etiquette, a detailed glossary, and access to resources such as the Employee Assistance Programme and our Learning and Development offer. Individuals are followed closely during their first six months in post, with 3 and 6 month check-ins, structured opportunities to provide feedback, ask questions or share concerns, and a nip it in the bud approach to resolving any issues. We are particularly aware of proactively offering coaching or mentoring support to any new starters from underrepresented groups. Page 19

20 Learning and Development Equality and Diversity is embedded in a range of Learning and Development activities across the CCG. It forms part of our statutory and mandatory training requirement, of which we are 97% compliant in 2017/18. The CCG reports on compliance with statutory and mandatory training to the Executive Team on a monthly basis, and quarterly to the CCG s Governing Body to ensure that staff are meeting their legal and organisational obligations in these areas. We provide Equality Analysis training twice a year to support managers in ensuring the decisions they make are fair, and equitable. 27% of the workforce has so far attended this training. This year, we have introduced a comprehensive learning and development offer incorporating a range of soft skills training delivered face to face and opened up to colleagues from our wider GP network and partner CCGs. With diversity and inclusion in mind, the programme has been designed to allow any individual in any role or any level to self-select to its modules. Each module has been mapped against our values and behaviours to encourage self-awareness and development of behaviours which are important to the CCG s culture and performance. We have an online e-library containing a wide variety of books spanning diverse subjects to encourage individuals to take responsibility for their own learning. We also regularly encourage online learning from a diverse range of subjects using the Future Learn online platform. Furthermore, we have sponsored technical training delivered externally, and in the spirit of inclusive talent management, have removed from our sponsorship application process the requirement that training is essential for an individual s current role. We have developed a people management development pathway, the purpose of which is to outline the Organisation s expectations for what it means to be a people manager within North West Surrey CCG. It provides clarification on the responsibilities of a line manager, what skills are needed to do this effectively, the tools which are available to support managers and a range of development opportunities to help managers develop into the role. We have also designed an Unconscious Bias training module aimed at managers to help reduce organisational biases. Collaboration and Inclusion We promote the use of psychometrics, such as MBTI, Lumina Spark and the HLM 360 Leadership model, to support the development of effective teams, as well as supporting individual self-awareness. The use of appropriate psychometrics and the opportunity for one to one coaching enables individuals to understand their own strengths and preferences, which in turn highlights how to best work within a diverse work group or team. We have worked closely with teams to improve their ways of working together, facilitating team events and discussions following the staff survey results which have led to practical inclusively tailored action plans specific to each team to implement, developed through consultation with staff within the team. We focused during 2017 on building levels of engagement and strengthening the opportunities amongst our staff for genuine involvement in decision-making. Page 20

21 Key Staff Experience Indicators North West Surrey CCG has for the past 2 years engaged with the National Staff Survey Programme, which has provided useful opportunities for benchmarking our performance in this area with that of similar organisations across the country. At the time, we also looked specifically for differences in responses between demographics at North West Surrey CCG. Although our BME group was too small to report on discretely in line with the Workforce Race Equality Standard, it was possible to identify some areas where our BME staff reported less positive experiences than their white counterparts. In particular, these included perceptions of bullying and harassment, discrimination and fairness in relation to career progression opportunities. There are early indications that the CCG has made improvements in these areas over the last year. Arrangements for Patient and Public Engagement The CCG coordinates a Patient and Public Engagement Forum (PPEF). The PPEF meets every three months and is chaired by the Lay Member for Patient and Public Engagement and reports into the Governing Body Committee. The PPEF is attended by six patient representatives nominated from Patient Participation Groups (PPGs) across the three localities, as well as representatives from local voluntary and community organisations. This brings a diverse range of views to the attention of the CCG and also provides scrutiny of the CCG s engagement and involvement plans. The CCG also coordinates a network meeting for the Chairs of PPGs associated with the CCG s member practices. This provides a valuable link with primary care and offers another source of information and concerns, some of which do highlight equality issues e.g. access to care in certain areas. Procurements which include changes to services we have Patient Advisory Groups to feed their comments and views into the new service specification. Two patient representatives and members from the voluntary organisations were closely involved with the procurement of adult community services, evaluating tenders and bidder presentations. They were able to offer perspectives related to different equality characteristics. The CCG s website offers translation, audio, font resizer and contrasting capabilities via a system called Browsealoud. Patients and the public are also encouraged to contact the CCG with queries, compliments and complaints and there is a section explaining how to get involved with the work of the CCG. A key assurance activity for this area was conducted by NHS England in late 2017, to assess North West Surrey CCGs compliance with statutory guidance on patient and public participation in commissioning health and care. The ten key actions that the CCG was assessed on included how it advances equality and reduces health inequality; how it provides support for effective engagement; and how it involves the public in governance. The CCG has received an indicative outcome and will continue to focus on ensuring all protected groups are able to fully participate in the commissioning of health and care. Final scores will be published by NSHE in the summer of 2018 on the MyNHS website as part of the suite of CCG Improvement and assessment indicators. Page 21

22 The CCG has a Your Health section on its website to ensure patients understand their rights under NHS choice. The CCG has been working to meet the Accessible Information Standards (AIS). This work has included the introduction of an SMS texting service for those with hearing impairments to be able to contact the CCG via text rather than by telephone; the introduction of Browse aloud on our website to provide translation, audio, font resizer and contrasting capabilities for those with visual impairments and those whose first language is not English; introduction of a standard statement to provide literature in various languages and formats on request; ensuring that large print, hearing loops and scribes are available if required and that the venue is Equality Act (2010) compliant as a standard provision when holding public and engagement meetings. The CCG also holds a list of special requirements for the members of the PPEF and PPG and will also ask for any special requirements when ad hoc or new meetings are being arranged. The CCG is also responsible for monitoring that providers and GP practices are working to meet the AIS. This is being done through contractual agreements and regular monitoring meetings. The CCG handles all complaints in accordance with the NHS Complaints Regulations. Going forward, equality monitoring forms will be sent to all complainants to enable the CCG to assess the degree to which its complaints procedures are used by people belonging to different equality groups. Monitoring of Provider Equality Standards The CCG monitors Provider compliance with equality standards through individual Clinical Quality Review Meetings, Workforce Assurance Reviews and reviews of annual NHS Staff Survey Results. The quality requirements within the contracts with providers require them to comply with national requirements in relation to Equality including: publishing an annual Equality and Diversity Report; publishing an annual position report in relation to Workforce Related Equality Standards; and compliance with requirements around Accessible Information standards Accessible Information Standard All organisations that provide NHS or adult social care must follow the accessible information standard by law. The aim of the accessible information standard is to make sure that people who have a disability, impairment or sensory loss get information that they can access and understand, and have communication support if they need. Working with its partners, the CCG has sought updates from all providers of services on their organisational positions with regard to compliance with the standards. Provider organisations have produced action plans for where there are gaps and have implemented action plans which will be monitored for progress. Page 22

23 The Primary Care Contracting team at North West Surrey CCG undertook a survey with all GP Practices in North West Surrey and were assured that patient information systems were able to meet the communication needs and preferences of all patients. Workforce Race Equality Standard (WRES) The NHS Workforce Race Equality Standard (WRES) and reporting against the requirements is included in the NHS standard contract since July The main purpose of the WRES is: to help local, and national, NHS organisations (and other organisations providing NHS services) to review their data against the nine WRES indicators; and to produce action plans to close the gaps in workplace experience between white and Black and Ethnic Minority (BME) staff, and, to improve BME representation at the Board level of the organisation. The WRES applies to all types of providers of non-primary healthcare services operating under the full length version of the NHS Standard Contract, and so is applicable to NHS providers, independent sector providers, and voluntary sector providers. The Contract requires all providers of NHS services (other than primary care) to address the issue of workforce race inequality by implementing and using the WRES and publishing an annual report. The WRES is made up from nine indicators. Four of the indicators focus on workforce data, four are based on data from the national NHS Staff Survey questions, and one indicator focuses upon BME representation on Boards. The WRES highlights any differences between the experience and treatment of White staff and BME staff in the NHS with a view to closing those gaps through the development and implementation of action plans focused upon continuous improvement over time. North West Surrey CCG s Quality Team monitors provider compliance with WRES requirements through the Clinical Quality Review Meeting and also through the Provider Workforce Assurance reviews. Commissioning and Redesign of Services Within the context of continuing challenge for the NHS nationally, North West Surrey CCG has been able to celebrate a number of important successes this year and continues to move forward as an innovative and successful commissioning organisation. As a member of the wider Surrey Heartlands partnership, we are also demonstrating our ability and commitment to work collectively with others across traditional boundaries in new and dynamic ways. This year we have continued the development of our locality hub programme, which provides a proactive and integrated service for older people all in one place. Building on the Bedser Hub at Woking Community Hospital, which opened last year, we are now developing similar services in Ashford and Weybridge. Initial feedback from the Bedser Hub has been extremely positive and importantly we are seeing a reduction in attendances at A&E and in hospital admissions for patients within the service. Equality and inclusion is integral to all of our engagement and involvement activity; ensuring the voices of protected, vulnerable, and seldom heard groups are heard by the CCG and shape health services and decisions. The CCG s service redesign and procurement processes enable us to consider a range of views, perspectives, and experiences by seeking to consult with protected and vulnerable groups when re-designing or introducing new services, procuring services and/or revising or introducing new policies and procedures. Page 23

24 We do not automatically assume our decisions will be equally beneficial for everyone. We test our assumptions before making decisions and assess the effects of a decision on particular populations. This makes it more likely that our decisions will promote equality of access and equity of outcomes. Equality analysis is embedded within our commissioning process and highlights positive and negative impacts on protected characteristics and other local disadvantaged groups, giving an opportunity to mitigate any negative impacts. This analysis contributes to the evidence on which decisions are based when recommendations and proposals are put before the Governing Body for consideration. We carry out these analyses to ensure we pay due regard to the three aims of the Public Sector Equality Duty (PSED) and Human Rights Act A range of different methods and means are used to inform and shape service and process design and ensure equality considerations are made: Clinical Advisory Groups (CAGs) are used to seek the clinical views of local clinicians working across primary, community and secondary healthcare; patients, their families and carers are engaged to seek their opinions and experiences of accessing existing health services and identifying what future service provisions could/should look like; local communities, support and voluntary sector groups are involved as representatives and subject matter experts for patients and/or specific conditions or needs related input; questionnaires are provided in multiple formats and via multiple mediums to assist with accessibility; surveys actively monitor the protected characteristics of participants; and patient and public meetings are held in inclusive and accessible environments with appropriate facilities to enable patients to engage fully, e.g. wheelchair accessible, available hearing loop capabilities. Our vision to ensure local residents have the best possible healthcare is dependent on developing and commissioning the right services. This year we have concluded a number of major procurement programmes to improve both quality and efficiency of local healthcare. These include a new integrated musculoskeletal service awarded to Ashford and St Peter s Hospitals NHS Foundation Trust, and the new contract for adult community services awarded to CSH Surrey from 1 April An enormous amount of work has gone into developing these new contracts both of which represent a significant shift in service design, providing more integrated and holistic services that will really benefit patients. We also led a major procurement of a new Non-Emergency Patient Transport Service on behalf of the Surrey CCGs (excluding Surrey Downs CCG), which was awarded to South Central Ambulance Service NHS Foundation Trust, from 1 April We are now looking forward to working closely with our new providers and to further improvements for local patients. These service re-designs/procurements are areas where the CCG has integrated equality, diversity, inclusion and human rights considerations into the design of its services and service outcomes using a comprehensive Equality Analysis process. The following services will be subject to procurement in 2018: Integrated Urgent Care (IUC); and NHS 111 and GP Out of Hours services. As stated, North West Surrey CCG is a member of the Surrey Heartlands Health & Care Partnership, working closely with other Surrey CCGs on a range of priorities, although the focus of the collaborative is changing with the development of the Surrey Heartlands STP. Page 24