Equality Information Report

Item: 11.1 Equality Information Report 2017-18 For further information please contact: Emdad Haque Senior Equality, Diversity and Inclusion Manager Emdad.Haque@nhs.net Draft 1.3 1

Contents Introduction About Haringey Our equality and health inequality duties S5-6 NHS mandatory standards Equality Delivery System (EDS2) S8-10 S3 S4 S7 CCG Equality Objectives S11 Advancing equality through commissioning S12-14 Our workforce Governance and leadership S15 S16 Inclusive engagement S17-18 Our providers Forward strategy for 2018-19 Appendix 1: Workforce and Governing Body Members Equality Information including the WRES Appendix 2: WRES Indicators Appendix 3: Haringey WRES Action Plan (2017-19) Progress Report S19 S20 S21-35 S36 S37 2

Introduction We produce our annual Equality Information Report to demonstrate to our stakeholders how Haringey CCG is meeting its duty under the Equality Act 2010. The report also shows the improvements we have made through the delivery of our objectives against the mandatory standards set out by NHS England including the Workforce Race Equality Standard (WRES), Equality Delivery System (EDS2) and the Accessible Information Standard. In 2017-18, we have made good progress in recruiting BME staff in our senior management jobs; there has been an 8% improvement of BME staff in bands 8a-VSM. Similarly the representation of disabled staff and LGBT staff have improved and now stand at 7% and 5% respectively which is above both the NCL and national average (see p21-35). Work continues on developing our partnership across Haringey and Islington to support a population-based approach to delivering health and social care. Commissioners and providers of health and social care organisations formed the Haringey and Islington Wellbeing Partnership to improve the health and wellbeing of both boroughs populations. Following changes across north central London, Haringey and Islington CCGs proposed a shared director-level structure across the two CCGs, led by a single Chief Operating Officer. We aim to improve our equality and diversity performance by delivering on our priorities to meet our statutory duties. Some of these priorities have been addressed through our North Central London Sustainability and Transformation Plan- and going forward, more work will be done with partners and providers to address health inequalities in a collaborative way. In July 2017 the Governing Bodies of NHS Haringey Clinical Commissioning Group, NHS Camden Clinical Commissioning Group, NHS Barnet Clinical Commissioning Group, NHS Enfield Clinical Commissioning Group and NHS Islington Clinical Commissioning Group established the NCL Joint Commissioning Committee ( Committee ). The Committee s role is to jointly commission the following services as these are most effectively commissioned collaboratively across the five CCGs: All acute services including core contracts and other out of sector acute commissioning; All learning disability contracting associated with the Transforming Care programme; All integrated urgent care (including 111/ GP Out-of-Hours services) Any specialised services not commissioned by NHS England. The new arrangements will help to ensure commissioning and future health services across the NCL system are more joined up, equitable and co-ordinated for local patients. This report provides a summary of our activities and there is more information in our CCG Annual Report 2017-18 which can be found on our website http://www.haringeyccg.nhs.uk 3

About Haringey Population Haringey's population now stands at 267,541 according to the 2014 Office for National Statistics Mid Year Estimates. Almost two-thirds of our population, and over 70% of our young people, are from ethnic minority backgrounds, and over 100 languages are spoken in the borough. Our population is the fifth most ethnically diverse in the country. Population growth locally is mostly due to the increase in birth rates and net gain from international migration. Top three countries for new national insurance number allocation are Italy, Spain and Poland. The borough has a population churn of 26%. Exceptionally diverse and fast-changing borough with a high turnover with net inward and outward migration. Those aged 20 64 make up 66.3% of the total population. The population of residents aged 65 and over in Haringey is 8.8%, much lower than 11.1% of residents in London. According to the Census 2011, 65% of the Haringey population are not White British. This is higher than the London figure of 55%. 23% are White- Other including people from the EU. The Census 2011 show 45% of Haringey residents were Christian. Second most common religion stated was Muslim (12.4%) followed by Hindu (5%) and Jewish (1.8%). However, 20% people state that they have no religion. The number of asylum seekers supported under Section 95 has been declining throughout the country. In Haringey these numbers have reduced to 162 as at quarter 2 2013 according to figures from the Home Office. This is the 4th highest figure in London. Health inequalities In the last 10 years the average life expectancy in Haringey has overtaken the England average, with men now expecting to live over 80 years and women over 84 years. However, in spite of an overall improvement in life expectancy over recent years, not all have benefitted, and inequalities in life expectancy remain. Women can still expect to live more than 4 years longer than men in Haringey and men living in Northumberland Park are still dying, on average, 7 years earlier than men in Crouch End. The main causes of premature deaths in males that contribute to the gap include cardiovascular disease, cancer and digestive system disorders. We are faced with a challenge of new and emerging needs as a result of demographic changes i.e. increased number of people from White Other backgrounds. If you d like to know more about our population visit www.haringey.gov.uk/jsna to view Haringey s Joint Strategic Needs Assessment (JSNA). The JSNA describes the health, care and wellbeing needs of the local population and is put together by the public health team in Haringey Council. The JSNA helps the CCG and the council commission the best services to meet the needs of the population. 4

Engagement Our equality and health inequality duties The CCG came into being in 2013 through an authorisation process by NHS England which made it a duty for the CCG to show due regard to the Public Sector Equality Duty (PSED) under the Equality Act 2010 and not delegate it to another organisation. Later on NHS England introduced more guidance for CCGs on how to demonstrate compliance and keep making continuous improvement in their equality and diversity performance (see the diagram below). Statutory duty Equality Act 2010 Health and Social Care Act 2012 Human Rights Act 1998 Mandatory Standards Equality Delivery System Workforce Race Equality Standard Accessible Information Standard CCG Response Diversity and Diversity Objectives Plan & Annual Action Plan Equality Information Assurance from providers through CQRG Equality Impact Analysis 5

Our equality and health inequality duties (cont d) General Duty under the Equality Act 2010 The general equality duty under the Equality Act 2010 requires the CCG, in the exercise of our functions, to have due regard to the need to: Eliminate discrimination, harassment and victimisation and any other conduct that is prohibited by or under the Act. Advance equality of opportunity between people who share a relevant protected characteristic and people who do not share it. Foster good relations between people who share a relevant protected characteristic and those who do not share it. These are sometimes referred to as the three aims or arms of the general equality duty. The Act explains that having due regard for advancing equality involves: Removing or minimising disadvantages suffered by people due to their protected characteristics. Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low. Protected characteristics are defined as: Age, Sex, Disability, Gender Reassignment (Transgender) Race, Religion or Belief, Sexual Orientation, Pregnancy and maternity Marriage and civil partnership, We additionally pay due regard to the needs of carers, seldom heard groups and vulnerable groups when making commissioning decisions Specific Duty The specific duty requires the CCG to publish equality objectives at least once every four years and to publish equality information once a year demonstrating that it has consciously thought about the three aims of the Equality Duty as part of its decision-making process. The Act also requires that employers with a workforce of over 150 employees publish information relating to employees who share protected characteristics. Although the CCG does not have 150 employees, as good practice we have included our employee and governing Body profile as part of this report. Under the Health and Social Care Act 2012, CCGs have duties to: Have regard to the need to reduce inequalities between patients in access to health services and the outcomes achieved (s.14t); Exercise their functions with a view to securing that health services are provided in an integrated way, and are integrated with health-related and social care services, where they consider that this would improve quality, reduce inequalities in access to those services or reduce inequalities in the outcomes achieved (s.14z1); Include in an annual commissioning plan an explanation of how they propose to discharge their duty to have regard to the need to reduce inequalities (s. 14Z11); Include in an annual report an assessment of how effectively they discharged their duty to have regard to the need to reduce inequalities (s. 14Z15). 6

NHS mandatory standards NHS Workforce Race Equality Standard (WRES) The NHS Workforce Race Equality Standard was developed and introduced in 2015. Organisations are required to review and report against nine indicators. The indicators are a mix of NHS staff survey data- and the workforce data comparing the experience of BME and white staff. It also compares the governing body data with the workforce data and local to show how representative the governing body is compared with the CCG workforce and the local population. Our first WRES report was published in July 2015, and then a progress report was published in July 2016 with an action plan. This year we have incorporated the WRES into our workforce and Governing Body Members report (See Appendix 1). Accessible Information Standard (AIS) The Accessible Information Standard was introduced requiring all organisations that provide NHS (including GP Practices) or adult social care to meet the standard by 31 July 2016. The aim of the standard is to make sure people who have a disability, impairment or sensory loss get the information they can access and understand, and any communication support they might need. This includes making sure people get information in different formats, for example, large print, Braille, easy read and support such as a British Sign Language interpreter, deafblind manual interpreter or an advocate. The Accessible Information Standard means that organisations providing health or social care need to do five things: 1. Ask people if they have any information or communication support needs and identify how to meet them. 2. Record those needs in a set way on the patients records. 3. Highlight or flag in the person s file or notes, so it is clear that they have information or communication support needs and details of how to meet those needs. 4. Share information about a person s needs with other NHS and adult social care providers when they have consent to do so. 5. Make sure that people get information in an accessible way and communication support if they need it. CCGs are exempt from meeting the standard. However, we are committed to the AIS, and we ensure that whenever we communicate with the public that we consider the requirements of the standard. Also we will work closely with our member GP Practices to provide the necessary support to enable them to meet the requirements of the standard and we will continue to seek assurance from provider organisations about their compliance with the standard, including evidence of how they are planning to meet the standard. 7

NHS Equality Delivery System (EDS2) overview The NHS Equality Delivery System was developed as an equality performance framework to assist NHS organisations to evidence their compliance with the Public Sector Equality Duty and embed equality and diversity within the organisation. At the heart of the EDS2 is a set of eighteen outcomes grouped into four goals: 1. Better health outcomes for all 2. Improved patient access and experience 3. Representative and supported workforce 4. Inclusive leadership EDS2 can help CCGs improve the services they provide for their local communities; improve the experiences of people using the services; consider reducing health inequalities in their locality; and to provide better working environments, free of discrimination, for those who work in the NHS. Meeting the Public Sector Equality Duty through NHS Mandatory Standards Organisations are required to grade their performance by using a grading system as follows: Red- Undeveloped People from all protected groups fare poorly compared with the demography of the borough OR evidence is not available, or if evidence shows that the majority of people in only two or less protected groups fare well Amber-Developing- People from only some protected groups fare as well as the people of the borough. Green-Progressing- People from most protected groups fare as well as the people of the borough Purple-Excelling- People from all protected groups fare as well as all people of the borough. 8

Equality Delivery System (EDS2)-grading processes The CCG uses EDS2 for its equality and diversity planning and implementation and service improvement to advance equality, as mandated by NHS England. As described in slide 8 the CCG has worked with community interest groups and carried out an EDS2 grading in 2017-18 which will help determine the priorities for 2018-19 (see the slide on forward strategy for more information). Our current performance is based on the grading in 2017-18 and the recent analysis of the CCG s evidence across the 4 EDS2 goals and 18 outcomes. Project planning and engaging Evidence gathering Grading and action planning Publishing grades 9

Equality Delivery System (EDS2)- grading outcomes We held a grading event in October 2016- and invited stakeholders including public Health, Healthwatch, voluntary organisations and providers to review the 2015-16 grades based on our achievements. Table top discussions were held on all outcomes in Goal 1 and 2 where group decided that, based evidence, the should be given an improved grading for outcomes 1.1, 1.2 and 2.2 from developing to progressing. Outcome Grade Outcome Grade 1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities 1.2 Individual people s health needs are assessed and met in appropriate and effective ways. 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed. Achieving 3.1 Fair NHS recruitment and selection processes lead to a more representative workforce. Achieving 3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations. Developing 3.3 Training and development opportunities are taken up and positively evaluated by all staff. Achieving Achieving Achieving 1.4 When people use NHS services their safety is prioritised and they are free from mistreatment and abuse and mistakes are minimised. 1.5 Screening, vaccination and other health promotion services reach and benefit all local communities. 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds 2.2 People are informed and supported to be involved in decisions about them. Achieving 3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source. Developing 3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives. Developing 3.6 Staff report positive experiences of their membership of the workforce. Achieving 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations 2.3 People report positive experiences of the NHS Developing 4.2 Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed. 2.4 People s complaints about services are handled respectfully and efficiently. Developing 4.3 All managers and staff support their staff to work in culturally competent ways within a work environment free from discrimination Developing Achieving Achieving Developing Developing Developing 10

CCG Equality Objectives 2017-19 Equality Objectives 2017-19 It is a specific duty of the CCG to publish equality objectives at least once every four years. In 2016-17 we refreshed our equality objectives for next two years in consultation with stakeholders and partners. These objectives are built around EDS2 and the WRES and are delivered through an annual action plan. The following few slides (and Appendix 1) explain how we are delivering our equality objectives. 11

Advancing equality through commissioning As a commissioning organisation our aim is to discharge our equality and health inequality duties through our commissioning functions. There are a number of ways we currently meet these duties. Equality duty Our approach to equality analysis uses a three lenses approach to ensure a robust compliance with the equality duty but also to make the process more meaningful and effective. In the next few slides we have highlighted some of the achievements in 2017-18. These achievements demonstrate how the CCG delivered its equality objectives 1 and 2. More information about the achievements can be read in the CCG s annual report 2017-18. Health inequality Equality Analysis Engagement In 2017-18 The CCG s equality focus was primarily around commissioning services based on local evidence and improving access to services for protected and vulnerable people in the community. This included access to existing services and any service which was redesigned and newly commissioned. Our Governing Body and relevant Committees have played an important role in assuring compliance with our statutory duties by scrutinising business cases and equality analysis completed by the commissioners. As sector leader and lead commissioner the CCG seeks assurance from providers on a number of equality policies as mandated by NHS England. This includes assuring the providers compliance with the equality duty and also all NHS mandatory standards (See page 18). Commissioning decisions Equality Analysis (Equality Impact Assessment) Lunch and Learn Session: An Equality Analysis (Equality Impact Assessment) Lunch and Learn Session took place on 06.12.17 The aims of the session included: To highlight the rationale behind Equality Analysis: how we should meet our public sector equality duty and advance equality of opportunity. To provide an overview of the Equality Analysis processes To provide information about NEL CSU support and how NCL CCGs can share good practice 12

Advancing equality through commissioning (cont d) Equality Objective 1: Commissioning services based on evidence to reduce health inequalities amongst protected and vulnerable groups Key achievements in 2017-18 Work continues on developing our partnership across Haringey and Islington to support a population-based approach to delivering health and social care. Commissioners and providers of health and social care organisations formed the Haringey and Islington Wellbeing Partnership to improve the health and wellbeing of both boroughs populations. Raise awareness amongst black men re: increased Prostate Cancer risk: Delivery of Men at Risk of Primary Care Awareness Training undertaken in October 2017 to GP Practices. Prostate Cancer UK resources for at-risk men e.g. posters, health information leaflets shared at cancer screening training and primary care event in October 2017. Information leaflets also disseminated a local venues in Haringey in December 2017 including local bus garages and Tottenham Hotspur. Increase awareness re: access to IAPT services for LGBT and BAME groups: Met with WH IAPT Lead December 2017: IAPT ethnicity data obtained along with the Trust Equality, Diversity & Inclusion (EDI) Progress Report & Action Plan. Information on Turkish Access Group and translated resources also provided. For the Palliative & End of Life Care (EOLC) Framework to include all protected characteristics to ensure equal access to EOLC: - Each GP surgery has a palliative care list and should have liaison with the DNs and Community Palliative care team. - ACP facilitator working in Haringey Nursing Homes to ensure conversations and ACP are undertaken. - Attended Haringey EOLC Steering Group January 2018 to request further Equalities data and to obtain further information on collaboration with different groups faith, LD and community groups - The Advanced Care Planning (ACP) Facilitator are working with residents who are approaching the end of life, and their families. As part of the national Future in Mind programme, Haringey CCG, in close partnership with Haringey Council, has been working with providers and stakeholders to implement our five year local CAMHS Transformation Plan which has highlighted the need of the LGBT community. The CCG and the Council are working with providers to ensure that they work with schools and national organisations to address the needs of the LGBT children. Wehave highlighted the needs of our LGBT community one of our priorities in the Health and Wellbeing Strategy. Learning disabilities: Haringey Learning Disabilities Mortality Review (LeDeR) Steering Group well established with review of cases plans to monitor progress of reviews and action plans for share learning and driving improvements. The LeDeR Steering Group will also focus on improving uptake of Annual Health Checks (AHC) and physical health screening. One of the services funded by the Better Care Fund, is Local Area Coordination. This is a long term, integrated, evidence based approach to supporting people with disabilities, mental health needs, older people and their families/carers. Over the past year the work of the Care Closer to Home Integrated Networks (CHINs) is a step forward in health and social care wrapping services around the needs of residents. Haringey is focusing on elderly care and frailty with all practices assigned to a CHIN. 13

Advancing equality through commissioning (cont d) Equality Objective 2: Improve access to all services by protected and vulnerable groups Key achievements in 2017-18 Making it possible for resident to access GP services 8am-8pm through extended access since April 2017. In 2017 we developed and published online training for GP receptionists to help people who are homeless access GP practices and produced 60,000 my right to access healthcare cards for people who are homeless to make sure they can get equal access to healthcare given that they are much more likely to use A&E services than other Londoners. Commissioned more appointments outside normal working hours (extended hours) via Federated4Health, Haringey s GP federation, which is made up of all the GP practices in Haringey. Patients can now access more evening and weekend appointments, due to the opening of primary care hubs in GP practices across Haringey. Appointments in the hubs are available from 8:00am to 8:00pm, Saturday and Sunday and 6:30pm and 8:30pm Monday to Friday; however, opening hours vary between hubs. Anyone who is registered with a GP in Haringey can access the appointments at any of the hubs appointments can be made by patients by calling their own GP practice, calling 111 and appropriate patients can be offered an appointment, or patients can call in the opening hours above, and book directly with the hubs. Investing in community based specialist palliative care services (SPC) throughout NCL, investment for a Single Point of Access for Last Phase of Life and the redesign of commissioning arrangements for Last Phase of Life services across NC. We are working with the lead commissioner CCG and providers to ensure patients have the right to access services within maximum waiting times. A four-month musculoskeletal (MSK) pilot was launched in January 2018 which provides a single point of access, offers patient choice for referrals into specialist services and ensures better co-ordination. The work is reducing waiting times for patients to below six weeks. We have tested some new ways of working such as urgent rapid access clinics for Children and Young People (CYP) extending best practice from the Whittington and we plan to test new innovative models during the next year. This will include) redesign of all pathways for CYP who access A&E and extending see and treat for CYP by our GPs in an urgent care centre at North Middlesex. Improving access to IAPT: The Haringey IAPT service, Let s Talk (www.lets-talk-iapt.nhs.uk), has grown from strength to strength in 2017-18. A number of changes and additions to the service have helped our patients gain access to a greater range of evidence-based treatments and support. In 2017-18, Haringey IAPT provided treatments to 5500 people (exceeding our target by 1.5%), with over 53% of patients who completed treatment showing clinical recovery (up 3% from last year). This has been possible through a single point of access for referrals, co-locating clinicians within physical health teams, working with Shaw Trust to offer a range of employment activities, mental health awareness workshops, Haringey IAPT is proud to be an inclusive service, with 35% of all patients who used the Haringey IAPT over the last year coming from a BME background. We believe that our education workshops play a large role in breaking down the barriers that prevent people from accessing mental health care, and in 2017-2018 we delivered outreach workshops to over 700 Haringey residents. We plan to continue this good work in the future. 14

Our Workforce Equality Objective 3: Recruit, support and retain staff from protected groups Support Retention The CCG employs 81 staff from diverse backgrounds (as at 31 st March 2018). Our workforce report provides a detailed breakdown of our workforce activities. Our commitment to advancing workforce equality has been strengthened by our work with other NCL CCGs, providers and NEL Commissioning Support Unit. In 2017-18 we have: Successfully established a joint Black, Asian, Minority Ethnic (BAME) staff Steering group with Haringey Council has now been running on a quarterly basis Recruitment Training Continued attracting applicants from diverse backgrounds by publicising jobs to local voluntary groups. Ensured our selection process followed the NHS recruitment and selection policy and good practice (e.g. ACAS code of practice). WRES EDS2 Started including a BME panel member in the recruitment panels for jobs in Bands 8a and above. Ensured our process of supporting staff with non-mandatory and CPD courses was fair and have monitored the take up by ethnicity. Followed the NHS change management policy in our team restructuring and completed equality analysis, where required, to ensure due regard to the equality duty. For further information see Appendix 1 and 3. 15

Governance and leadership Equality Objective 4: Strengthen the role of governance and leadership beyond compliance Our CCG Governing Body is ultimately responsible for assuring NHS England that the CCG is compliant with the Public Sector Equality Duty and is meeting the requirements of the mandatory standards. Mandatory standards Governing Body Equality duty PPE Committee Quality Committee HR and OD Team CCG Assurance Equality and Diversity Team Our CCG Governing Body assures through the Quality Committee and that the CCG is meeting all its duties and seeking assurance from providers. The Quality Committee oversees the implementation of the CCG s Equality and Diversity Strategy. The CCG is supported by NEL CSU Equality and Diversity Team who work closely with the PPE Committee on engagement- and the CSU Teams around compliance and provider assurance. 16

Inclusive engagement Our engagement activities are designed to deliver inclusive engagement outcomes that enable the CCG to deliver our equality objectives 1 and 2 In July 2017, Haringey CCG received its assessment from NHS England who stated: Our assessment of Haringey CCG s delivery of its statutory obligations for the collective duty to involve is Good. Our assessment of the individual duty is Good. 17

Inclusive engagement (cont d) Our engagement activities are designed to deliver inclusive engagement outcomes that enable the CCG to deliver our equality objectives 1 and 2 For further information about our recent engagement activities with patients and the community please visit our engagement page on the CCG s website http://www.haringeyccg.nhs.u k/about-us/engagement 18

Our providers We have a duty to ensure that all our providers are complying with their public sector equality duty- and they are implementing the mandatory standards e.g. the WRES, EDS2 and Accessible Information Standard. Below we have listed our main providers and have included an overview of their current performance. Our main providers Barnet, Enfield and Haringey Mental Health NHS Trust www.beh-mht.nhs.uk/equal-opportunitiesand-diversity.htm North Middlesex University Hospital NHS Trust www.northmid.nhs.uk/work-with-us/equalityand-diversity Royal Free London NHS Foundation Trust www.royalfree.nhs.uk/about-us/equality-anddiversity University College London Hospital NHS Foundation Trust https://www.uclh.nhs.uk/aboutus/wwd/ses/pages/ Home.aspx Whittington Health http://www.whittington.nhs.uk/ Adopted WRES Adopted EDS2 Published Equality Objectives Published Annual Equality Information Accessible Information Standard The CCG seeks regular assurance from its providers through contract monitoring and at the Clinical Quality Review Group (CQRG). Amongst providers information the CCG seeks assurance on the progress on the provider s implementation of the WRES, EDS2 and Accessible Information Standard. 19

Forward strategy for 2018-19 We have a shared vision and a collective commitment to work together in new ways to change and improve health and care services in North London for the benefit of our residents. Our main focus in 2018-19 is complying with our equality and health inequality duty. We recognise the challenges we face both in terms of demand for services and diminishing resource make is even more challenging for us to advance equality for all groups in the community. However, we remain strongly committed to meeting our legal duties by working with our staff, governing body members, the voluntary sector, and all our partners and providers. Priorities CCG level Improve the way we do equality analysis and how we use the outcome to inform our commissioning decisions Training for managers and Governing Members Implementing the WRES Action Plan Targeted engagement with local protected groups Collaborative working with Public Health and the Health and Wellbeing Board NCL Level Work with providers around EDS2 and the WRES and holding them to account Work towards harmonising strategic equality objectives across NCL Develop systems and processes to benchmark work and share good practice Prepare for the implementation of the Workforce Disability Equality Standard (WDES) 20

Appendix 1 Equality Information Report 2017-18 Workforce and Governing Body Members Equality Information including the WRES For further information please contact: Emdad Haque Senior Equality, Diversity and Inclusion Manager Emdad.Haque@nhs.net 07753836900 21

Summary Under the Equality Act 2010, we are required to publish our equality information to show how we are meeting the public sector equality duty as a commissioning organisation and an employer. This appendix is part of the equality information report and shows how the CCG has performed in terms of implementing the Workforce Race Equality Standard (WRES) and Equality Delivery System (EDS2) to meet its public sector equality duty. As of 31 st March 2018, Haringey CCG employed 81 staff including 25 office holders who are not employees of the CCG but are on the payroll. We have included them for WRES purposes only. This is not a big number when divided into different protected groups. Secondly, the race equality data in some indicators is too small to draw any meaningful conclusion as a small change in the number can skew the percentage significantly, and therefore the percentages need to be treated with caution.. Since 2016-17, the number of BME staff has increased by 8% in Bands 8a-VSM, but has decreased by 4% in Bands 1-7. It shows that the percentage of White staff has decreased by 6% and BME staff has increased by 6%- but this may not be a reflection of the number of staff but due to non-disclosure by a large number of Office Holders. 21% of staff have not disclosed their ethnicity. 7% of the total staff are from LGBT backgrounds. 7% have declared to have a disability 64% of the total staff are from over 40 age groups. White members on the Governing Body are overrepresented compared with the workforce and also the population- and BME member are underrepresented compared with the workforce and local population. The CCG s 2017 staff survey outcomes show- More White staff experienced harassment, bulling or abuse from patients, relatives or public than BME staff. More White staff experienced harassment, bulling or abuse from staff than BME staff. More White staff (14%) experienced discrimination from colleagues and managers than BME staff (8%); More White staff (74%) think that the CCG provides equal opportunities than BME staff. 22

Introduction Workforce and GB members Recruitment Staff experience Background As part of the Equality Information Report, the CCG publishes its workforce information every year. This is to show how the CCG is meeting its duty under the Equality Act 2010 in relation to workforce. In addition the CCG has been publishing the Workforce Race Equality Standard (WRES) report since 2015. This year we have combined the WRES report with the workforce diversity report so that we can show how the CCG is performing across all protected characteristics. This will also help us in our readiness to adopt the Workforce Disability Equality Standard (WDES). As at 31 st March 2018 the CCG employed 81 staff including Office Holders. The report includes information about our current workforce and Governing Body Members, recruitment, training and staff survey by protected groups. We have not included information about gender re-assignment as there was no data to report-currently the ESR does not have a category for gender-reassignment. How we have prepared the report This report shows how the CCG has progressed against the nine indicators for the period 2017-2018 and includes (where applicable) a comparison to the 2016-2017 WRES data. The report also contains recommended actions for the CCG to implement in 2018-19 to improve the CCG s position about race equality (Appendix 1). To demonstrate how the CCG meets each indicator, data has been collated from several sources, including workforce data from Electronic Staff Records (ESR) and TRAC; local demographic data from the 2011 Census as recommended in the WRES guidelines. The data on recruitment and non-mandatory training and CPD has been gathered from the April 2017 March 2018 records. The Staff Survey 2017 WRES questions outcomes have been used for the WRES indicators (5-8) 23

Introduction Workforce and GB members Recruitment Staff experience The roles of CCGs in implementing the WRES Clinical Commissioning Groups (CCGs) have two roles in relation to the WRES as commissioners of NHS services and as employers. In both roles their work is shaped by key statutory requirements and policy drivers including those arising from: The NHS Constitution The Equality Act 2010 and the public sector Equality Duty The NHS standard contract and associated documents The CCG Improvement and Assessment Framework In addition to the NHS standard contract, the CCG Improvement and Assessment Framework also requires CCGs to give assurance to NHS England that their providers are implementing and using the WRES. Implementing the WRES and working on its results and subsequent action plans should be a part of contract monitoring and negotiation between CCGs and their respective providers. If there is something amiss with the providers implementation or use of the WRES, and what the results of WRES actually show, CCGs should have meaningful dialogue with those providers. However, the credibility of the CCGs relationship with its providers can only be meaningful if the CCG itself is taking serious action to improve its performance against the WRES indicators. CCGs should commit to the principles of the WRES and apply as much of it as possible to their workforce. In this way, CCGs can demonstrate good leadership, identify concerns within their workforces, and set an example for their providers. Formally, of course, CCGs are not required by the NHS standard contract to fully apply the WRES to themselves as some CCG workforces may be too small for the WRES indicators to either work properly or to comply with the Data Protection Act. However, neighbouring or similar (comparator) CCGs may wish to submit a jointly co-ordinated WRES report and action plan; this can counter any potential risk of small workforce numbers. 24

Introduction Workforce and GB members Recruitment Staff experience Race WRES Indicator 1: Percentage of staff in each of the AfC Bands 1-9 or Medical and Dental subgroups and VSM (including executive Board members) compared with the percentage of staff in the overall workforce disaggregated by: Non-Clinical staff Clinical staff - of which - Non-Medical staff - Medical and Dental staff The WRES indicators include both clinical and non-clinical staff. The CCG reports its staff data by including permanent staff and those who are on the payroll but not employed by the CCG (e.g. Office Holders). For comparison purpose, the CCGs has kept the grouping of the data to Band 1-7, and from 8s to 9 and VSM and has used a separate category for Office Holders who do not fit under either of the first two categories and they are not staff of the CCG (e.g. Governing Body members who are clinical leads and are on payroll). Numbers have been included next to the percentages to show statistical significance. 25

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 1: cont d Workforce by ethnicity compared with local population 2015-16 2016-17 2017-18 Performance compared with 2016-17 Population (2011 Census) White 54% 57% 41 51% 6% 61% BME 41% 28% 23 28% = 39% Not disclosed 5% 15% 17 21% 6% n/a The figures in the table includes staff and office holders to show the overall commissioning workforce. 21% of the total staff have not disclosed their ethnicity- and it is due to the high number of non-disclosure amongst the Office Holders (56%). The percentage of non-disclosure of ethnicity by staff in the CCG is slightly below the NCL CCGs average (22%), as indicated in the pie chart. However, the CCG needs to update this data to ensure greater transparency and clarity. Due to non-disclosure by a high number of staff, it appears that there has been a decrease in the number of White staff since 2016-17 (6%), and they appear to be underrepresented compared with the local white population (61%). Similarly, the percentage of BME staff, however, has remained the same as 2016-17, and appears to be underrepresented compared with the local BME population (39%). 26 Note: Change less than 2% is not shown

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 1: cont d Staff as at 31 st March 2018 and percentage changes from 2016-17 Bands 1-7 Change in % representation Bands 8a -VSM Change in % representation Office Holders Number % Number % Number % Change in % representation White 9 39% = 22 67% 8% 10 40% 5% BME 12 52% 4% 10 30% 8% 1 4% = Not disclosed 2 9% = 1 3% = 14 56% 6% The above table shows the percentage changes in staffing in the CCG which includes Office Holders. The changes in percentage need to treated with caution as they may indicate a small or no change in the numbers of staff. Also it should be noted that a large number of Office Holders have not disclosed their ethnicity (56%). In the graph we have shown the average percentage of BME workforce across NCL CCGs for comparison purpose. Progress summary White staff in Bands 1-7 No significant change White staff in Bands 8a- VSM- decreased by 8% BME staff in Bands 1-7- decreased by 4% BME staff in Bands 8a-VSM- increased by 8% The number of Office Holders from both White backgrounds has decreased by 5%. 27

Introduction Workforce and GB members Recruitment Staff experience Breakdown of workforce by protected group as at 31 st March 2018 and comparison with NCL CCGs average Age group HCCG NCL CCGs Under 31 12% 10% 31-40 24% 31% 41-50 26% 30% 51 and above 38% 29% Gender HCCG NCL CCGs Female 71% 70% Male 29% 30% Marital Status HCCG NCL CCGs Divorced 3% 5% Married 43% 46% Single 43% 41% Legally Separated 0% 1% Civil Partnership 2% 1% Widowed 0% <1% Do not wish to disclose 9% 7% Disability HCCG NCL CCGs Yes 7% 3% No 72% 72% Do not wish to disclose 21% 25% Religion/Belief HCCG NCL CCGs Atheism 12% 15% Buddism 0% <1% Christianity 38% 37% Hinduism 2% 7% Do not wish to disclose my religion/belief 31% 26% Islam 3% 5% Jainism 2% 1% Judaism 2% 2% Sikhism 0% <1% Other 10% 7% Key highlights Sexual Orientation HCCG NCL CCGs Gay 5% 4% Lesbian 2% 1% Bi-sexual 0% 0% Heterosexual 66% 72% Do not wish to disclose 28% 23% 64% of Haringey CCG s staff are over 40 years old The CCG has a high number of female staff than male staff. 7% of the CCG s workforce has a disability, compared with 3% across NCL. LGBT staff in the CCG represent 7%, compared to 5% in NCL CCGs. 28

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 9: Percentage difference between the organisations Board membership and its overall workforce GB Members ethnicity data as at 31 st March 2018 compared with local population and CCG workforce GB Members 2016-17 2017-18 Demography CCG employees GB Members CCG employees Comparison with local demography Comparison with CCG employees White 44% 61% 80% 51% 66% +14% +29% BME 6% 35% 13% 28% 34% -21% -15% Not disclosed 50% 4% 7% 21% N/A Key highlights The above information is based on the CCG s voting members and staff that are employed by the CCG (excluding office holders). There is an underrepresentation of BME members and overrepresentation of White members on the Governing Body compared with the local population and the CCG workforce- and the NCL CCGs average (see pie chart). 29 Note: Change less than 2% is not shown

Introduction Workforce and GB members Recruitment Staff experience Training WRES Indicator 4: Compare the data for White and BME staff: Relative likelihood of staff accessing non-mandatory training and CPD Non-mandatory training and CPD in NCL CCGs by ethnicity 35% 2% Both White and BME staff have accessed non mandatory training and CPD in 2017-18. However, as the number of staff accessing non-mandatory training and CPD is very small in the CCGs we have aggregated the figures of all NCL CCGs which look more meaningful. 63% BME staff in NCL CCGs are almost 50% less likely to access non-mandatory training and CPD compared with White staff White BME Do not wish to disclose 30 Note: Change less than 2% is not shown

Introduction Workforce and GB members Recruitment Staff experience The CCG follows the NHS Recruitment and Selection Policy and the terms and conditions set out in Agenda for Change. We monitor diversity data of all applicants who apply for jobs, and those who are shortlisted and appointed. However, we do not monitor equality information of temporary or agency staff. The following data therefore is not necessarily indicative of any trend in the recruitment but merely reflects the data of protected groups from 1 st April 2017 to 31 st March 2018. When recruiting staff we ensure: We monitor the diversity data of all applicants Our panels are fully trained and are aware of our equality commitments We follow the best practice e.g. Two Ticks symbol (positive about disabled people) The CCG monitored the diversity information of all new recruits in 2017-18 and here are some key highlights Disability: 6% of the new recruits had a disability Age: 50% of all new recruits were aged 31-40. Gender: Female new recruits represent 71% of the total staff recruited in the year. Sexual orientation: Heterosexual new recruits represent 67% and gay 11%. Marital status: 44% are married and 39% single Religion/belief: The CCG recruited staff from diverse religious backgrounds- and Christians represent 34% of the new recruits. Race: See the next slide

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 2: Compare the data for White and BME staff: Relative likelihood of staff being appointed from shortlisting across all posts Recruitment from 1 April 2017-31 March 2018 by ethnicity Ethnicity Applicants Shortlists Appointments NCL CCGs average (appointments) White 193 22% 38 20% 7 18% 21% BME 641 73% 88 14% 10 11% 14% Not disclosed 42 5% 7 17% 1 14% 24% As shown in the above table, we have analysed the recruitment data on White and BME staff and those who did not declared their ethnicity by comparing the BME shortlist data with the BME applicant data and the BME appointment data with the BME shortlist data. The same has been applied for applicant, shortlisting and appointments information or White staff. The last column shows the NCL CCGs average % breakdown at appointment for benchmarking purposes. In 2017-18 the CCG employed 18 staff White staff were 1.63 times more likely to be appointed compared with BME staff. In NCL CCGs White staff were 1.5 times more likely to be appointed compared with BME staff (Note: The shortlist and appointment % figures are a comparison of the ethnic group numbers compared only to that ethnic group and not the overall candidates at that stage, as a result the total for each of these stages do not add up to 100%, as can be seen at applicants stage) 32

Introduction Workforce and GB members Recruitment Staff experience Recruitment of staff by protected characteristic (from 1 st April 2017 to 31 st March 2018 Recruitment by gender Recruitment by disability Recruitment by sexual orientation Recruitment by age 29% 6% 22% 11% 11% 11% 28% 71% 94% 67% 50% Female Male Yes No Gay Heterosexual Do not wish to disclose Under 31 31-40 41-50 51-60 Recruitment by marital status Recruitment by religion/belief 11% 6% 11% 22% 11% 39% 44% Atheism Christianity Do not wish to disclose Islam Other 22% 34% Divorced Married Single Do not wish to disclose

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 3: Compare the data for White and BME staff: Relative likelihood of staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation (This indicator will be based on data from the most recent two-year rolling average). The CCGs monitor all disciplinary cases based on protected characteristic. Where the number is less than 5, the CCG will not mention the number to maintain the anonymity of the individuals concerned. Disciplinary cases in NCL CCGs by ethnicity 10% The number of disciplinary cases across NCL is small- and a small number can make a significant difference in the percentage- and therefore the figures provided need to be treated with caution. The 2017-18 data shows that BME staff were less likely to enter formal disciplinary investigation than White staff. However, when compared with the percentage of staff in the CCGs it looks disproportionate. For example across NCL CCGs BME staff represent 27% of the total workforce but they represent 40% of the staff that entered into a formal disciplinary. 40% 50% White BME Do not wish to disclose 34

Introduction Workforce and GB members Recruitment Staff experience Staff Survey (WRES Indicators 5-8: Compare the outcomes of the responses for White and BME staff) Percentage of the CCGs staff that said YES to the WRES questions in the 2017 staff survey Staff Survey indicator (WRES) Ethnic Group Haringey NCL CCGs average Indicator 5- KF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months Indicator 6- KF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months Indicator 7- KF 21. Percentage believing that trust provides equal opportunities for career progression or promotion Indicator 8- Q17- In the last 12 months have you personally experienced discrimination at work from any of the following: Manager, Team Leader, Other Colleagues? White 14% 13% BME 8% 13% White 34% 30% BME 23% 41% White 74% 74% BME - 27% White 14% 11% BME 8% 23% Figures show staff experience of the CCG compared with their counterparts (e.g. White vs BME). More White staff experienced harassment, bulling or abuse from patients, relatives or public than BME staff. More White staff experienced harassment, bulling or abuse from staff than BME staff. More White staff (14%) experienced discrimination from colleagues and managers than BME staff (8%); More White staff (74%) think that the CCG provides equal opportunities than BME staff. 35

Appendix 2: WRES Indicators WRES Indicators The aim of the WRES is to help NHS organisations improve their race equality performance. The standard is mandatory- and CCGs are required to implement them in their own organisations and also to hold their providers to account. 2017 updated WRES include: Indicators: 1-4- Workforce indicators, 5-8: Staff survey indicators, 9: GB(Board) Members indicator 36