Equality Information Report

Equality Information Report 2017-18 Our vision: to work together with the Barnet population to improve health and wellbeing For further information please contact: Emdad Haque Senior Equality, Diversity and Inclusion Manager Emdad.Haque@nhs.net 020 3688 1121 Final 1

Contents Introduction About Barnet Our equality and health inequality duties S5-6 NHS mandatory standards Equality Delivery System (EDS2) S8-10 S3 S4 S7 Mandatory Standards CCG Equality Objectives S10 S11 Advancing equality through commissioning S12-14 Our workforce Governance and leadership Inclusive engagement Our providers Forward strategy Appendix 1: Workforce and Governing Body Members Equality Information including the WRES Appendix 2: WRES Indicators Appendix 3: WRES Action Plan (2017-19) Progress Report S15 S16 S17 S18 S19 S20-34 S35 S36 2

Introduction We produce our annual Equality Information Report to demonstrate to our stakeholders how Barnet Clinical Commissioning Group (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 refreshed our Equality and Diversity Strategy for 2018-20 by using EDS2 and we now have an action plan in place for 2018/19 which aims to deliver our equality objectives. We are committed to commissioning services that achieve the best clinical outcomes for patients and a positive patient experience. The way we achieve this is by engaging patients, community groups, staff and clinicians in the design and procurement of our services and by applying innovative ideas. We use every opportunity to listen to our patients, whether through local Patients Participation Groups (PPGs) or voluntary sector engagement events, or planned engagement throughout the business planning process and ensure their views reflect in our commissioning decisions. 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, we will work collaboratively with our partners and providers to address health inequalities. In July 2017, the Governing Bodies of NHS Barnet CCG, NHS Camden CCG, NHS Enfield CCG, NHS Haringey CCG and NHS Islington CCG 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 www.barnetccg.nhs.uk 3

About Barnet Barnet is home to 369,887 residents, based on a 2016 estimate. The Borough has a higher proportion of its total population who are aged over 65 when compared to London. The number of people aged 65 and over is projected to increase by 34.5% by 2030, over three times greater than other age groups. Barnet s rising population will place pressure on all health and social care services, with a number of implications for health and wellbeing. Key issues include: Obesity and the related conditions for adults, children and young people; Mental health and learning disability; Long-term conditions; Integrated care; Primary care development; Diabetes mellitus; and Conditions attributable to cold weather Population and diversity The population of Barnet is projected to become increasingly diverse, with the Black, Asian and Minority Ethnic (BAME) population projected to increase from 38.7 to 43.6% of the total Barnet population. One of the key challenges will be meeting the diverse needs of these different and growing communities. Colindale, Burnt Oak and West Hendon have populations that are more than 50% Black, Asian and Minority Ethnic backgrounds. Over 50% of all 0-4 year olds in Barnet were from a Black, Asian and Minority background in 2015 and this is forecast to continue to increase. There are more children from all Black and Minority Ethnic groups in the 0 9 age group, than there are White children. Children and young people in the 10 19 age groups are predominantly White. This demonstrates a more diverse population shift in terms of ethnicity. Health inequalities There are inequalities in life expectancy in Barnet by gender, locality/ward and the level of deprivation. Life expectancy at birth in females (85.0 years) is higher than in males (81.9 years) and overall life expectancy for both the male and female population in Barnet is higher than the average for England (male =79.4 years, female =83.1 years). The Garden Suburb ward has the highest life expectancy for both males (84.1 years) and females (88.5 years) while the Burnt Oak ward has the lowest life expectancy for both males (75.8 years) and females (81.6 years). In addition, the life expectancy gap is wider and mortality is higher in the most deprived areas compared to the least deprived areas in Barnet. It is clear from international studies and evidence that people from more deprived groups tend to: have higher incidence of cancer; be diagnosed later; have less treatment; and have poorer outcomes 4

Engagement Our equality and health inequality duties Barnet CCG came into being in 2013 through an authorisation process by NHS England which included making 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 continue 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 (EDS2) Workforce Race Equality Standard (WRES) Accessible Information Standard (AIS) CCG Response Equality and Diversity Strategy & Annual Action Plan Equality Information Equality and Diversity Working Group Assurance from providers through Clinical Quality Review Groups 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 Barnet 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 Barnet 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 Barnet CCG does not have 150 employees, adopting 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 a duty 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 workforce data comparing the experience of BAME and white staff. It also compares the Governing Body data with the workforce data and local demography to identify how representative the Governing Body is compared with the CCG workforce and the local population. Our first WRES report was published in July 2015, followed by a progress report that 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 our Workforce and Governing Body Equality Information Report 2017-18). Accessible Information Standard (AIS) The Accessible Information Standard required 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 receive information in a way that they can access and understand, and provide any communication support they might need. This includes making sure people receive 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: 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. In addition, 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 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) performance update Our current performance is based on the grading from 2016-17. This helped us shape our equality objectives in the Equality and Diversity Strategy 2018-20. In 2017/18 we have sustained our grades and a new grading is planned with the local interest groups and the Council Public Health for 2018/19, starting with Goals 3 and 4 in June 2018, followed by Goals 1 & 2 in October 2018. This will help us inform our action plan for 2019/20. Outcome Grade Outcome Grade 1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities 1.2 Individual peoples 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. Developing 3.1 Fair NHS recruitment and selection processes lead to a more representative workforce. Developing 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 Developing 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. Developing 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 Developing Developing Achieving Developing 10

CCG Equality Objectives Our Equality Objectives in the CCG s Equality and Diversity Strategy 2018-20 have undergone a series of internal engagement events with staff and Governing Body members. These objectives are aligned with the national best practice tool EDS2. We have ensured the objectives are based on Barnet priorities and fully aligned with our CCG and NCL strategic plans. An annual action plan for 2018/19 is being developed and is based around EDS2 outcomes and local intelligence to deliver these 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 robust compliance with the equality duty and 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 Barnet CCG delivered its equality objectives 1 and 2. More information about the achievements can be read in Barnet CCG s annual report 2017-18. Health inequality Equality Analysis Engagement In 2017/18, Barnet 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 that was redesigned or newly commissioned. Our Governing Body, and relevant Committees, have played an important role in ensuring compliance with our statutory duties by scrutinising business cases and equality analysis completed by the commissioners. Commissioning decisions As sector leader and lead commissioner, Barnet CCG seeks assurance from Providers on a number of equality policies as mandated by NHS England. This includes gaining assurance that providers are compliant with the equality duty and also all NHS mandatory standards (See page 18). 12

Advancing equality through commissioning Equality Objective 1: Commissioning services based on evidence to reduce health inequalities amongst protected and vulnerable groups. Barnet CCG aims to work effectively to maximise the local NHS s contribution to local health and wellbeing. We are here to improve people s health, reduce health inequalities and promote prevention and early intervention to support local people to maximise their personal health and wellbeing. In order to deliver this objective, we engage with, and strive to understand, the needs and wants of local people and communities. Key achievements 2017-18 Across NCL, we have developed our Sustainability and Transformation Plan (STP) to deliver the triple aims of improved health and wellbeing, transformed quality of care delivery, and sustainable finances as set out in the national Five Year Forward View. Locally as partners, we have a shared vision, a collective agenda and the commitment to work together in new ways to transform the health and care services of North London. The commissioning and launch of the Dementia Hub in May, in partnership with the Alzheimer s Society, was a real highlight. The Hub provides accessible, and much-needed support, in the community for our local residents living with dementia and acts as a focal point to support services across the Borough. End of life care: Continuing Healthcare commission high quality care provision for eligible service users at the end of their life. We continue to work closely with local Hospice teams and District Nursing services to ensure that individuals can receive care in their preferred place. In 2017/2018, 76% of CHC eligible patients were supported in their preferred place of care at the end of their life. A Red Bag (important information about a care resident s health) scheme in care homes was successfully introduced. Reconfigured adult community services. Streaming of appropriate patients from the Emergency Department to GP surgeries. Extended Access service for 2017/2018 the CCG commissioned an extra 38,000 appointments. Building on a suite of locally commissioned services in primary care, Barnet CCG commissioned several new local services to help meet the changing healthcare needs of the local population. Investment was committed to continue commissioning the extended access service to local primary care services. Barnet CCG has commissioned CommUNITY Barnet to support its patient and community engagement. Through targeted resourcing, and a waiting times reduction programme, Barnet CCG reduced the number of young people waiting for treatment for over 12 weeks from 119 to 65 and average waiting times from 131 days to 90 days (between 30th September 2016 and 30th September 2017). 13

Advancing equality through commissioning (cont d) Equality Objectives 2: Improve access to all services by protected and vulnerable groups In 2017, we have worked with our partners to engage with the public and begin to implement shared plans to deliver improvements to health and care and spend money wisely. Some highlights of this include: Key achievements in 2017-18 Making it possible for residents to access GP services 8am-8pm through extended access in April 2017. Following capital investment of 1million by Camden & Islington Foundation NHS Trust, we opened the Women s Psychiatric Intensive Care Unit on 13th November 2017. This will ensure that women that require intensive care in NCL are not placed out of area as a first response to their crisis and need for intensive care. One of the first areas nationally to launch the new integrated urgent care model. This includes: o Mental Health patients can now ring 111, and be transferred directly transfer to crisis team for advice and support. o Enables clinical staff to get through to a clinical expert for urgent advice and support by dialling the appropriate number. Successful bid for enhanced mental health liaison services in A&E at University College Hospital in 2017/2018, and North Middlesex University Hospital in 2018/2019. Launched a specialist Perinatal mental health service for mums across North Central London, following a successful first wave bid for national funding. Made it quicker and safer for patients to get home from hospital by working at agree standard ways of working and working more effectively with social care. We have worked with CommUnity Barnet and others to ensure these are accessible to everyone who has an interest in the issues being discussed. Involving parents/carers of people with learning disabilities, and other conditions, by collaboratively working with the local authority and the involvement Board. 14

Workforce Equality Objective 3: Recruit, support and retain staff from protected groups Support Retention Barnet CCG employs 85 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 CSU. In 2017/18 we have: Continued attracting applicants from diverse backgrounds. Ensured our selection process followed the NHS recruitment and selection policy and good practice (e.g. ACAS code of practice) Recruitment Training Ensured our process of supporting staff with non-mandatory and CPD courses was fair and have monitored the uptake by ethnicity. WRES EDS2 Followed the NHS change management policy in our team restructuring and completed equality analyses, where required, to ensure due regard to the equality duty. 15

Governance and leadership Equality Objective 4: Strengthen the role of governance and leadership beyond compliance Barnet 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 Clinical Quality and Risk Committee (CQRC) Equality duty Senior Management Team CCG Assurance Barnet CCG Governing Body seeks regular assurance that its duties are being met and that providers, from whom it commissions services, are complying with this duty. The Equality and Diversity Working Group supports and oversees the implementation of Barnet CCG s Equality and Diversity Strategy and is Chaired by a member of the Governing Body. Membership of the Group includes Human Resource & Organisational Development, Engagement, Project Management Office, Equality and Diversity and Commissioning. The Group is a sub-committee of the Patient and Public Engagement (PPE) Committee. The Group also invites Healthwatch and Public health to discuss EDS2 grading. The CQRC provides the necessary scrutiny on all reports before they go to the Governing Body. 16

Inclusive engagement Our engagement activities are designed to deliver inclusive engagement outcomes that enable Barnet CCG to deliver our equality objectives 1 and 2 Barnet CCG works hard to embed engagement across the organisation and to work closely with our partners and key stakeholders such as Barnet Council, Healthwatch Barnet, CommUnity Barnet, the other CCGs in NCL and the Health and Wellbeing Board. Barnet CCG s Governing Body Lay Member is responsible for ensuring effective patient and public engagement. When we have targeted audiences for public engagement events, we have worked with CommUnity Barnet and others to ensure these are accessible to everyone who has an interest in the issues being discussed. The aim of our engagement work is, not only to consult people about the services they need, but to involve them in co-creating them for the future. A good example of this is the procurement exercise for Children s Integrated Therapies (occupational therapy, physiotherapy and speech and language services) undertaken in January and February 2018. Young people were trained and supported to be a part of the panels that scored the bids and interviewed the shortlisted providers to make a final recommendation. Throughout the year, the Learning Disabilities Team made regular visits to the specialist learning disabilities service to speak to patients as part of contract monitoring activities. Feedback was used to inform the commissioning approach and provide assurance. Case study In June 2017, we hosted an engagement event attended by 85 delegates, including 29 members of the public and 33 representatives from community and voluntary sector stakeholders. The event was focused on Care Closer to Home, particularly GP extended access, integrated working and digital services. The views obtained at this event, along with those we heard at the previous Care closer to Home event in February 2017, were used to develop the CCG s Personal Medical Services (PMS) contract Commissioning Intentions for GP services. This included improved access, specifically relating to increasing the number of bookable online appointments and how more integrated services will be delivered in Care Closer to Home Integrated Networks (CHINs). 17

Our providers We have a duty to ensure that all our providers are complying with their public sector equality duty and that 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 Royal Free London NHS Foundation Trust www.royalfree.nhs.uk/about-us/equality-anddiversity Adopted WRES Adopted EDS2 Published Equality Objectives Published Annual Equality Information Accessible Information Standard Central London Community Healthcare NHS Trust www.clch.nhs.uk/about-us/equality-anddiversity.aspx Barnet CCG seeks regular assurance from its providers through contract monitoring and at the Clinical Quality Review Group (CQRG). Based on providers information, Barnet CCG seeks assurance on the progress on their implementation of the WRES, EDS2 and Accessible Information Standard. 18

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 facing Barnet CCG, both in terms of demand for services and diminishing funding, which make it challenging for us to advance equality for all groups in the community, therefore, some prioritising may be necessary. 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 Enhance the ways we undertake equality analysis and how we use the outcomes to inform our commissioning decisions Train managers and Governing Body Members Implement 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 hold them to account Work towards harmonising strategic equality objectives across NCL Develop systems and process to benchmark work and share good practice Prepare for the implementation of the Workforce Disability Equality Standard (WDES) 19

Appendix 1 Equality Information Report 2017-18 Workforce and Governing Body Members Equality Information including the WRES 20

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 Barnet 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. Barnet CCG employs 85 staff (as of 31 st March 2017) including 15 office holders who are not employees of the CCG but are on the payroll. We have included them for WRES purpose only. This is not a large number when divided into different protected groups. Please note, the race equality data in some indicators is too small to draw any meaningful conclusion as a small change in the number can change the percentage significantly and, therefore, the percentages need to be treated with caution. Barnet CCG has made an improvement in the appointment of BAME staff compared to White staff. For example, BAME staff were three times less likely to be appointed compared with White staff in 2015/16. This has improved to 1.75 times less likely in 2017/18. In 2017/18, there were two staff among the new recruits who declared a disability. White staff were twice more likely to access non-mandatory training and Continuing Professional Development (CPD) courses than BAME staff and the ratio was the same as 2015/16 There has been an increase in the percentage of BAME staff in Barnet CCG since 2016/17 There were less than five disciplinary cases over the last two years (2016-18). The 2017 Staff Survey outcomes show that BAME staff reported more bulling and harassment from staff, and more discrimination from colleagues/managers than White staff. 21

Introduction Workforce and GB members Recruitment Staff experience Background As part of the Equality Information Report, Barnet 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, Barnet 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 Barnet 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, Barnet CCG employed 85 staff, including Office Holders. This 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 is no available data to report and currently the Electronic Staff Records (ESR) system does not have a category for gender-reassignment. How we have prepared the report This report shows how Barnet 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 Barnet CCG to implement in 2018/19 to improve the CCG s position about race equality. To demonstrate how Barnet CCG meets each indicator, data has been collated from several sources, including workforce data from 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) 22

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 CCG s 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 workforce, and set an example for their providers. Formally, 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. 23

Introduction Workforce and GB members Recruitment Staff experience Race WRES Indicator 1: Percentage of staff in each of the Agenda for Change (AfC) Bands 1-9 or Medical and Dental subgroups and Very Senior Managers (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 As mentioned on page five and appendix 2, the WRES indicator has been changed since 2016 and now includes all clinical and non-clinical staff. Barnet 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 purposes, Barnet CCG has kept the grouping of the data to Band 1-7, and from 8 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 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. 24

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 1: cont d Workforce by ethnicity compared with local population White BAME 2015/16 2016/17 2017/18 Performance compared with 2016/17 Population (2011 Census) 58% 59% 56% 3% 64% 29% 32% 27% 5% 36% Not disclosed 13% 10% 16% 6% n/a The table includes staff and office holders to show the overall commissioning workforce. 16% of the total staff have not disclosed their ethnicity and this is percentage is made up of Office Holders number of non-disclosures (67%). Barnet CCG needs to update this data to ensure greater transparency and clarity. There has been a small change in the make up of White staff since 2016/17 (-3%), and they appear to be slightly underrepresented compared with the local white population (64%). The percentage of BAME staff has also decreased marginally (5%), and appear to be underrepresented compared with the local BAME population (36%). The disclosure of ethnicity has decreased by 6% since 2016/17 but is greater than the NCL average of 22%.7. 25 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 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 13 57% = 30 64% = 5 33% -22% BAME 9 39% 2% 14 30% = 0% -18% Not disclosed 1 4% -3% 3 6% = 10 67% 40% The above table shows the percentage changes in staffing in Barnet CCG and 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. Progress summary White staff in Bands 1-7 no significant change White staff in Bands 8a- VSM - no significant change BAME staff in Bands 1-7 - increased by 2% BAME staff in Bands 8a-VSM - no significant change. The number of Office Holders that do not disclose their ethnicity has increased by 40%. Currently the data is showing that there are no BAME Office Holders, however, we know this is not the case. Note: Change less than 2% is not shown 26

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 BCCG NCL CCGs Under 31 4% 10% 31-40 23% 31% 41-50 25% 30% 51 and above 47% 29% Gender BCCG NCL CCGs Female 80% 70% Male 20% 30% Marital Status BCCG NCL CCGs Divorced 1% 5% Married 66% 46% Single 29% 41% Legally Separated 0% 1% Civil Partnership 0% 1% Widowed 0% <1% Unknown 4% 7% Do not wish to disclose 0% 5% Sexual Orientation BCCG NCL CCGs Gay 1% 4% Lesbian 0% 1% Bi-sexual 0% 0% Heterosexual 74% 72% Do not wish to disclose 24% 23% Disability BCCG NCL CCGs Yes 6% 3% No 66% 72% Do not wish to disclose 29% 25% Religion/Belief BCCG NCL CCGs Atheism 11% 15% Buddism 0% <1% Christianity 33% 37% Hinduism 11% 7% Do not wish to disclose my religion/belief 27% 26% Islam 6% 5% Jainism 1% 1% Judaism 6% 2% Sikhism 0% <1% Other 4% 7% Key highlights The CCG employs more disabled staff (6%) compared with the NCL average. Nearly 50% of all staff are over the age of 50 years old. Female staff represent 80% of the total workforce, compared to 70% across NCL LGBT staff represent only 1%, compared to 5% in NCL. 27

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 9: Percentage difference between the organisations Board membership and its overall workforce Governing Body Members ethnicity data as at 31 March 2018 compared with the local population and the CCG workforce GB Members 2016-17 2017-18 Demography CCG Staff GB Members CCG Staff Comparison with local demography Comparison with CCG workforce White 55% 60% 67% 61% 64% 3% 6% BAME 18% 34% 7% 33% 36% -29% -26% Not disclosed 27% 6% 27% 6% N/A N/A Key highlights The above information is based on Barnet CCG s voting members and staff that are employed by Barnet CCG (excluding office holders). There is an underrepresentation of BAME members on the Governing Body reported compared with the local BAME population and the CCG workforce and the NCL CCGs average. 28 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 BAME 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 BAME 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 Barnet CCG we have aggregated the figures of all NCL CCGs which look more meaningful. 63% BAME staff in NCL CCGs are almost half as likely to access non-mandatory training and CPD compared with White staff White BME Do not wish to disclose 29 Note: Change less than 2% is not shown

Introduction Workforce and GB members Recruitment Staff experience Barnet 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 recruitment but merely reflects the data of protected groups from 1 April 2017 to 31 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) Barnet CCG monitored the diversity information of all new recruits in 2017/18 and the following are some key findings: Disability: 6% of our total new recruits had a disability Age: 35% of all new recruits were aged 50 and above Gender: Female new recruits represent 67% of the total staff recruited in the year. Sexual orientation: Heterosexual new recruits represent 82% and gay 6%. Marital status: 47% are married and 35% single Religion/belief: Most staff were recruited from Christian (26%), Atheist (26%) and Hindu backgrounds (12%) Race: See the next slide

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 2: Compare the data for White and BAME 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 White 354 36% 77 22% 21 27% 19% BAME 570 57% 86 15% 10 12% 14% Not disclosed 72 7% 9 13% 3 33% As shown in the above table, we have analysed the recruitment data on White and BAME staff and those who did not declare their ethnicity by comparing the with the BAME applicant data and the BAME appointment data with the BAME shortlist data. The same has been applied to applicant, shortlisting and appointments information for White staff. In 2017/18 Barnet CCG employed 44 staff BAME staff were 2.25 times less likely to be appointed compared with White staff. This has improved from 3 times less likely in 2016/17. In NCL CCGs, White staff were 1.36 times more likely to be appointed compared with BAME staff 31

Introduction Workforce and GB members Recruitment Staff experience Recruitment of staff by protected characteristic (from 1 April 2017 to 31 March 2018 Recruitment by gender Recruitment by disability Recruitment by sexual orientation Recruitment by age 6% 6% 12% 6% 6% 33% 35% 32% 67% 88% 82% 27% Female Male Yes No Do not wish to disclose Gay Heterosexual Do not wish to disclose Under 31 31-40 41-50 51-60 Recruitment by marital status Recruitment by religion/belief Atheism Divorced Christianity 35% 12% 6% 47% Married Single Civil Partnership Widowed 3% 6% 9% 18% 26% Hinduism Do not wish to disclose my religion/belief Islam Jainism Do not wish to disclose 12% 26% Other

Introduction Workforce and GB members Recruitment Staff experience WRES Indicator 3: Compare the data for White and BAME 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). Barnet CCG monitors all disciplinary cases based on protected characteristics. Where the number is less than 5, the CCG will not declare the number in this report to maintain the anonymity of the individual/s concerned. Disciplinary cases in NCL CCGs by ethnicity 10% The number of disciplinary cases across NCL is small and this can make a significant difference in the percentage, therefore, the figures provided need to be treated with caution. The 2017/18 data shows that BAME staff were less likely to enter formal disciplinary investigations than White staff. However, when compared with the percentage of staff across the NCL CCGs it appears disproportionate. For example across NCL CCGs BAME 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 33

Introduction Workforce and GB members Recruitment Staff experience Staff Survey (WRES Indicators 5-8: Compare the outcomes of the responses for White and BAME staff) Percentage of CCG staff that said YES to the WRES questions in the 2017 staff survey Staff Survey indicator (WRES) Ethnic Group Barnet 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, Colleagues White 29% 13% BME 10% 13% White 33% 30% BME 55% 41% White 67% 74% BME 33% 27% White 10% 11% BME 32% 23% Figures show staff experience of the CCG compared with their counterparts (e.g. White/BAME). More White staff reported that they had experienced bulling, harassment and abuse from relatives than BAME staff. More BAME staff reported that they had experienced bulling and harassment from staff compared to White staff. More BAME staff reported that they had experienced discrimination from colleagues and managers than White staff. 34

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 hold their providers to account. 2017 updated WRES include: Indicators: 1-4- Workforce indicators, 5-8: Staff survey indicators, 9: GB (Board) Members indicator 35

Appendix 3: WRES Action Plan (2017-19) Progress Report Indicator Action Outcome Lead Progress so far 1. Percentage of staff in each of the AfC Bands 1-9 and VSM (including executive Board members) compared with the percentage of staff in the overall workforce. (clinical and non-clinical) 2. Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff being appointed from shortlisting across all post (internal and external) Attract applicants from the local community by publicising jobs locally. Provide training to Governing Body Members and staff on unconscious bias and recruitment and selection training. Ensure, where possible, there is a BME panel member on the selection panel for positions in Band 8a and above. CCG jobs publicised through local partners and community organisations. Likelihood of BME staff being shortlisted and appointed increased across all Bands to a comparable level with White staff. Workforce Lead/Communi cation & Engagement Lead Workforce Lead/OD Lead Action to be taken: Vacancies are publicised through the communication and engagement team to local community groups such as Patient newsletters, voluntary action groups, disability group. Recruiting staff from BAME backgrounds to sit on interview panels for certain posts in Band 8A+ Advice, information and training provided to panel members to ensure quality and equality of recruitment process. Monitoring the data annually which we publish in our WRES progress report Further action to be taken: Planning on delivering further unconscious bias training/recruitment and Selection training to all staff including GB members. 3. Relative likelihood of BME staff entering the formal disciplinary process, compared to that of White staff entering the formal disciplinary process, as measured by entry into formal disciplinary investigations. Continue monitoring all disciplinary cases. Disciplinary cases are dealt with in a fair and consistent manner. Workforce Lead All policies including the disciplinary policy are Equality Impact assessed. HR meet on a weekly basis to monitor/review all ER cases across NCL, Case numbers are shared with key HR data on a monthly basis with EMT boards. In addition we work in Partnership with our Union colleagues to map against protected characteristics and provide data for action planning purposes. 4. Relative likelihood of BME staff accessing nonmandatory training and CPD as compared to White staff. Publicise non-mandatory training and CPD programmes. Encourage and motivate BME staff through PDP & objective setting Take up of non-mandatory training and CPD increased. OD Lead Each PDP is being monitored and a Training Needs Analysis will be created to produce an organisation OD plan. We will be monitoring training requests for 18/19 and matching this against who can access and parity of ability to access Further Action to be taken: All training is advertised in Staff Comms, and Newsletters and the Intranet Monitor attendance lists against E&D data 5. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months. 6. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 7. Percentage believing that CCG provides equal opportunities for career progression or promotion. 8. In the last 12 months have you personally experienced discrimination at work from any of the following: Manager, Team Leader, Other Colleagues Continue offering equality and diversity training Promote dignity at work policy through Board Development Sessions and staff meetings Celebrate diversity in the CCG to raise awareness Monitor all external and internal recruitment activities Reduced incidents bullying and harassment in the organisation. More staff should feel that the CCG is a fair employer OD Lead Corporate message about equality, diversity and inclusion highlighting the CCG s position and commitment to race equality. Staff Involvement Group is set up to take forward actions from the staff survey results. Staff away day has taken place. OD leads have been appointed to take forward a OD plan, which include an organisational training plan. WAP process to ensure all post are signed off and advertised appropriately in NCL. Further action to be taken: Training being rolled out across NCL for managers and staff re B&H 9. Percentage difference between the organisation s voting membership and executive membership of the Board Continuously review the makeup of Governing Body voting members to ensure race equality. Update GB members ethnicity data GB voting members reflective of the staff and local community. Workforce/CC G EMT The CCG is working to ensure the GB members reflect the community we serve, and we are updating the ethnicity data across NCL every year to monitor that. We will look to review Board composition and action plan against % difference 36