Public Sector Equality Duty Report 2017

Public Sector Equality Duty Report 2017 Title of Report: Public Sector Equality Duty Report 2017 This paper is for: Approval Recommendation: The board is asked to approve the report. For further information or for any enquiries relating to this report please contact: Paula Wilkins, Chief Nurse: p.wilkins@nhs.net Yasmini Mahmood, Equality, Diversity and Inclusion Manager, NHS NEL CSU yasminmahmood@nhs.net Date: 27 th March 2018 Reporting Officer: Yasmin Mahmood Agenda Item: 37/18 Lead Director: Paula Wilkins Version: 4 Report Summary: Under the Equality Act 2010, public bodies have a general duty to eliminate discrimination, advance equality of opportunity and promote good relations between people sharing different protected characteristics. To meet the general duty, CCGs have a specific duty to publish information to demonstrate compliance with the general equality duty. Annually West Kent CCG publishes a report to demonstrate its efforts around meeting its duties under the Equality Act. This report highlights progress made between January and December 2017 and it includes the full range of work undertaken by the CCG, including: equality analyses on commissioning priorities, partnerships, patient and public engagement, Equality Delivery System (EDS2) reviews and benchmarking using the Workforce Race Equality Standard (WRES). FOI status: This paper is disclosable under the FOI Act Strategic objectives Strategic Goal C: Deliver improved health outcomes and reduced West Kent CCG Front Sheet

links: Board Assurance Framework links: health inequalities Strategic Goal F: Ensure robust governance Strategic Goal G: Organisational competence Strategic Goal H: Underpin our business with patient and public engagement Strategic Goal C: Failure to make strategic changes needed to deliver Mapping the Future may result in a local healthcare system that; is unsustainable in the long term; is unable to ensure high quality accessible services for local people; and does not deliver improved outcomes and reduced inequalities. Strategic Risk F: Loss of control of corporate governance could result in the CCG acting ultra-vires and becoming subject to regulatory or legal action, with resultant harm to the CCG s reputation, influence and capability, as well as possible financial harm. Strategic Risk G: The CCG s failure to deliver the requirements of NHS England (including the quarterly CCG Assurance Framework and the terms of the CCG s Authorisation) could result in the CCG losing its freedom to operate independently (or ultimately being de-authorised). Strategic Risk H: Failure to work in partnership with patients and public may result in failure by the CCG to deliver its health and social care integration objectives. Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Equality and diversity assessment Non-compliance with the Equality Act 2010, through a failure to publish an annual public sector equality duty report, will be the key risk to the CCG. Existing in-house resources were used to develop this report. The Public Sector Equality Duty Report has relevance to all the 9 protected characteristics under the Equality Act 2010. Information published in this report helps to demonstrate the CCG s compliance with the Equality Act. Has an equality assessment been undertaken? Yes (please append the action plan to this paper) Will be necessary if for either Decision or Approval Not applicable (please indicate which senior manager agreed that an equality assessment was not required) West Kent CCG Front Sheet

As the Public Sector Equality Duty report is a compilation of all the work the CCG has undertaken between January and December 2017 to meet the three aims of the general duty under the Equality Act a separate equality analysis is not required for this paper. Management of Conflicts of Interest Public and Patient Engagement/Impact on patient services Nil The report highlights the key patient and public engagement activities undertaken in the past year. Report history: This paper was considered by the Equality and Diversity Working Group in January 2018 and the Quality Committee in February 2018. Appendices See Appendix 1 for the Public Sector Equality Duty Report 2017 Next steps: The Public Sector Equality Duty Report 2017 will be published on the CCG s website following approval by the Governing Body. West Kent CCG Front Sheet

West Kent CCG Annual Equality Report 2017 Patient focussed Providing quality Improving outcomes

Contents 1. Introduction page 3 2. Strategic context page 6 3. Organisational context page 7 4. West Kent Clinical Commissioning Group s population page 8 5. Commissioning Intentions page10 6. Equality Analysis page12 7. Quality Innovation Performance and Productivity page14 8. Equality Objectives page14 9. Equality Delivery System (EDS2) page15 10. Public Health page17 11. Tenders, Contracts and Performance Monitoring page18 12. Workforce Race Equality Standard page19 13. Training and Development page20 14. Employee Engagement page20 15. Patient and Public Engagement page21 16. Partnerships page30 17. Safeguarding Children and Adults page 30 18. Summary page 33 Version 1 Yasmin Mahmood December 2018 Version 2 Equality and Diversity January 2018 Working Group Version 3 Quality Committee February 2018 Version 4 Governing Body March 2018 This report was commissioned by NHS West Kent Clinical Commissioning Group and produced by the Equality, Diversity and Inclusion Manager for NHS NEL Commissioning Support Unit (CSU). If you would like a summary version of this report in an alternative format or more details on its contents, please contact the Chief Nurse or the NEL Commissioning Support Unit Lead. Paula Wilkins Chief Nurse NHS West Kent CCG Wharf House, Medway Wharf Road, Tonbridge, Kent, TN9 1RE Tel: 01732375212/07500950890 Email:p.wilkins@nhs.net Yasmin Mahmood Equality, Diversity and Inclusion Manager NHS NEL Commissioning Support Unit 75-77 Worship St, London EC2A 2DU Tel: 020 3668 3103/ 07812 348197 Email: yasminmahmood@nhs.net 2

1. Introduction Legislative context As a public sector body, West Kent Clinical Commissioning Group (CCG) has a statutory requirement to meet the legal duties as required within the Equality Act 2010. The general duty requires public bodies to show due regard to: Eliminating unlawful discrimination or any other conduct prohibited by or under the Act Advancing equality of opportunity between persons who share a protected characteristic and persons who do not share it. Fostering good relations between people who share a relevant protected characteristic and people who do not share it. There are nine protected characteristics covered by the Equality Act: Age, Disability, Gender re-assignment, Marriage and Civil partnership, Pregnancy and maternity, Race including nationality and ethnic origin, Religion or belief, Sex (male/female), Sexual orientation. The specific duties require public bodies to publish relevant, proportionate information showing how they meet the Equality Duty by 31 January each year and to set specific measurable equality objectives by 6 April every four years starting in 2012. Both general and specific duties together constitute the Public Sector Equality Duty (PSED). As a statutory public body, the NHS West Kent Clinical Commissioning Group must ensure it meets these legal obligations by publishing information demonstrating it is meeting the three aims of its General Equality Duty through its commissioning activities and decision-making process. West Kent CCG s Annual Public Sector Equality Duty Report for the period January to December 2017 reports on key activities it has undertaken and structures it has put in place to ensure it is meeting its Public Sector Equality Duty. Equality Objectives: West Kent CCG developed its first set of equality objectives in 2013 when it was authorised and has been monitoring progress against it since. In keeping with its specific duty under the Equality Act, the CCG refreshed and updated its Equality Objectives for 2017-21 to reflect its current context with the support of its Equality and Diversity Working Group (E&DWG). See Section 8 (Page 19) for more detail. 3

Equality Benchmarking Tools: In addition, NHS England has developed a number of tools to support CCGs and healthcare providers to meet their Equality Duties. These include: Equality Delivery System (EDS2), National Workforce Race Equality Standard (WRES) Accessible Information Standard Sexual Orientation Monitoring Standard, and National Workforce Disability Equality Standard from April 2018. The NHS Standard Conditions of Contract 2017-19 (Service Conditions 12 and 13) provides CCGs with the lever to assure themselves that provider organisations are delivering against their equality duties and reporting progress in terms of improving access and health outcomes for all. The NHS Standard Contract is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care. Regulatory Framework: CCG Improvement and Assessment Framework 2016-17: NHS England has a statutory duty under the Health and Social Care Act 2010 to conduct an annual assessment of CCGs. The new CCG Improvement Assessment Framework (IAF) for 2016/17 replaces the earlier CCG Assurance Framework and aims to make CCGs more accountable to the public. The framework links together the aims of the Five Year Forward View, NHS Planning Guidance, and the Sustainability and Transformation Plans (STPs) for each area, and focusses on 4 domains: Better Health, Better Care, Sustainability and Leadership. The Leadership domain will review how the CCG is performing against the following indicators: Probity and corporate governance, workforce engagement, the CCG s local relationships and quality of leadership. The workforce engagement indicator will review the CCG s progress against the Workforce Race Equality Standard and staff engagement index, while the indicator on local relationships will assess engagement with local partners, including local authorities, providers, patients, communities, the voluntary and independent sectors for annual EDS2 reviews. West Kent CCG s Assurance Rating for 2016-17 on Well-Led domain: West Kent CCG was rated Good for the Well-Led domain for the second consecutive year in 2016-17. The assessment included a review of the systems it had in place to meets its Public Sector Equality Duty. 4

Care Quality Assessment Inspections for key providers The Care Quality Commission also assesses health care providers for their progress on the Workforce Race Equality Standard and staff engagement under the Well-Led Domain. West CCG s key providers received the following ratings under the Well-led domain: Kent Community Health NHS Foundation Trust (KCHFT) was rated as Good (in September 2014). Maidstone and Tunbridge Wells NHS Trust (MTW) was rated Inadequate (in 2014, progress report for May 2015 demonstrates some improvements). An inspection of the trust has recently taken place and results are expected shortly. Kent and Medway NHS and Social Care Partnership Trust (KMPT) was rated Good (in April 2017). 5

2. Strategic Context West Kent CCG s priorities for the year were driven by national priorities driven by the NHS Five Year Forward View, local NHS priorities and those of the Kent and West Kent Health and Wellbeing Boards. The Kent and Medway Sustainability and Transformation Partnership has been set up by local health and care leaders to encourage and support better health and well-being, and provide improved and sustainable health and care services for the population of Kent and Medway. The Partnership is a collaboration of all NHS and top tier local authority organisations across Kent and Medway, all of whom are involved in the planning, provision and delivery of health and social care services in this area. The Partnership oversees the development of the health and care as part of the Sustainability and Transformation Plan (STP) for Kent and Medway. The partnership will look at supporting mechanisms and behaviours to secure best value from available resources. The focus for the STP would be to develop more collaborative ways of working, such as Accountable Care Partnerships and to move away from transactional relationships. Key areas of focus under the plan include: Developing Local Care Plans, which will bring primary care general practices into stronger clusters, and aggregate clusters into multispecialty community provider (MCP) type arrangements, and, potentially, into a small number of larger accountable care organisation (ACO) type arrangements that hold capitated budgets. This model will enable services to operate at a scale where it will be possible to bring together primary, community, mental health and social care to develop truly integrated services. A commitment has also been made for a Kent and Medway-wide strategy for Hospital Care, focussing on four key areas: Care transformation: by preventing ill-health and bring excellent care closer to home. Productivity: Maximising synergies and efficiencies in shared services, procurement and prescribing. System leadership: through investment in digital infrastructure, estates and workforce. Enablers: developing the commissioner and provider structure to unlock scale and impact. 6

3. Organisational context NHS West Kent CCG is a clinically-led statutory NHS body, created on 1st April 2013 as a result of the Health and Social Care Act 2012 and consequent amendments to other legislation, including the NHS Act 2006. The CCG is responsible for planning and commissioning health care services for the West Kent area in partnership with a network of service providers, including healthcare trusts, voluntary sector and local authorities. It works collaboratively with these agencies and patients, carers and the public to commission the right services, in the right place, at the right price. Since April 2016 WKCCG has also taken on the role of Co-Commissioning GP services in the local area. The CCG s membership includes 60 GP practices in the West Kent area. Operational leadership of the CCG is delivered through its Governing Body, on which GP Locality Representatives are in the majority. The CCG has offices in Tonbridge and Maidstone. The CCG purchases a range of services from NHS NEL Commissioning Support Unit (including the Equality and Diversity service), which supports the CCG meet its statutory duties under the Equality Act 2010. All Governing Body members have a collective and individual responsibility to ensure compliance with the public sector equality duty, which will in turn secure the delivery of successful equality outcomes for us, both as a commissioner and an employer. The Governing Body Lay Member for Patient and Public Engagement is responsible for ensuring patient and public involvement in service design, review and change. The Lay Member champions equality and diversity at board level and has extensive experience of engagement. All Governing Body members share the responsibility in ensuring that the voice of the local population is heard in all aspects of the CCG s business. The Accountable Officer has responsibility for ensuring that the necessary resources are available to progress the equality and diversity work plan within the organisation and ensuring that the requirements of this framework are consistently applied, co-ordinated and monitored. The Chief Nurse is the executive lead for equality and diversity and provides assurance reports to the Governing Body, Executive Management Team and the Quality Committee. Equality and Diversity Working group To ensure robust delivery of its equality and diversity work plan, an Equality and Diversity Working Group (EDWG) was established in 2013. The group currently includes: the Chief 7

Nurse, the GB Lead for Patient and Public Involvement and Equality & Diversity and two representatives from NEL Commissioning Support Unit the Engagement Manager and the Equality, Diversity and Inclusion Manager. The group also receives input from the commissioning and HR teams. The EDWG is chaired by the Governing Body lead on Patient and Public Engagement and meets bi-monthly. It feeds back to the CCG s Quality Committee, Executive Management Team and the Staff Forum. It takes a strategic lead on provider assurance on equality and diversity and overseeing the progress of the CCG s equality and diversity work plan. 4. West Kent Clinical Commissioning Group s Population Population: Key Facts This section includes key population facts and demographic profiling of the West Kent area. West Kent is comprised of 60 GP practices, responsible for a population registered with general practice of 476,223 (March 2015). The CCG s population is expected to increase by 19% by 2035 (up to 561,883), with the proportion of people over 65 expected to grow the most by 20125 (by 19%). West Kent Clinical Commissioning Group (CCG) is the largest of Kent s seven CCGs, with 31.2% of the overall Kent registered practice population. The majority of patients registered with West Kent practices live within the district authorities of Maidstone, Sevenoaks, Tonbridge & Malling and Tunbridge Wells. However, patients from Swanley (in Sevenoaks District) are predominantly registered with practices in the Dartford, Gravesham and Swanley CCG. Life Expectancy Life expectancy at birth is 82.85 years in West Kent - higher than the Kent average of 81.7 years. There is however, substantial variation among wards across West Kent. Detling and Thurnham ward, Maidstone has the highest life expectancy at birth, at 89.5 years, whilst the lowest is Bridge at 76.5 years. Under 75 mortality has decreased in all diseases, except respiratory disease, which has increased over the past 10 years, though there was a reduction in 2015 of 0.85 per 100,000 people. Health Inequalities Although people in West Kent generally live longer than the rest of Kent, those in more deprived areas have been found to die up to 13 years earlier than those in more affluent areas. 8

Areas of high deprivation often have lower levels of education, higher crime rates, poor housing conditions, more homelessness and poorer overall health outcomes. For example, Maidstone, a WK area with the lowest life expectancy at birth, has the second highest rates of homeless people in Kent, almost four times the number of people in 2008, usually found within the town centre. Each district within West Kent has areas with poor health outcomes that are also the areas with high deprivation, poor levels of educational attainment, high in fuel poverty, poor air quality and high crime rates. Age The age profile of the West Kent CCG population is broadly similar to that of Kent; however, it has a slightly lower proportions of patients aged between 16 and 29, and marginally higher proportions of people aged between 40 and 54 years. More males than females are found in the under 25 population, although from the age of 85 there are notably higher proportions of females than males. In March 2015, 18.9% of the registered population in West Kent CCG was aged 65 and above, compared to 19.4% of the registered population aged 65 and over across Kent. Across West Kent CCG, 6.0% of the registered population are aged 0 to 4 years compared to 5.9% in Kent. Childhood indicators such as infant mortality and low birth weight babies are similar to the Kent average, although there is variation between wards. More children are placed in KCC Foster care in West Kent than the Kent average. Sevenoaks has the highest number of Irish Traveller and Gypsy Roma children in Kent. Ethnicity Approximately 4.9% of the CCG population is from a non-white background while 3.8% classified themselves as Other White and 2.5% as Asian British. People of Arabian ethnic background comprised 0.1% of the population. Ethnic diversity is greatest in the under 15 age group, with 7.45% of the age cohort being of non-white ethnicity. The majority of these individuals identified as either Mixed ethnicity (3.7%) or Asian ethnicity (2.7%). Among the 65 and above population, 1.3% of the population were non-white, with the majority being of Asian ethnicity (0.7%). In West Kent CCG, the population of Gypsy or Irish travellers is 0.37%; which is slightly higher than the Kent average of 0.32%. Migration Between mid-2012 and mid-2013, there was a net increase of 10,000 migrants, with 7,000 from within the UK, and 3,000 international migrants. Tunbridge Wells was the only Kent district with a larger out flow than in flow. 9

Although there is an awareness of changes in the local demographic profile as a result of migration from Eastern European countries, there is currently no data available to assess their specific needs. Languages spoken According to the 2011 Census, 95.5% (1,346,814) of the Kent population spoke English as their main language. Other languages commonly spoken in West Kent include: Polish, Punjabi, Chinese, French, Bengali, Portuguese, Tamil and Spanish. Homelessness Within West Kent, Maidstone has the highest number of individuals accepted as homeless(2.4 per 1000). The lowest rates are observed in Sevenoaks and Tonbridge and Malling (both 0.5 per 1000). Disease Distribution The key points around disease distribution are: Recorded prevalence of diabetes in West Kent CCG is lower than the Kent average, but increasing at a similar rate to the Kent average. Prevalence of asthma in West Kent CCG is similar to Kent (5.6% and 5.5%). Prevalence of Coronary Heart Disease is lower than Kent and Medway and England. West Kent CCG has a slightly higher recorded cancer prevalence (2.3%) than both Kent and Medway (2.2%) and England (2.1%). Mortality rates are highest in lung cancer for men, and for women rates are highest for lung and breast cancer. Prevalence of mental health conditions is similar to Kent and Medway, and lower than national. Prevalence of people with learning disabilities is lower in West Kent CCG than in Kent and Medway. Dementia prevalence in West Kent CCG is similar to Kent and Medway and England at 0.6%. Referrals into memory assessment clinics continue to increase by approximately 405 per year and emergency admissions with dementia codes as primary or secondary diagnosis have increased by 106.6 per 100,000 population. 5. Commissioning Intentions West Kent CCG s key areas of focus for 2017-19 will be: (1) Developing contracts that enable and support the work of the STP, built on costs rather than prices and contracts to reduce the transactional burden. The contracts with key providers (MTW, KCHFT and KMPT) would enable redesign of local, urgent and elective care within available finances for West Kent and in line with STP direction. 10

(2) Delivering local care together through the West Kent Improvement Board and Local Care Delivery Board as vehicles for collaborative work and co-design on this programme. (3) Working together to ensure resilience and high quality of care focussing on local work, maximising resources, clear focus on quality of care and outcomes for patients and the public. (4) New forms of partnerships with provider trusts through a shared clinical strategy with key providers and commissioning and contractual arrangements that support the same. (5) Progressing towards new Kent and Medway NHS Governance: in keeping with the Five Year Forward View. The new forms of collaborative working being developed across Kent and Medway include: new models of care, the development of Accountable Care Partnerships and establishment of a single strategic commissioning organisation. These will new relationships will also guide the financial flows and management of service delivery. West Kent Local Care Model: Improving access to care in the community The proposed West Kent Local Care Model for the future is organised at four different levels General Practice, cluster, local care hubs and west Kent wide services. Each setting will offer a different combination of accessibility and scale to cater to different types of services with different user population sizes and workforce models. Two of the levels GP Practice and west Kent wide services are already actively used. To ensure that the local care model meets the needs of the population through more co-ordinated and integrated care, general practices have organised themselves into clusters and plans are being developed for local care hubs. There are seven clusters in west Kent covering populations of between 46,000 and 82,500. Local care hubs will both deliver services and be used by clinicians and other professionals to deliver services in the community. Each hub will be a communitybased building enabling the delivery of a range of health and care services that: don t need to be delivered in a hospital setting but need to be delivered to a population bigger than cluster level. deliver services around frailty and other pathways which need a physical building. Some of the key principles informing the development of local care hubs include: complement services delivered at practice and cluster level in delivering clinical pathways for different populations co-location of accessible health, social care and voluntary sector services designed around pathways for vulnerable groups (frail, mental illness, long term conditions, dementia) as part of a patient pathway continuum from clusters into 11

secondary care a shift in patient expectation, viewing the hub as the place to attend for their first line health needs measurable shift and impact on secondary care (i.e. reduced outpatients taking place inside a hospital ) West Kent CCG has plans to work with CCGs on its borders to maximise opportunities. Specifically this will relate to services provided through the local care hubs and CCG-wide services in other areas that may be closer geographically to people that live on the borders of west Kent. Such a system will ensure that groups more vulnerable to exclusion due to geographical barriers have sufficient access to primary care services. 6. Equality Analysis The CCG has ensured that an equality analysis is undertaken before services and products are redesigned, procured or decommissioned. Equality analysis offers a structured process of ensuring that the needs of people with the nine protected characteristics under the Equality Act are considered when services are reviewed, redesigned and procured. The process ensures services and policies consider the positive, negative and neutral impact to protected groups as a result of a service redesign, decommissioning or procurement. Where negative or adverse impacts are identified, the service is able to consider ways of mitigating them in a planned manner. Since January 2017, equality analyses have taken place on the following: Medicines Optimisation Restricting the prescribing of over the counter medicines Children s Community Nursing Service development of a new service specification Care Home Strategy Local Care Plan Community Falls Prevention Service (New Service Model) Procurement of West Kent IAPT service 12

Care Homes Strategy: Improving access to primary care for older people West Kent CCG Governing Body approved the implementation of the Care Home Strategy in July 2017. The strategy is being implemented in four phases. Phase 1 focuses on improved primary care and enhanced primary care support. The aim of enhanced primary care service is to improve quality of care to older people in care homes by providing an additional level of proactive and preventative care over and above the General or Personal Medical Services (GMS/PMS) contract provided by all GPs to all nursing, residential and combined homes. Under this scheme, all GP practices will be eligible to deliver enhanced services and receive enhanced payment. The proposed service includes: 1. GP General Specialist Review upon admission to care home 2. Regular GP home round 3. Enhanced review post hospital discharge The contractual vehicle employed for this service will be a new Local Enhanced Service (LES). All practices will be eligible to provide the LES to care homes. To ensure equitable provision of medical cover and continuity of care in West Kent there will be one to one mapping of care homes to GP practices. There will be a single provider of GMS/PMS services to all patients in the named nursing, residential or dual registered home. All patients cared for within the home will be registered to the single provider on a permanent or temporary basis, unless the patient exercises choice in agreement with their existing GP provider. Care homes will be tiered from highest to lowest medical need and reimbursement will be reflective of the care home classification. West Kent care homes beds will be placed in one of three tiers. An equality analysis of the strategy was undertaken and a commitment was made to ensuring that: detailed care homes plans will be informed by patient participation groups, carers and voluntary and community groups. People with communication difficulties arising from a disability will be supported through communications in an appropriate format, via an appropriate medium (in the case of learning difficulties) in accessible language terms (in the case of autism) using unambiguous language. The project team will engage with specific patient/public groups to consider patient access and compliance with access requirements with regards to built environment. For each service commissioned, the service provider will be expected to ensure that staff receive training to ensure a quality service is offered to disabled patients including people with complex mental health needs and have a strong awareness of the needs of the nine protected groups covered by the Equality Act (relevant to the service). Translation and interpretation services will be provided for patients and carers with limited knowledge/understanding of English and cultural and faith needs of service users will be considered as part of staff training and competencies. For example, by providing 13

chaperones as requested, being aware of religious holidays and special dates when booking appointments and awareness of cultural needs of specific faith groups, such as Muslim and Jewish women. 7. Quality Innovation Productivity and Prevention (QIPP) Programme QIPP is a national programme for the NHS aimed at making efficiency savings while delivering Quality, Innovation, Productivity and Prevention outcomes. The QIPP framework at West Kent CCG includes an equality analysis. 8. Equality objectives Between July and October 2017, with the support of its Equality and Diversity Working Group, West Kent CCG undertook a review of its progress against its last set of equality objectives, along with a study of its Equality Delivery System (EDS2) and Workforce Race Equality Standard (WRES) results over the past two years. The evidence baseline was used to formulate a new set of equality objectives which were discussed and agreed with staff, the CCG s Quality Committee and Governing Body. The new set of Equality Objectives for 2017-21 are as follows: The Equality Objectives for 2017-21 are: Ensure patients and carers have equality of access and improved health outcomes through annual monitoring of providers. Provider assurance to take place annually between September and December at the Performance and Quality Committee meetings and/or Equality and Diversity Working Group meetings. Ensure staff complete their appraisals within 12 months of their joining. All staff need to complete appraisals by March 31 st each year, with clear Personal Development Plans to meet changes in healthcare commissioning. Engage and promote voice of patients, carers and public in all commissioning and decommissioning of services in 2017-18. Describe how engagement has made a difference annually to the Governing Body. Ensure all strategies undergo an equality analysis in 2017-18 for commissioned and decommissioned services to ensure fair access and outcomes for all. 14

Strategies submitted to the Governing Body will be audited for compliance annually. The Equality Objectives for 2017-21 map against the four EDS2 goals (see Table 1.1) and will be refreshed annually and championed by the Executive and Governing Body members. Table 1.1 West Kent CCG s Equality Objectives Objective 1. Ensure patients and carers have equality of access and improved health outcomes through annual monitoring of providers. Provider assurance to take place annually between September and December at the Performance and Quality Committee meetings and/or Equality and Diversity Working Group meetings. 2. Ensure staff complete their appraisals within 12 months of their joining. All staff need to complete appraisals by March 31 st each year, with clear Personal Development Plans to meet changes in healthcare commissioning. 3. Engage and promote voice of patients, carers and public in all commissioning and decommissioning of services in 2017-18. Describe how engagement has made a difference annually to the Governing Body. 4. Ensure all strategies undergo an equality analysis in 2017-18 for commissioned and decommissioned services to ensure fair access and outcomes for all. Strategies submitted to the Governing Body will be audited for compliance annually EDS2 Goal Goal 1: Better Health Outcomes for All Goal 3: Representative and Supported Workforce Goals 1 and 2: Improved Patient Access and Experience Goals 1,2 and 4: Improved Patient Access 9. Equality Delivery System (EDS2) The refreshed Equality Delivery System (or EDS2) is a performance improvement tool to help NHS organisations improve their equality performance and outcomes through a review of qualitative and quantitative evidence related to protected characteristics defined by the Equality Act 2010. The EDS2 monitors performance through a grading process with its local partners against 4 key areas or goals. These are: Goal 1: Better Health Outcomes Goal 2: Improved Patient Access and Experience Goal 3: A Representative and Supported Workforce Goal 4: Inclusive Leadership Grades using the EDS2 can either be: Excelling, Achieving, Developing or Undeveloped based on a RAG-rating methodology. West Kent CCG is implementing the EDS2 framework for the third consecutive year in 2016. 15

During 2017-18, engagement will be carried out with local stakeholders and staff in order to review the CCG s performance against four domains or goals identified below: Table 1.2 West Kent CCG EDS2 Schedule EDS2 Goal Grading achieved in 2016/17 1 Better Health Outcome Engagement and Assessment to take place in March 2018 Engagement and Assessment to take 2 Improved patient access and experience place in March 2018 Engagement will take place following 3 A representative and supported workforce publication of staff survey results in February 2018. Assessment to take place in January 4 Inclusive leadership 2018. Goal 1 and 2: Better Health Outcomes and Improving West Kent CCG is undertaking the assessment of goals 1 & 2 in partnership with local stakeholders in March 2018. The services to be reviewed will be finalised following discussions with commissioning managers and patient groups. In 2016-17, the CCG reviewed its IAPT Primary Care Psychological and Adult Continence services. Improvements resulting from the review include: IAPT Primary Care Psychological Service: Quarterly reporting on service user feedback was initiated with the lead provider. Friends and Family Tests were to be reported annually by the lead provider. Access to be service was to be reviewed monthly to monitor take-up from all sections of the community. Web-based and telephonic access were also reviewed to promote greater usage from all groups. The engagement which informed the EDS2 review for 2016-17 also informed the reprocurement of the service in August 2017. The areas for improvement identified through the EDS2 engagement have been built into the contract with the new provider. Adult Continence service: The meridian performance report on patient satisfaction and usage was to be reviewed with providers quarterly. Providers to report on telephonic follow-up with patients at agreed intervals. Clinical sites providing the service were to be reviewed for accessibility by public transport. Review of the service s website to ensure it provides patients with up-to-date and relevant information. 16

Goal 3: A Representative and supported workforce EDS2 Goal 3 and Outcome 4.3 will be graded as part of its staff forum following publication of the staff survey results in February 2018. Goal 4: Inclusive Leadership This goal assesses the CCG s commitment to equality, diversity and inclusion based on a review of commitment shown by members of its Governing Body (GB) and leadership team and a selection of its board papers over the past year. Outcome 4.1, which reviews commitment to equality, diversity and inclusion by its leadership team will not be undertaken in 2017-18, as several GB members are stepping down and a re-election to the board will be taken place in March 2018. Outcome 4.2 will be assessed in January 2018 and validated by an external partner organisation. 10. Public Health Kent Public Health Observatory provides the CCG with a range of analyses that helps understand the local health needs through their website. These include a report on health inequalities that shows marked differences in prevalence between the most and least deprived areas. The gap between Year 6 pupils in the most and least deprived areas in Kent has shown a large increase from 6.6 percentage points in 2008/09 to 11.8 percentage points in 2016/17. Children from Black and Asian ethnic origins are also more likely to be obese compared to their white classmates. This is the case in both Reception and Year 6 but is more marked in year 6. The Observatory has also completed an analysis of the drivers behind prevalence rates for each of the Districts across Kent which are published on their website http://www.kpho.org.uk. These include deprivation, ethnicity and mapping the locations of greenspace, food outlets, public & private sports facilities and supermarkets. Locality mapping of the main assets and vulnerabilities may guide understanding of some of the possible determinants of obesity within the local context. National Child Measurement Programme data for West Kent shows that in Reception, obesity and excess weight rates for Tonbridge & Malling, Tunbridge Wells and Sevenoaks are showing evidence of increase whilst Maidstone trend is flat from 2010/11. For Year 6 Maidstone Sevenoaks and Tonbridge & Malling is flat but Tunbridge Wells is reducing. The WK Health and Well Being Board has an obesity sub-group which brings together key partners which report directly to the Board. District Local Children s Partnership Groups across West Kent have also prioritised childhood obesity. 17

One You Kent Reducing health inequalities through access to information and advice One You Kent is a one-stop site on Kent County Council s website which provides extensive advice and information on a range of services that help to improve health outcomes and reduce inequalities. These include: smoking cessation, weight management, NHS Health Checks, physical exercise and access to healthy living advisors. Residents in the West Kent area also have access to the One You apps which can help them have constant access to advice and information on healthy livings. More information can be found on: http://www.kent.gov.uk/social-care-and-health/health/one-you-kent. 11. Tenders, contracts and performance monitoring Under the Equality Act 2010, NHS providers are required to comply with a number of equality-related requirements. The NHS Standard Contract is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care. CCGs are required to hold providers to account on the clauses included in the NHS Standard Contract 2017/19, including Service Conditions 12 and 13, which relates to: User Involvement and Equity of Access, Equality and Non-Discrimination. Providers holding contracts over 200,000 must ensure that: Parties do not discriminate between or against service users, carers or legal guardians with regards to the nine protected characteristics or any other non-medical characteristics, except if permitted by law. Legal adjustments are made for service users, carers and legal guardians with language or communication difficulties arising from a limited knowledge of English or a disability. The provider must carry out an annual audit of this and highlight improvements. Providers show compliance with Section 149 of the Equality Act, which includes: showing due regard to the three aims of the Public Sector Equality Duty Provide a plan on how it is complying with the clause. Implement the EDS2 in case of NHS Trusts and Foundation Trusts Implement the Workforce Race Equality Standard and provide progress reports. Providers holding contracts less than 200,000 ( small providers ) have to ensure: There is no discrimination between or against service users, carers or legal guardians on grounds of the nine protected characteristics or any other non-medical characteristics, except as permitted by Law. Assistance and reasonable adjustments are made for users, carers and legal guardians with language and communication difficulties. 18

To ensure compliance with the NHS Standard Conditions of Contract, West Kent CCG undertakes an annual audit of key providers. In 2017, desk-top review of the following key providers were undertaken, followed by a request for progress reports. See Table 1.2 for key highlights. Table 1.2: West Kent CCG s key providers compliance on equality and diversity Provider Equality Delivery System WRES Annual Equality Report on website Equality Objectives published CQC Results for Well-Led Domain Kent Community Health Foundation Trust No report on website Yes action plan for 2017-18 published Annual Report 2016/17 on website Workforce charts published, March 2017; Yes Good Maidstone and Tunbridge Wells NHS Trust EDS2 Report for 2016/17 on website covers Outcomes 1.2, 2.2 and Goal 3 (all outcomes except 3.2) WRES Report and Action plan for 2016/17 Annual Equality Report 2016 on website Yes, 4 equality objectives included in Annual Equality report 2016 Inadequate (2014), results from inspection in 2017-18 expected. Kent and Medway NHS and Social Care Partnership Trust No report on website WRES Report 2016 Annual Report 2016/17 No Good (April 2017) 12. Workforce Race Equality Standard The Workforce Race Equality Standard (WRES) is a benchmarking tool introduced by NHS England to assess the progress of race equality within NHS organisations annually, following an initial evidence baseline gathered in 2015. The WRES is based on new research on the scale and persistence of such disadvantage and the evidence of the close links between discrimination against staff and patient care. The Standard will highlight any differences between the experience and treatment of White staff and BME staff in the NHS with a view to closing the gap through an action plan. The CCG Improvement and Assessment Framework 2016/17 assesses how CCGs are using the intelligence gathered from WRES to initiate change and monitor providers under the Leadership domain. West Kent CCG has collated its data against the indicators for third year in 2017. 19

An internal report and action plan on the WRES was considered by the Governing Body in November 2017 and the findings will be used to inform the EDS2 grading for Goals 3 and Outcome 4.3 and its action plan. The CCG has been monitoring key providers for their compliance on the WRES through its contract monitoring process and Quality Committee (see Table 1.1 on page 17). 13. Training and Development Staff and Governing Body members at West Kent CCG are supported to be compliant with the Equality Act through access to training, guidance on undertaking equality analysis and opportunity to participate in engagement workshops with patients, carers and the public. In 2017, staff benefited from: 2 equality and diversity awareness training sessions in June and July 2017 1 Equality Analysis training session in July 2017. Compliance rates for equality and diversity statutory and mandatory training as at October 2017 was: 78%. 14. Employee Engagement Staff have the opportunity to voice their concerns to the organisation through a quarterly staff forum and an annual staff survey. The staff forum was set up following a recommendation from last year s EDS2 engagement on Goal 3 and Outcome 4.3. It is currently attended by representatives from key functions and is supported by the CCG s Company Secretary. In addition, staff have opportunity to voice their concerns on equality and diversity through the annual engagement event to grade Goal 3 of the EDS2 and through team meetings and one-to-one meetings. Around 40 members of staff participated in the workshop to develop the CCG s Equality Objectives for 2017-21 in August 2017. 15. Patient and Public Engagement Section 242 of the NHS Act 2006, places a statutory duty on NHS organisations to involve and consult patients and the public in the planning of service provision, development of proposals for change and decisions about how services operate. Section 24A of the NHS Act 2006 places a statutory duty on NHS organisations to report on consultations and the influence on commissioning decisions. These duties complement the 20

general equality duty to eliminate discrimination, advance equality of opportunity and promote good relations among people with different protected characteristics. WK CCG seeks every opportunity to involve local people in our mission of commissioning a safe, sustainable and affordable patient-focused healthcare service that provides quality patient experience and improves outcomes for local people. Engagement Networks and Structures A detailed database of West Kent contacts is maintained and updated regularly to ensure information and engagement requests are cascaded out to a wide range of stakeholders. These include individual Health Network members, Healthwatch, voluntary organisations, communities with particular and diverse interests, councils, schools/colleges and health and care providers. Our Health Network is a virtual group of patients, the public and voluntary groups who are interested in getting more involved in how services are planned and designed. Applications for the network are available on the website: https://www.westkentccg.nhs.uk/getinvolved/west-kent-health-network/ and included in the Patients Newsletter which is sent out to all on the contacts database regularly. Our PPG (Patient Participation Group) Chairs Group continues to meet every six to eight weeks to discuss individual commissioning priorities, review engagement plans and contribute to the discussion in the moment. A range of new venues are being trialled. Recent agenda items have included an update on the financial recovery plan and the introduction of a PPG Chairs buddying project to boost attendance and refresh membership. This project is part of the incentive payment scheme. The system, through which PPG chairs can access financial support for engaging with their practice populations to get feedback on agreed priorities, is going well. We are keen to support the Chairs and GP practices in setting up and/or maintaining Patient Participation Groups and have made a range of PPG information and tools available on the CCG website: http://www.westkentccg.nhs.uk/get-involved/patient-participation-groups/ An engagement update report is provided to the bi-monthly Quality Committee so that any common themes across other quality reports can be identified and acted on or other areas in need of engagement identified. In 2017, the CCG undertook a range of engagement activities. A cross-section of these are presented in the Table 1.3 below: 21

Focus of work Engagement activity How the engagement feedback is being used Sustainability A report pulling together feedback from all the and listening events has been prepared by Transformation independent analysts. It will go to the Local Care Partnership (STP) Board on 5 December. local care, and integrated urgent care Six public listening events were held across west Kent in August and September. More than 200 people attended, and heard presentations on local care plans, integrated urgent care and stroke services. There were questions and answers, followed by small group discussions about local care and urgent care. All feedback was captured. Overall, there was a positive reaction to the local care model and the plans for integrating and improving urgent care and 111. Key concerns included: transport issues, capacity to deliver especially regarding workforce and a lack of focus on mental health and social care provision. Attendees felt that the reputation of NHS 111 could be a hindrance, and that communication of changes is key for success. A detailed report is being finalised and will be published and shared with participants, the Local Care Board and the wider STP partnership. It shows the synergy between areas as a similar process is underway across Kent and Medway. The final version will be published on the CCG website. In October, engagement staff participated in two targeted community and voluntary sector STP events where 130 organisations met to discuss how they could be part of the STP. This work is the start of a closer partnership between the STP and the voluntary sector. Contact with west Kent community and voluntary sector organisations will continue to be expanded and new distribution networks developed to facilitate better signposting, more joined-up services and ensure better representation from different population groups. The west Kent self-care and social prescribing group met: there will be a whole-kent One You promotion event in late January and a bid for national funding is being submitted to support social prescribing across the GP clusters by Involve (a voluntary sector organisation which facilitates partnership working) working with the CCG. This will include an online directory and outreach or community workers in each of the seven clusters. Additional roadshows were carried out at community events with a high footfall, to reach seldom heard groups and working age adults. All evidence is being reported to the STP programme management team and an evidence log kept. Engage Kent undertook a specific piece of work targeting seldom heard Members of the STP Patients and Public Advisory Group (PPAG) attended the STP One Year On Conference to contribute the patient/lay perspective, while engagement staff helped to record attendees views. West Kent patient rep John Potts has joined the Improvement Board and strategic commissioning work streams, and is hoping to facilitate closer working between the PPGs and the district councils. 22