Equality Act 2010 Public Sector Equality Duty. Annual Compliance Report on the CCG s Four-Year Equality Objectives.

Equality Act 2010 Public Sector Equality Duty Annual Compliance Report on the CCG s Four-Year Equality Objectives 28 January 2016

1. Introduction and Context Introduction NHS Southwark Clinical Commissioning Group (CCG), like other NHS and public bodies, has a number of equality duties that they must comply with. In this respect, the key statutory duties are contained in the: Human Rights Act 1998 Equality Act 2010 (which includes the Public Sector Equality Duty) Health and Social Care Act 2012 Equality objectives The Public Sector Equality Duty (PSED) is a statutory duty, which is incorporated into the Equality Act 2010. This duty requires public bodies to set their four-year equality objectives, based on key local equality priorities, and report progress on them by 31 January of each year. The challenges to make local NHS services inclusive for Southwark s diverse population cannot be underestimated, particularly under the present financial constraints on health and social care expenditure. The equality objectives reflect local equality priorities for Southwark s diverse population. The CCG s four-year equality objectives were chosen as part of the authorisation process in 2012. They reflect the key equality priorities pertinent at that time. These are: 1. Equality Objective 1 Engagement and Patient Experience 2. Equality Objective 2 Learning Disability 3. Equality Objective 3 Mental Health 4. Equality Objective 4 Provider Contracts 5. Equality Objective 5 Care Homes in Southwark About this report This is the CCG s fourth annual compliance report on our four-year equality objectives. The scope of this report is limited only to the CCG s five equality objectives. The full range of the CCG s activities in relation to equality, human rights and health inequalities are captured in our Equality Delivery System (EDS2) reporting framework, which will be presented and discussed at the Governing Body meeting in March 2016, and will be available via the web link below. The previous equality objectives progress reports (2013, 2014 and 2015) can be viewed by following the links at: http://www.southwarkccg.nhs.uk/about-us/equality-and-diversity/pages/default.aspx Report development and feedback Prior to publication on the CCG s public website (29 Jan 2016), this report was presented for feedback at the: Quality and Safety Sub-Committee (QSSC) 12 Jan 2016 Equality and Human Rights Steering Group (EHRSG) 27 Jan 2016 2

Integrated Governance and Performance Committee 28 Jan 2016 Equality and human rights duties what the CCG needs to do In addition to the PSED, the CCG has other equality, human rights and health inequalities duties that it must comply with. These include: Nine protected groups must not unlawfully discriminate in commissioning services or employment practice in relation to the nine protected groups: Age Disability Gender Reassignment Marriage and Civil Partnership Pregnancy and Maternity Race Religion or Belief Sex Sexual orientation Public Sector Equality Duty must work towards the general duty and specific duties (see below) General duty must pay due regard to the three aims of the general duty this means tackling prejudice, promoting equality of opportunity and taking into account the needs of all the protected groups in the way we commission services Specific duties must set four-year equality objectives, based on key local equality priorities, and report progress on them by 31 January of each year Human rights must ensure that commissioning decisions safeguard vulnerable people, and do not put people s lives at risk or expose them to inhumane and degrading treatment The NHS Constitution this brings together a number of rights, pledges and responsibilities for staff and patients alike all in one place Health inequalities must work towards reducing health inequalities for the whole local population, including seldom heard and socio-economically deprived communities Equality analysis (EA) no longer a strict legal requirement, but EAs provide evidencebased assurance of how the NHS is promoting equality, protecting human rights, reducing health inequalities and compliance with the general duty Equality Delivery System (EDS2) must comply with the mandatory (April 2015) equalities reporting framework for the NHS, which consists of four goals and 18 outcomes 3

2. Equality Objectives Progress in 2015 Equality Objective 1 - Engagement and Patient Experience progress in 2015 Aim of the objective The aim of this objective is to ensure equality of access and patient-centred services for Southwark s diverse population. This means: Previous actions on this objective Moving the equalities work to the Membership and Engagement Team Aug 2014 Establishing the Equality and Human Rights Steering Group (EHRSG) Nov 2014 Engagement on Extended Primary Care Access Working with Southwark Council to map marginalised groups in Southwark focusing on equality of access to mental health services for high risk and vulnerable groups. Outreach work by engaging people involving patients, carers and stakeholder organisations representing the nine protected groups including seldom-heard and socio-economically deprived communities Promoting equality, protect human rights and address health inequalities Progress made in 2015 on this objective The CCG has engaged with a diverse range of local people, stakeholders, patients and organisations on various aspects of commissioning, access and health and wellbeing outcomes. For further information, please see the CCG s annual report on engagement. Both the CCG s Membership and Engagement Workplan 2014-15 and Annual Report on Engagement 2014-15 can be found on the website at: http://www.southwarkccg.nhs.uk/news-and-publications/publications/policies-strategiesregisters/pages/default.aspx Increasing involvement and engagement of seldom heard voices: an outreach project The CCG had recognised that, in addition to the nine protected groups, there was a gap in involving and engagement with with seldom-heard communities, and agreed an approach at the Engagement and Patient Experience Committee (EPEC) in January 2015, which is being reported at EPEC on 22 January 2016 and will be available as part of a EPEC papers by following the links at: http://www.southwarkccg.nhs.uk/get-involved/epec/pages/default.aspx

Outcomes of the outreach project Outcomes of the engagement identified at the beginning of the approach include: Increased awareness of opportunities for engagement and involvement Building confidence in local people to have their say Increased participation of people with mental and/or physical health issues and/ or learning disabilities Increased engagement activities for people with different levels of literacy and numeracy skills Improved engagement with people who do not have English as a first language Increased engagement with different age groups Increased engagement activities for people who have work commitments. Methodologies A range of methodologies were used including: Outreach with specific groups such as the Latin American women rights service, Dragon Café, CoolTan Arts, Southwark Disability Association, Substance Misuse User Council and Speaking Up Use of personas to engage with people with dementia and their carers Engagement with obese people (BMI 35) Outreach at shopping centres (East Street Market, Tenants and Residents Associations) to identify people of working age Work with the Youth Council and organisations working with children and young people Attendance and speaking at Pensioners Forum, Health Fair as part of the Black History Month and Link Age AGM Running a focus group at a Black Majority Church 5

Next steps for the outreach project A full evaluation report on the project is being written with recommendations that will build on the outcomes. For example, consideration is being given to: develop an engagement template for commissioners to help them plan their engagement, map clients/ stakeholders (including seldom heard groups) and develop methodologies to successfully engage with a range of people, linking with and carrying out an equality analysis develop a sophisticated database working with the voluntary sector to ensure we have up-to-date contact details of all community and voluntary organisations in Southwark. We will then be able to filter results to target our engagement e.g. older people s organisations, mental health organisations, youth groups and faith groups working more closely with Southwark Council s community participation team to collate a range of patient stories across different demographic groups National Patient Insight Dashboard The CCG has subscribed to the national Patient Insight Dashboard to provide granular patient feedback using a range of data including national surveys, Family and Friends Test, patient opinions, NHS Choices and from our providers (hospital trusts and GPs). Equality Objective 2 - Learning Disability progress in 2015 Aim of the objective The aim of this objective is protect human rights, improve equality of access, outcomes and autonomy for Previous actions on this objective Key areas of development in 2014 include: Establishment of the Winterbourne View Steering Group Establishment of the Winterbourne Concordat 6

people with learning disabilities. This means: Acknowledging the consistent evidence that people with learning disabilities fair worst when accessing mainstream health and social care services Focusing on implementing the Winterbourne View recommendations, which raised fundamental human rights issues about dignity, respect and equality of treatment for people with learning disabilities Establishment of the Strategic Local Area Plan Rolling out of Personal Health Budgets (PHBs) for NHS fully funded healthcare clients with learning disabilities Joint health and social care reviews of out of borough placements for clients with learning disabilities Quarterly reporting on status of all patients with a learning disability and challenging behaviour or autism in inpatient beds Development of a service specification for in and out of borough learning disability placements Continued use of the Out of Borough Placement Protocol Use of the Any Qualified Provider (AQP) Framework to monitor the quality of homes outside the borough. Agreement with the AQP Team that quality data will be collected on all residents in the home rather that just the client placed by the CCG thus allowing broader monitoring of quality and facilitate more accurate benchmarking Progress on this objective in 2015 The CCG, in partnership with Southwark Council, continue to make good progress on this objective. For example: Personal Health Budgets (PHBs) are fully rolled out for both adults and children in receipt of continuing healthcare Joint CCG and local authority (LA) PHBs policy developed for children and young people Choice and control is at the centre of the Children and Families Act 2014 (the Act), which places greater emphasis on enabling parents and young people to influence the design, delivery and review of their support The Act introduces education, health and care plans for all children and young people aged 0 25 with special educational needs and disabilities 7

Education, health and care plans respond to the spectrum of special needs that a young person may have, by outlining support and provision targeted to these specific needs The Act also introduces a duty on local authorities to provide the option for parents and young people to access personal budgets The CCG and the LA fulfil this duty by implementing the PHB Policy, which will form part of the Children and Adults Services Special Educational Needs and Disability policy (currently being developed) Winterbourne View and Transforming Care Winterbourne View has been renamed as Transforming Care, which refers to the following cohort people in in-patient beds for mental and/or behavioural healthcare who have either learning disability and/or autistic spectrum disorder (including Asperger s syndrome) The CCG continues to work in partnership to ensure continued compliance with Transforming Care The CCG and LA have a Transforming Care RAG Report which is updated monthly to track all individuals in assessment and treatment and/or out of area placements The CCG reports bi-weekly and monthly to NHS England on clients in the transforming care cohort This is discussed in detail at the Transforming Care Steering Group (this replaced the Winterbourne Steering Group), which occurs every 6-8 weeks The CCG is compliant with all seven Transforming Care commissioning standards Internally, with regard to Transforming Care compliance, the CCG reports to the Integrated Governance & Performance Committee and via this committee to the CCG Governing Body Development of risk registers The CCG is working with the LA to develop risk registers that: track the at risk of admission to assessment and treatment due to breakdown of care in the community track all child and adolescent mental health services (CAMHS) in assessment and treatment meeting the transforming care criteria and those at risk of admission due to breakdown of care in the 8

community Care Treatment Reviews The CCG is leading on the implementation of Care Treatment Reviews (CTRs) for all clients meeting the Transforming Care criteria in assessment and treatment (A&T) beds within 6 weeks of admission The CCG has also worked with relevant community teams to put in place core admission CTRs to try and avoid admissions to A&T - these are in place for both adults and CAMHS Equality Objective 3 - Mental Health progress in 2015 Aim of the objective The aim of this objective is to ensure equality of access to mental health services for black, Asian and minority ethnic communities (BAME) and marginalised groups in Southwark. This means: Learning from previous interventions such as Delivering Race Equality and the Count me in Census about the disproportionate access and use of mental health services by the Black, Asian and Minority Ethnic (BAME) communities Previous actions on this objective Jointly reviewed with public health the prevalence of psychosis amongst the black, Asian and minority ethnic (BAME) community to inform local intelligence and clinical/community care interventions Review of BAME and marginalised groups in Southwark in relation to mental health services Personal health budgets and mental health My Life, My Home, My Choice a joint project with Southwark Council to look at how personal health and social care budgets can be used to support people who would otherwise require residential care providing more choice and control to the individual over the care and support they receive Progress in 2015 on this objective During 2015, the CCG and its partners, focused on engaging thematically with BAME communities and wider, in relation to mental health, wellbeing and dementia. Summary of Dragon Café topics 2014/15 As part of a rolling monthly programme of engagement with patrons of the Dragon Café, the mental health commissioning team engaged on eight topics concerning mental health services in Southwark. These are: Mental Health Strategy 9

Recognising and addressing the disproportionate level of compulsory sectioning of Black African/Caribbean men under the Mental Health Act Promoting anti-stigma messages about mental health and self-directed care and wellbeing Engaging and involving the BAME communities and marginalised groups to ensue mental health services are accessible and patient-centred Wellbeing Hub Child and Adolescent Mental Health Services (CAMHS) Adult Mental Health (AMH) Service Re-design Dementia and mental health services for older adults BAME Communities Parity of esteem integration or physical and mental health services Crisis Care Concordat, which focusses on four main areas: 1. Access to support before crisis point 2. Urgent and emergency access to crisis care 3. Quality of treatment and care when in crisis 4. Recovery and staying well Outcomes of the engagement Patrons spoke extensively about their experiences in crisis and relayed the importance of crisis support out of hours such as the use of online peer support and blogging Extension of the crisis telephone line was widely supported as was the addition of crisis beds in South London and Maudsley NHS Foundation Trust (SLaM). The mother of a Southwark service user praised the support they gained in A&E at King s for their responsive and caring approach to mental health assessment BAME Engagement During 2015, the CCG and Southwark Council focused on engaging with the BAME community at a number of events. These engagement events built on the Overview and Scrutiny review and Mental Health Needs assessment to identify which groups are affected by inequality of access and support. The learning from the events were also fed into Southwark s Joint Mental Health Strategy. Key areas of focus included: 10

Access to community services as Southwark inpatient services are utilised by more black African/Caribbean men due to psychosis than the general population Access to interpreters where there may be possible language barriers Staff understanding of behaviour in the context of cultural and religious beliefs What can Southwark do to ensure more BAME residents utilise community based mental health services? Outcomes of the engagement Patrons expressed feelings that there are very good mental health support groups in Southwark for some cultural groups but not others The nature of these groups very much depend on the culture, such as Somalian women are very close knit and it is culturally acceptable to openly discuss mental health whereas in groups of Arabic men, this is a very different ethos When patrons were asked about access to services for BAME groups, they felt they could only answer from their own perspective, but related in general to the idea that if mental health services were not specifically labelled at the entrance, then patients and service users from particularly underrepresented cultural backgrounds may feel more comfortable in accessing the services Wellbeing hub engagement and launch The wellbeing hub was launched in April 2015. Prior to procurement of the service and launch, proposals were taken to the Dragon Café to test the proposed areas of support, navigation and information built into the service model. The emergent themes included: Crisis when I m in crisis I don t always know what I need, I need some level of guidance of what is available and what may help so I can make a decision Access buddying systems, paid peer support, open access and drop in services Support Networks guidance and support on communicating your illness with families and 11

delivery of structured sessions with carers/family and friends to understand an individual s illness and signs to look out for Ethos: everyone who comes into contact with services should be made to feel like they are the best person in the world and not just another person to walk through the door everyone is equal and it is just a case of unlocking talent the importance of lived experience should be at the heart of the hub Engagement with the Latin American population In 2016/17, the CCG and Southwark Council are focusing on the Latin American population in relation to the prevalence of dementia in BAME communities. This initiative has been informed by engaging with the local Latin American community, and the findings for the research paper, Dementia in a Black and minority ethnic population: characteristics of presentation to an inner London memory service. Engagement on improving dementia services in Southwark The CCG and Southwark Council engaged local people in various ways on improving dementia services, and understand what outcomes are important two people with dementia and their carers. The methodologies included: Surveys Semi-structured interviews, use of personas, focus groups and tea party In-depth case studies Patient journey mapping Community asset mapping Persona of Sam Focus groups 12

Tea Party Key themes emerging from the engagement Understanding dementia in the context of the whole person Receiving care at home Opportunities to participate in the community Living well throughout life course Improved acute care Improved care home provision Increased support for carers Deliver personalised care Challenge the culture around receiving support Tackle issues facing all older people What patients and carers want Receive a timely diagnosis, delivered in a sensitive way Feel listened to and able to make decisions about their own care needs Feel valued and understood Supported to live well Know that everything will be taken care of Know that loved ones will be supported What professionals want Information and advice / training / awareness raising Clarity over the right pathway 13

To understand the benefits of diagnosis Understand what support is available Next steps from the dementia engagement outcomes The main outcomes identified will help us to improve the dementia pathway for patients and carers in Southwark The Institute of Public Care (IPC) is supporting the CCG and Council to develop an integrated dementia care pathway for Southwark The engagement will inform the CCG and Local Authority's plans over the next 5 years Equality Objective 4 - Provider Contracts progress in 2015 Aim of the objective The aim of this objective is for the CCG to assure itself that provider contracts, service level agreements, and commissioning specifications are safe and meet the needs the local diverse population. This means: Monitor and review services for quality and safety Previous actions on this objective Established a Quality and Safety Sub-committee (QSSC) in September 2014, tasked with monitoring and improving the quality, safety, equality and compassionate care outcomes from providers. Established a Equality and Human Rights Steering Group, which reports to the QSSC to ensure that equality and human rights underpin not only commissioning, but also how we monitor the quality of provider services. Developed a provider Quality Site-Visit Framework Progress in 2015 on this objective The CCG produces quarterly provider quality reports, and work continues to further develop them with particular focus on patient experience and soft intelligence The framework for quality site visits has been refined to be more responsive and informative to visits The CCG has also made prearranged visits to female acute mental health at SLaM, maternity ward at 14

Ensure access to services is equitable for the local diverse population and delivered with compassionate care King s, Improving Healthcare Limited (IHL) in primary care, and currently arranging a visit to theatres in King s and to a best practice ward at SLaM An action plan followed the last visit to IHL, which will be monitored through the appropriate contract meetings With Kings, the CCG is very much positioning itself as a critical friend with informal as well as more formalised visits to its clinical areas with the support of King s director of nursing and the incoming medical director Commissioning for outcomes and development of Local Care Networks As part of the Four Year Forward Plan, the CCG is moving towards a commissioning for outcomes based approach. This is a whole population approach, and known as outcome based commissioning. This new approach moves away from the traditional activity based model to an outcomes based system. This means that rather than specifying providers how services should be delivered, commissioners instead, focus on the health and wellbeing outcomes they want for the whole of Southwark s diverse population. The new commissioning model also moves away from lots of separate contracts and towards populationbased contracts that maximize quality outcomes (effectiveness and experience) for the available resources. Focusing on commissioning services that are characterised by these attributes of care also take into account people s diverse needs. With an outcomes based system, service providers work collaboratively, through Local Care Networks (LCNs) to redesign care pathways that: prioritise clinical and functional outcomes that are meaningful to patients enhance patients experience of care promote prevention and wellness reduce the burden of disease and health inequalities 15

One of the enablers of LCNs are GP Federations, one in the north, and one in the south of the borough working as active partners within the LCNs to deliver enhanced local health and social care services. More strategically quality outcomes are being looked at as underpinning the development of the five year forward view plan for the CCG, and patient defined outcomes will direct the success of delivery of care in these new contracts Equality Objective 5 Care Homes in Southwark progress in 2015 Aim of the objective The aim of this objective is to ensure care home residents human rights are protected so that they are treated with dignity, respect and compassionate care. This means: Improving the support framework for those with dementia and nursing needs Ensuring all care homes in Southwark have the same high quality standard of compassionate care across the borough Previous actions on this objective A comprehensive review of the approach and provision of Home Care services to the community, including nursing provision and care for those with dementia Developed and implemented a pilot project My Home Life Southwark Care Home Improvement Project. My Home Life is a nation initiative aimed at improving the quality of care homes. Southwark have adopted and begun implementing this model Working with the CCG to improve access to nursing for those living with dementia in in care homes Developed a standard care professional personal and skillset specification Started to develop Transformational Leadership skills (embedding Human Rights, Compassionate Care and the Francis and Winterbourne View recommendations) Developed an improvement and outcomes framework including a learning and development academy Provision of training and development opportunities via a new learning and development academy Progress in 2015 on this objective The CCG has taken a multidisciplinary approach (MDT) to improving the quality of care in care homes in Southwark in order to achieve the following aims: To ensure that the clinical services provided in care homes are contributing to the delivery of better 16

Work with providers to improve staff training, talent management and recruitment of high quality compassionate staff outcomes for the clients that live there To provide a consistent primary care service to care homes with nursing supported by a multidisciplinary approach including secondary care, the Care Homes Support Team, Community Pharmacy and Social Care To work collaboratively to develop and embed good practice to ensure high quality care for these clients To support the achievement of the CCG s objective to improve health and address inequalities Actions taken GP Contract for Care Homes with Nursing - an enhanced Primary Care contract was procured, which included a set number of sessions and required a commitment to multi-disciplinary and multiagency collaboration. Outcome measures were also put in place that emphasised proactive medical management and a reduction in unplanned hospital use Consultant Support A Consultant Physician in Clinical Gerontology from King s College Hospital NHS Foundation Trust worked to provide additional medical support through joint visits and to provide mentoring and support of the GPs working with the care homes with nursing Health and Social Care Integration - Southwark council appointed two social workers to work exclusively in care homes with nursing to support the enhanced model. Multi-disciplinary Team working a core multidisciplinary team was developed that comprised: Three GPs working with the care homes with nursing Consultant Old Age Physician Two social workers Older People s Specialist Nurses from Guy s and St Thomas NHS Foundation Trust 17

A care homes pharmacist from the NHS Southwark Clinical Commissioning Group Medicines Optimisation Team Specialist Palliative Care Teams from Guy s and St Thomas NHS Foundation Trust and St Christopher s Hospice Staff and managers from the care homes with nursing Multidisciplinary team meetings these are held on a monthly basis in each home to discuss residents needs, provide coordinated support and ensure learning. Care Homes Network Meeting - a quarterly care homes network meeting was held jointly with NHS Lambeth Clinical Commissioning Group and the care homes with nursing in the area. This group: provided a space to discuss topical issues in care homes with nursing featured presentations from care homes with nursing on clinical innovations in their homes received external speakers, for example from London Ambulance Service, who shared information the network Initial results from the changes Initial results show that in 2014/2015 in Southwark, amongst elderly residents in care homes: The rate of A&E attendances fell by 15% The rate of emergency admissions fell by 13% The proportion who attend A&E but were discharged without admission fell by 31% Of those who attended A&E but who were not admitted, the proportion undergoing only minor investigation and treatment in A&E fell by 14% The principal source of this improvement is the coordinated, proactive and integrated approach to working with care homes with nursing to support their residents 18

Professionals involved with the services report greater work satisfaction and improved care through working together, sharing learning and concerns within a professional community Conclusions and way forward The importance of initiating and maintaining good relationships between primary care and care home management teams Close relationships between the link consultant geriatrician and the GPs means we can share communication in a useful and reciprocal way An MDT community means that all the relevant professionals are able to communicate effectively and support patient centred care Social work and health care working closely together improves the management of safeguarding ensuring that we are effective, appropriate and proactive in keeping patients safe and in respecting patient s choices A regular network meeting provides a platform for shared learning and change Having 1-2 regular GPs serving each home encourages continuity and reduces variation in care We are able to work together with the patient and families and provide truly holistic and considerate care Regular audit of hospital admissions and the sharing of results with the multidisciplinary team drives improvement in the quality in all areas from advanced care planning which is unique for each patient to reviewing themes which prompt development of safer protocols across the homes The communication with and support and vision of NHS Southwark Clinical Commissioning Group has meant that the funding requirements are recognised and continue for this effective service 19

3. Other Developments Equality Delivery System (EDS2) In 2015, the CCG took further initiatives to assure itself that addressing equality, human rights and health inequalities for Southwark people are at the heart of its functions. In particular, the CCG undertook a comprehensive EDS2 self-assessment across the four goals and 18 outcomes. In addition, on 1 December 2015, the CCG held an equality and human rights stakeholders workshop. EDS2 self-assessment During 2015, the CCG conducted a comprehensive self-assessment on how it was progressing against EDS2 s four goals and 18 outcomes. In summary: Goal one (better health outcomes) the self-assessment indicates that the CCG is amber (developing) largely because the CCG does not have full data about health outcomes of our diverse population from the perspective of the nine protected groups Goal two (improved patient access and experience) the self-assessment indicates that the CCG is amber (developing) largely because the CCG does not have full data about access and patient experience of our diverse population from the perspective of the nine protected groups Goal three (a representative and supported workforce) the self-assessment indicates that the CCG is green (achieving) Goal four (inclusive leadership) the self-assessment indicates that the CCG is amber (developing) A key finding of the self-assessment is that the CCG needs to review the use of both provider and public health data. Equality and human rights stakeholders workshop On 1 December 2015, the CCG held an equality and human rights stakeholders workshop with invited local people and organisations that broadly represent the nine protected groups. The purpose of the workshop was to ascertain from the participants the answer to some key questions: 1. Examples of good experience of using local health care services 2. Examples of bad experience of using local health care services, and what would have made these better? 3. Examples of what we can all do together to ensure that we are meeting the needs of our diverse communities? The workshop report is currently available via the link below. A key issue highlighted was around access to interpreting services. These and other issues will be incorporated into the development of the EDS2 action plan, revised equality objectives and the equality and human rights strategy. http://www.southwarkccg.nhs.uk/about-us/equality-and-diversity/pages/default.aspx

4. Risk factors There is no discernible risk to the CCG in this area. The CCG is able to demonstrate a strong track record in continuously embedding equality and human rights outcomes into its commissioning processes as well as compliance with statutory equality duties and governance. The next statutory requirement is for the CCG to publish evidence by 31 January 2016 on progress being made on its four-year equality objectives. 5. Conclusions and next steps Over the past three years, since its inception, the CCG has made good progress on its equality objectives that were initially set in 2012 as part of the authorisation process. As can be seen in this report and the previous three reports, steady and measurable progress has been made on all of the five equality objectives. The EDS2 self-assessment and the stakeholder workshop on equality and human rights highlighted a number of local equality gaps. Potentially, an outcomes based commissioning model with providers working collaboratively, through Local Care Networks (LCNs) to redesign care pathways, could meet the healthcare needs of Southwark s diverse population better. Going forward, consideration should be given to refresh the current four-year equality objectives to reflect current challenges, gaps identified, Five Year Forward Plan and the CCG moving towards a commissioning for outcomes based system. In this respect, consideration should be given to refresh the current equality objectives to be aligned with commissioning for outcomes, EDS2 gaps and joint commissioning with Southwark Council, in particular, aligning them with the joint commissioning units for children and young people, mental health and adults with complex care needs. Next steps The CCG is committed to commissioning for outcomes that includes promoting equality, protecting human rights and reducing health inequalities. In 2016/17 the CCG will be: Developing an EDS2 action plan to address issues identified in the EDS2 selfassessment on all four goals and 18 outcomes. Map demographic data that is available from providers, and use this to understand the impact of services on our diverse community, identify any gaps and work with providers to address these Identifying and refreshing the equality objectives that come out of EDS2 self-assessment, and aligning them with local equality priorities, commissioning for outcomes and joint commissioning with Southwark Council 21