Commissioning for outcomes: Equality and health inequalities at the heart of project planning

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Information about Commissioning for outcomes: Equality and health inequalities at the...
Health & Medicine

Published on March 10, 2014

Author: NHSExpo



Health and Care innovation Expo 2014 - Pop-up university, Day 1.

Commissioning for outcomes: Equality and health inequalities at the heart of project planning.

Angela N Mkandla, Fiona Pearson, Permjeet Dhoot, Sharon Benford & Hayley Haycock.

#ccgs #Expo14NHS

Equality and health inequalities at the heart of project planning 03 March 2014

Public sector equality duty (Equality Act 2010) • Eliminate discrimination, harassment, victimisation and other conduct prohibited by the Act • Advance equality of opportunity between persons who share a relevant protected characteristic and those who do not share it • Foster good relations between persons who share a relevant protected characteristic and persons who do not share it

Specific duties • Publish information to demonstrate compliance with the public sector Equality Duty, annually from 31 January 2014. The information must be published in such a manner that it is accessible to the public, either in a separate document or within another published document • Prepare and publish equality objectives at least every four years starting by April 2013. All such objectives must be specific and measurable

Health inequality: NHS England‟s duty The Health and Social Care Act 2012 “must, in the exercise of its functions, have regard to the need to – (a) reduce inequalities between patients with respect to their ability to access health services; and (b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.” (Section 13G)

Equality Delivery System (EDS2) • Tool kit to help NHS organisations improve the services they provide for their local communities, consider health inequalities in their locality and provide better working environments for those who work in the NHS. • Used effectively, it supports NHS organisations to meet their legal equality duties under the Equality Act 2010, deliver on the NHS Outcomes Framework and the NHS Constitution and, if they are providers, meet the Care Quality Commission‟s “Essential Standards of Quality and Safety”. • The refreshed EDS2 is now being used by many NHS organisations - the use of the EDS (or an equivalent to it) was part of the CCG authorisation process and NHS England has given a commitment to implement it at national level.

Equality-based SWOT analysis Project management lifecycle

Project objective Increase the number of black minority ethnic (BME) males accessing healthchecks due to increased incidence of coronary heart disease (CHD) in this population. Proposed approach Specifically target taxi drivers to access healthchecks via local walk-in centres. Justification Taxi drivers are representative of the BME population, have strong community links and highest rate of mortality from CHD than other occupational groups. Scope BME taxi drivers in the local NHS area.

Design phase (or initiation / start-up) – Define scope and objectives, and how you plan to deliver against them – Model organisation and governance structure – Initial look at business case and risks – Get approval to proceed Equality – Screen for any known equality and health inequality issues in the stakeholder groups the project impacts. To start your analysis you will need to have a clear idea of who is intended to benefit from the project and why. – An equality-based SWOT analysis is a useful way of doing this. A yes / no / maybe response is all that is necessary at this stage... Make use of links with colleagues in: • Public health • Equality / health Inequality • Analysts • NICE Guidance • Community groups

Strengths Positive impact (Yes) Links to existing activity (Yes) Good data (Yes - quantitative) Strong governance (Yes) Weaknesses Potential negative impacts (Yes) Lack of positive impacts (No) Lack of data (Yes) Poor stakeholder buy-in (Maybe) Opportunities to… Lessen negative impacts (Yes) Strengthen positive impacts? (Yes) Build a representative team and governance structure? (Maybe) Create an inclusive project environment (Maybe) Threats Barriers to engaging stakeholders and / or delivery partners? (Yes) Dependencies / interdependencies? (Maybe) Resource pressures (Maybe) Protected characteristics: • Age • Disability • Gender reassignment • Pregnancy / Maternity • Race • Religion / Belief • Sexual orientation • Marriage / civil partnership

Reflect the key results of your SWOT analysis in your project documentation, paying attention to: • Any initial known risks for equality / health inequality • Remember the evidence will not always „fit‟ the wording of protected characteristics. For example, impact on: Homeless people, alcohol and drug users, asylum seekers and refugees. Social and geographical inclusion must be considered • How the project / programme‟s strategic objectives align to the goals of the NHS Equality Delivery System (EDS2) • Have you reflected equality and health inequality in: • team role descriptions • terms of reference • board / meeting agendas Record approach in: Project brief Initial risk register Project organisation / governance charts Role descriptions Aim to submit the equality outputs of the design stage to your inaugural project board meeting for approval.

You‟ve got approval to proceed. Now: • Expand business case (reasons for doing this) • Appoint team and project board • Agree scope • Define products project will deliver • Plan the „how‟ and „when‟ • Identify how you will control the project » Quality » Reporting » Risks / Issues Equality • Focus is on building your evidence base • Revisit and expand on your earlier SWOT analysis to inform development of the project plan.

Prompts Representation • Qualitative and quantitative information on all affected groups? Access • Same levels of access to any service / product? • Different levels of use • Social / physical barriers to participation (e.g. language, format, physical access/proximity) Outcomes • User experience? • Are some groups more likely to achieve positive outcome from your product / service than others? • Do the outcomes differ over time? Specific needs • Do particular groups have different needs (e.g. people with sensory or learning disabilities)? Perception • Is project is viewed more or less favourably by particular groups of people / communities? As you revisit the SWOT analysis, think about:

Strengths – Positive impact for BME and gender – Strong quantitative database on CHD and risk factors for the BME population Weaknesses – Targeting only one segment of a group of people (i.e. only BME taxi drivers) may result in those of a different ethnicity or gender feeling that their needs are being deliberately excluded. – Lack of qualitative data – looking beyond the statistics Opportunity – Could open up to all taxi driver community and / or other occupational groups – Could reach to the wider community via the taxi driver population Threats – Difficulty of engaging with a group that is transient by nature and whose job may interfere with their participation in the scheme – Dependency on success of NHS walk-in centres? – Successfully engaging the local GP community who may perceive that project interferes on their own ability to effectively engage with patients.

Evidence-based planning Your plan should detail how the project will move forward or mitigate against the identified strengths (e.g. positive impacts), weaknesses (e.g. negative impacts), opportunities (e.g. to reduce health inequality) and threats – and importantly, who will do it! It might also consider plans to: • Strengthen data collection (e.g. taking into account your own experience or speaking directly to affected groups • Ensure project complies with statutory regulations • Incorporate lessons learnt in equality and health inequality from related projects Record approach in: Project initiation document Risk/issue register Plan Benefits management strategy / realisation plan Stakeholder engagement strategy Communications plan TIP: When allocating project resource to equality, tasks should be proportionate to the impact of the project / programme on reducing inequalities / promoting equality.

Effectively engaging your stakeholders is key to the success of any project Consider whether you have identified and spoken to the right people to help you make an informed assessment of equality and health inequality issues. Engagement may range from running public consultations or focus groups to actively involving stakeholder groups in shaping how the project can meet their needs, including the decision making process. You will need to be open and honest about the type of engagement that you are expecting. Depending on your project, think about using: • Staff or staff networks • Trade unions • Voluntary groups / third sector • End users • Patient and community groups

Input into project plan – Wider engagement sessions (e.g. focus sessions with the taxi driver community) – Scope role of community „health champions‟ – Activity to engage local GP community – Open approach to wider taxi driver community Project risk register – Transient nature of taxi driver community means project messages may not get through – Dependency on success of local NHS walk-in centre – Risk that GPs will not support initiative due to perceived impact on their lists

Record approach in: Risk/Issues register Plan Products of the project / programme Quality Log Plan the work…work to the plan! Remember that the duties on reducing health inequalities and advancing equality should be considered as on-going process, with continuous review and monitoring. This includes reviewing the potential risks and costs to the organisation, service users or employees if planned actions are subject to change. Keep a record of any quality checks you use to ensure equality and health inequality is kept integral to the project‟s design and implementation.

Mitigation Confirm approach with Council (taxi licencing authority) to encourage participation and ensure any identification of ill health resulting from the scheme could not affect their employment Project issue! After initial enthusiasm for the project, our taxi drivers have started to withdraw from the scheme after a rumour circulates that taxi drivers found to have ill-health during the healthchecks may have their licence revoked. If not addressed, this risks upsetting the entire approach…. Opportunity! Taxi drivers keen on formalising the role of „community health champion‟. Project Board agrees a change to the project to include a two-day training course for the health champions, to cement learning in: • heart health • getting healthy and staying fit • Delivering health messages to family and friends

Evaluate Was equality and health inequality sufficiently considered within the project / programme? What went well or could have gone better? Can you make any future recommendations for others embarking on similar work? Communicate Communicate the details of your analysis and any recommended follow-up actions to those who will become responsible for the project / programme as it moves towards „business as usual‟. Strengthen good practice by sharing the equality findings of your work with staff, service users and communities. Record approach in: Lessons learnt log End project report / end programme review Project handover documentation

Evaluate – Additional health champion training builds capacity to work with local health workers to better address needs of taxi drivers as a group. – More health messages delivered amongst taxi drivers, their families and communities than NHS could have achieved alone. – Care needs to be taken to ensure you promote an inclusive approach Communicate – Lessons learnt shared with local commissioners and equality leads


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