The Equality Delivery System

THE EQUALITY

DELIVERY SYSTEM:

KEY CHALLENGES AND OPPORTUNITIES

A report of a roundtable discussion with equality practitioners

July 2011

www.brap.org.uk

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CONTENTS

Why a roundtable on the Equality Delivery System? 4

Making the Equality Delivery System work:

a summary of the discussion 5

Key questions for equality practitioners 7

About brap 12

The Equality Delivery System

4

WHY A ROUNDTABLE ON THE EQUALITY DELIVERY SYSTEM?

The Department of Health is promoting the Equality Delivery System (EDS) to all health organisations as a means of delivering on equality

outcomes. The EDS has been marketed as a friendly, non-bureaucratic approach to both meeting legislative requirements and delivering better

health outcomes for service users.

Promoting and embedding equality is not a new ideal. Unfortunately, the EDS has to join the queue at the end of a number of initiatives which

have all been about promoting equality and diversity in health.

But this doesn‟t mean that the EDS isn‟t useful, and the objective of this roundtable was to discuss the practical implementation of the system

with people who have responsibility for implementing equality within health trusts.

The roundtable was held in June 2011.

The guest list

not all delegates were able to attend on the day

Steve Corton

Head of Community Engagement, Dudley

PCT

Janet Fox

Head of Equality and Organisational

Development, Birmingham Community

Healthcare Trust

Satpal Gill

Head of Employee Resourcing and Staff

Experience, Birmingham and Solihull

Mental Health Foundation Trust

Balraj Rai

Head of Inclusion, NHS West Midlands

Polly Sharma

Senior Equality and Diversity Lead,

Birmingham and Solihull Mental Health

Foundation Trust

Yvonne Thompson

Head of Equality and Human Rights, Heart

of Birmingham tPCT

Joy Warmington

CEO, brap

Anne Gynane

Director of Workforce and OD, the Royal

Orthopaedic Hospital

Antony Hooker

Senior HR Manager – Governance, University

Hospital Birmingham

Kevin Nembhard

Equality Diversity and Human Rights Manager,

Birmingham Community Healthcare Trust

Kate Pready

Regional Advisor (Services), Age UK

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MAKING THE EQUALITY DELIVERY SYSTEM WORK: A SUMMARY OF THE DISCUSSION

When a new piece of legislation or regulation comes into effect, it‟s not uncommon for organisations to miss

how the new requirements can be used to achieve important outcomes.

The EDS has the potential to help organisations deliver on a range of existing agendas, such as creating a

modern workforce, improving health outcomes for marginalised groups, and embedding fairness in the

commissioning process.

However, a critical success factor in all these areas is staff taking ownership of equality issues for themselves.

Although fulfilling EDS requirements alone won‟t achieve this, the System does identify key areas and

opportunities for empowering staff.

The EDS can help organisations meet their requirements under the Equality Act and the Care Quality

Commission registration requirements. Attendees were provided with a compliance map, showing synergies

between the EDS, CQC outcomes, and the NHS Constitution.1

However, merely „superimposing‟ EDS requirements on top of existing equalities strategies may send out the

message that the EDS is just another initiative the NHS has to respond to.

Staff are suffering „initiative-itis‟ and negative perceptions of the EDS as just another „equality strategy‟ are the

biggest barriers to the System achieving the outcomes identified above.

1 Copies of this document are available by emailing [email protected].

2

It is important to

recognise the

synergy of the EDS

with existing

regulation

1

Taking a tick box

approach to the

EDS is a missed

opportunity


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The positioning of the EDS (who will drive it forward) and its accountability (monitoring and reporting

arrangements) need careful consideration, as these issues have „let down‟ equality and diversity in the past.

„Line of sight‟ is particularly important: managers in the sector have not always exhibited the principles of

equality and transparency in their leadership of organisations. This can appear to staff as if they are held

accountable for outcomes which their managers are not.

Similarly, monitoring and accountability mechanisms in the past have been overly bureaucratic. This has stifled

staff motivation to act positively: faced with the possibility of doing the wrong thing, staff often opt to do nothing

at all. Internal accountability mechanisms should help create a permissive, „can-do‟ culture.

The scrutiny of EDS via local stakeholders needs careful consideration.

There are logistical concerns, such as how trusts (especially those with a regional remit) will determine their

local populations.

However, there are also capability issues: how can equality strategies be communicated to people simply, and

– crucially – will those people be in a position to understand, interrogate, and analyse the information

effectively?

Trusts may need to invest in securing relationships with those they wish to use as part of the scrutiny process

so that information is well understood, and that progress on equality can be fairly assessed and monitored and

include those who have an interest in service reform.

Finally, how do organisations avoid the tokenism that arises from consulting people simply on the basis of an

aspect of their identity?

4

It is important to

build the capacity

of local groups so

they are able to

scrutinise plans,

priorities, and

outcomes

effectively

3

Positioning and

accountability are

crucial

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KEY QUESTIONS FOR EQUALITY PRACTITIONERS

As part of the discussion, the group looked at what they thought were some of the key challenges with specific EDS outcomes. These are

summarised on the following pages.

Each page focuses on a particular EDS objective. Currently, the System has four objectives:2

1. Better health outcomes

2. Improved patient access and experience

3. Empowered, engaged and well-supported staff

4. Inclusive leadership at all levels

Each objective has a „narrative‟ or explanation, and these are reproduced under each heading.

The tables that follow have three headings:

Summary: each objective has specific outcomes associated with it. NHS organisations will be asked to develop priorities based on their

grading against these outcomes. The section is a summary of the outcomes under each objective

Challenge: these are the challenges identified during the debate as being particularly pressing issues for anyone charged with delivering

outcomes. Often, they relate to particular challenges professionals have faced in similar situations

Discussion points: devised after the discussion, these are pointers on some of the issues we think equality practitioners will want to mull over

as they think about best practice. They reflect brap‟s knowledge of designing fairer systems within the health sector

2 The version of the Equality Delivery System being discussed was the most up to date version at the time (released March 2011).


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BETTER HEALTH OUTCOMES

The NHS should achieve improvements in patient health, public health and patient safety for all, based on comprehensive evidence of needs and

results.

Summary Challenges Discussion points

The outcomes under this objective

are connected by a common theme

of promoting patient voice as a

means of improving services.

Meeting the outcomes in this

section will require organisations to

undertake demographic analyses of

their communities to determine

health needs; engage with patients

to assess whether needs are being

met; and thoroughly involve patients

in the design and delivery of

services.

Organisations successfully meeting this

objective will require comprehensive and

robust engagement strategies.

Central to this is clearly defining

„engagement‟ – having a rationale for who is

involved and supporting their engagement

with the Trust. In part this may mean

investing in building people‟s capacity to

comment and take part.

This objective requires balancing „voice‟ against other

types of evidence that health organisations collect.

Automatically privileging the experiences and views of

members of the public – especially when they claim to

be speaking on behalf of others – won‟t necessarily lead

to better health outcomes. There are a range of relevant

factors it‟s important to be aware of when making

decisions (internally generated quantitative data,

resource constraints, and strategic plans to name just a

few). It is important, then, to have the confidence to

make the right choices based on all these factors and

communicate to people the reasons behind your

decision.

As the shift continues from patient influence toward

patient participation in decision making (through Health

and Wellbeing Boards) it will become increasingly

important to ensure participants have the skills to make

robust, evidence-based decisions. brap have worked

with local authorities to identify and train people in the

skills needed to participate in decision making and this

has made the engagement process much more fruitful

and productive.

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IMPROVED PATIENT ACCESS AND EXPERIENCE

The NHS should improve accessibility and information, and deliver the right services that are targeted, useful, useable and used in order to

improve patient experience.


Many of the outcomes in this

section centre around patient

experience and in particular the

question of how those things that

are important to patients can be

upheld and protected.

In addition, some of the outcomes

require organisations to have robust

means of feeding complaints and

experiences into service

improvement processes.

When it comes to improving patient

experience, one of the key challenges is

identifying things that are actually important

to people. Many past initiatives have tended

to focus on outcomes that don‟t actually

improve patient experience.

As such, organisations successfully

delivering this objective will have to think

critically about how they engage with

patients to identify the important features of

the care experience.

The final element of this objective is

translating findings from these consultations

into practicable actions.

Human rights principles can be a useful tool to embed

equalities practice into the everyday activities of staff.

The Department of Health have recognised the

importance of using human rights to improve patient

experience and reduce health inequalities in their

national cancer strategy, Improving Outcomes (available:

http://tinyurl.com/4sh72u8). In it, they refer to a human

rights standard brap developed for Macmillan Cancer

Support as a means of “moving away from using process

measures to assess progress on equality issues, towards

measuring the outcomes that really matter to patients.”


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EMPOWERED, ENGAGED AND WELL-SUPPORTED STAFF

The NHS should increase the diversity and quality of the working lives of the paid and non-paid workforce, supporting all staff to better respond

to patients‟ and communities‟ needs.


This objective has two main aims.

First, to embed fairness into

recruitment, pay, training, and

performance management

procedures.

Second, to create a workplace that

is fair, welcoming, and free from

discrimination and bullying. Staff

should be provided with flexible

working options.

Embedding fairness within organisational

policies and procedures has a number of

challenges associated with it. First and

foremost, a key issue is that many people

equate „equality‟ with politically correct fads,

rather than an important attempt to ensure

people are treated fairly.

Secondly, ensuring workplaces are fair

means getting to grips with certain key skills

and competencies, such as:

understanding legal definitions of

discrimination and harassment, and

ensuring staff are aware of these

meanings too

understanding how unfairness manifests

itself: that is, what it „looks like‟ in

different situations

understanding certain technical

processes: how to conduct a pay audit,

for example, or knowing how to devise

fair recruitment procedures

A key question for equality practitioners (and managers) is

how to engage with staff so they take ownership of

equalities issues in the workplace. In brap‟s experience,

staff become more motivated to champion equalities when

they see it having a demonstrable impact on improving

outcomes for them, their colleagues, and service users.

Unfortunately, past equalities approaches have stimulated

a lot of paperwork but not generated a lot of change.

However, new ways of doing equality being developed by

brap and others are helping organisations achieve big

equality wins, which acts as a spur for further action.

Delivering on this objective also requires staff

understanding what unfairness „looks like‟ in different day-

to-day situations. In particular, it may be necessary for

some staff members to be made aware of how

inappropriate behaviour is „hidden‟ or condoned within a

hierarchical workplace structure. Seniority and status are

not excuses for treating people badly. Under the EDS

everyone has responsibility for acting in a fair and equitable

manner, and it may be useful to provide clarity about what

precisely constitutes inappropriate behaviour at work.

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INCLUSIVE LEADERSHIP AT ALL LEVELS

NHS organisations should ensure that equality is everyone‟s business, and everyone is expected to take an active part, supported by the work of

specialist equality leaders and champions.


Outcomes in this section relate to

how leaders (from board members

downwards) manage equality within

the organisation, particularly in

relation to (a) the formulation of

strategic objectives and (b) the

support and motivation provided to

(frontline) staff.

Leaders are often automatically given

responsibility for progressing equality within

organisations without serious consideration

of whether they actually have the skills,

knowledge, and motivation to affect change.

However, managerial competence on this

issue is important since the actions and

behaviours of leaders is crucial to the

credibility equality has within an organisation

and its subsequent adoption by staff.

It can be daunting for managers to admit they need extra

help or support on this issue – partly because it is difficult

to acknowledge any weakness or shortcoming, and

partly because equality is often not seen as a

competence that can be developed. Instead, it‟s often

viewed as a skill or understanding that people are born

with, and experience shows that some people feel

admitting ignorance in this area leaves them open to

accusations of racism, sexism, and so on.

This is unfortunate because meaningful equalities

practice is something that can be learnt. Within

organisations, there are certain skills managers and

leaders can develop around achieving service outcomes,

promoting customer satisfaction, managing „diverse‟ staff

teams, conflict management, and commissioning for

fairer outcomes. Many of these skills require leaders to

re-think their approach to equalities – and, often, what

they think equalities is – but they are essential to creating

a change in organisational culture.

ABOUT BRAP

brap is a think fair tank, inspiring and leading change to make public, private and voluntary sector

organisations fit for the needs of a more diverse society.

brap offers tailored, progressive and common sense approaches to equalities training, consultancy

and community engagement issues.

In recent years, brap has supported and trained hundreds of health frontline staff and managers

working in a range of contexts (mental health, acute care, commissioning, public health,

community care) to improve equality practice. This has included:

developing bespoke impact assessment strategies

conducting training programmes for staff

running consultation events with hard to reach groups

developing equality policies and organisational change strategies

In recent years brap have also been at the forefront of pioneering new approaches to protecting

the human rights of service users. For example in 2007 brap piloted a human rights in healthcare

project with the Department of Health (DoH) in Birmingham and since then we have developed a

national human rights standard for cancer services on behalf of Macmillan Cancer Support

(recommended by DoH as good practice in their latest national cancer strategy).

brap | 9th Floor, Edgbaston House | Hagley Road | Birmingham | B16 8NH

Email: [email protected] | Telephone: 0121 456 7401 | Fax: 0121 456 7419

We can help you:

design out inequality from service pathways, and solve losses in efficiency and

performance

improve your ability to manage and gather relevant evidence from local stakeholders

to ensure your organisation is held to account and rated appropriately under the EDS

develop new mechanisms that positively influence staff behaviour without recourse to

bureaucratic – and ineffective – regulation

facilitate patient voice so it‟s not simply about making demands on the system, but

creating a new co-operative staff-patient relationship

Documents

The Equality Delivery System