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Advancing Equality

Foreword

Health inequalities are unfair and avoidable differences in health across the population and between different groups within society. Action on health inequalities requires improving the lives of those with the worst health outcomes, fastest. After wide ranging involvement and engagement with our communities, employees and service providers, we set out below our equality objectives[1].

We believe that these objectives will enable us to optimise the positive impact we hope to make in our first 4 years as an integrated care system. We will measure progress along the way and provide annual progress reports for you to view the actions we have taken.

A man with dark hair, wearing doctors scrubs, sat at a desk in front of a computer.

Equality and human rights are central to the way we plan and operate as a public body, an employer and a planner of healthcare services. In addressing inequalities we will build on the previous work of the Greater Manchester Clinical Commissioning Groups and their partners, draw collective strengths together and work in an integrated way with all of our localities to ensure that the delivery of services is appropriate for the populations using them.

As we develop, Greater Manchester Integrated Care (GM IC) must create the conditions for a more equal, more humane and a fairer health and care system. We know that we have significant challenges ahead, but one of the most fundamental commitments we make as an integrated system will be to address those unwarranted and harmful disparities in health and care access, experiences and outcomes just because of who we are.

The Health and Care Act 2022 has allocated clear levels of responsibility to address inequalities and advance equalities to Integrated Care Boards. The statutory nature of NHS GM IC will allow us to build on the ambitious ways we have been working over the last five years and continue to deliver even better health and care for the people of Greater Manchester. While developing new ways of working, we will plan more inclusively and deliver services that are accessible, effective and safe for all the communities we serve.  By working together, we can make improvements and bring about effective change.

Dr Vish Mehra, GM IC Board Equality Lead

[1] The NHS Integrated Care Board is a listed Public Authority for the purposes of the Equality Act 2010, and thereby is obliged to set out its Equality Objectives every 4 years alongside its progress towards meeting the Public Sector Equality Duties.  Our Equality Objectives also integrate the new equality considerations as set out in the Health and Social Care Act 2022.

We have developed our Equality Objectives to describe how we are meeting our obligations under the Public Sector Equality Duty and our ambition to commission health services that meet the needs of our local diverse communities and populations and reduce avoidable health inequalities in all aspects of our role and functions.

We have prioritised three overarching Equality Objectives for 2023 to 2027. These relate to:

  • Our People
    • We will strengthen inclusive and accountable decision making and leadership with a clear organisational commitment to advance Equality and Inclusion
    • We will improve representation and provide an accessible and inclusive working environment and culture enabling NHS GM Integrated Care to become an employer of choice where all people can flourish
  • Our Communities and Insight
    • We will engage and involve communities who experience discrimination and disadvantage in planning, design, and delivery of health interventions.
  • Improving our Outcomes
    • We work with others to drive the reduction of inequalities in access, experience and outcomes of health and care services
    • We will set equality performance goals and develop a measurement framework to evidence how we are addressing inequalities and advancing equalities
    • We will pro-actively address existing systemic and structural racism in all its manifestations through the implementation of an anti-discrimination approach for NHS GM Integrated Care

We will measure progress along the way and provide annual progress reports for you to view the actions we have taken.

Our programme of work aligns with the equalities legislation as required by the two Acts below

 Equality Act 2010

In the Equality Act 2010, nine characteristics were identified as ‘protected characteristics’. These are the characteristics where evidence shows there is still significant discrimination in employment, provision of goods and services and access to services such as education and health. These are groups of people who are offered specific protection from unfair treatment. It is against the law to discriminate against anyone because of:

  • age
  • gender reassignment
  • being married or in a civil partnership
  • being pregnant or on maternity leave
  • disability
  • race including colour, nationality, ethnic or national origin
  • religion or belief
  • sex
  • sexual orientation

Protected Characteristics

Age

What is age discrimination? | Equality law: discrimination explained – YouTube

Disability

What is disability discrimination? | Equality law: discrimination explained – YouTube

Gender reassignment 

What is gender reassignment discrimination? | Equality law: discrimination explained – YouTube

Marriage or civil partnership

What is pregnancy and maternity discrimination? | Equality law: discrimination explained – YouTube

Race

What is race discrimination? | Equality law: discrimination explained – YouTube

Religion or belief

What is religion or belief discrimination? | Equality law: discrimination explained – YouTube

Sex

What is sex discrimination? | Equality law: discrimination explained – YouTube

Sexual Orientation

What is sexual orientation discrimination? | Equality law: discrimination explained – YouTube

 

Health and Care Act 2022

Under this Act, the ICB is required to have regard to the need to:

  • Reduce inequalities between persons with respect to their ability to access health services, and
  • Reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.

It places a new quality of service duty on ICBs which includes addressing health inequalities. It introduces a performance assessment framework for ICBs that will require NHS England to ‘conduct a performance assessment annually’ of each ICB which must include an assessment of how each ICB has discharged its functions across a range of matters including reducing inequalities, improving quality of service and public involvement and consultation.

By contrast, the health inequalities duties as currently drafted apply only to patients and their ability to access services and the outcomes from the provision of health services. We must also act in a manner compatible with the Human Rights Act. Human Rights are underpinned by a set of common values and have been adopted by the NHS.

The worst effects of the pandemic have reinforced existing patterns of inequality within our communities. As Greater Manchester recovers, we must ensure that it is inclusive and breaks down structural inequalities, limits the long-term negative effects of the pandemic and strengthens the resilience of our communities and wider services. This goes beyond the equalities agenda as set out in the Equality Act, and includes residents facing poverty, poor health and wellbeing and struggling to retain or secure employment, as well as prejudice and barriers to the opportunities others can access.

There are also wider inequality gaps along demographic, socio-economic and geographical fractures formed by deeply rooted structural and systemic inequalities. Recognising these patterns and addressing the inequalities behind them, needs to run through the core of everything we do. Removing the multiple and intersecting barriers to activity, widening opportunities to move and designing moving into everyday life for people and communities that have traditionally been excluded, underserved, left out or left behind.

We are working hard to create inclusive services that reflects the communities of Greater Manchester addressing the needs of communities and staff from different backgrounds and with different needs.

We are committed to driving equality, diversity and inclusion among our own workforce and the wider health and care workforce in Greater Manchester. We aim to create a working culture that recognises, respects and values differences for the mutual benefit of the organisation and the individual.

As an NHS organisation we aim to:

  • Ensure staff fully understand equality and diversity issues
  • Feel empowered to challenge prejudice and make reasonable adjustments in their own work areas
  • Include equality and diversity training for all staff
  • To ensure all staff promote the cultural and behavioural changes to ensure equality and diversity is demonstrated in all aspects of our work
  • Provide an environment for our staff which is free from unlawful discrimination

As part of the Public Sector Equality Duty, we are required to produce an annual workforce report. This can be seen in our annual equality publication. Our first report will be published in July 2023 which marks the first anniversary of the creation of the ICB.

The Accessible Information Standard (AIS) aims to make sure people who have a disability, impairment or sensory loss get the information they can access and understand, and any communication support they might need.

This includes making sure people get information in different formats, for example, large print, Braille, easy read; and support such as a British Sign Language interpreter, deafblind manual interpreter or an advocate. The AIS means that organisations providing health or social care need to ensure five things:

  • Ask people if they have any information or communication support needs and identify how to meet them.
  • Record those needs in a set way on the patients’ records.
  • Highlight or flag in the person’s file or notes, so it is clear that they have information or communication support needs and details of how to meet those needs.
  • Share information about a person’s needs with other NHS and adult social care providers when they have consent to do so.
  • Make sure that people get information in an accessible way and communication support if they need it.

Our Primary Care Team in Manchester has produced a toolkit to support primary care providers to meet the Accessible Information Standards. Click here to view it.

Equality Impact Assessments help us to fulfil our equality, health and care, human rights and related duties and obligations to reduce avoidable health inequalities in all aspects of our role and functions. All employees of NHS Greater Manchester are required to undertake full Equality Impact Assessments before designing, changing or decommissioning services, or implementing policies that affect the Greater Manchester Integrated Care System.

An Equality Impact Assessment is a way to assess the impact of new or existing policies and/ or services on particular groups of people, to find out if there is a positive or negative outcome and make reasonable changes where possible.  It is an opportunity to identify possible disadvantages, decide if they are discriminatory and the extent to which discrimination can be eliminated, minimised or justified. We also use Equality Impact Assessments as a way of ensuring that we are meeting our legal duties in respect of equality.

Copies of the EIA’s are available on request.

We commission our services mainly through an NHS Trusts collaborative and an alternative collaborative that are also required to comply with the Equality Act 2010.

As part of our role as commissioner of care we seek assurance from our providers on how they are meeting the public sector equality duty and NHS England’s mandatory standards.

Our aim is to focus on:

  • Increasing collaboration with the provider collaboratives and commission co-production to ensure high quality of clinical care is afforded equitably to all our citizens
  • Ensure equality in access to services by protected and ‘at risk’ groups
  • Greater involvement of citizens in the planning and delivery of the care that they receive
  • Ensure staff representation in senior management roles and staff experience of equality of opportunity in career progression and promotion, with a particular focus on race and disability

In developing our equality objectives and targets, we have made a conscious decision to ensure that we focus on the requirements of the Equality Act 2010 and Public Sector Equality Duty as the Specific Equality Duties require.

We have, however, incorporated current health inequalities targets where these naturally align with our equality objectives and equality targets and doing so would neither undermine compliance with our existing equality duties nor the existing or forthcoming health inequalities duties, powers or responsibilities.

Our aim is to drive strategic and demonstrable equality improvements by reference to the nine protected characteristics in the Equality Act 2010 for the people we serve, the people that we employ and in the exercise of our broader activities and functions, interlocked with the requirements of the Health and Social Care Act 2022 and the Human Rights Act (1998).

We must publish equality information every year. Our Equality Information Report will provide information about how we are meeting our duty to make continuous improvements in advancing equality for our citizens and staff. Our first report will be due in July 2023. Other equality information that we must publish on an annual schedule will soon be available, listed below.

  • Equality Delivery System (EDS)
  • Workforce Race Equality Standard (WRES)
  • Workforce Disability Equality Standard (WDES)
  • Gender pay gap report
  • Public Sector Equality Duty Report (PSED)

 

Inclusion spelt out in scrabble letters with different coloured stick people above each letter.

About the NHS GM Inclusion Staff Network (ISN)

The GM Integrated Care Inclusion Staff Network has been set up to ensure that staff from all protected characteristic groups under the Equality Act 2010, have a safe space to voice concerns, provide critique, and oversee matters related to diversity, equality, and inclusion within Greater Manchester Integrated Care. The purpose of the Inclusion Staff Network is to foster an inclusive working environment and to increase participation of staff in decision making, directly shaping of the organisation.

The Inclusion Staff Network is open to staff from all protected characteristic groups as well as allies who wish to drive change and pose meaningful challenge to the system.

Through this Network, staff can:

  • Have open and honest conversations
  • Build professional and social networks
  • Develop their careers through workshops and projects
  • Become inclusive leaders
  • Provide feedback on corporate policies, initiatives, and plans
  • Celebrate diversity through events and engagement activities

The meetings take place every month and we welcome new members to grow and develop the Network.

If you’d like to attend, please contact Harvey Kennedy-Pitt at harvey.kennedy-pitt@nhs.net  for more information.

See you there!

Fairer Health for All is our response to ‘Build Back Fairer’ – a set of national and city-region ambitions and recommendations by the Institute of Health Equity and the Independent Equality Commission.

More than a mantra or a rally cry, Fairer Health for All is a system-wide commitment and framework for reducing health inequalities and tackling inequalities across the wider, social determinants of health. It describes how we will create a greener, fairer, more prosperous city-region.

Read more here.

We have partnered with the LGBT Foundation to create a set of resources to support how we can be more inclusive of the LGBTQ+ community in the workplace. Together we can create a more inclusive culture.

View our LGBT Foundation Resources.

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