equality information report 2017-18 · 1 equality information report 2017-18 for further...

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Equality Information Report 2017-18

For further information please contact:

Emdad HaqueSenior Equality, Diversity and Inclusion [email protected]

Final-July

“Working with the people in Camden to achieve the best health for all”

mailto:[email protected]

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Contents

Introduction S3

About Camden S4

Our equality and health inequality duties S5-6

NHS mandatory standards S7

Equality Delivery System (EDS2) S8-10

CCG Equality Objectives S11

Advancing equality through commissioning S12-14

Our workforce S15

Governance and leadership S16

Inclusive engagement S17

Our providers S18

Forward strategy for 2018-19 S19

Appendix 1: Workforce and Governing Body Members Equality

Information including the WRES

S20-34

Appendix 2: WRES Indicators S35

Appendix 3: NCL CCGs WRES Action Plan (2017-19) Progress

Report

S36

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Introduction

We produce our annual Equality Information Report to demonstrate to our stakeholders how Camden CCG is meeting its duty under the Equality

Act 2010. The report also shows the improvements we have made through the delivery of our objectives against the mandatory standards set out

by NHS England including the Workforce Race Equality Standard (WRES), Equality Delivery System (EDS2) and the Accessible Information

Standard. In 2017-18, we refreshed our EDS2 grading which informed our 2018-19 action plan which will deliver our equality objectives. The

CCG has progressed from ‘developing’ to ‘achieving’ in seven EDS2 outcomes (see page 10)- and has achieved 1:1 ratio in appointing White

and BME staff which is a significant achievement.

Camden’s population is diverse, growing and continually changing, and is marked by significant differences in health experience and outcomes

between the most and least deprived communities. Alongside this, the NHS faces significant healthcare challenges and in Camden these include

health inequalities, an aging population, high levels of mental illness and obesity.

Our commitment to our community is commissioning to achieve the best clinical outcomes for patients and better patient experience. The way we

achieve this is by engaging patients, community groups, staff and clinicians in the design and procurement of our services- and by applying

innovative ideas. We use every opportunity to listen to our patients, whether through local patient groups or voluntary sector engagement events,

or planned engagement throughout the business planning process- and we ensure their views reflect in our commissioning decisions.

In July 2017 the Governing Bodies of NHS Camden Clinical Commissioning Group, NHS Barnet Clinical Commissioning Group, NHS Enfield

Clinical Commissioning Group, NHS Haringey Clinical Commissioning Group and NHS Islington Clinical Commissioning Group established the

NCL Joint Commissioning Committee (‘Committee’).

The Committee’s role is to jointly commission the following services as these are most effectively commissioned collaboratively across the five

CCGs:

• All acute services including core contracts and other out of sector acute commissioning;

• All learning disability contracting associated with the Transforming Care programme;

• All integrated urgent care (including 111/ GP Out-of-Hours services)

• Any specialised services not commissioned by NHS England.

The new arrangements will help to ensure commissioning and future health services across the NCL system are more joined up, equitable and

co-ordinated for local patients.

This report provides a summary of our activities and there is more information in our CCG Annual Report 2017-18 -which can be found on our

website www.camdenccg.nhs.uk

http://www.camdenccg.nhs.uk/

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About Camden

• Camden occupies just 1.4% of London but is home to 2.8% of the

population

• An estimated 244,000 people were living in Camden in 2016

• Expected to increase by around 27,300 by 2030, and by 50,400

by 2050

• Largest population growth expected in over 65s in the future

• After English, the three most commonly spoken languages are

Bengali (13%), French (8%) and Spanish (6%)

Camden health headlines

• Camden is significantly more deprived compared to

England, and is the fifteenth most deprived borough in

London. The most deprived people in the borough are not

only more likely to suffer from ill health than the more

affluent; they also tend to be sicker with multiple long term

conditions. The long term conditions most strongly

associated with deprivation in Camden (adjusted for age)

are diabetes, learning disabilities, chronic lung disease

and chronic liver disease.

• The prevalence of long term conditions increases with

age, with 60% to 65% of people aged over 55 diagnosed

with a long term condition in each locality. The prevalence

of having at least one diagnosed long term condition is

highest among the black population, and is consistently

lower for BAME groups in the South locality compared to

BAME groups in the North and West localities.

• People suffering from poor general health, mental ill

health, and low life expectancy are generally concentrated

in a few, deprived wards in the borough including St

Pancras and Somers Town, Haverstock, and Kilburn. In

contrast, residents in the most affluent parts of the

borough have longer life expectancy, better general

health, and fewer mental health problems than the

England average.

• Despite the fact that the gap in life expectancy has not

widened in Camden, unlike in the rest of England, there is

evidence that the gap still exists, therefore suggesting that

the poorest are still being left behind: proportionately,

more people in the most deprived areas have reported

poor health over the past 10 years.

Percentage breakdown of Camden resident population by age group and

ethnicity, 2017

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Our equality and health inequality duties

The CCG came into being in 2013 through an authorisation process by NHS England which made it a duty for the

CCG to show ‘due regard’ to the Public Sector Equality Duty (PSED) under the Equality Act 2010 and not

delegate it to another organisation. Later on NHS England introduced more guidance for CCGs on how to

demonstrate compliance and keep making continuous improvement in their equality and diversity performance

(see the diagram below).

Statutory duty

Mandatory Standards

CCG Response

Equality Act 2010

Health and Social Care Act 2012

Human Rights Act 1998

Equality Delivery System (EDS2)

Workforce Race Equality Standard (WRES)

Accessible Information Standard (AIS)

Diversity and Inclusion Plan & Annual Action

Plan

Equality Information Report

Equality and Inclusion Strategy Group

Assurance from providers through CQRG

Equality Impact Analysis

Enga

gem

ent

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General Duty under the Equality Act 2010

The general equality duty under the Equality Act 2010 requires the

CCG, in the exercise of our functions, to have due regard to the need

to:

• Eliminate discrimination, harassment and victimisation and any other

conduct that is prohibited by or under the Act.

• Advance equality of opportunity between people who share a

relevant protected characteristic and people who do not share it.

• Foster good relations between people who share a relevant

protected characteristic and those who do not share it.

These are sometimes referred to as the three aims or arms of the

general equality duty. The Act explains that having due regard for

advancing equality involves:

• Removing or minimising disadvantages suffered by people due to

their protected characteristics.

• Taking steps to meet the needs of people from protected groups

where these are different from the needs of other people.

• Encouraging people from protected groups to participate in public

life or in other activities where their participation is disproportionately

low.

Protected characteristics are defined as:

Age, Sex, Disability, Gender Reassignment (Transgender)

Race, Religion or Belief, Sexual Orientation, Pregnancy and maternity

Marriage and civil partnership,

We additionally pay due regard to the needs of carers, seldom heard

groups and vulnerable groups when making commissioning decisions

Specific Duty

The specific duty requires the CCG to publish equality

objectives at least once every four years and to publish

equality information once a year demonstrating that it has

consciously thought about the three aims of the Equality

Duty as part of its decision-making process.

The Act also requires that employers with a workforce of

over 150 employees publish information relating to

employees who share protected characteristics. Although

the CCG does not have 150 employees, as good practice

we have included our employee and governing Body profile

as part of this report.

Under the Health and Social Care Act 2012, CCGs have

duties to:

• Have regard to the need to reduce inequalities between

patients in access to health services and the outcomes

achieved (s.14T);

• Exercise their functions with a view to securing that health

services are provided in an integrated way, and are

integrated with health-related and social care services,

where they consider that this would improve quality,

reduce inequalities in access to those services or reduce

inequalities in the outcomes achieved (s.14Z1);

• Include in an annual commissioning plan an explanation of

how they propose to discharge their duty to have regard to

the need to reduce inequalities (s. 14Z11);

• Include in an annual report an assessment of how

effectively they discharged their duty to have regard to the

need to reduce inequalities (s. 14Z15).

Our equality and health inequality duties (cont’d)

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NHS mandatory standards

NHS Workforce Race Equality Standard (WRES)

The NHS Workforce Race Equality Standard was developed and

introduced in 2015. Organisations are required to review and report

against nine indicators. The indicators are a mix of NHS staff survey

data- and the workforce data comparing the experience of BME and

white staff. It also compares the governing body data with the

workforce data and local to show how representative the governing

body is compared with the CCG workforce and the local population.

Our first WRES report was published in July 2015, and then a

progress report was published in July 2016 with an action plan. This

year we have incorporated the WRES into our workforce and

Governing Body Members report (See Appendix 1).

The Accessible Information Standard means that organisations

providing health or social care need to do five things:

1. Ask people if they have any information or communication

support needs and identify how to meet them.

2. Record those needs in a set way on the patients’ records.

3. 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.

4. Share information about a person’s needs with other NHS

and adult social care providers when they have consent to do

so.

5. Make sure that people get information in an accessible way

and communication support if they need it.

CCGs are exempt from meeting the standard. However, we are

committed to the AIS, and we ensure that whenever we

communicate with the public that we consider the requirements

of the standard. Also we will work closely with our member GP

Practices to provide the necessary support to enable them to

meet the requirements of the standard and we will continue to

seek assurance from provider organisations about their

compliance with the standard, including evidence of how they

are planning to meet the standard.

Accessible Information Standard (AIS)

The Accessible Information Standard was introduced requiring all

organisations that provide NHS (including GP Practices) or adult

social care to meet the standard by 31 July 2016.

The aim of the standard is 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.

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The NHS Equality Delivery System was developed as an equality performance

framework to assist NHS organisations to evidence their compliance with the

Public Sector Equality Duty and embed equality and diversity within the

organisation.

At the heart of the EDS2 is a set of eighteen outcomes grouped into four goals:

1. Better health outcomes for all

2. Improved patient access and experience

3. Representative and supported workforce

4. Inclusive leadership

Organisations are required to grade their performance by using a grading system

as follows:

Red- Undeveloped

People from all protected groups fare poorly compared with the demography of

the borough OR evidence is not available, or if evidence shows that the majority

of people in only two or less protected groups fare well

Amber-Developing- People from only some protected groups fare as well as the

people of the borough.

Green-Progressing- People from most protected groups fare as well as the

people of the borough

Purple-Excelling- People from all protected groups fare as well as all people of

the borough.

EDS2 can help CCGs improve the services they provide for

their local communities; improve the experiences of people

using the services; consider reducing health inequalities in

their locality; and to provide better working environments,

free of discrimination, for those who work in the NHS.

NHS Equality Delivery System (EDS2) overview

Meeting the Public Sector Equality Duty through NHS Mandatory Standards

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Equality Delivery System (EDS2)-grading processes

The CCG uses EDS2 for its equality and diversity planning and implementation and service improvement to advance

equality, as mandated by NHS England. As described in slide 8 the CCG has worked with community interest groups

and carried out an EDS2 grading in 2017-18 which will help determine the priorities for 2018-19 (slide 19 on forward

strategy for more information).

Our current performance is based on the grading in 2017-18 and the recent analysis of the CCG’s evidence across

the 4 EDS2 goals and 18 outcomes.

Publishing grades

Grading and action planning

Evidence gathering

Project planning

and engaging

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Equality Delivery System (EDS2) performance update

OutcomeGrade

2017-18Outcome

Grade

2017-18

1.1 Services are commissioned, procured, designed and delivered to

meet the health needs of local communities

Achieving 3.1 Fair NHS recruitment and selection processes

lead to a more representative workforce.

Achieving

1.2 Individual people’s health needs are assessed and met in

appropriate and effective ways.

Achieving 3.2 The NHS is committed to equal pay for work of

equal value and expects employers to use

equal pay audits to help fulfil their legal

obligations.

Achieving

1.3 Transitions from one service to another, for people on care

pathways, are made smoothly with everyone well-informed.

Developing 3.3 Training and development opportunities are

taken up and positively evaluated by all staff.

Achieving

1.4 When people use NHS services their safety is prioritised and they

are free from mistreatment and abuse and mistakes are minimised.

Achieving 3.4 When at work, staff are free from abuse,

harassment, bullying and violence from any

source.

Achieving

1.5 Screening, vaccination and other health promotion services reach

and benefit all local communities.

Developing 3.5 Flexible working options are available to all

staff consistent with the needs of the service

and the way people lead their lives.

Achieving

2.1 People, carers and communities can readily access hospital,

community health or primary care services and should not be

denied access on unreasonable grounds

Achieving 3.6 Staff report positive experiences of their

membership of the workforce.

Achieving

2.2 People are informed and supported to be involved in decisions

about them.

Achieving 4.1 Boards and senior leaders routinely

demonstrate their commitment to promoting

equality within and beyond their organisations

Achieving

2.3 People report positive experiences of the NHS Developing 4.2 Papers that come before the Board and other

major Committees identify equality-related

impacts including risks, and say how these

risks are to be managed.

Achieving

2.4 People’s complaints about services are handled respectfully and

efficiently.

Developing 4.3 All managers and staff support their staff to

work in culturally competent ways within a

work environment free from discrimination

Achieving

As explained in the previous slides, the CCG is required to use EDS2 to grade its performance. The following grades were determined

following a grading exercise with both internal and external stakeholders in 2017-18. For Goals 1 & 2 commissioners presented evidence

about three service areas: End of Life, Mental Health and Primary Care which were graded individually by community interests. Goals 3 and

4 were internally graded and the outcomes were shared with the Joint Partnership Group for comments.

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CCG Equality Objectives 2016-20

It is a specific duty of the CCG to develop and publish equality objectives at least once every four years. In 2016-17, we refreshed our equality

objectives in the Diversity and Inclusion Plan for the next four years in consultation with stakeholders and partners. These objectives are built

around EDS2 and the WRES and are delivered through an annual action plan.

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Advancing equality through commissioning

As a commissioning organisation our aim is to discharge our equality and health

inequality duties through our commissioning functions. There are a number of

ways we currently meet these duties.

Our approach to equality analysis uses a three lenses approach to ensure a robust

compliance with the equality duty but also to make the process more meaningful

and effective.

In the next few slides we have highlighted some of the achievements in 2017-18.

These achievements demonstrate how the CCG delivered its equality objectives 1

and 2. More information about the achievements can be read in the CCG’s annual

report 2017-18.

In 2017-18 The CCG’s equality focus was primarily around commissioning services

based on local evidence and improving access to services for protected and

vulnerable people in the community. This included access to existing services and

any service which was redesigned and newly commissioned.

Our Governing Body and relevant Committees have played an important role in

assuring compliance with our statutory duties by scrutinising business cases and

equality analysis completed by the commissioners.

As a sector leader and lead commissioner the CCG seeks assurance from

providers on a number of equality policies as mandated by NHS England. This

includes assuring the providers compliance with the equality duty and also all NHS

mandatory standards (See page 18).

Equality

duty

EngagementHealth

inequality

EqualityAnalysis

Commissioning decisions

Key areas in 2017-18:• Long term conditions• Care navigating• Social prescribing• Low vision• Admission avoidance• Mental health • Primary Care estate • Primary Care –mental health

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Advancing equality through commissioning (cont’d)

Equality Objective 1: Continue commissioning services based on evidence to reduce health inequalities

amongst protected and vulnerable groups

Key achievements in 2017-18

In 2017 we worked with our partners to engage with the public and begin to implement shared plans across North London to deliver

improvements to health and care and spend money wisely. Some highlights of our achievements include:

• Making it possible for residents to access GP services 8am-8pm through extended access in April 2017.

• Following capital investment of £1 million by Camden & Islington Foundation NHS Trust we opened the Women’s Psychiatric Intensive

Care Unit on 13 November 2017. This will ensure that women that require intensive care in NCL are not placed out of area as a first

response to their crisis and need for intensive care.

• One of the first areas nationally to launch the new integrated urgent care model. This includes:

Mental Health patients can now ring 111, and be transferred directly to a crisis team for advice and support.

Enabling clinical staff to get through to a clinical expert for urgent advice and support by dialling the appropriate number.

Successfully bidding for enhanced mental health liaison services in A&E at University College Hospital in 2017/18, and North

Middlesex University Hospital in 2018/19.

Launched a specialist perinatal mental health service for mums across North Central London, following a successful first wave bid

for national funding.

Made it quicker and safer for patients to get home from hospital by agreeing standard ways of working and working more

effectively with social care.

We are working as partners to deliver the North Central London sustainability and transformation plan. As a group of organisations, we have

developed plans to improve services and to reduce the pressure on the health and care system. We aim to do this through:

Increasing our prevention programmes with the aim of supporting people to stay well and when people become unwell, to recover quickly.

• Partnering with people and organisations to help our residents to remain independent for as long as possible as they age, and to have

more control over their own health and wellbeing.

• Giving our children and their mothers, families and their care givers the right support so they can have the best possible start in life.

• Providing care closer to home so people only go to hospital when it is clinically necessary.

• Giving mental health services equal priority to physical health services.

• Improving our cancer services.

• Providing a consistent standard of care available to everyone and reduce variation.

• Attracting people to live and to work in north London, so we have the best possible workforce to deliver high quality services to our

community.

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Advancing equality through commissioning (cont’d)

Equality Objective 2: Improve access to all services by protected and vulnerable groups


• Camden GP Hub is open seven days a week, 365 days a year: 6.30-8pm,

Monday to Friday and 8am-8pm, Saturday, Sunday and bank holidays.

• The CCG supported practices in 2017/18 on meeting their Accessible Information

Standard.

• Continuing to reduce waiting times for the Children and Adolescent Mental Health

Service (CAMHS), with Camden currently having the third lowest waiting time in

the country.

• Achieving a rating of 'outstanding' in the national assessment for diabetes by NHS

England.

• Reducing variation in patient access to locally commissioned services, through

introducing a Universal Offer contract with general practices where patients must

have access to all services.

• Remaining on track to continue to achieve NHS England’s target of annual health

checks for 79% of people with learning disabilities. Uptake of Annual health

checks with people with learning disabilities increased by 10% from 62% 2016/17

to 72% for 2017/18

• Commissioners and social care providers have worked with people with a learning

disability to access primary care.

• Investing in primary care quality improvement at neighbourhood level, increasing

collaborative working between general practices and significantly improving the

achievement of clinical outcome targets for long term conditions.

• Improving access to support routine care, urgent care and admission, specialist

care including Eating Disorder. A new Fitzrovia Youth in Action peer support

service commenced. A bid for additional Children Wellbeing Practitioners was

successful with three posts being supported in Camden.

• A resilience network to develop the range of voluntary and community services

providing mental health support has been established. Contracts have been

awarded for Cultural Advocacy, Peer Mentoring and Employment and these

services are in mobilisation.

• Developed and promoted with Healthwatch a new GP registration form in Easy

Read Format.

In 2017 we worked with Bexley and north and central

London CCGs, along with NHS England, to trial the

first NHS online pilots in the country. NHS online offers

local people an alternative way to contact their GP and

access online GP consultations when necessary. We

also worked on behalf of London CCGs with NHS

England (London region) to raise awareness of GP

online services and GP extended access services

across London. Nearly two million Londoners are now

registered for GP online services and every London

borough offers evening and weekend appointments to

people in their local area.

In 2017 we developed and published online training for

GP receptionists to help people who are homeless

access GP practices and produced 60,000 ‘my right to

access healthcare’ cards for people who are homeless

to make sure they can get equal access to healthcare

given that they are much more likely to use A&E

services than other Londoners.

Finally at the beginning of 2018 we began working with

partners including the Mayor of London, London

Councils, Public Health England and the NHS, on a

joint plan to cut rates of new HIV infection and

eliminate associated discrimination and stigma. This

followed the signing of the 'Paris Declaration on Fast-

Track Cities Ending the AIDS Epidemic' in January

2018

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Our workforce

Equality Objective 3: Recruit, support and retain staff from protected groups

WRES

EDS2

Recruitment

Training

Support

Retention

The CCG employs 136 staff from diverse backgrounds (as at 31st March

2018). Our workforce report provides a detailed breakdown of our

workforce activities. Our commitment to advancing workforce equality has

been strengthened by our work with other NCL CCGs, providers and NEL

Commissioning Support Unit. In 2017-18 we have:

• Continued attracting applicants from diverse backgrounds.

• Ensured our selection process followed the NHS recruitment

and selection policy and good practice (e.g. ACAS code of

practice)

• Ensured our process of supporting staff with non-mandatory

and CPD courses was fair and have monitored the take up by

ethnicity.

• Followed the NHS change management policy in our team

restructuring and completed equality analysis, where required,

to ensure ‘due regard’ to the equality duty.

For further information on our workforce and Governing Body see

Appendix 1

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Governance and leadership

Equality Objective 4: Strengthen the role of governance and

leadership beyond compliance

CCG Assurance

Equality duty

Mandatory standards

Our CCG Governing Body is ultimately responsible for

assuring NHS England that the CCG is compliant with the

Public Sector Equality Duty and it is meeting the

requirements of the NHS mandatory standards.

Governing

Body

Executive Team

Equality and

Inclusion Group

• Our CCG Governing Body assures via support from Executive Team

and the Clinical Quality and Review Committee, that the we meet our

duties as a public sector body- and we seek assurance from

providers about their compliance with the equality duty.

• The Equality and Inclusion Strategy Group is a Task and Finish

Group which supports and oversees the implementation of the

CCG’s Diversity and Inclusion Plan- and is chaired by a Lay Member

from the Governing Body. Membership of the Group includes Public

Health, HR & OD, Engagement, Equality and Diversity- and

Commissioning.

• The Group also invites Healthwatch to discuss EDS2 grading.

• The Governance Team, and HR/OD Team support the Equality and

Diversity Team by providing governance advice, and HR/OD

information.

Governance

Team

HR and OD

Team

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Inclusive engagement


• We continued to support a well-established group (Camden Patient & Public Engagement Group (CPPEG) which supports us in ensuring

that patients are integrated into the governance functions of the CCG. The group represents some of the protected groups in Camden.

• We engaged a range of organisations in our Equality Delivery System (EDS2) grading.

• We have engaged with local people to obtain user feedback on services designed to support people with long term conditions. We invited

them to open meetings to listen to the results and ask questions at CPPEG open meetings. The public consultation on Acute Mental Health

Day Units was another opportunity for local people to attend public meetings and give comments via email or online surveys.

• The CCG holds providers to account with elected patients sitting on Clinical Quality Review Groups and by local providers also attending

CPPEG operational and open meetings to discuss performance. This focuses on what is going well, what needs to improve and how

providers are reassuring themselves on who the patient experience is improving.

• We have made our website more accessible for the community

Patient and community involvement at the CCG is proactively promoted via the public website (get involved page - to view click here).

Our engagement activities are designed to deliver inclusive engagement outcomes that enable the CCG to deliver our

equality objectives 1 and 2

When the CCG undertakes engagement and community work we refer to the nine protected

characteristic groups (age, disability, gender reassignment, marriage and civil partnership,

pregnancy and maternity, race, religion or belief, sex and sexual orientation) to ensure that local

people and seldom heard groups are not neglected in our work. This is also respected in our

commissioning and procurement approach. Elected patients sit on the CCG commissioning and

procurement committees, and seek assurance that appropriate engagement has taken place.

Patients and stakeholders are also involved in individual procurement of new services. For

example, in the procurement of extended access for general practices in Camden, a PPG member

and representative from Healthwatch Camden were involved in the procurement of the service

(which included involvement in being a member of the panel evaluating the Pre-Qualification

questionnaire (PQQ) and Invitation to Tender (ITT) submissions). Service user involvement

continued to be a key requirement of the service with the successful provider presenting the

service model and answering questions from the public at an open public meeting.

Source CCG website: Making our website information more accessible to all groups

http://www.camdenccg.nhs.uk/getinvolved/

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Our providers

We have a duty to ensure that all our providers are complying with their public sector equality duty- and they are implementing the mandatory

standards e.g. the WRES, EDS2 and Accessible Information Standard. We are working with other NCL CCGs in seeking assurance from

providers on their compliance with the equality duty and all NHS mandatory standards on equality and diversity.

Below we have listed our main providers and have included an overview of their current performance.

• The CCG seeks regular assurance from its providers through contract monitoring and at the Clinical Quality Review Group (CQRG).

• Amongst providers information the CCG seeks assurance on the progress on the provider’s implementation of the WRES, EDS2 and

Accessible Information Standard.

• The above is based on the assurance by individual Trust – and we are working with some providers to obtain further clarification about the

compliance with specific standards.

Our main providers

Adopted

WRES

Adopted

EDS2

Equality

Objectives

Equality

Information

Accessible

Information

Standard

University College London NHS Foundation

Trust

Central and North West London NHS

Foundation Trust

Camden and Islington NHS Foundation Trust

Royal Free London NHS Foundation Trust

Tavistock and Portman NHS Foundation

Trust

Great Ormond Street Hospital for children

NHS Foundation Trust

Note: Further information can be read on the Trusts’ website.

19

Forward strategy for 2018-19

We have a shared vision and a collective commitment to work together in new ways to change and improve health and care services in North London for

the benefit of our residents. Our main focus in 2018-19 is complying with our equality and health inequality duty. We recognise the challenges facing the

CCG both in terms of demand for services and diminishing funding- which make it challenging for us to advance equality for all groups in the community-

therefore, some prioritising may be necessary However, we remain strongly committed to meeting our legal duties by working with our staff, governing

body members, the voluntary sector, and all our partners and providers.

• Improve the way we do equality analysis and how we use the outcome to inform our commissioning decisions

•Training for managers and Governing Members

• Implementing the WRES Action Plan

•Targeted engagement with local protected groups

•Collaborative working with Public Health and the Health and Wellbeing Board

CCG level

•Work with providers around EDS2 and the WRES and holding them to account

•Work towards harmonising strategic equality objectives across NCL

•Develop systems and processes to benchmark work and share good practice

•Prepare for the implementation of the Workforce Disability Equality Standard (WDES)

NCL Level

Priorities

20

Workforce and Governing Body Members

Equality Information including the WRES

Equality Information Report 2017-18

For further information please contact:

Emdad HaqueSenior Equality, Diversity and Inclusion Manager, NEL [email protected] 3688 1121

Appendix 1

mailto:[email protected]

21

Summary

Under the Equality Act 2010, we are required to publish our equality information to show how we are meeting the public sector equality

duty as a commissioning organisation and an employer. This appendix is part of the equality information report and shows how the CCG

has performed in terms of implementing the Workforce Race Equality Standard (WRES) and Equality Delivery System (EDS2) to meet its

public sector equality duty.

The CCG employs136 staff as of 31st March 2017 including 31 office holders who are not employees of the CCG, but are on the payroll. We

have included them for WRES purposes only. This is not a big number when divided into different protected groups. Secondly, the race

equality data in some indicators is too small to draw any meaningful conclusion as a small change in the number can skew the percentage

significantly, and therefore the percentages need to be treated with caution.

.

• In 2017-18, the likelihood of BME staff being appointed was equal to White staff.

• Since 2016-17, the number of BME staff increased by 3% in Bands 8a-VSM and 5% in bands 1-7.

• The number of White staff decreased by 2% and now stands at 51%

• 18% of staff have not disclosed their ethnicity.

• 6% of the total workforce have disclosed their sexual orientation as LGBT.

• 40% staff are between the ages of 31 and 40.

• More BME staff experienced bullying and harassment compared with White staff, but less than the NCL CCGs average.

• More White staff think that the CCG provides equal opportunities than BME staff, but more BME staff (65%) think the CCG provides equal opportunities compared to the NCL average (27%).

• BME members on the Governing Body are underrepresented compared with the workforce and also the population.

22

Introduction Workforce and GB members Recruitment Staff experience

Background

As part of the Equality Information Report, Camden CCG publishes its workforce information every year. This is to show how

the CCG is meeting its duty under the Equality Act 2010 in relation to workforce. In addition the CCG has been publishing the

Workforce Race Equality Standard (WRES) report since 2015. This year we have combined the WRES report with the

workforce diversity report so that we can show how the CCG is performing across all protected characteristics. This will also

help us in our readiness to adopt the Workforce Disability Equality Standard (WDES).

As at 31st March 2018 the CCG employed 136 staff including Office Holders. The report includes information about our

current workforce and Governing Body Members, recruitment, training and staff survey by protected groups. We have not

included information about gender re-assignment as there was no data to report- currently the ESR does not have a category

for gender-reassignment.

How we have prepared the report

This report shows how the CCG has progressed against the nine indicators for the period 2017-18 and includes (where

applicable) a comparison to the 2016-17 WRES data. The report also contains recommended actions for the CCG to

implement in 2018-19 to improve the CCG’s position about race equality (Appendix 3).

To demonstrate how the CCG meets each indicator, data has been collated from several sources, including workforce data

from Electronic Staff Records (ESR) and TRAC; local demographic data from the 2011 Census as recommended in the

WRES guidelines. The data on recruitment and non-mandatory training and CPD has been gathered from the April 2017 –

March 2018 records.

The Staff Survey 2017 WRES questions outcomes have been used for the WRES indicators (5-8)

23

The roles of CCGs in implementing the WRES

Clinical Commissioning Groups (CCGs) have two roles in relation to the WRES – as commissioners of NHS services and as

employers. In both roles their work is shaped by key statutory requirements and policy drivers including those arising from:

The NHS Constitution

The Equality Act 2010 and the public sector Equality Duty

The NHS standard contract and associated documents

The CCG Improvement and Assessment Framework

In addition to the NHS standard contract, the CCG Improvement and Assessment Framework also requires CCGs to give

assurance to NHS England that their providers are implementing and using the WRES. Implementing the WRES and working on its

results and subsequent action plans should be a part of contract monitoring and negotiation between CCGs and their respective

providers. If there is something amiss with the providers’ implementation or use of the WRES, and what the results of WRES

actually show, CCGs should have meaningful dialogue with those providers. However, the credibility of the CCGs relationship with

its providers can only be meaningful if the CCG itself is taking serious action to improve its performance against the WRES

indicators.

CCGs should commit to the principles of the WRES and apply as much of it as possible to their workforce. In this way, CCGs can

demonstrate good leadership, identify concerns within their workforces, and set an example for their providers. Formally, of course,

CCGs are not required by the NHS standard contract to fully apply the WRES to themselves as some CCG workforces may be too

small for the WRES indicators to either work properly or to comply with the Data Protection Act. However, neighbouring or similar

(comparator) CCGs may wish to submit a jointly co-ordinated WRES report and action plan; this can counter any potential risk of

small workforce numbers.


24

WRES Indicator 1: Percentage of staff in each of the AfC Bands 1-9 or Medical and Dental subgroups

and VSM (including executive Board members) compared with the percentage of staff in the overall

workforce disaggregated by:

• Non-Clinical staff

• Clinical staff - of which

- Non-Medical staff

- Medical and Dental staff

Race


• The WRES indicators include both clinical and non-clinical staff. The CCG reports its staff data by including

permanent staff and those who are on the payroll but not employed by the CCG (e.g. Office Holders).

• For comparison purpose, the CCGs has kept the grouping of the data to Band 1-7, and from 8s to 9 and VSM and

has used a separate category for Office Holders who do not fit under either of the first two categories and they are

not staff of the CCG (e.g. Governing Body members who are clinical leads and are on payroll).

• Numbers have been included next to the percentages to show statistical significance.

25

2015-16 2016-17 2017-18Performance

compared

with 2016-17

Population(2011 Census)

White 60% 53% 52% 1% 64%

BME 33% 27% 30% 3% 36%

Not

disclosed7% 20% 18% 2% n/a

Workforce by ethnicity compared with local population

The figures in the table includes staff and office holders to show the overall commissioning

workforce.

18% of the total staff have not disclosed their ethnicity- and it is due to the high number of non-

disclosure amongst the Office Holders (74%). The CCG needs to update this data to ensure

greater transparency and clarity.

There has been a small change in the make up of White staff since 2016-17 (1%), and the

percentage of BME staff, however, has increased marginally (3%).

The disclosure of ethnicity has improved by 2% since 2016-17 and it’s comparable with the NCL

overall disclosure rate of 22% (as indicated in the pie chart)


WRES Indicator 1: cont’d

26

WRES Indicator 1: cont’d

Bands 1-7Change in %

representationBands 8a -VSM

Change in %

representationOffice Holders

Change in %

representation

Number % Number % Number %

White 22 56% 4% 41 62% = 7 23% 7%

BME 17 44% 5% 23 35% 3% 1 3% 2%

Not disclosed 0 3% 2 3% 23 74% 9%

Staff as at 31st March 2018 and percentage changes from 2016-17

The above table shows the percentage changes in staffing in the CCG

which includes Office Holders. The changes in percentage need to be

treated with caution as they may indicate a small or no change in the

numbers of staff. Also it should be noted that a large number of Office

Holders have not disclosed their ethnicity. In the graph we have shown the

average percentage of BME workforce across NCL CCGs for comparison

purpose.

Progress summary

White staff in Bands 1-7 – increased by 4%

White staff in Bands 8a - VSM- no significant change

BME staff in Bands 1-7- increased by 5%

BME staff in Bands 8a-VSM- increased by 3%

The number of Office Holders from both White and BME backgrounds has

increased.


27


Breakdown of workforce by protected group as at 31st March 2018 and comparison with NCL CCGs average

Age group CCCG NCL CCGs

Under 31 12% 10%

31 - 40 40% 31%

41 - 50 34% 30%

51 and above 14% 29%

Sexual Orientation CCCG NCL CCGs

Gay 4% 4%

Lesbian 1% 1%

Bi-sexual 1% 0%

Heterosexual 72% 72%

Do not wish to disclose 22% 23%

Marital Status CCCG NCL CCGs

Divorced 7% 5%

Married 40% 46%

Single 46% 41%

Legally Separated 0% <1%

Civil Partnership 0% 1%

Widowed 0% 0%


Disability CCCG NCL CCGs

Yes 1% 3%

No 83% 72%


Gender CCCG NCL CCGs

Female 66% 70%

Male 34% 30%

Religion/Belief CCCG NCL CCGs

Atheism 16% 15%

Buddism 0% <1%

Christianity 41% 37%

Hinduism 7% 7%Do not wish to disclose my

religion/belief 24% 26%

Islam 5% 5%

Jainism <1% 1%

Judaism <1% 2%

Sikhism 0% <1%

Other 6% 7%

Key highlights

• Camden has relatively young workforce compared to other NCL CCGs• The CCG has a good gender balance between male and female staff• The CCG employs less disabled staff (1%) compared with the NCL average.• Only 14% of all staff are over the age of 50 years old; this the NCL average of

29%.• The CCG employs more LGBT staff at 6% compared to the NCL average of 5%.

28


WRES Indicator 9: Percentage difference between the organisations’ Board membership and its overall workforce

Key highlights

• The above information is based on the CCG’s voting members

and staff that are employed by the CCG (excluding office

holders).

• There is an underrepresentation of BME members on the

Governing Body compared with the local BME population and

the CCG workforce.

• It appears the CCG has a higher percentage of White and a

lower percentage of BME Governing Body Members compared

with the NCL CCGs average (see pie chart)

Note: Change less than 2% is not shown

2016-17 2017-18 DemographyComparison with local

demography

Comparison with

CCG employees

GB

Members

CCG

employees

GB

Members

CCG

employees

White 75% 53% 76% 52% 66% +10% +24%

BME 13% 27% 12% 30% 34% -22% -18%

Not

disclosed 12% 20% 12% 18% N/A

GB Members ethnicity data as at 31st March 2018 compared with local population and CCG workforce

29


Training WRES Indicator 4: Compare the data for White and BME staff: Relative likelihood of staff accessing

non-mandatory training and CPD

Note: Change less than 2% is not shown

63%

35%

2%

Non-mandatory training and CPD in NCL CCGs by ethnicity

White BME Do not wish to disclose

Both White and BME staff have accessed non mandatory training and CPD in 2017-18. However, as the number of staff accessing non-mandatory training and CPD is very small in the CCGs we have aggregated the figures of all NCL CCGs which look more meaningful.

BME staff in NCL CCGs are almost twice less likely to access non-mandatory training and CPD compared with White staff


The CCG monitored the diversity information of all new recruits in 2017-18 and here are some key highlights

Disability: None of the new recruits had a disability

Age: 52% of all new recruits were aged 31-40.

Gender: Female new recruits represent 55% of the total staff recruited in the year.

Sexual orientation: Heterosexual new recruits represent 72% and gay 4%.

Marital status: 35% are married and 41% single

Religion/belief: Most staff were recruited from Christian (38%), Atheist (26%) and Hindu backgrounds (14%)- and 24% did not disclose

Race: See the next slide

The CCG follows the NHS Recruitment and Selection Policy and the terms and conditions set out in Agenda for Change. We monitor diversity data of

all applicants who apply for jobs, and those who are shortlisted and appointed. However, we do not monitor equality information of temporary or

agency staff. The following data therefore is not necessarily indicative of any trend in the recruitment but merely reflects the data of protected groups

from 1st April 2017 to 31st March 2018. When recruiting staff we ensure:

• We monitor the diversity data of all applicants

• Our panels are fully trained and are aware of our equality commitments

• We follow the best practice e.g. Two Ticks symbol (positive about disabled people)

31

Recruitment from 1 April 2017- 31 March 2018 by ethnicity

Ethnicity Applicants Shortlists Appointments NCL CCGs average

(appointments)

White 329 29% 64 19% 12 19% 21%

BME 711 62% 69 10% 13 19% 14%

Not disclosed 104 9% 17 16% 4 24% 27%


As shown in the above table, we have analysed the

recruitment data on White and BME staff and those

who did not declared their ethnicity by comparing

the BME shortlist data with the BME applicant data

and the BME appointment data with the BME

shortlist data. The same has been applied for

applicant, shortlisting and appointments information

for White staff. The last column shows the NCL

CCGs average % breakdown at appointment for

benchmarking purposes.

(Note: The shortlist and appointment % figures are a comparison of the

ethnic group numbers compared only to that ethnic group and not the overall

candidates at that stage, as a result the total for each of these stages do not

add up to 100%, as can be seen at applicants stage)

WRES Indicator 2: Compare the data for White and BME staff: Relative likelihood of staff being appointed from

shortlisting across all posts

In 2017-18 the CCG

recruited 29 staff

BME staff were

equally likely to be

appointed compared

with White staff. This

has improved from

3.44 times less likely

in 2016-17.

In NCL CCGs White staff were 1.5 times more likely to be appointed compared with BME staff


Recruitment of staff by protected characteristic (from 1st April 2017 to 31st March 2018

55%

45%

Recruitment by gender

Female Male

0%

86%

14%

Recruitment by disability

Yes No Do not wish to disclose

4%

72%

24%

Recruitment by sexual orientation

Gay Heterosexual Do not wish to disclose

10%

52%

38%

Recruitment by age

Under 31 31 - 40 41 - 50

35%

41%

3%

21%

Recruitment by marital status

Married Single Civil Partnership Do not wish to disclose

10%

38%

14%

24%

10%4%

Recruitment by religion/belief

Atheism

Christianity

Hinduism

Do not wish todiscloseIslam

Other

33


WRES Indicator 3: Compare the data for White and BME staff: Relative likelihood of staff entering the formal

disciplinary process, as measured by entry into a formal disciplinary investigation (This indicator will be based on

data from the most recent two-year rolling average).

50%

40%

10%

Disciplinary cases in NCL CCGs by ethnicity

White BME Do not wish to disclose

The CCGs monitor all disciplinary cases based on protected characteristic. Where the number is less than 5, the CCG will not mention the number to maintain the anonymity of the individuals concerned.

The number of disciplinary cases across NCL is small- and a small number can make a significant difference in the percentage- and therefore the figures provided need to be treated with caution. The 2017-18 data shows that BME staff were less likely to enter formal disciplinary investigation than White staff. However, when compared with the percentage of staff in the CCGs it looks disproportionate. For example across NCL CCGs BME staff represent 27% of the total workforce but they represent 40% of the staff that entered into a formal disciplinary.

34

Staff Survey (WRES Indicators 5-8: Compare the outcomes of the responses for White and BME staff)


Staff Survey indicator (WRES) Ethnic Group Camden NCL CCGs average

Indicator 5- KF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

White 4% 13%

BME 4% 13%

Indicator 6- KF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

White 20% 30%

BME 26% 41%

Indicator 7- KF 21. Percentage believing that trust provides equal opportunities for career progression or promotion

White 92% 74%

BME 65% 27%

Indicator 8- Q17- In the last 12 months have you personally experienced discrimination at work from Manager/team leader or other Colleagues?

White 6% 11%

BME 10% 23%

Percentage of the CCGs staff that said ‘YES’ to the WRES questions in the 2017 staff survey

Figures show staff experience of the CCG compared with their counterparts (e.g. White/BME).

• More BME staff experienced bullying and harassment from staff than White staff but less than the NCL CCGs average

• More BME staff (10%) experienced discrimination from colleagues and managers than White staff (6%), but the BME figures in the CCG is less than the NCL average (23%)

• More White staff think that the CCG provides equal opportunities than BME staff, but more BME staff (65%) think the CCG provides equal opportunities compared to the NCL average (27%)

35

Appendix 2: WRES Indicators

2017 updated WRES include:

Indicators: 1-4- Workforce indicators

, 5-8: Staff survey indicators , 9:

GB(Board) Members indicator

The aim of the WRES is to help NHS organisations improve their race equality performance.

The standard is mandatory- and CCGs are required to implement them in their own organisations and also to hold their providers to account.

WRES Indicators

36

Appendix 3: Camden WRES Action Plan (2017-19) Progress Report

Indicator Action Outcome Lead Progress so far

1. Percentage of staff in each of the AfC Bands

1-9 and VSM (including executive Board

members) compared with the percentage of staff

in the overall workforce.

(clinical and non-clinical)

Attract applicants from the local

community by publicising jobs locally.

CCG jobs publicised

through local partners and

community organisations.

Raksha Merai &

Sharon Wynter-

Smith

Vacancies were publicised through the communication and engagement team to

local community groups such as Patient newsletters, voluntary action groups,

disability group.

2. Relative likelihood of BME staff being

appointed from shortlisting compared to that of

White staff being appointed from shortlisting

across all post (internal and external)

Provide training to Governing Body

Members and staff on unconscious bias

and recruitment and selection training.

Ensure, where possible, there is a BME

panel member on the selection panel for

positions in Band 8a and above.

Likelihood of BME staff

being shortlisted and

appointed increased across

all Bands to a comparable

level with White staff.

Raksha Merai &

Sharon Wynter-

Smith

Further actions taking place:

• Recruiting staff from BAME backgrounds to sit on interview panels for

certain posts in Band 8A+

• Monitor the data annually which we publish in our WRES progress report

• Delivering further unconscious bias training/Recruitment and Selection

training to all staff including GB members across all NCL CCGs.

3. Relative likelihood of BME staff entering the

formal disciplinary process, compared to that of

White staff entering the formal disciplinary

process, as measured by entry into formal

disciplinary investigations.

Continue monitoring all disciplinary cases. Disciplinary cases are dealt

with in a fair and consistent

manner.

Raksha Merai &

Sharon Wynter-

Smith

All policies including the disciplinary policy are Equality Impact assessed. HR

meet on a weekly basis to monitor/review all ER cases across NCL, Case

numbers are shared with key HR data on a monthly basis with EMT boards. In

addition we work in Partnership with our Union colleagues to map against

protected characteristics and provide data for action planning purposes.

4. Relative likelihood of BME staff accessing

non-mandatory training and CPD as compared

to White staff.

Publicise non-mandatory training and

CPD programmes.

Encourage and motivate BME staff

through PDP & objective setting

Take up of non-mandatory

training and CPD

increased.

Raksha Merai &

Sharon Wynter-

Smith


• Each PDP will be monitored and a Training Needs Analysis created to

produce an organisation OD plan. We will be monitoring training requests

for 18/19 and matching this against who can access and parity of ability

to access

• All training will be advertised in Staff Comms, and Newsletters and the

Intranet

• Monitor attendance lists against E&D data

5. Percentage of staff experiencing harassment,

bullying or abuse from patients, relatives or the

public in last 12 months.

• Continue offering equality and

diversity training

• Promote dignity at work policy through

Board Development Sessions and

staff meetings

• Celebrate diversity in the CCG to raise

awareness

• Monitor all external and internal

recruitment activities.

• Conduct mini staff survey in June

2018 – and bullying and harassment

will be one of the areas.

Reduced incidents bullying

and harassment in the

organisation.

More staff should feel that

the CCG is a fair employer

Raksha Merai &

Sharon Wynter-

Smith

• Corporate message about equality, diversity and inclusion highlighting

the CCG’s position and commitment to race equality.

• Staff forums are set up take forward actions from the staff survey results.

Staff away days have taken place:

• OD leads have been appointed to take forward a OD plan, which include

an organisational training plan.

• WAP process to ensure all post are signed off and advertised

appropriately in NCL.

• Training being rolled out across NCL for managers and staff re B&H

6. Percentage of staff experiencing harassment,

bullying or abuse from staff in last 12 months

7. Percentage believing that CCG provides

equal opportunities for career progression or

promotion.

8. In the last 12 months have you personally

experienced discrimination at work from any of

the following: Manager, Team Leader, Other

Colleagues?

9. Percentage difference between the

organisation’s voting membership and executive

membership of the Board

Continuously review the makeup of

Governing Body voting members to

ensure race equality.

Update GB members ethnicity data

GB voting members

reflective of the staff and

local community.

Raksha Merai &

Sharon Wynter-

Smith


The CCG is working to ensure the GB members reflect the community we serve,

and we are updating the ethnicity data across NCL every year to monitor that.

• We will look to review Board composition and action plan against %

difference

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