EQUALITY, DIVERSITY AND HUMAN RIGHTS STRATEGY 2018-2021

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CONTENTS

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Beatrice FraeknelChairman

This strategy sets out our commitment to taking equality, inclusion, diversity and human rights into account in everything we do, whether that’s through our aspiration to deliver perfect care for our patients and service users to employing a diverse workforce in a Just and Learning Culture.

Our aspiration as outlined in the Trust’s People Plan is simple, ‘to create a compelling place to work where we attract, retain and develop the best people to deliver the best care and be the best they can be’. To do so we believe we need to become a truly inclusive employer, one who embraces all talent and sees equality, diversity and inclusive practice as a way of increasing performance and gaining competitive advantage if we truly embrace a culture that celebrates diversity. The culture we aspire to will be inclusive and we will continue to promote a zero tolerance approach towards all forms of inequality including bullying, discrimination and harassment.

Having significantly expanded as an organisation over the last three years, it is has enabled us to take a fresh look at our current position and agree a new strategic approach to embedding equality, diversity and human rights in all that we do. This includes revised governance arrangements through a sub committee of the Trust Board. Our recently refreshed staff charter and organisational values highlights our expectation of valuing difference and individuality and respecting colleagues so to create an environment which respects and celebrates diversity, equality and inclusion.

Our approach over the last few years has been focused on governance, compliance and the core

building blocks to formulating a good strategy. The introduction of the National NHS Workforce Race Equality Standard has enabled good discussion and focus from the Trust Board, including the piloting of a reciprocal mentoring scheme last year.

Going forward our reinvigorated networks aspire to develop greater partnerships internally and externally to drive change and ensure diversity, equality and human rights is at the heart of all we do. We are also leading an Equality, Diversity and Inclusion governance project to inform and provide options to the development of an integrated and quality framework for the emerging Cheshire and Merseyside Sustainability and Transformation Partnerships (STP).

At Mersey Care we believe that everyone is a leader; all people, from all backgrounds, in all professions, at all bands.

We believe that inclusive, values led leadership is a personal responsibility for us all regardless of role. We acknowledge that we each contribute to, and are accountable for the environment that we collectively create and the impact that this has on both the people who receive our care and on those who provide it.

Our aspirations to deliver Perfect Care can only be achieved if we focus towards becoming an inclusive employer and service provider. Recognises, valuing and respecting people’s individuality and different and harnessing these differences to deliver the best care and enabling our staff to be the best they can be.

FOREWORD

Joe RaffertyChief Executive

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PurposeThis strategy sets out our commitment to promoting equality, diversity and human rights. It outlines our key priorities that will support us to drive forward equality, diversity and human rights and to deliver continuous improvement in Mersey Care’s ambitions to deliver Perfect Care. This strategy document includes our Equality Objectives which are aligned to the Equality and Delivery System (EDS2) improvement framework.

1.1 Why equality, diversity and human rights important to Mersey CareThere are ethical, business, economic and legal drivers for equality, diversity and human rights and it is clear that they must play a central role in improving the quality of care that we deliver.

We are promoting an inclusive culture that celebrates diversity, not as something that is nice to do, but because it is crucial in achieving our ambition of becoming a Just and Learning organisation. We are committed to understanding and removing barriers at a service level for patients, service users and carers who share protected characteristics. This will enable us to improve access, health outcomes and experience for all our patients and service users and ultimately to reduce health inequalities.

1.2 Links to Trust Wide Vision and ValuesEquality, diversity and human rights is a thread throughout our trust wide objectives and values.

Mersey Care’s ambition is to strive for Perfect Care for the people we serve. We have set ambitious goals in pursuit of this:• Adopt a ‘No Force First’ approach (avoid

physical restrain, including medication led restraint)

• Zero suicide for those in our care• Improve physical health for our service users• Implement a Just and Learning Culture.

We recognise that embedding a human rights based approach to our decision making will support both the Fairness, Respect, Equality, Dignity and Autonomy (FREDA) principles of the Human Rights Act but will also prevent unnecessary restraint.

Evidence highlights the increased level of mental health problems such as anxiety, depression and stress, particularly for LGBTQI+ individuals. The negative impacts of discrimination and marginalisation for these individuals is well established but the available data relating to suicide and self harm is limited. Mersey Care are working with LGBTQI+ individuals and groups to develop an inclusive approach to our zero suicide campaign.

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We are working with our communities to better understand their needs based on their protected characteristics and aim to deliver our services using person centred care approaches.

The principles of fairness and respect are a thread throughout our work to implement a just culture. We believe that this work promotes inclusion and celebrates individuality and transparency for our staff.

Our values are those of:• Continuous Improvement• Accountability• Respect• Enthusiasm• Support

Buildings that work for us

Technology that helps us

provide better care

Improvequality

(STEEP)

Save time and

money

Great managers and teams

A productive, skilled

workforce

Side by side with service users and

carers

Effective partnerships

Researchand

innovationGrow our

service

OUR PEOPLE

OUR

SE

RVICES

OUR RESOURCES OUR FUTU

RE

EMPO

WER

ED

SERVICES USERS AND CARERS

EMPOWERED TEAMS

Striving for perfect

care and a just culture

PASSION FOR IMPROVEMENT

PROFESSIONAL AND OTHER STANDARDS

RESPECT FOR OTHERS

DRIVE AND PASSION

HEALTH ANDWELLBEING

EFFECTIVE OPEN COMMUNICATION

SELF DEVELOPMENTRESPECT FOR TEAMWORK

ENGAGEMENT AND COLLABORATION

COMPASSIONATE COMMUNICATION

BEHAVIOURS FOR COLLABORATION

FLEXIBILITYRESPECT FOR

SHARED VALUESPRIDE

JUST AND LEARNING CULTURE

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2.1 Equality ActIn 2010 equalities legislation was significantly updated with the passing of the Equality Act. The Equality Act has two aims, which are to harmonise and consolidate the different strands of discrimination law (over 100 pieces of separate legislation) into one single act. Therefore simplifying and strengthening the law to support progress on equality.

There are nine protected characteristics covered by the legislation including:• age• disability• ethnicity• gender• faith• sexual orientation• marriage and civil partnerships• pregnancy and maternity• gender reassignment.

The public sector has additional duties placed on them within the Equality Act which help public authorities avoid discriminatory practices and integrate equality into their core business. These are known as the Public Sector Equality Duties

and include the general and specific duties which are:• Eliminate unlawful discrimination, harassment

and victimisation and any other conduct that is unlawful under the Equality Act

• Advance equality of opportunity• Foster good relations

The general duty is underpinned by specific duties which include the requirement to:• Set specific, measurable equality objectives.

(At least one every four years)• Analyse the effect of our policies and practices

on equality and consider how they further the equality aims. (Known as equality analysis)

• Publish sufficient information to demonstrate we have complied with the general equality duty on an annual basis. (Equality monitoring information.

2.2 The Human Rights ActThe Act sets out the fundamental rights and freedoms that individuals in the UK have access to and embodies the FREDA principles of fairness, respect, equality, dignity and autonomy. The Act includes the right to:• life

BACKGROUND

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• freedom from torture and inhuman or degrading treatment

• right to liberty and security• freedom from slavery and forced labour• right to a fair trial• no punishment without law• respect for your private and family life, home

and correspondence• freedom of thought, belief and religion• freedom of expression• freedom of assembly and association• marry and start a family• protection from discrimination in respect of

these rights and freedoms• peaceful enjoyment of your property• education• participate in free elections

2.3 Equality Objectives 2018-2021Equality, Diversity and Human Rights are the thread that runs throughout our People Plan and Perfect Care Strategies. We aim to recruit and retain a highly skilled, motivated workforce that is representative and better equipped to understand the needs of our diverse population. We will continuously work to empower and engage our patients, service users and their carers to better understand the barriers at a service level and influence other factors that lead to health inequalities.

Our objectives have been identified using:• equality monitoring information from patient

complaints and Friends and Family Test• feedback from Merseyside CCG’s Equality Team• feedback from Staff Networks• feedback from Service User Group• EDS2 outcomes• our staff feedback• our staff survey• our Trust Board• Equality, Diversity and Human Rights

committee.

Mersey Care’s objectives for 2018-2021 for are:• to improve year on year the reported employee

experience for protected groups • to embed high quality equality analysis through

use of data into the design, delivery of services including our decision making processes

• to reduce health inequalies for protected groups by improving access to all services (includes accessible information standard)

• to improve year on year the reported patient / service user experience for protected groups.

2.4 Equality Delivery System (EDS2)The NHS Equality Delivery System (EDS2) is a framework that enables Trust’s, in discussion with local people, review and improve their performance for people with protected characteristics protected by the Equality Act 2010. Using the EDS2 will also help the Trust deliver on the Public Sector Equality Duty (PSED).

The Trust’s equality objectives have been mapped to the EDS2 goals. The Trust has been following EDS and the refreshed EDS2 since 2011 and will continue to utilise this framework to support a performance culture related to inclusion.

Mersey Care are working alongside Equality and Inclusion colleagues from across the Borough on a project led by Merseyside CCG, which has created a system wide approach system wide approach across merseyside. In addition Mersey Care are leading on a project across the Cheshire and Merseyside Sustainability and Transformation Partnership (STP) to develop a consistent and cohesive approach to equality, diversity and inclusion with shared objectives and key performance indicators across all NHS organisations in the area. The project aspires to reduce duplication and will create professional development opportunities for equality and diversity leads.

We recognise that patients will face similar barriers in each health care Trust so have combined our resources to work on sustainable solutions that will improve access to services and reduce health inequality for people who share protected characteristics.

We will seek feedback on an annual basis from staff and patients and service users on progress relating to achieving the EDS2 goals and will publish the outcomes as part of annual reporting process. Along side an Annual Report, equality metrics for services and workforce and interpretation and translation usage.

Mersey Care have taken a system wide approach to identifying key objectives for EDS2. We are working with our NHS colleagues across Merseyside to deliver upon a set of shared objectives. This

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work is supported by Merseyside CCG and local Healthwatch organisations.

Accessible Information StandardThe aim of this Standard is to establish a framework and set a clear direction such that people who use NHS services (and where appropriate carers and parents) who have information or communication needs relating to a disability, impairment or sensory loss receive: • Accessible information: information which is

able to be read or received and understood by the individual or group for which it is intended

• Communication support: support which is needed to enable effective, accurate dialogue between a professional and a service user to take place;

So that they can access services appropriately, independently and be able to make decisions about their health, wellbeing, care and treatment. The Trust is required to ensure that they:1. Ask: identify / find out if an individual has any

communication / information needs relating to a disability or sensory loss and if so what they are.

2. Record: record those needs in a clear, unambiguous and standardised way in electronic and / or paper based record / administrative systems / documents.

3. Alert / flag / highlight: ensure that recorded needs are ‘highly visible’ whenever the individuals’ record is accessed, and prompt for action.

4. Share: include information about individuals’ information / communication needs as part of existing data sharing processes (and following existing information governance frameworks).

5. Act: take steps to ensure that individuals receive information which they can access and understand, and receive communication support if they need it.

We have a number of ways to support us to achieve this and will describe how we have set about to make this happen and it also includes our data for the:• Equality information • Equality objectives• Equality Delivery System• Workplace Race Equality Standard• Accessible information

Equality AnalysisEquality Analyses are designed to allow organisations to identify the impact and effect of their decisions on people with protected characteristics under the Equality Act 2010. Where negative impacts are identified the Trust needs to take steps to eliminate or reduce that disadvantage for staff, service users, patients, carers and visitors to the Trust. We are working with our staff and commissioners to improve the quality of Equality Analysis that prompt staff to use a wide range of information when considering changes to service delivery and workforce practices.

2.5 Workforce Race Equality Scheme (WRES)WRES requires all NHS Trusts to comply with reporting and action planning in nine key areas. The actions in the WRES are a key part of the strategy and all Trusts are required to report progress against the WRES which is published by NHS England.

Greenlight ToolkitThe Greenlight Toolkit provides a framework for auditing and improving mental health services to ensure that they are effective in supporting people with autism and people with severe learning disabilities. There are three audits included in the toolkit:

a) The Basic Audit – this is intended to assess compliance with the standards that were identified as relatively easy to achieve.b) The Better Audit – trusts scoring well on the basic audit are asked to consider completion of this.c) The Best Audit – this contains issues considered to be the most challengingMersey Care’s mental health and learning disability services conduct annual self assessments against a mixture of the audits and develop improvement plans which are reported to the Equality, Diversity and Human Rights CommiteeGender Pay Gap All employers with over 250 employees are required under the Gender Pay Gap legislation to publish their gender pay gap as of 31 March 2017. This has to be completed by 30 March 2018 and published on the trust website.

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The trust uses the national job evaluation framework for Agenda for Change to determine the appropriate pay banding of a role. This framework provides a clear process of paying staff equally for the same or equivalent work.It must be noted that the gender pay gap differs to equal pay. Equal pay is in relation to pay differences between men and women who carry out the same job, which is unlawful. The gender pay gap shows the difference in average pay of all men and the average pay of all women employed by the Trust. It is therefore possible to have genuine pay equality but still have a significant gender pay gap.

With approximately 80% of the NHS workforce being women and because there is a more equal gender split of higher paid staff such as doctors, the average earnings for women overall is significantly lower, despite the fact that a man and a woman doing the same job are on the same pay grade.

Our Trust position can be found on our website: merseycare.nhs.uk

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Leadership at Mersey CareAt Mersey Care we believe that everyone is a leader; all people, from all backgrounds, in all professions, at all bands.

We believe that leadership is personal responsibility for us all regardless of formal role in acknowledgement that we each contribute to, and are accountable for the environment that we collectively create and the impact that this has on both the people who receive our care and on those who provide it.

The attributes and expectations of both informal and formal leaders is reflected in our coproduced Trust CARES. Values and Staff Charter (implemented 2014, refreshed 2018), our Leading Perfect Care Plan (January 2016) and leadership competency framework (April 2018). These documents describe behaviours that that are evidenced within Professor Michael West’s research that create environments where diversity is respected and celebrated and where people are enabled and empowered to maximise their unique talents and experience to provide the very best quality, continually improving, compassionate care; Perfect Care.

In short, the development of Inclusive, Values led leadership and stewardship is central to Mersey Care’s Just and Learning Culture and our ability to deliver Perfect Care.

Values for Inclusion are our Golden ThreadOur ethos ‘attract for values and train for skill’ transcends our employee lifecycle and begins in our outreach work within our local communities.

Working in partnership with other public and third sector organisations we have developed and delivered our award winning pre-employment / apprenticeship programme to provide training, qualifications and support that enable people who have been previously disadvantaged, to secure sustainable employment within our Trust and to progress their future careers within care.

A bespoke BME version of our pre-employment Programme is being coproduced with our Equality and Diversity Groups and will commence January 2018.

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This is one example of how our Trust is working hard to develop different access routes to employment and skills and is a key part of our plans to ensure our workforce is truly reflective of the communities we serve.

Assessment, development and embedding of inclusive behaviours continue throughout the Mersey Care employee lifecycle to ensure our values are truly embedded and enacted.

Our CARES values and Staff Charter have been incorporated wthin all of our people management and development policies and processes including recruitment, induction, PACE appraisal (Performance, Achievement, Contribution and Evaluation), talent and succession planning (Maximising Potential) and supervision.

To ensure our leaders are enabled to demonstrate the style and behaviours that are desired our Trust has prioritised and invested in a comprehensive support and development offer aimed to shift thinking and behaviours in order to engage and empower our workforce to work inclusively and collaboratively. Leadership and Management development resources on the Staff and Managers Hub are available to all.

We offer a full pathway of bespoke values led programmes that support aspiring, middle and strategic / system leader. The bespoke programmes have been designed with inclusion and collective leadership principles.

Leaders are supported to develop their emotional intelligence, consider their own biases and improve relationship management skills. Interventions to support translation of learning to practice are also provided e.g. personal coaching and Action Learning Sets, Work based improvement projects.

Particular focus is placed on the impact of the leader on the team, their psychological safety and their ability to learn, continually improve the quality care and other outcomes. For this reason, our approach integrates leader and team development

simultaneously.

Team Development – Psychological Safety At Mersey Care, we recognise that organisations are complex, social environments, human systems. Working together in teams ( or interdependently ) requires there to be an understanding and valuing of the contributions of others. We acknowledge that people are different and differences can lead to unnecessary barriers that influence relationships and outcomes. The adopted methodology for Team Based Working is Affina ( previously Aston OD ) which is the evidenced based methodology developed by Professor West.

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Staff Engagement and InvolvementInvolvementWe will be open and transparent in our communications regarding employee experience data for different groups and will work with staff to develop action plans to make improvements where employee experience falls short of the standards we are striving for.

We will actively involve staff in changes to policies, procedures and service developments and improvements that will affect them. We recognise the benefits that diversity of thought bring to an organisation, and will encourage staff from different groups to get involved in developing employment practice, and in developing new models of working aligned to our Perfect Care Strategies. We will engage with our inclusion networks, and we will encourage staff to join, and will develop our networks across the Cheshire and Merseyside Sustainability and Transformation Partnerships (STP)

Support for StaffFor staff requiring individual support and advice relating to inclusion and diversity issues, we will ensure multiple options are available in addition to their managerial team:• Inclusion networks for particular characteristics

(BME, Disabled, LGBTQI+ and Gender Equality)

• Just and Learning Ambassadors• Freedom to Speak Up Guardian• Tell Joe (to contact the Chief Executive directly

with concerns)• Staff side organisations

CelebrationCelebrating diversity will be central to our approach. We will be a visible partner in the work we are doing collaboratively, both locally and nationally. We will improve our presence at Inclusion and Diversity related events, such as local Prides and community events and will encourage staff to take the lead in campaigns.

RespectRaising awareness of inclusion and diversity issues and promoting inclusive practice is a core element of our wider Respect campaigns. The Mersey Care Staff charter developed by our staff, is central to our employee practices and we will not accept standards that fall below those expected. We will champion and recognise inclusive behaviour.

Patient InvolvmentPeople Participation Programme team and service are accountable to the Executive Director of Communications and Governance. Mersey Care has People Participation programme based upon a commitment to co-production at all levels of

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our organisation. This programme encompasses a wide range of activities where decisions are made which affect the experience of and outcomes for service users, patients and carers. Enabling service users and carers to participate as equal partners in all aspects of the Trust is an important way for Mersey Care to meet its legal obligation, to protect and promote the human rights of vulnerable people in its care but more than that it is the central facet upon which we deliver care

Central to Mersey Care’s success is the realisation that an essential component of quality service development and delivery is the lived experience of service users and carers of those services. Service users and carers have a wide range of valuable knowledge, skills and experience in addition to their knowledge and experience of Trust services.

The participation of a diverse range of service users and carers who reflect the community served by the Trust is essential if the Trust is to be a relevant and responsive organisation. Participation as equals in decision making has good recovery outcomes for service users and carers. It also has good outcomes for the Trust such as improved staff and services.

Participation of service users and carers as equal partners in decision making is a means of tackling the power imbalance that often exists between professionals and lay people, and a means of achieving cultural change. The Trust also ensures that service users and carers are properly trained, supported, and recognised for their contribution to the work of the Trust. Our vision and values for people participation are set out in our Framework for People Participation (HR31).

Patient ExperiencePatient experience is led by our Patient Safety Lead and reports to the Medical Director. It includes all we do and is not just about the care received but how we communicate, how our environments impact on the service delivery. It is essential to ensure that services are developed and improved as a result of patient opinions and feedback. All Trust staff should feel empowered to put the experience of patients, service users and carers in all that we do.

Patient experience will shape and influence continuous improvement linked to Trust values and key work strands such as involvement in own care and access to services. The Trust is constantly evolving and needs to ensure that the best possible care is provided to all those in receipt of services and that we learn from their experiences to support these improvements.

A positive experience of care can have a positive impact on clinical outcomes, people need to feel involved in their care and treatment, feel listened to with their views and opinions respected.

The Trust has established a new Patient Experience Committee chaired by a Non-Executive Director which will set standards for all divisions to achieve and monitor adherence. This committee will report into the Quality Assurance Committee on a quarterly basis.

Patient experience includes all we do and is not just about the care received but how we communicate, how our environments impact on the service delivery and experience and is essential to ensure that services are developed and improved as a result of patient opinions and feedback. All Trust staff should feel empowered to put the experience of patients, service users and carers in all that we do.

Patient experience will shape and influence continuous improvement linked to Trust values and key work strands such as involvement in own care and access to services. The Trust is constantly evolving and needs to ensure that the best possible care is provided to all those in receipt of services and that we learn from their experiences to support these improvements.

There are many Patient Experience initiatives currently active within the Trust including patient forums, patient surveys, patient comments, stakeholder events as well as information collected through complaints, SUI’s, PALS. Patient experience feeds into and supports the Trust’s governance arrangements or is used to identify themes and trend or to focus future direction of investigation or questioning linked to the quality agenda.

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How we engage with service users, patients and carersThere are several ways that experience or comments are received about the services provided by the Trust these include:• consultation• ward based community meetings• speaking directly with staff• completing one of the patient or carer

experience surveys,• the national Friends and Family Test question

with the option to leave free text comments• the national annual community mental health

survey • sharing your views and opinions via our

website www.merseycare.nhs.uk • Contacting the Patient Advice and

Liaison Service (PALS) palsandcomplaints@mersecare.nhs.uk 0151 471 2377 or 0800 328 2941

• NHS Choices or Patient opinion web sites www.nhs.uk or www.patientopinion.org

• Heathwatch listening events and enter and view visits

• Social media• Patient stories

Our GovernorsThose living in communities that are served by Mersey Care can become members, with the Membership Community made up of public, service users, carers and staff members.

We have in excess of 13,000 members and we strive to ensure this is represented of the communities we serve. We regularly review the representativeness of our membership and use census data to develop membership targets in respect of the protected characteristics.

We are currently underrepresented in respect of some ethnic and age groups and we use this information to target the recruitment of members to ensure we continually improve representativeness.

Governors are elected to our Council of Governors from our membership in order to represent members’ interests.

Our governors bring a wealth of experience, time and commitment to our Trust and work closely with the Board to influence decision making and ensuring all services are continually improving. We undertake a review of the representativeness of our Council of Governors prior to elections and focus election awareness sessions accordingly.

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7. GovernanceGovernance arrangements will ensure that the Trust Board is receiving regular assurance that the Trust is meeting the Public Sector Equality Duty and delivering the expectations set out in this strategy.

The delivery of the strategy will be overseen by the Mersey Care Equality, Diversity and Human Rights Committee. The Committee is chaired by a Non Executive Director and is attended by the

Executive Lead for Equality, Diversity and Human Rights. It has a membership of corporate and clinical leads, staff and patient representatives, staff network leads and equality advisors.

The group is responsible for setting strategic direction of the agenda, monitoring its delivery and championing the values and behaviours of the Trust. The group will review progress against planned priority areas in line with actions and timescales as well as feedback from ongoing engagement activity.

Trust Board

EqualityPatient

Experience

QAC (Quality Assurance

Committe)

LocalDivision

SecureDivision

Liverpool and Sefton

CommunityDivision

Staff Inclusion Networks

Specialist Learning Disability Division

CorporateDivision

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Mersey Care NHS Foundation Trust

V7 BuildingKings Business Park

PrescotL34 1PJ

Tel: 0151 473 0303