Equality Duty Annual Report

2016/17

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Contents Page no.1 Foreword 32 Introduction 43 Organisational context/ equality governance 54 Our communities and health needs 65 Embedding equality in commissioning 76 Meeting Public Sector Equality Duties 87 Fostering good relations 98 Partnerships and performance monitoring 109 Workforce information 1210 Equalities in our ways of working 1311 Equality progress in 2016 1712 Next steps and conclusion 17-18

Appendices Page no1 Equality action plan 192 List of representatives 223 Accessible information standard – case study 234 Commissioning case study 245 Engagement case study – Black history celebration event 286 Plan on a page 297 Workforce data 30-34

Accessibility NHS Bexley Clinical Commissioning Group (CCG) supports the NHS Accessible Information Standards and therefore if you require a copy of this document in a different format you can do so by contacting the Patient Experience Team.

We will do our best to support and develop equitable access to all policies and procedures. You can contact us by:

Telephone: 0800 328 9712

Email: bexccg.contactus@nhs.net

If you would like more details on any of the contents, or copies of this document, please contact the CCG Lead.

Annie GardnerHead of Patient Experience & EqualitiesNHS Bexley CCG221 Erith RoadBexleyheathKent DA7 6HZ

Acknowledgement: Thanks go to all colleagues from NHS Bexley Clinical Commissioning Group and South East Commissioning Support Unit who contributed to this report.

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ForewordThis is the fourth annual public sector equality report for NHS Bexley Clinical Commissioning Group (CCG). It shows our commitment to promoting equality and reducing health inequalities and sets out how we have fulfilled our responsibilities arising from the Equality Act 2010, both to patients and as an employer. The Act requires public bodies to publish appropriate information showing compliance with the Equality Duty on or before 31st January each year.

This information includes overviews of our roles and aims, and of Bexley’s diverse population and health challenges. It sets out our legal responsibilities in demonstrating ‘due regard’ to the Public Sector Equality Duty’s three aims and provides evidence for meeting the specific equality duty. It sets out the way we strive to commission for inclusion. It also lists our four Equality Objectives and explains how we monitor the equality and performance of our providers.

The report highlights examples of work we have undertaken in 2016 to take account of the needs of our diverse population. It looks at our plans to improve the way we commission services, identifies future areas for development and demonstrates our approach to inclusion.

In 2016 Bexley CCG has been working across the borough and in South East London to develop integrated services to improve health and care outcomes and reduce inequalities. We have also worked collaboratively with our partners in the local health and care economy to commission and deliver high quality services for our diverse communities. Through our commissioning we are committed to reducing health inequalities, promoting equality and improving health outcomes in a cost effective way that provides good value for money.

We are indebted to local people who have helped us to better understand local needs and whose involvement is integral to all that we do. We are also fortunate to have a history of strong partnerships with Bexley Council, NHS providers, the voluntary and community sector and will continue to work together to deliver the changes and improvements that are required.

Many thanks to all the clinicians and staff who continue to be at the heart of clinical commissioning and who are committed to getting it right for Bexley residents.

We celebrate the progress that has been made this year and recognise much more still needs to be undertaken for Equality and Diversity to be truly embedded within the CCG. However, we are confident that through delivery of our plans and continued collaboration a real difference to health and care in Bexley will be seen in the future.

Paul Cutler PPI Lay Member & Governing Body Equality Champion

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IntroductionThe Equality Act 2010 provides a legal framework to strengthen and advance equality and human rights and consists of general and specific duties. This requires that all organisations that rely on public finances are subject to the public sector equality duty (PSED) and must show that they are complying with legislation and pay ‘due regard’ to the three aims of the duty.

The general duty requires public bodies to show due regard to:

Eliminating unlawful discrimination or any other conduct prohibited by or under the Act

Advancing equality of opportunity between persons who share a protected characteristic and persons who do not share it

Fostering good relations between people who share a relevant protected characteristic and people who do not share it

There are nine protected characteristics covered by the Equality Act:

Age Disability Gender reassignment Marriage and civil partnership Pregnancy and maternity Race (including nationality and ethnic origin) Religion or belief Sex (male/ female) Sexual orientation

We also consider carers as an additional protected characteristic when making commissioning decisions.

The specific duties require public bodies to publish relevant proportionate information showing how they meet the Equality Duty by 31st January each year and to set equality objectives every four years.

Both general and specific duties are known as the Public Sector Equality Duties (PSED). As a statutory public body the CCG must ensure it meets these legal obligations and intends to do so by publishing information demonstrating how we have used the Equality Duty as part of the process of decision making.

We are committed to making sure the services we commission provide equitable access to all our registered populations and that they reduce the barriers, disadvantages and poorer health outcomes experienced by particular vulnerable groups.

Organisational context

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NHS Bexley Clinical Commissioning Group (CCG) plan and buy health services for Bexley residents, the CCG assumed statutory responsibilities from 1 April 2013.

The CCG is a membership organisation made up of all the GP practices in Bexley. Our aim is to secure the best possible health and care services for everybody to reduce health inequalities and improve health outcomes in a cost effective way that provides good value for money.

We use what we know about the health needs of our residents to plan how and where to provide care, which we commission from hospital, community services and other providers of care.

Equality GovernanceAll Governing Body members have a collective and individual responsibility to ensure compliance with the public sector equality duty (PSED), which in turn secures the delivery of successful equality outcomes for us both as commissioners and an employer. The Governing Body provides leadership to equality and diversity by:

Agreeing equality objectives and improvement plans Ensuring that equality is a key consideration in Governing Body decisions Actively championing equality and diversity, supporting the CCG Equality

Steering Group and attending forums with patients, carers and voluntary and community groups

All Governing Body members share the responsibility in ensuring that the voice of the local population is heard in all aspects of the CCG’s business.

The Governing Body includes a Patient and Public Involvement Lay Member who champions equality and diversity at board level.

The Chief Officer has responsibility for ensuring that the necessary resources are available to progress the equality and diversity agenda within the organisation.

The Director of Quality and Governance has executive accountability for equality; the Head of Patient Experience and Equality has operational responsibility. Together they will ensure the CCG is meeting its legal responsibilities by:

Ensuring that governance arrangements for tackling health inequalities and promoting equality are effective and followed

Developing and monitoring the implementation of robust working practices that ensure equality and diversity requirements form an integral part of the commissioning cycle

Ensuring that the governing body, staff and member practices remain up to date with the latest thinking around diversity and have access to appropriate resources, advice and training opportunities

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All line managers have responsibility for Ensuring employees have equal access to relevant and appropriate

promotion and training opportunities Highlighting any staff training needs arising from the requirements of this

framework and associated policies and procedures Support staff to work in culturally competent ways within a work

environment free from discrimination

Equality Steering Group (ESG)The CCG convened an Equality Steering Group in 2015. The remit of this group is to focus, support and monitor the implementation of the Equality Delivery system and to ensure compliance with the Equality Duties under the Equality Act 2010.

The ESG is chaired by the PPI Lay Member and schedules four meetings a year. Progress, and updates from ESG are reported through the Quality and Safety subcommittee and are presented to the Governing Body and Bexley Patient Council.

Our communities and health needs of Bexley populationThe information we use to understand the health and wellbeing and the diverse characteristics and needs of the people of Bexley is obtained from the Joint Strategic Needs Assessment (JSNA)

Population estimates for 2016 suggest that the resident population for Bexley is 241,500. This is projected to increase to 246,600 by 2021 and

increase further to 252,500 by 2026.

Life expectancy for both men and women is similar to London but higher than the England average. The gap in life expectancy is 7.2 years lower for men and 7.5 years lower for women in the most deprived areas of Bexley than in the least deprived areas.

Deprivation in Bexley (16.7) is lower than the England average (21.7). Approximately 17.5 per cent of children live in poverty (9,650) compared to 21.8 per cent in London and the England average of 18 per cent.

The over 75 year old population in Bexley has increased since 2001 and is predicted to reach 25,100 by 2031. A more rapid increase is projected from 2018.

21.6% of the Bexley population is made up of Black and Minority Ethnic (BME) groups, which is projected to increase by 27.2% by 2031. The Black African community are the ethnic group with the highest proportion of residents in Bexley.

For children aged 10 to 11 (year six primary care school group), 36.9 per cent (952) are classified as being overweight or obese, compared to 37.2 per cent for London, and 33.2 per cent for England. The most recent figures published

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by Public Health England on healthy weight (2012/2014) show that 25 per cent of Bexley’s adult population were either obese or overweight. This is higher than both the London (20 per cent) and England (24 per cent) averages.

The health of Bexley’s population illustrates the need for continued action to address health inequalities; prevention, identification and good management of long term conditions.

Embedding equality within the commissioning cycleBexley CCG is committed to ensuring that the public sector equality duty is embedded in all aspects of commissioning activities throughout the commissioning cycle.

Bexley Commissioning Intentions The CCG’s vision is for the residents of Bexley to stay in better health for longer with the support of good quality integrated care, available as close to home as possible – backed up by accessible, safe and expert hospital services when they are needed.

The CCG has identified seven key health related priority schemes to focus on locally in 2016 and beyond. More information about what the CCG intends to do to improve all of the priority can be found in the Plan on a page – 2016 and beyond (see appendix 6).

More than 60 stakeholders were able to comment and help shape the CCG’s suggested commissioning intentions at an event in Bexleyheath. The feedback from this session was used to further enhance and develop the CCG’s commissioning intentions for 2016/17, which were approved by the Governing Body in March 2016.

The CCGs commissioning intentions for 2016/17 align to the Our Healthier South East London strategy. In summary, the CCG’s priority schemes for 2016/17 include:

Primary care development

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Planned care services Urgent and emergency services Maternity care services Children and young people’s services Queen Mary’s and Erith hospitals Cancer and end-of-life care

South East London Sustainability and Transformation PlanIn December 2015, South East London health and care systems were asked to come together to create a local blueprint for implementing the Five year Forward View, for the period up to March 2021, known as Sustainability and Transformation Plans (STP’s). Bexley CCG has been working with the other five South East London CCG’s to develop plans that meet the needs of Bexley’s diverse population, whilst ensuring that we engage and listen to our local communities. (More details on the STP can be found under the section – partnership working)

Quality monitoring providersA key aspect of commissioning is to monitor the contract and services the CCG has commissioned to ensure that these services deliver high quality care for all.

In Bexley the Quality and Safety subcommittee (a subcommittee of the Governing Body) is responsible to provide assurances that current contracted services are monitored appropriately and that Public Sector Equality Duties are being met.

Meeting the Public Sector Equality Duty in 2016The Equality Act 2010 requires the CCG to pay due regard to the three aims of the general duty of the act (as described on page 4). We want to embed Equality, Diversity and Human Rights in all we do and make sure that the decisions we take are fair and equitable.

We do not automatically assume our decisions will be equally beneficial for everyone. We test our assumptions before making decisions and assess the effects of a decision on particular populations. This makes it more likely that our decisions will promote equality of access and equity of outcomes.

Equality analysis is embedded within our commissioning process. This ensures that service proposals going before the Governing Body for consideration include an equality analysis and contributes to the evidence on which decisions are based. We carry out these analyses to ensure we pay ‘due regard’ to the three aims of the PSED and Human Rights Act

The CCG carries out Equality Analysis to highlight positive and negative impacts on protected characteristics and other local disadvantage groups, giving an opportunity to mitigate any negative impacts. Also Equality Analysis is used to inform decision making. Below are examples of Equality Analysis carried out in 2016.

Falls Business Case Cancer Pathway – improved cancer identification Re-procurement – Termination of Pregnancy

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Re-procurement – Community Dietetics

Fostering good relations Bexley Patient and Public Advisory NetworkBexley CCG has a growing database of contacts in the community and voluntary sector.

The CCG has collaborated with organisations to engage residents and patients on a number of projects, including the Our Healthier South East London (OHSEL) issues paper, which outlined the issues across South East London that he programme has been created to address. Community and voluntary sector organisations have given invaluable support extending our reach into seldom heard communities

Bexley Patient CouncilThe Patient Council is a subcommittee of the Governing Body and is made up of community champions representing the diversity of all communities in Bexley. The Chair of the Patient Council is the Governing Body PPI Lay Member; involvement also includes Healthwatch Bexley and Bexley Voluntary Service Council. See appendix 2 to see details of membership of patient council and organisations/ communities they represent.

The Patient Council met bi-monthly to discuss topics relevant to the CCG and the services it commissions as well as local and wider NHS issues and other engagement. Examples of work include:

Providing advice and feedback on primary care developments Engaging of patients and the public on the CCG’s commissioning intentions

for 2016/17 any beyond Taking part in contract monitoring and review meetings between the CCG and

service providers (areas include MSK, cardiology, urgent care/out-of-hours and diabetes)

Working with CCG to develop site services and patient environment as the QMH site is developed

Working with members to develop the equality agenda and taking part in the equality steering group

Working with Bexley’s children and young people to develop a youth council who are engaged in service redesign and other CCG developments

Supporting engagement on the Our Healthier South East London programme

Reports and minutes from Bexley Patient Council are discussed at the CCG’s Governing Body meetings and available to public via our website. Representatives from the Patient Council took part in the development of the CCG’s Equality Delivery System process and will be invited to join the EDS2 panel to discuss and agree EDS2 grading with other local people and stakeholders at an event in spring 2017.

Reader’s panelThe CCG established a reader’s panel of local people to ensure that our written materials and communications provide clear, relevant and understandable information for the public.

Public sessions at Governing Body meetings

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All CCG Governing Body meetings take place in public. During meetings we run a public forum session where members of the public are able to ask questions. These are well attended and the notes are published on our website.

Topics discussed in 2016 included integrated care services, finances and the Our Healthier South East London programme. This is an example of how we demonstrate our value of transparency as well as our commitment to facilitate public participation in our work.

Mystery Shopper As a CCG it is important that we continuously improve and develop ways in which we engage and the mystery shopper scheme has been one of our major successes since its inception in 2014.

In 2016 a total of 1567 mystery shopper reports were received (2,632 since the scheme was launched). We also saw an increase in the number of residents registering to join the scheme and to date we now have 235 members.

With diversity in mind we wanted to ensure that the mystery shopper scheme was as inclusive and far reaching as possible. Whilst it is recognised that there is still work to be done in this area it is encouraging to see that some of our members represent people with learning disabilities, carers, maternity service users, older residents and representatives from a number of different faiths and nationalities.

The feedback we receive from mystery shoppers allow us to see how services are received and feel through patients eyes – ultimately identifying what is working well and what could be better. Discussions about feedback also help staff to realise the impact their actions have on a patient’s experience (good or bad).

Partnerships and performance, monitoring providersNHS Bexley CCG works in partnership with other commissioners to deliver high quality care and support and with the community in the commissioning of services. There is also good record of partnership working and strong relationships with:

South East London Clinical Commissioning Groups – The six CCGs in South East London (Lewisham, Lambeth, Southwark, Greenwich, Bromley and Bexley) have established collaborative arrangements to meet their shared commissioning responsibilities

Health and wellbeing board – is a partnership that encourages local service commissioners and providers to work together to advance the health and wellbeing of the borough

London Borough of Bexley – to jointly commission services Bexley Public Health Bexley healthwatch Voluntary and community organisations Healthcare providers – such as local acute, community and mental health

hospitals

South East London Sustainability and Transformation Plan

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In December 2015, health and care systems were asked to come together to create their local blueprint for implementing the Five year Forward View for the period up to March 2021, known as Sustainability and Transformation Plans (STP’s). The South East London draft plan was submitted on 30 June 2016. The STP is the “umbrella” plan for South East London and draws extensively on the Our Healthier South East London (OHSEL) strategy. Over the next five years the South East London STP commitments are to:

Support people to be in control of their health and have a greater say in their own care

Help people to live independently and know what to do when things go wrong Help communities to support each other Make sure primary care services are consistently excellent and have an

increased focus on prevention Reduce variations in outcomes and address inequalities by raising the

standards in our health services Develop joined up care so that people receive the support they need when

they need it Deliver services that meet the same high quality standards whenever and

wherever care is provided Spend our money wisely to deliver better outcomes and avoid waste

These priorities have been informed by a case for change that includes population health needs by an equalities impact assessment carried out in 2014 that identified approaches and considerations in the further development of the OHSEL strategy, and by a further equalities analysis in 2015 that made recommendations in respect of priority groups for further engagement and for reaching ‘seldom heard groups’.

Our Healthier South East London Equality Steering Group (ESG)Bexley CCG is a member of the OHSEL Equality Steering Group. The role of the group is:

To ensure that the OHSEL strategy and STP plan meets the requirement of the Equality Act 2010 and specifically the Public Sector Equality Duty

To ensure that the OHSEL strategy meets the requirements of the Health and Social Care Act 2012, with specific reference to tackling health inequalities

To commission and approve independent equalities analyses and impact assessments as appropriate

To monitor progress on meeting the equalities requirements set out above and to produce reports

To promote best practice approach to equalities work and highlight any concerns

Consolidated Elective Orthopaedic ServiceOHSEL is exploring the benefits and feasibility of a consolidated elective orthopaedic service for inpatient operations in South East London. The OHSEL ESG has overseen the commissioning and delivery of an equality analysis of elective orthopaedics care in South East London. The analysis showed the following groups as particularly impacted by the potential changes: older people, disabled people,

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females, people undergoing gender reassignment, people in economic and social deprivation and carers. The report also highlighted that people with different disabilities have different needs and for those with learning disabilities, epilepsy or cerebral palsy, evidence exists to demonstrate disproportionate need. This will be further explored with stakeholders representing disability as engagement continues.

In the engagement phase of the work the analysis suggested that OHSEL considers asking questions on issues such as the location and access of services, the design of services and monitoring and feedback. This will enable OHSEL to understand to what extent location, the design of services and how feedback is captured is important to patients. The social demographic analysis demonstrates difference in population groups across the CCGs. The north west of OHSEL, including Lambeth, Southwark and Lewisham, tend to have higher densities of deprivation and those with a disability. In comparison the south of the study area tends to have higher densities of older people and carers.

Workforce informationThe Public Sector Equality Duty requires that information on the make-up of the workforce must be published where public authorities have 150 or more employees. The data does not have to be published by organisation with less than 150 employees to protect staff identify under the Data Protection Act. Bexley CCG has a total of 65 employees and purchases additional commissioning support services from South East Commissioning Support Unit (CSU).

The workforce is a critical factor in the effective delivery of Bexley CCG business. A quarterly workforce monitoring report is submitted to the senior management team of the CCG including workforce information relating to numbers of staff in post, turnover and sickness absence and an equalities profile relating to six of the nine protected characteristics.

Although Bexley CCG has no legal duty to publish our workforce data, as the CCG employs less than 150 staff, the CCG has chosen to do so as part of our good practice.

Appendix 7 provides a snapshot profile of the organisation (as at 31 November 2016) which includes Governing Body composition (Ethnicity) and BME staff in bands 8 -9 compared to overall workforce.

Workforce Race Equality Standard (WRES)The workforce Race Equality Standard (WRES) is a benchmarking tool introduced by NHS England to assess the progress of race equality within NHS organisations annually. The WRES is based on new research on the scale and persistence of such disadvantage and the evidence of the close links between discrimination against staff and patient care.

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The standard highlights any differences between the experience and treatment of white staff and BME staff in the NHS with a view to closing those metrics through an action plan.

The CCG has completed the WRES reporting template, a copy of which will be made available on the CCG website.

Workforce Race Equality Standard in Bexley CCG providersSince 2015-16 all CCGs need to demonstrate that they are giving “due regard” to using the WRES indicators and assurance that their Providers are implementing WRES.

Assurance is provided through reports received at Clinical Quality Reference Group (CQRG) that Providers are publishing WRES data and addressing any key shortcomings or gaps between the treatment and experience of white and BME staff

An analysis of performance across the CCG’s Providers will be reviewed by the Equality Steering Group in 2017/18.

Equality in our ways of working The CCG requires all staff to undertake mandatory equality and diversity training within 3 months of commencing employment, with refresh every three years. Training is provided via an online module which aims to offer:

A broad based knowledge of equality and diversity Ability to empathise with colleagues and patients from diverse backgrounds Ensure access and services are appropriate to individuals needs

The CCG also considers equality when developing our policies, presenting papers to Governing Body and when formulating proposals for change to services. This is to ensure that these do not discriminate against protected groups and to identify opportunities to promote equality. Our premises are accessible and we ensure that our public meetings are held in accessible premises.

Our main Provider organisationsWE commission from service providers that meet NHS standards and need to be assured of the quality of services they provide, which includes compliance with the Public Sector Equality Duty (PSED). Our contracts and service specifications require providers to ensure equity of access to services. Once we have reviewed a service prior to commissioning we write detailed service specifications to tell potential providers what we want the service to do and ensure a section on equality and diversity is included. Once a contract is awarded we monitor performance and hold providers to account.

Individual providers publish their own Equality Data to show how they are meeting the requirements of the PSED. Whilst the CCG is an associate commissioner for some NHS providers we still monitor their compliance with equality.

NHS Provider Annual equality report published

Equality objectives

WRES results published on

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on website published on website

website

Lewisham & Greenwich NHS Trust

Yes Yes Yes

Oxleas NHS Foundation Trust

Yes Yes Yes

Bexley CCGs Quality and Patient Experience teams regularly review provider’s patient experience and equality intelligence. Any issues or queries are taken to the relevant Clinical Quality Review Group (CQRG) meetings, ensuring any issues are discussed and addressed quickly and providers are held to account to improve patient experience.

Complaints The Patient Experience Team (PET) deal with queries, concerns and formal complaints relating either to the commissioning of services or to services commissioned by the CCG. Equality and diversity monitoring is an important source of information helping us to identify whether certain groups experience problems disproportionately to other groups. Intelligence gathered is analysed and brought together in quarterly insight reports so trends and themes can be identified and addressed.

An equality and diversity questionnaire is sent to all complainants with their acknowledgement. During the reporting period in question the CCG received a total of 18 formal complaints, of which just 8 related to CCG services. All complainants were provided with and requested to complete our equality monitoring questionnaire. Nil returns were received.

Themes from the 8 complaints mainly related to Continuing Healthcare retrospective reviews and commissioning/funding decisions. However, one complaint related to the CCG actions to implement requirements of the Accessible Information Standard (AIS). More information about this complaint and resulting actions can be found at appendix 3.

Serious Incidents All serious incidents from NHS providers are reported on STEIS and reviewed by our Quality Team. This means that we are able to triangulate data with other information (including complaints data) to see if any group is disadvantaged or impacted upon. Additionally intelligence gained is used to monitor contracts and assure quality safety standards.

Engagement and communicationsThe NHS Act places a statutory duty on NHS organisations to involve and consult patients and the public in planning of service provision, the development of proposals for change and decisions about how services operate. The CCG is committed to developing effective and sustainable relationships with our patients, carers, the public and partners in health, social care and the voluntary and community sector to improve the lives of our local population. Patient experience is different for every person but by gathering feedback in a consistent and on-going way we are able to identify where changes may be needed to improve services. The CCG’s communication and engagement strategy has helped it to meet its general

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equality duty, especially around promoting good relations between different groups of people.

The long term vision for patient and public involvement (PPI) and engagement is that the partnership between the local community and the CCG is evident in all its work. In this our objectives are to:

Ensure engagement in pathway redesign, service changes, strategy and priorities

Engage hard to reach and vulnerable communities Reduce inequalities through greater involvement Develop effective partnerships with community and voluntary groups (e.g.

Healthwatch) to ensure active engagement of patients and carers

To support targeted involvement the CCG Patient Experience Team works collaboratively with local communities from different geographical areas, communities of interest and seldom heard groups to ensure their views are integral in the commissioning, design, delivery and evaluation of services.

Over the past year the Patient Experience Team (PET) has actively engaged with patients, carers and the public. Additionally they have engaged with local groups and organisations representing the 9 protected characteristics through focus groups, attending community interest forums and holding meetings relating to commissioning projects. Examples of this work include:

engagement and activities around re-tender of services, pulmonary rehabilitation, community dietetics, development of Queen Mary’s Hospital

Engagement with carers and people with learning disability, focus group to understand needs and current experiences (plus collation of patient stories)

Visits to several pop in parlours across the borough to engage with older people

Community campaign to raise awareness of Men’s Health week – June 2016 Celebration event to mark national Older People Day – June 2016

The CCG have focused on attending local community groups to discuss projects and present information that is relevant to them. For example the PET have attended a variety of groups to share key messages including older people (pensioners forum), youth council, Multifaith forum, Mencap, Asian Women’s group, Maternity Service Liaison Committee

We encourage direct feedback through a range of methods that suit different people, including making information available (if requested) in different languages and formats (e.g. large print or easy read), surveys, online feedback (contact us mailbox), public meetings etc. In addition the CCG regularly hears patient stories at QSSC meetings and uses this direct feedback to improve services through commissioning activities. The successful introduction of a mystery shopper scheme also means that our ears are constantly to the ground listening and acting on the experiences of our patients.

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Effort is made to engage with seldom heard groups by contact through existing forums and representative groups. We recognise the importance of enabling these groups to be involved in their preferred local communities where they feel most comfortable and supported. We go to specific community meetings by arrangement (community forums, PPG’s, BME groups etc.). Through grass routes involvement and large scale public/community events the CCG is able to listen to residents (or their representatives) about experiences of healthcare services and engage these groups directly in its work. This year the CCG has engaged directly with seldom heard communities on a number of projects by working in partnership to forge strong links within these groups.

Examples of engagement to reach groups with protected characteristics include:

Celebrating diversity (Black History) community event in October 2016 Patient council, includes representation from most protected characteristic

groups, they meet every 6 – 8 weeks. Outreach with ‘seldom heard groups’ including lesbian and gay group, Asian

women’s group, youth ambassadors, pensioners forum, Mencap, Maternity service users and carers

In December 2016 we worked with people with learning disabilities and their carers to gather feedback as to the difficulties they face in accessing services and how these could be overcome. (Big Health Check Day)

In January 2016 we attended the Carer’s Partnership Board engagement event to understand needs, priorities and concerns or carers across Bexley

The PET has built a comprehensive stakeholder distribution list, this helps ensure information about local health care and opportunities for involvement are disseminated widely throughout the borough. We also use a number of online platforms to engage with the public, our staff and GP members, this includes;

Public website Staff intranet GP extranet Twitter GP and staff briefing Stakeholder briefings

Interpreting servicesThe CCG has in place an interpreting and translation service to assist patients in primary care settings. The service can provide face to face and telephone interpreting services in a range of languages and can translate documents upon request This service enables those with interpreting needs to access and increase knowledge of local health services, improving health and wellbeing and supporting community cohesion.Equality progress in 2016

Equality Steering Group (ESG)The Equality Steering Group was established in 2015 and reports to the Quality and Safety subcommittee. The purpose of the ESG is to ensure that the CCG meets the

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General and Specific duties under the Equality Act 2010 across all commissioning decisions, contracting and workforce. The ESG also ensures that equality, diversity and human rights is actively promoted, communicated and managed from the workforce and community of Bexley alongside the continuing work with other partners to contribute to reducing health inequalities.

The ESG held two meetings in 2016, one in January and the second in November 2016. It is recognised that there was a gap in meetings, which was due to staff changes/organisation restructure and recruitment of a new PPI Lay Member. However, these have now been addressed and following induction of PPI Lay Member in September 2016 and action by the Head of Patient Experience and Equalities steps have been taken to review the ESG terms of reference and identify an updated work plan for 2017 and beyond.

EDS2The CCG has implemented EDS2, the preferred equalities reporting framework for the NHS, to help meet its PSED. Following recruitment of new PPI Lay Member and review of equality action plan/ membership of ESG action plans are being made for the CCG to undertake a self-assessment against the four goals and 18 outcomes set out within EDS2. This involves gathering evidence against each goal and outcomes using a RAG rating, and will be completed by end of March 2017. Following this a date will be identified to convene a panel, which will include representatives from local organisations, to take feedback on the CCG rating with the aim of publishing an agreed EDS2 rating by the end of June 2017.

Equality Objectives and action plan progressThe CCG equality action plan and objectives highlights six key areas for action. See appendix 1.

Next steps and areas for action A number of areas have been identified, which we will use to inform our equality actions in 2017/18. These actions are:

Review the CCG equality objectives Collect equality monitoring information when we engage with protected

characteristic groups and use this to widen engagement and drive improvement of services

Address any actions identified by the Workforce Equality Report (appendix C) Address any actions identified in the EDS2 process (appendix D) Deliver lunch and learn session on EDS2 and WRES to staff PPI Lay Member to review equality training needs for Governing Body

Conclusion We are committed to reducing health inequalities, promoting equality and valuing diversity as integral part of everything we do.

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This report demonstrates that NHS Bexley CCG has undertaken significant work in relation to equality and diversity. We have shown our commitment to commissioning for equal access to health care for vulnerable groups and for improving health outcomes. It also demonstrates our compliance with the requirements of the Public Sector Equality general and specific duties. It shows how we have made our commissioning decisions and what needs to be undertaken in the next year to continue commissioning for diversity.

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Objectives Specific action/deliverables Update/notes

1. Embed the PSED into the work of the organisation via effective governance arrangements and appropriate training. (Meet statutory requirements of the Equality Act)

A. CCG has a robust Equality Impact Assessment (EiA) process for all commissioning and business cases

All business cases include EiA as part of the process. This is assessed at all stages of the approval process

B. The Quality and Safety sub-committee ensure all new policies, strategies, proposals and business cases are accompanied by EiA

The EiA involves a comprehensive check list for completion and the Quality Impact Assessment includes ensuring compliance with relevant Policy/Guidance/ Procedures, particularly compliance with the Equality and Diversity Act 2010

C. All CCG staff are aware of and understand equality diversity and human rights

All CCG staff complete mandatory online equality and diversity training, with refresh every three years.

2. To put the general equality duty into practice across the organisations functions including policy and decision making and commissioning

A. CCG ensures all commissioning and business case proposals are accompanied by robust EiA

All business cases include an EiA as part of the process. This is assessed at all stages of the committee approval process.

B. CCG ensure all contracts include reference to compliance Standard NHS contracts template adopted

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Appendix 1 – Equality Action Plan

with Equality Act 2010 which includes provision and requirement to comply with the Equality Duty. Where this provision is not contained the contract will be reviewed making all providers that we commission from aware that all contracts would be subject to the requirements of the Equality Act

We use the NHS Standard Contract, with Equality Duty, and this will continue.

3. Ensure the specific requirements of the PSED are met by publishing objectives at least every four years and information on progress annually

A. The CCG publishes annual equality information Information first published Jan 14

Refreshed report published annually thereafter.

B. The CCG has identified and published equality objectives Equality objectives were agreed in 2013.

These will be reviewed and refreshed during 2017 following completion of EDS2 grading assessment.

C. The CCG has effective governance arrangements for equality and diversity work

The work of the Equality Steering Group is presented to and reviewed by the Quality and Safety Committee. This provides assurance to the Governing Body that the CCG is fulfilling its equality goals and objectives

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4. Develop Equality and Diversity Focus Group with representation from patients and public – ensuring robust governance arrangements for engagement and sharing information with the Governing Body

A. Promote diversity and inclusion in the engagement of patients and provision of accessible information

Communications and Engagement strategy to be refreshed in 2017

Attend and promote CCG work at local community meetings – presentations and documents shared tailored to audience

Community roadshow/engagement events planned throughout 2017

The CCG has in place a range of systems and methods to ensure that local patients and the public are able to be involved in decision making

The CCG uses a variety of media to champion the need to hear the multiple perspectives of diverse people, patients and communities (including social media)

B. Establish Equality Steering Group A small group of senior managers and representatives (including PPI Lay Member and Chair of Patient Council) have been recruited to join the Equality Steering Group.

Terms of reference for the group have been developed and refreshed in 2016

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Appendix 2 List of patient council representatives/ network & groups they represent

Name of Group Protected characteristic group representedPPI Lay Member - ChairCrayford Town Forum Age, marriage and civil partnership, race, religionDiabetes UK Bexley Long term conditionsBexley Multifaith Forum Faith, religionPPG Albion Surgery Age, marriage and civil partnership, race, religionCarers Support Bexley CarersHaven LGBTPPG Plas Medygg Age, marriage and civil partnership, race, religionPPG Plas Medygg Age, marriage and civil partnership, race, religionPPG Station Road Surgery Age, marriage and civil partnership, race, religionBexley Pensioners Forum Older peoplePPG Bellegrove Road Age, marriage and civil partnership, race, religionSouth East Cancer Network Long term conditionNHS retirement fellowship Older peopleErith Town Forum Age, marriage and civil partnership, race, religionMencap Bexley People with learning disabilities and carersAge UK Bexley Older people and carersBVSC Voluntary / community groupsPPG Lyndhurst Road surgery Age, marriage and civil partnership, race, religionInspire disability trust DisabilityHealthwatch BexleyMystery Shopper champion Age, marriage and civil partnership, race, religion, long

term conditionsBexley safer neighbourhood Age, marriage and civil partnership, race, religionMaternity service liaison committee (MSLC)

Maternity & pregnancy, sex (female), marriage & civil partnership

Turkish community Age, marriage and civil partnership, race, religionSNAP DisabilityBexley youth council Age, sex (male/female)KAB Age, marriage and civil partnership, race, religionInsight Bexley Age, marriage and civil partnership, race, religion

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Appendix 3 Accessible Information Standard (AIS) case study

BackgroundThe AIS is a mandatory requirement on all providers of NHS and publicly funded adult social care services. It aims to make sure that people who have a disability or sensory loss get information they can access and understand, plus any communication support needed. The standard tells organisations how they should ensure patients and service users (and carers/parents) can access and understand information, including information in accessible formats. The standard also advises how organisations should ensure people get support from a communication professional, if needed, and about changing working practices to support effective communication.

Bexley CCG considered the requirements of AIS and the impact of this on our duties as a Commissioner. Some actions undertaken are listed below.

Supporting Bexley GP practices Production of a guidance pack giving quick references to the standard, a guide on

clinical systems, posters for display, listing of relevant organisations that can provide supporting communication tools

Raised awareness through presentations at various forums, including the CCG primary care development group and offering advice to GP/ practices who required more support

CCG activities Commissioning and contract management teams working with providers to seek

assurance and evidence of compliance with AIS. CCG staff advised of the standard and its aims through regular communication

channels. Plus access to a suite of AIS tools and support A presentation and information was shared with Bexley Patient Council to ensure

they were aware of the standard and advised of the CCG actions for compliance The CCG privacy statement was updated to reflect the standard Equality work plans to include reference to AIS and assurance of compliance

In 2016 concerns were highlighted that patients who have a hearing impairment are unable to access urgent GP appointments as arrangements for BSL services must be booked in advance. This indicated some patients/ carers may be disadvantaged if they needed to access an urgent appointment.

Following a review the CCG enhanced access arrangements for communication support, specifically to meet the needs of service users using walk in services etc. Consequently a service level agreement was agreed to provide online virtual sign language interpretation services, this allows patients to sign to a BSL interpreter via a mobile device and for the interpreter to explain what is being signed and vice-versa.

In summary the CCG has taken very seriously the requirement to implement AIS and ensured mechanisms are known and available to support patient needs.

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Appendix 4Equality Case Studies in commissioning/procurement

Physical disability procurementThe CCG and London Borough of Bexley (LBB) separately commissioned a range of services for residents with physical and sensory impairments as described below:

People with physical and sensory impairment - LBB commissioned Equipment Services - LBB and the CCG (jointly commissioned) Wheelchair services – CCG commissioned

In 2015/16 joint working took place to bring these services together and commission them jointly under one contract. By making this change it was hoped to make the user experience more streamlined and bring together some of the great ways in which services were already being provided.

Before the commissioning process began we engaged with service users and carers to ask them to help share the design of the new contract specification. To ensure as many people as possible could contribute the following methods and opportunities to engage were developed:

Attending a listening event where service users could hear about plans and share experiences

Completing an online survey or paper survey Asking service users and carers to contacting the Patient Experience Team to

share views and give their feedback

An engagement event was held and a survey was distributed to a selection of service users, with copy also accessible online on the CCG and LBB websites. The survey was also available at Inspire for service users to access, copies and distributed to local outlets including libraries. A total of 148 feedback forms were received with a range of comments (some from service users and some from carers)

Key themes captured from engagement and survey results are as follows: Commissioning day services and be-friending support is important Services should not be directed to be delivered within patients home. A lot of

people feel isolated and therefore enjoy attending the facilities provided by Inspire.

It is important to involve users all through the process – not just through the procurement stage. People would like to be included in contract monitoring as new service emerges.

People feel unable to approach staff and management at Inspire with any concerns/ problems – this is something that should be considered and addressed within the new service specification

Essential that good KPI’s are a feature to ensure quality and effectiveness of the new service

Concerns/Issues

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People concerned about support to help with direct payments and personal assistants.

Wheelchair serviceThere were a number of comments regarding the wheelchair service mainly around inflexibility and manner/attitude of staff (which people said was at times rude). Feedback also indicated the repair service was poor, communication difficult (unable to get through on phone and then no follow up with progress). There were also concerns about length of time for repairs and that there did not appear to be much choice in the range/type of equipment offered.

General overarching feedback highlighted that:

More help and support is needed for carers There is limited access to OT’s Resources are limited and private providers and NHS clinicians do not

integrate well

As a result of engagement activity 7 people expressed an interest in taking part in a focus group to support on-going involvement in the procurement process. 4 were service users and 3 carers.

A focus group was held with service users including a deaf man for whom we provided an interpreter, all were involved in setting questions and then evaluating the tenders for wheelchair, equipment and physical disability services.

All feedback and contributions from the focus group were added to the business case which was agreed by the CCG Governing Body in May 2016.

CAHMSDuring 2015/16 the CCG undertook some work to develop early intervention services for children and young people, and mental health and emotional wellbeing. As an integral part of the redesign of CAMHS across the LBB and CCG, a project board was established to review the Bexley population baseline and need for CAMHS.

Some initial analysis through this process was undertaken to understand the prevalence of difficulties experienced by children and young people who are experiencing emotional and mental health difficulties. This information was used to inform the new CAMHS offer and the design of this transformation plan.This plan was developed through the involvement of key stakeholders in Bexley including children, young people and families.

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A partial screenshot of the outcome of a survey monkey exercise with schools is shown below.

In developing the plan we analysed data from the JSNA to better understand the emotional wellbeing and mental health needs of children and young people in Bexley. In addition to the core planning group, wider stakeholder engagement included the following:

Bexley Youth Council School and Educational Improvement Team Youth Offending Team (YOT) lead Schools GPs Bexley Voluntary Service Council

The wider stakeholder engagement was carried out using a variety of methods, including: Survey and discussions with 250 young people Survey and discussions with 60 schools – Headteachers, Designated

Safeguarding Leads and SENCOs Bexley Youth Council consulted other young people and developed a short film Surveys of parents and children from universal and targeted groups, such as

looked after children, young offenders, children and young people experiencing emotional health problems

A professional focus group was held with GPs Feedback from CAMHS Young People’s Health Forum – ‘Breaking Stigma’ Involvement from the CCG’s Clinical Lead on the Project Board

Support and ratification from the CCG’s Governing body, and Bexley Health and Wellbeing Board.

Further consultation is planned to take place as we work to develop our whole system approach to Child Mental Health and Emotional Wellbeing including:

Focus group with parents and carers of children with complex needs Focus group with parents and carers of general child population Borough wide survey to all families in Bexley.

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0.0%20.0%40.0%60.0%80.0%

If you have a problem, who do you talk to ? You can choose several answers.

Example of young people’s survey responses

Focus group engagement with children in 5 primary schools and 7 secondary schools – with the support of Young Minds.

One to one interviews with parents, local leaders of Council, CCG, Community NHS Trust, Voluntary Sector, Acute NHS Trusts.

Professional focus groups with teachers / social care / voluntary sector/Educational Psychologists and other Early Intervention team staff and healthcare professionals.

The findings of the consultation exercises to date are reflected in the high level recommendations below:

Create a viable mental health service for young people with mild to moderate needs that is accessible and non-stigmatising in the community.

Create and communicate clear pathways for young people needing support for their emotional wellbeing and mental health.

Create a single point of access for GPs and Schools to refer to for ‘tier 2’ which can also act as helpline with expert advice available to signpost families and offer advice to schools.

Create supportive communities – e.g. consider the use of mindfulness in schools, a public health promotion scheme to de-stigmatise issues of mental health and workshops to support parents on Child Mental Health.

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Appendix 5Black History Month – Engagement in partnership with Insight Bexley

In 2016 we worked with Insight Bexley to deliver a Black History celebration event.

Insight Bexley provides support for refugees, minority ethnic groups and young people and act as an agent to improve the everyday life, conditions of asylum seekers and refugees, and promote social inclusion by facilitating integration and equal participation within society.

The Chair of Bexley CCG and Patient Experience Team were in attendance throughout the event, which was also supported by a range of stall holders to talk about the work of the CCG and to listen to people’s experiences, concerns and needs.

List of stall holders in attendance Bexley CCG – Mystery Shopper Bexley Voice Index Care - Residential care activities for the elderly & disabled Re-instate Healthwatch Bexley Bexley multifaith forum Bexley Council Forward UK Bexley Women's Aid People's network for change

The event was also an opportunity to recognise and celebrate a number of projects within the community that support engagement and work with our diverse community. Pictured below is the Chair of the CCG with some of the 2016 award winners

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Appendix 6

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Appendix 7 - Workforce

As at 31 November 2016

The following tables are a profile of the CCG relating to the main protected characteristics. Tables do not include Governing Body membership.

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A White - British66%

B White - Irish2%

G Mixed - Any other mixed background

2%

H Asian or Asian British - Indian12%

J Asian or Asian British - Pak-istani2%

L Asian or Asian British - Any other Asian background

2%

N Black or Black British - African

5%

P Black or Black British - Any other Black background

2%

R Chinese2%

S Any Other Ethnic Group2%

Z Not Stated6%

Ethnic Orgin

No38%

Not Declared60%

Undefined2%

Disability

21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-650

2

4

6

8

10

12

14

16

Age

Female Male0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Gender

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Atheism

Christian

ity

Hinduism

I do not w

ish to

disclose

my relig

ion/belief

Islam

Other

Undefined

05

10152025303540

Religious Belief

Heterosexual45%I do not wish to dis-

close my sexual orien-tation54%

Undefined2%

Sexual Orientation

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British88%

German2%

Polish2%

(blank)9%

Nationality

Governing Body composition (Ethnicity)

A White - British H Asian or Asian British - Indian Z Not Stated0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

Ethnicity

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BME staff in bands 8 – 9 compared to overall workforceG M

ixed - A

ny other

mixed back

...

H Asian or A

sian Briti

sh - I

ndian

J Asia

n or Asia

n British - P

akista

ni

L Asia

n or Asia

n British

- Any o

ther...

N Black o

r Blac

k Briti

sh - Afri

can

P Black o

r Blac

k Briti

sh - Any o

ther ...

R Chinese

S Any O

ther Eth

nic Gro

up

0

1

2

3

4

5

6

7

8Etnicity

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