The strategic role of equality and diversity in health

Adopting a comprehensive and strategic approach to equality and diversity in health is crucial to delivering better health outcomes for all. In this article, Kathy Sutton explores how health inequalities can be reduced and communities strengthened by embedding equality and diversity in every aspect of performance.

Kathy spoke to a number of leading specialists at a national, regional and local level:

• Surinder Sharma, National Director for Equality and Human Rights, Department of Health
• Staynton Brown, Assistant Director of Equality, Diversity and Human Rights, Lambeth Primary Care Trust
• Shahnaz Ali, Associate Director of Equality and Diversity, North West Strategic Health Authority
• Dave Thomson, Assistant Director of Inclusion and Partnership, Five Boroughs Partnership NHS Trust
• Ann Crowder, Equality and Diversity Manager, Northamptonshire Healthcare NHS Trust
• Richard Kramer, Director of Connected Care programme, Turning Point

The following article reflects their views and experience.

Discussion points

The interviewees were asked to consider the following questions:

• How can we ensure that equality and diversity functions are mainstreamed?
• How do we balance the need for information against the need for action in our localities?
• How can local authorities work effectively with primary care trusts (PCTs) and strategic health authorities (SHAs)?
• What should partnership with the third sector involve?
• How can commissioning involve service users and carers in its design?

Better health for all

Equality and diversity are central to promoting better health and wellbeing for all. Developing a strategic approach is integral to delivering better services built around individual need.

Surinder Sharma, National Director for Equality and Human Rights at the Department of Health (DH), says:

“Diversity and equality are central to our vision. The whole direction of reform ... is leading to personalisation of health and social care. Services are increasingly built around the complex needs of individuals and staff are equipped to deliver this.”

The business case

Sharma believes that while there is a clear moral, legal and social case for promoting equality and diversity, there is also a strong business case. He says:

“If we get services wrong and they are not tailored to meet individual need, they simply don’t work in the end. We can save time and money and make services more efficient and effective by adopting a strategic approach to equality and diversity.”

Staynton Brown, Assistant Director of Equality, Diversity and Human Rights at Lambeth PCT, agrees:

“Equality and diversity is central to providing the most efficient and effective health and social care services for everyone. It is about the best use of our resources to meet the needs in our communities.”

Human rights

The principles on which equality and diversity are based are linked to human rights values. Sharma explains:

“A lot of these things are common sense. We need to treat people as we would want our mother, our father, our family and ourselves to be treated. This is synonymous with best practice.”

Strategic and operational framework

Embedding equality and diversity in the strategic and operational framework of organisations delivering health services is critical to delivering better health for all.

At a national level the Department of Health has set the vision and laid out the principles in the NHS constitution. The Equality and Diversity Council reports on equality and diversity issues to the NHS Management Board.

SHAs have responsibility for setting the ambition and direction at a regional level.

PCTs have responsibility for local commissioning of services, for promoting equality in health, and for reducing health inequalities. They work in partnership with local government and the third sector to develop effective programmes.

Key issues

In the North West the SHA recognises that it that has a major responsibility, as the largest employer in the region, for improving representation within the workforce. It also links equality and diversity to the way it measures success.

Shahnaz Ali, Associate Director of Equality and Diversity for North West SHA, explains:

“Our major function is that we are primary systems managers. We are responsible for getting better health outcomes and reducing health inequalities for all the strands of our population. We have to provide leadership and manage performance so that we gain improvement across all the major NHS programmes. We have to get away from a 'tick box' compliance approach.”

Challenges

Surinder Sharma believes that the NHS, as a major employer, has to anticipate legislation and provide leadership and excellence in workforce development. Local government also has to take a lead.

Sharma outlines a further major challenge:

“We have to make our policy framework living. We must ensure that individuals receiving health and social care services have their diversity recognised. They should be treated as individuals, each with different needs at every stage of their experience of the NHS and social care delivery.”

This requires an approach which is both top-down and bottom-up, involving the wider community. Shahnaz Ali believes that this also requires “setting up a robust infrastructure and obtaining the right information so that we can embed equalities into every major programme including world-class commissioning.”

In the North West the challenge has been translated into a five-point strategy:

1. Increase the diversity, the representation and the working lives of the workforce.
2. Develop data to monitor, information to manage, and knowledge to act.
3. Develop the right services: targeted, useful, usable and used.
4. Move beyond legal compliance to initiating best practice.
5. Develop specialists and leaders.

NHS North West’s Equality and Diversity strategy – on the NHS North West website

Getting the right information

The North West SHA carried out a major mapping exercise of the region’s 64 NHS bodies. This investigated organisational capacity, capability, compliance, successes and best practice. The findings were reflected in the SHA's five-year strategy and updated Single Equality scheme.

At a local level, Staynton Brown believes that lack of information can act as a barrier to developing innovative practice with key groups. He says:

“We often know anecdotally that there are issues facing parts of our population, but because we do not have the information we sometimes fail to act. At a local level we have to get that balance right.”

The North West found that equality and diversity leads and managers were struggling to find the most up-to-date evidence relating to the needs and experiences of diverse groups. It therefore created the Health Equality Library Portal (HELP) – the most comprehensive single-destination resource for quantitative, qualitative and background information relating to every diversity strand.

Health Equality Library Portal

Developing the right services

Five Boroughs Partnership NHS Trust has combined its equality and diversity functions with public and patient involvement and social inclusion. Dave Thomson, Assistant Director of Inclusion and Partnership for the Trust, says:

“As a service sector organisation we should always be treating people with dignity and respect. While wanting to develop and deliver more personalised services, we need to understand the diverse needs of the communities we serve.

“We use different mechanisms for getting the voices of different people heard, from direct engagement through forums and patient experience surveys to 'Big Brother'-style video booths. We involve service users and carers in the design and monitoring of our services and, wherever practicable, we tailor and adjust these to meet their needs.”

Northamptonshire Healthcare NHS Foundation Trust has linked community engagement with service development by carrying out wellness training with black, Asian and minority ethnic (BAME) communities. Its trainees include people from the African-Caribbean, Bangladeshi and Somali communities, members of the Gypsy and Irish Traveller communities and carers and service users from the Irish community.

As well as working with their communities, those who have been trained also work directly with mental health services, helping patients and service users as individuals or in small groups to develop their personal wellbeing plans.

Ann Crowder, Equality and Diversity Manager for Northamptonshire Healthcare NHS Trust, explains:

“We focus on the strengths of those communities that we have failed to engage with and that face barriers in accessing our services. We work with them to build up their skills and capacity so that they can, when trained, deliver services. It’s a new form of commissioning.”

Commissioning services

Finding new ways to commission services with the community rather than for it can help to strengthen relationships and also break down silos.

North West SHA developed the Health Equality Stakeholder Engagement approach (HESE). This established a complete methodology for:

• establishing suitable stakeholder partners
• budgeting the cost of sustainable engagement
• structuring events to obtain the maximum quality of engagement.

Shahnaz Ali says:

“We work with the third sector as equal partners in developing our regional strategies and our equality impact assessments. We benefit from their challenge to traditional thinking and an improved evidence base.”

Turning Point is one of the country’s leading social care organisations. Connected Care is Turning Point’s model for community-led commissioning. It brings the voice of the community to the design and delivery of all health, housing, education and social services. It works on the basis that each individual with complex needs requires a personalised response from services.

Richard Kramer, Director of the Connected Care programme, says:

“Our research shows that integration fails when it is approached from a structural perspective and works best when the service user is at the centre. In conjunction with the bottom-up approach there must be top-down support from commissioners to bring about the necessary local service change.”

Initiating best practice

NHS North West takes a performance-centred approach, centred on its recently launched Equality Performance Improvement Toolkit (EPIT).

EPIT has five measured goals linked to the five year equality and diversity strategy. NHS organisations are required to self-assess themselves as ‘developing’, ‘achieving’ or ‘excellent’ in each area. The assessments are made available on the website so that trusts can share best practice with each other.

Equality Perfomance Improvement Toolkit

Partnerships for the future

Working in partnership with other statutory agencies – including local government and the third sector – is a crucial part of improving performance. Sharma concludes:

“We are making progress but there is more to do. This means moving beyond the minimum standard laid down in law and embracing excellence. We have to think more laterally and work to improve services to meet the diverse needs in our communities more effectively. Inclusion and innovation in service delivery are an essential part of the equality and diversity agenda.”

Discuss this article

To discuss the issues raised in this article, please visit:

Healthy Communities Community of Practice (CoP) – on the Communities of Practice website

Article published February 2010.