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Equality and Diversity

Our Approach at NHS Nottingham City CCG

NHS Nottingham City CCG recognises and values the diverse needs of its population and is committed to reducing health inequalities and improving the equality of health outcomes within the City. We aim to ensure the provision of accessible healthcare and to develop a diverse and well-supported workforce which is representative of the population we serve.

NHS Nottingham City CCG embeds equality and diversity considerations into all aspects of our work, including policy development, commissioning processes and employment practices.

What do we Mean by Equality and Diversity?

Equality is not about treating everyone the same; it is about ensuring that access to opportunities are available to all by taking account of people’s differing needs and capabilities.

Diversity is about recognizing and valuing differences through inclusion, regardless of age, disability, gender, race, religion or sexual orientation.

The Equality Act 2010 came into force on 1 October 2010 and replaced previous anti-discrimination laws with a single Act to more effectively tackle disadvantage and discrimination on the basis of any of the following protected characteristics:
  • Age
  • Disability
  • Gender re‐assignment
  • Marriage and civil partnership 
  • Pregnancy and maternity 
  • Race 
  • Religion or belief (including no religion or belief)
  • Sex 
  • Sexual orientation

Public Sector Equality Duty

As part of the Act, a new public sector equality duty came into force (which replaced the previous race, gender and disability duties). Its aim is to ensure that public bodies play their part in promoting a fair and more equal society.
The public sector equality duty consists of a general duty, which came into force on 5 April 2011, and specific duties which came into force on 10 September 2011.
The general duty consists of three aims, which require public bodies to have due regard for the need to:
  • Eliminate discrimination, harassment and victimisation.
  • Advance equality of opportunity between people who share a relevant protected characteristic and those who don’t.
  • Foster good relations between people who share a relevant protected characteristic and those who don’t.
The specific duties require public bodies to:
  • Publish relevant, proportionate information demonstrating compliance with the general duty at least annually, starting 31 January 2012.
  • Prepare and publish specific, measurable equality objectives at least every four years starting 6 April 2012.

Making Sure Everybody Counts

The NHS Equality Delivery System was introduced during late 2011 to help NHS organisations deliver better outcomes for patients and communities, and better working environments for staff, which are personal, fair and diverse with equality of opportunity and treatment for all.
It provides a framework for assessing an organisation’s equality performance (in line with legislative requirements) and is structured around four overarching goals: 
  • Better health outcomes for all.
  • Improved patient access and experience.
  • Empowered, engaged and included staff.
  • Inclusive leadership at all levels.
The Equality Delivery System requires NHS organisations to engage with their local populations and their workforce to determine performance through a grading process. 

Our equality vision, pledges and objectives

To strengthen our equality performance we have developed the following equality, diversity and inclusion vision for the CCG:

We will work together to embed equality, diversity and inclusion considerations into all of the CCG's mainstream business, so that the population we serve experiences equal access to better health outcomes from continually improving local health services. As an equal opportunity employer we will build and maintain a diverse, culturally competent CCG workforce, supported by an inclusive leadership team.

Our vision is supported by the following set of pledges:

As a commissioner, we will:

  • Engage with people from all protected characteristic and inclusion health groups in our population, particularly those whose voices may not be routinely heard, to ensure that we have the right information to commission the right health services that can be accessed by the people who need them.
  • In line with the national Commissioning for Quality and Innovation (CQUIN) Framework, focus a proportion of our CQUIN monies to incentivise our providers to demonstrate the extent to which they are improving their equality performance in specific areas.
  • Work with our providers as part of our service review and performance management arrangements to ensure that we receive robust assurances in relation to equity of access to services and understand any potential equality impacts resulting from non-achievement of performance standards.
  • Consistently use equality analyses to assess the effect that policy development and commissioning, amending or decommissioning health services may have on the public and other organisations.

As an employer, we will:

  • Ensure that our recruitment and retention processes advance equality of opportunity and are applied consistently to all grades throughout the organisation.
  • Provide training and development opportunities that equip our workforce to build into all of the CCG's activities an understanding of the needs of our diverse population.
  • Consistently use equality analyses to assess the effect that policy development and commissioning, amending or decommissioning health services may have on CCG staff.
  • Ensure that equality, diversity and inclusion considerations routinely underpin all of the CCG's governance structures and are actively promoted by the CCG's leadership team.

In accordance with the public sector equality duty, the CCG has developed the following equality objectives, which are relevant to current identified local health needs, local health inequalities and national commissioning aims. They also acknowledge the benefits of having a diverse workforce:

Objective 1: Increase the number of people from black and minority ethnic (BME) groups entering psychological therapies.
To achieve a year-on-year increase in numbers of people from BME groups entering psychological therapies. People from BME groups are often underserved in primary mental health services and are much less likely than other groups to be referred to psychological therapies.

Objective 2: Improve prevention and early detection of breast cancer in women and prostate cancer in men, to increase survival rates. 
To improve cancer prevention and early detection so that 95% of women will survive breast cancer within one year of diagnosis (an increase of 2.5% by April 2015) and 87% of men will survive prostate cancer within one year of diagnosis (an increase of 5% by April 2015).

Objective 3: Reduce unplanned and emergency admissions for children, young people and people over 85.
To achieve a 3% reduction in both unplanned admissions to acute care and attendance at the Emergency Department for people aged 85 years and over by March 2015, and to achieve a 5% reduction in emergency admissions for children and young people by March 2016.

Objective 4: Increase the diversity of the CCG’s workforce, focusing on disability, race and sexual orientation.
To achieve a year-on-year increase in the diversity of the CCG’s workforce across all grades, with a specific focus on disability, race and sexual orientation.

NHS Nottingham City CCG recognises that is essential for us to fully understand the health needs of our population if we are to be successful in addressing health inequalities.
We produce an annual Joint Strategic Needs Assessment (JSNA) in conjunction with the Local Authority. This identifies where inequalities exist and describes the future health and wellbeing needs of Nottingham City’s population. The Joint Strategic Needs Assessment examines a variety of behavioural factors and the health needs for children, young people, families, and adults. Health needs and access to services are addressed for most protected groups. 
Targeted health needs assessments are also completed in areas where it is felt there is a lack of information. In recent years, this has resulted in JSNA chapters now being dedicated to homelessness, sex workers, offenders’ health and wellbeing, asylum seekers, refugee workers and migrant workers, maternities and pregnancies, physical disabilities, learning disabilities and carers.
These health needs assessments form a key part of the evidence base on which our commissioning decisions are made in order to improve health and well-being and reduce inequalities.
NHS Nottingham City CCG is committed to being a fair and inclusive employer. We recognise that employees are essential to the provision of high quality healthcare and we are committed to maintaining a working environment that promotes the health and well-being of our employees.
We have a full range of human resources policies that have been aligned with the Equality Act 2010. All policies have had equality impact assessments completed and have been developed in partnership with staff-side representatives.
An Annual Staff Survey is completed, which will be structured around the four pledges to staff in the NHS Constitution and addresses equality and diversity issues.  
Results of the surveys are analysed in order to highlight any differences in experience reported by staff from some of the protected groups.
NHS Nottingham City CCG is committed to ensuring that the organisation pays due regard to the three aims of the public sector equality duty. The systematic analysis of the impact of our actions and decisions on equality is one way that this can be achieved.

Equality impact assessments

The completion of equality impact assessments is no longer a statutory requirement. However, NHS Nottingham City CCG believes that these are central to being a transparent and accountable organisation. The assessments ensure that we do not disadvantage people from certain groups by the way that we commission health services or through our employment practices. It is also a way of identifying where we might better promote equality of opportunity.

What are equality impact assessments?

An equality impact assessment is a useful tool that enables organisations to assess the implications of their decisions on the whole community. Carrying out an equality impact assessment will help organisations to:
  • Eliminate discrimination and tackle inequality.
  • Target resources in an efficient and fair way.
  • Develop a better understanding of the communities they serve and create stronger social and community networks.

Our approach at NHS Nottingham City CCG

We require that equality impact assessments be an integral part of service planning and policy development. They are required to be completed whenever we plan, change or remove a service, policy or function.
Our process requires individuals and teams to think carefully about the likely impact of their work on different communities or groups. It involves anticipating the consequences of the organisation’s strategies, policies, procedures and functions on different communities and making sure that any negative consequences are eliminated or minimised and opportunities for promoting equality are maximised.
We have developed an Integrated Impact Assessment Toolkit to assist managers in undertaking assessments. 

Completed equality impact assessments

For more information please contact Trish Gamble, Equality, Diversity and Inclusion Co-ordinator, at

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