Learning Objectives & Outcomes

1. Quality & Equality WorkshopDelegates: Primary Care Staff 2012Julia Allen, Equality & Diversity Manager

2. Learning Objectives & Outcomes Programme Aims The course will introduce participants to the Equality Act 2010 By the end of the course participants should be: • Familiar with the concepts of “protected characteristic groups” and “prohibited discrimination” • Able to identify circumstances and situations where discrimination may occur • Have an understanding of what is required of public authorities and their contractor partners ie those carrying out public functions • Be able to understand in a commissioning or provider context what is lawful and unlawful under the Equality Act 2010 and the PSED

3. Workshop Aims • To raise awareness and increase knowledge of diversity and equality of opportunity issues as an: employer, commissioner & service provider or contractor partner • To evidence the essential link between quality and equality • To explore the enabling role that managers, staff & partner organisations are expected to play in the delivery of fair and accessible services to a diverse range of patients, carers and colleagues • Raise confidence sufficiently to enable managers, staff & partners to recognise & challenge inappropriate behaviour and prohibited discrimination • To raise awareness of Hate Crime - how to recognise & report & our duty of care to recognise, act & support alleged victims of hate crime

4. What will we cover today that impacts on our practice in NHS? • Equality Act 2010 • Equality Duty from 6 Apr 2011 & 10 Sept 2011 • New Discrimination Framework & new types of discrimination • Diversity + Inclusion = Equality • Case Studies & Scenarios • Interactive sessions to put some of this information into practice

5. What is Equality? The Equalities Review, led by Trevor Phillips in 2007, defined the meaning of equality as follows: • “An equal society recognises people’s different needs, situations and goals, and removes the barriers that limit what people can do and be.” • Quality service provision is a key component of creating a fairer society.

6. E&D: A broad inclusive concept Overview: What’s it all about? • It’s about understanding people & the workplace implications of their differences and their similarities • It’s also about how people access information, services, premises and employment • How the NHS commissions inclusive services

7. What is Equality?Diversity + Inclusion = Equality Equality Equal opportunities is focused on the eradication of discrimination • creating an environment where everyone has equal accessto a range of benefits such as employment, training – and healthcare • providing the right to equivalent opportunities for employmentregardless of difference that is irrelevant to someone’s ability to do the job properly • a legal requirement • Problem focused

8. What is Diversity?Diversity + Inclusion = Equality Diversity • Recognising & valuing difference & deriving business benefits from the added value diversity brings • Reaching all parts of our local communities with our information & services • Developing a more representative workforce • Improving our business performance. • Diversity is about more than remaining within the law • It’s widely agreed to be positive for business Opportunity focused

9. No equality without inclusion Diversity + Inclusion = Equality Quality can’t be delivered successfully without equality as an integral part of our practice Our attitudes, behaviours & assumptions in the workplace can make the difference in achieving inclusion

11. In an interview situation how are we ‘seduced by sameness’? How much of the decision making process for who is recruited is based on what the candidate: Halo & Horns research • Says?% • How they sound? eg tone of voice, accent % • How they look?% • Bletchley Park 1940 - Alan Turing • Famous code breaker • Laid foundations for the first PC - Colossus • Urban legend – Apple logo?

12. Human Rights overview • Human rights seek to ensure that people are treated with fairness, respect, equality, dignity and autonomy in their everyday experience of public services - Fairness - Respect - Equality - Dignity - Autonomy ie self directed

13. Disability: 20% have at least 1 disability or long term health condition (49,000 people) Age: 24.8% are 60 & over (>60,000 people) LGB: Around 19,000 people or 5% to 7% of people in Tameside are estimated to be lesbian, gay, bisexual. Of these people, many access the specialist services delivered by the Lesbian & Gay Foundation in Manchester each year. This figure is an estimate based on the Treasury’s 5-7% estimate of the LGB population that they made in advance of civil partnership legislation back in 2005. Race: 7.32% belong to the BAME population (<18,000 people) Demographic profiling:NHS T&G serves a population of approx 245,000 people of which:

14. Latest Equality Legislation • Harmonising existing plethora of legislation into one new Act • New Equality Act 2010 – 90% came into force from 1 October 2010 providing a modern, single legal framework with clear, streamlined law to more effectively tackle disadvantage and discrimination. • 6 April 2011 introduced new Single Equality Duty on all public bodies & their contractor partner organisations • More accountable to the public – under transparent rights & responsibilities

15. Equality Act 2010 – the background • Pre 1 Oct there were 116 pieces of discrimination legislation & 13 Codes of Practice After more than 30 years of discrimination legislation: • Women are still paid on average 22% less per hour than men. • Nearly one in five people of working age have a disability and are twice as likely to face bullying or harassment in the workplace as non-disabled people. • People from ethnic minorities are significantly less likely than average to be in work and when in work are paid less than average.

16. The big changes • Public Sector Equality Duty (6 April 2011) • Strengthened discrimination framework (includes new types of discrimination) • Pre-employment health questions removed (1 October 2010) • Third party harassment • Positive action provisions of the Equality Act come into force 6 April 2011 • Age discrimination in GFS likely 2012 – no specific exception for health & social care • Publication of information to demonstrate compliance with the public duties by 31 January 2012 • Publication of equality objectives by 6 April 2012

17. EDS The Equality Delivery System is designed as a tool to be used to help all staff and NHS organisations understand how equality can drive improvements and strengthen the accountability of services to patients and the public. It will help ensure that everyone - patients, public and staff - have a voice in how organisations are performing and where they should improve. Sir David Nicholson KCB CBE , NHS Chief Executive and Chair of NHS Equality & Diversity Council 29 July 2011

18. EDS 4 Goals

19. Who is protected? The Act protects people who have a protected characteristic (these used to be called grounds or strands). The relevant characteristics are: •Age •Gender •Gender Variance (definition changed) •Disability (definition changed) •Race –this includes ethnic or national origins, colour & nationality •Sexual Orientation •Religion or Belief •Marriage and Civil Partnership •Pregnancy, Maternity & Breastfeeding Mums • Carers * • Military veterans *

20. What the Law prohibits

21. Discrimination is illegal • It is when someone acts based on assumptions, stereotypes or prejudice that discrimination can happen. • Discrimination means treating someone less fairly because they are from a particular group or background or because of perceived difference.

22. Types of discrimination * • Direct (Hate Crime) • Indirect • Positive Action • Positive Discrimination • Harassment (& 3rd party harassment) • Victimisation New since 1 Oct 2010: • By perception • By association • Failure of duty to make reasonable adjustments

23. Types of Discrimination What you need to know Objective justification Direct discrimination, harassment and failure of duty to make reasonable adjustments cannot be justified. Indirect discrimination and discrimination arising from disability have an objective justification defence. Direct discrimination, includes eg Hate Crime •Indirect discrimination •Harassment •Victimisation •Positive discrimination •Positive action √ •Discrimination by perception •Discrimination by association •Discrimination arising from disability •Failure of duty to make reasonable adjustments ILLEGAL

24. What is Hate Crime? • Hate crime is a serious criminal offence committed against a person or property due to hatred of that person’s protected characteristic - gender, race, religion, colour, ethnicity, disability, gender variance or sexual orientation. • Hate Crime is a form of direct discrimination (treating someone to a lesser service because of their protected characteristic(s) • ILLEGAL

25. Disability Hate Crime • The Association of Chief Police Officers (ACPO) and the Crown Prosecution Service have a nationally agreed definition of Disability Hate Crime • Any criminal offence which is perceived, by the victim or any other person, to be motivated by a hostility or prejudice based on a person's disability or perceived disability. • ILLEGAL

26. Recognise & Report Hate Crime Incidents No incident is too small. Make a record of any incident and actions taken, for future reference. Alert the Safeguarding team where appropriate. How you can report Hate Crime • Call the PoliceIn an emergency call 999. Ask for an officer to attend the victim’s home • In a non-emergency victims should call 0161 872 5050 in Tameside • Reports of Hate Crime can be made anonymously • Report via Another Agency There are a number ofthird party reporting centresin Tameside.

27. Discrimination by perception • Direct discrimination also includes: discrimination because a person is wrongly thought to have a particular protected characteristic or is treated as if they do. • ILLEGAL

28. Discrimination by association Protecting carers from discrimination – arises from the above extension to discrimination • Means an employer could not refuse to recruit or promote someone because of their caring responsibilities • eg caring for a disabled person, or having caring responsibilities at any point on the age spectrum, that is caring for a child or elderly relative or other • The mother of a disabled child who is not herself disabled but who is treated less favourably because of her association with her disabled child (Coleman case) • ILLEGAL

29. What is harassment & victimisation? Harassment Victimisation Being unfairly singled out for bad treatment of some kind. Less favourable treatment of an employee because they have taken some action in relation to discrimination (e.g. they have made a complaint of direct or indirect discrimination or they have been a witness in such a case). ILLEGAL • Harassment is seen when someone’s dignity is violated or an intimidating, hostile or offensive environment is created by unwanted behaviour or attitudes. Remember it is the victim’s perception that is most relevant here. Perception is reality. • ILLEGAL

30. Failure of duty to make reasonable adjustments • A reasonable adjustment is a change a public body like the NHS needs to make to your practices (the way you plan and deliver a service for example), premises or business in order to meet the duties of the Equality Act 2010. • An example of a reasonable adjustment includes providing a reasonable number of parking spaces for disabled people near to the entrance to your GP surgery or hospital, or providing TypeTalk to deaf or hearing impaired patients or Text resize on your website pages for visually impaired patients or it may be a change to working practices, or to your workstation after assessment by Access to Work from Dept Work & Pensions or phoning a blind patient with appointment details or to request to come in for test results instead of by letter.

31. Scenario A • Jonathan is the partner of Kate, who is a resident of a local authority care home. Jonathan decides to undergo gender reassignment and staff at Kate’s care home discover this. As a result Kate is now treated less favourably by staff compared with other residents. • Is this: A) direct discrimination B) indirect discrimination C) discrimination by association D) not discriminatory

32. Scenario B • A local dental service has a policy of reminding patients of forthcoming appointments by telephone. This puts deaf people who cannot use the telephone at a disadvantage, as they do not receive a reminder of their appointment. • Is this: (select 2) A) direct discrimination B) failure of duty to make reasonable adjustments C) not discriminatory

33. Scenario C • Jenny was the chair of an interview panel of four. • There were 7 candidates to interview, 3 men and 4 women, when the last candidate came into the interview room, it was clear that the interviewee was different, she was well groomed and interviewed well. • At the end of the interview Jenny asked the panel for their scores and their thoughts regarding the interviewees presentation and answering of the questions posed. • There were two candidates who scored the same with little chance of splitting the two and both were female, however during the discussions regarding which candidate to appoint one panel member raised the issue about the final candidate being ‘obviously Trans’ and that this might cause issues with other staff and make them feel uncomfortable in relation to using same sex facilities such as the toilets. • Was this discussion legal in the workplace?

34. Scenario D • You are required to find a solution to a work based problem & need to seek input from a qualified colleague who seems to have a ‘difficult communication style’ • The other person is not helpful in response to your e-mail requests & has repeatedly sent you obstructive e-mails (at work) in reply to your reasonable questions & requests for help • This is the 4th separate occasion this has happened. • Is this treatment (towards you): A) harassment B) victimisation C) not discriminatory? • When could the person be personally liable for any damages awarded?

35. Act brings new Equality Duty 6 April 2011

36. CCG Authorisation • Equality training included in the CCG Development Plan • CCG is an active partner in the design, development and follow through of the next JSNA 2011 • Service Strategies are developed with the full engagement of public / service user representative as appropriate (QIPP leads and commissioning managers) • AoEs are required for all commissioning decisions and business cases subject to inclusion in our targeted Rolling Programme of AoEs for the next 12 months (QIPP leads and commissioning managers) • AoE targeted training is available monthly to nominated AoE Lead staff across the CCG. The CCG will require assurance from those working in its name (eg Commissioning Support Services) that due regard has been taken to evidence our compliance with the Equality Duty in terms of analysing any key decisions for likely adverse impact on protected groups. • CGG has established a relationship with and regular attendance at the Consumer Advisory Panel meetings, who carry out a scrutiny recommendation function for the PCT / CCG going forward. • Draft the CCG Communication and Engagement plan • Analysis of Effects assurance: Question be inserted into CCG equivalent of Exec and Board Papers for organisational assurance at sign off stage • Adopt new national NHS equality performance framework – EDS (Equality Delivery System) • EDHR Schedule within all provider partner contracts 

37. CCG Authorisation & EDHR Some of the key EDHR issues: • Tackling health inequalities and advancing equality (required Skill) • Support in preparing to take on your equality and diversity duties (through the use of the NHS Equality Delivery System – national toolkit). •  Patient & Public Engagement is embedded into the organisation and the full commissioning process (Consumer Advisory Panel – established scrutiny role for inclusion across each of the protected groups) • Particularly as one of the key objectives of the introduction of emerging CCGs is to bring commissioning decisions closer to service users, involvement of the (potential) users of services at every stage of commissioning, and in decision making is the default position of the emerging CCG.. • The emerging CCG has embedded patients and public involvement with the decision-making process - "No decision about me without me". This includes public/patient involvement with difficult decisions. • The emerging CCG has a set of values that are clear and clearly articulated at all levels within the emerging CCG, even to individual clinician level, both in the Constituent practices and in providers. • It is clear how these values translate into the behaviours of the organisation, including the behaviours of the Leadership team and constituent practices and clinicians. • The principles of involving the public and patients in the emerging CCG's processes ("nothing about me without me"), equality and diversity and reducing inequalities is enshrined in these behaviours.

38. Act brings new Single Equality Duty • The Equality Act 2010 replaces the current public sector duties to promote equality with a single equality duty extending to other protected characteristics. This means each having due regard to the need to eliminate discrimination, harassment, victimisation and other prohibited conduct in our day to day practice and planning.

39. Key dates for the equality duty • 6 April 2011 General Duty came into force • Publication of information to demonstrate compliance with the public duties by 31 January 2012 • 6 April 2012 listed bodies to publish objectives via a 4 year new Strategy

40. Compliance with the general equality duty is a legal obligation, but it also makes good business sense. The 3 aims of the general duty • Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. • Advance equality of opportunity between people who share a protected characteristic and those who do not. • Foster good relations between people who share a protected characteristic and those who do not.

41. What does having ‘due regard’ mean? • Removing or minimising disadvantages suffered by people due to their protected characteristics. • Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. • Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

42. Summary of duty requirements Principles: • General and specific duties: As with previous duties, the essence of the equality duty remains the requirement to have due regard to the need to achieve the three general duty aims. • The public sector Equality Duty, requires public bodies to consider all individuals when carrying out their day to day work – in shaping policy, in delivering services and in relation to their own employees.  • It requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people when carrying out their activities.

43. Specific Duties • The Equality Act 2010 (Specific Duties) Regulations 2011came into force on 10 September 2011. • The specific duties help public bodies perform the Equality Duty better. They do this by requiring public bodies to be transparent about how they are responding to the Equality Duty – requiring them to publish relevant, proportionate information showing compliance with the Equality Duty, and to set equality objectives.  • The Government believes that public bodies should be accountable to their service users.  Publishing information about decision-making and the equality data which underpins those decisions will open public bodies up to informed public scrutiny.  It will give the public the information they need to challenge public bodies and hold them to account for their performance on equality.  Moreover, knowing that such information will be published will help to focus the minds of decision-makers on giving proper consideration to equality issues.

44. What do the Specific Duties require? The specific duties require public bodies to: • publish information to show their compliance with the Equality Duty, at least annually; and • set and publish equality objectives, at least every four years. All information must be published in a way which makes it easy for people to access it.

45. Equality Information required • The NHSmust publish sufficient information to demonstrate that we have complied with the general equality duty. This must be done by 31 January 2012, and at least annually after that. • The information to be published must include: information on the effect that our policies and practices have had on employees and people from the protected groups; evidence of the analysis undertaken to establish whether our policies and practices will (or have) furthered the three equality aims in the general equality duty; details of the information used in that analysis, and details of the engagement we undertook. • By 6 April 2012, and at least every four years after that, we also need to publish equality objectives and details of the engagement we undertook in developing them.

46. Commissioning & Procurement • The duty applies to procurement and commissioning by public authorities. The requirement to comply with the general duty applies to all contracts, regardless of the value. • The equality duty applies to all of our work, including services, policymaking, employment, planning, procurement and statutory decision-making.

47. The power of attitudes, behaviours & assumptions in the workplace The platinum standard for E&D istreating people the way they would like to be treated. It also means not stereotyping people in response to perceived differences eg age, gender, gender variance, disability, race, sexual orientation, religion or belief, marriage and civil partnership, pregnancy maternity & breastfeeding mums, and carers. ‘Reasonableness’ is the key. TIP: Be prepared for the unexpected.

48. True or false? Decide whether statements on next slides are true or false?

49. Definition of disability ‘a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities’ Formerly Disability Discrimination Act 1995 True or False?

50. There are at least approx 8.6 million disabled people in the UK = 20% = 1 in 5 True or False?