Aim of this presentation
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Promuovere l'equità in sanita: un modello da
NHS Scotland
8 Maggio 2013
James Glover, Head of Equality & DiversityNHS Lothian, Scotland
Aim of this presentation
• To share good practice about how equity can be built into the planning and delivery of health services, using a model from the National Health Service in Scotland.
Contents
• Setting the scene: an introduction to NHS Lothian and the Scottish context
• What are the equity issues faced by health services?
• What are the starting points in developing an equity strategy?
• The main components• Impact assessment and the Equity
Standards• Making the strategy work
Introduction to the speaker
• James Glover, Head of Equality & Diversity, NHS Lothian
• Government Equity Commission• Services in charity and community
sector • Research scientist
Setting the scene: what do we mean by equity and discrimination?
• Equity• Discrimination
Setting the scene: an introduction to NHS Lothian
Introduction to NHS Lothian (1)
• Lothian region covers Edinburgh and much of South Eastern Scotland, with a population of 880,000
• NHS in Scotland has separate funding and policy arrangements to rest of UK
• Six large hospitals in Lothian (3 teaching), budget €1.8bn
• 23,000 staff• Community health
through 300 sites
Introduction to NHS Lothian (2)
Lothian’s population…• Ageing rapidly• One person in five has a
disability• 7% from ethnic minorities• 8-10% are lesbian, gay,
bisexual• Pockets of severe
deprivation, especially in communities where there were heavy industries
Who has poorer health?
Why does NHS Lothian need an equity strategy?
• Legal requirements• Government health policy• Drive for safer, more
efficient services• Drive for better patient
experience
Equity laws in the UK
• Rights for individuals since 1970
Plus….• The Public Sector Equality Duty for race, disability,
gender, age, sexual orientation, religion• The organisation must take proactive steps, not
about individual rights• Workforce and service delivery• Regulator: Equality and Human Rights Commission
Starting points in developing an equity plan
• Leadership commitment• A committee with responsibility
for equity • Evidence• Involvement of patient and
community representatives• An honest assessment of the
current position – e.g. use the International Equity Standards and impact assessment
Engagement in developing an equity strategy
In NHS Lothian we invited 10 key local representatives to form a steering group:
• The group was made up of people with a wide range of characteristics
• Met 5 times over 8 months
• Identified areas needing improvement, and prioritised actions
• Carried out an impact assessment of the resulting plan
Using the Equity StandardsFive Standards looking at:1. The organisation’s equity policies and processes, and
the way it employs its workforce2. How people access services and information3. Equity in quality of care4. Equity in engagement with patients and the
community5. Working with partner organisations to achieve equity
• Use on the whole organisation, or• Use on a specific service• Use to identify weaknesses and strengths
Impact assessment – what is it?
• A way of identifying the likely impacts of a plan or policy…
- on equity for disadvantaged groups- on the environment- on privacy- on Human Rights
• In this presentation we will talk about impacts on equity for disadvantaged groups: “EQIA”
Impact assessment – why do it?
• Legally required in Scotland• International Equity
Standards 1.1 • Good practice reasons
– Improves policies and plans– Saves money– Helps decision making– Helps to counter negative
publicity– Helps identify gaps in data
and research
Impact assessment – what are the steps?
Typically, in a group….1. Take a policy or plan2. Identify what evidence is available 3. Identify how the policy or plan might affect
different groups of people4. Identify ways of dealing with negative impacts
and promoting positive impacts5. Agree actions6. Monitor
Impact assessment – when should it be done?
Can be done….• Early on to help with deciding on
options
Or• Once the policy or plan has been
drafted BUT before it is finally approved
Impact assessment – who should take part?
Ideally…• The owner of the policy
or plan• The senior person
responsible• Representatives of
patients or the local community
• Operational staff• A trade union
representative• A facilitator
Making impact assessment work – taking action
• Must include an action plan
• Actions must:- be specific- be realistic- be measurable
- have a time scale- have a named
person responsible
Impact assessment – what can go wrong?
• Not enough data or research• The wrong people around the table• Doing it too late, so that changes can
not be made to the plan or policy• Failing to monitor the actions
NHS Lothian’s model
• Centralised, expert-led EQIA model
• Flexible EQIA toolkit• “Rapid” impact assessment
includes health inequalities • About 100 EQIAs each year• Always follow up actions• Monitor committees and
services• Training and support where
performance poor
Importance of monitoring
• Actions arising from EQIAs (after 4-6, 12 months)
• 2009: 20% of actions completed
• 2011: virtually 100% of actions completed after 6 months
Does impact assessment make a difference?
EQIA making a difference (1)
Child Healthy Weight plan: • Initial plan was to work with all
schools in a universal approach. Following the EQIA the programme was redirected to work much more intensively with schools in the most deprived areas only.
• The results of the EQIA went back to the national group co-ordinating child healthy weight work, and this approach was then copied across Scotland.
EQIA making a difference (2)
It was proposed to cut the funds for a local “branch” GP surgery in an area of deprivation and expand the main surgery instead: • The EQIA identified that there would be significant negative impacts if funding for a local extension surgery was reduced. • As a direct result the proposal was reversed and the surgery remains open.
The cost of not doing EQIA….
• Major project to redevelop a hospital site in Edinburgh involved building a multi-level car park
• Plans were not subjected to EQIA
• Project managers “forgot” to include measures for disability access – including elevators
• Had to fit elevators after the building completed, at huge cost
Do equity strategies work?
• NHS Lothian’s equity strategy has helped us to become the best performing NHS organisation in Scotland for equity
• EQIA process widely used by others, including in other European countries
• Improving patient feedback, including from disadvantaged groups
Summary
• Equity strategies and why they are needed• What are the steps?• Using the International Equity Standards to
measure performance• Involving people in developing your equity
strategy• Using impact assessment to build equity
into processes and plans
For more information:James GloverHead of Equality & [email protected]+44 131 465 5720 (office)+44 779 282 6954 (mobile)
To see NHS Lothian’s Equity Strategy, and our impact assessments, go to “Your rights” on the NHS Lothian website at www.nhslothian.scot.nhs.uk
To see the International Equity Standards go to www.hphnet.org> Events>Task Force Meetings> Migrant-Friendly & Culturally Competent Health Care