Health and Care Innovation Expo: Pop up university. Day 1: Commissioning for Outcomes: Equality and Health Inequalities at the Heart of Project Planning. Angela N Mkandla, Fiona Pearson, Permjeet Dhoot, Sharon Benford & Hayley Haycock. #Expo14NHS

1. Equality and health inequalities at the
heart of project planning
03 March 2014

3. Public sector equality duty (Equality Act
2010)
• Eliminate discrimination, harassment, victimisation and other conduct
prohibited by the Act
• Advance equality of opportunity between persons who share a relevant
protected characteristic and those who do not share it
• Foster good relations between persons who share a relevant protected
characteristic and persons who do not share it

4. Specific duties
• Publish information to demonstrate compliance with the public sector
Equality Duty, annually from 31 January 2014. The information must be
published in such a manner that it is accessible to the public, either in a
separate document or within another published document
• Prepare and publish equality objectives at least every four years
starting by April 2013. All such objectives must be specific and
measurable

5. Health inequality: NHS England‟s duty
The Health and Social Care Act 2012
“must, in the exercise of its functions, have regard to the need to –
(a) reduce inequalities between patients with respect to their
ability to access health services; and
(b) reduce inequalities between patients with respect to the
outcomes achieved for them by the provision of health
services.” (Section 13G)

6. Equality Delivery System (EDS2)
• Tool kit to help NHS organisations improve the services they provide for their
local communities, consider health inequalities in their locality and provide
better working environments for those who work in the NHS.
• Used effectively, it supports NHS organisations to meet their legal equality
duties under the Equality Act 2010, deliver on the NHS Outcomes Framework
and the NHS Constitution and, if they are providers, meet the Care Quality
Commission‟s “Essential Standards of Quality and Safety”.
• The refreshed EDS2 is now being used by many NHS organisations - the use
of the EDS (or an equivalent to it) was part of the CCG authorisation process
and NHS England has given a commitment to implement it at national level.

7. Equality-based SWOT analysis
Project management lifecycle

8. Project objective
Increase the number of black minority ethnic (BME) males
accessing healthchecks due to increased incidence of coronary
heart disease (CHD) in this population.
Proposed approach
Specifically target taxi drivers to access healthchecks via local
walk-in centres.
Justification
Taxi drivers are representative of the BME population, have
strong community links and highest rate of mortality from CHD
than other occupational groups.
Scope
BME taxi drivers in the local NHS area.

9. Design phase (or initiation / start-up)
– Define scope and objectives, and how you
plan to deliver against them
– Model organisation and governance structure
– Initial look at business case and risks
– Get approval to proceed
Equality
– Screen for any known equality and health
inequality issues in the stakeholder groups the
project impacts. To start your analysis you will
need to have a clear idea of who is intended
to benefit from the project and why.
– An equality-based SWOT analysis is a useful
way of doing this. A yes / no / maybe response
is all that is necessary at this stage...
Make use of links
with colleagues in:
• Public health
• Equality / health
Inequality
• Analysts
• NICE Guidance
• Community
groups

10. Strengths
Positive impact (Yes)
Links to existing activity (Yes)
Good data (Yes - quantitative)
Strong governance (Yes)
Weaknesses
Potential negative impacts
(Yes)
Lack of positive impacts (No)
Lack of data (Yes)
Poor stakeholder buy-in
(Maybe)
Opportunities to…
Lessen negative impacts (Yes)
Strengthen positive impacts? (Yes)
Build a representative team and
governance structure? (Maybe)
Create an inclusive project
environment (Maybe)
Threats
Barriers to engaging
stakeholders and / or delivery
partners? (Yes)
Dependencies /
interdependencies? (Maybe)
Resource pressures (Maybe)
Protected
characteristics:
• Age
• Disability
• Gender
reassignment
• Pregnancy /
Maternity
• Race
• Religion / Belief
• Sexual orientation
• Marriage / civil
partnership

11. Reflect the key results of your SWOT analysis in your project
documentation, paying attention to:
• Any initial known risks for equality / health inequality
• Remember the evidence will not always „fit‟ the wording of
protected characteristics. For example, impact on:
Homeless people, alcohol and drug users, asylum
seekers and refugees. Social and geographical inclusion
must be considered
• How the project / programme‟s strategic objectives align to
the goals of the NHS Equality Delivery System (EDS2)
• Have you reflected equality and health inequality in:
• team role descriptions
• terms of reference
• board / meeting agendas
Record
approach in:
Project brief
Initial risk
register
Project
organisation /
governance
charts
Role
descriptions
Aim to submit the equality outputs of the design stage to
your inaugural project board meeting for approval.

12. You‟ve got approval to proceed. Now:
• Expand business case (reasons for doing this)
• Appoint team and project board
• Agree scope
• Define products project will deliver
• Plan the „how‟ and „when‟
• Identify how you will control the project
» Quality
» Reporting
» Risks / Issues
Equality
• Focus is on building your evidence base
• Revisit and expand on your earlier SWOT analysis to
inform development of the project plan.

13. Prompts
Representation • Qualitative and quantitative information on all affected
groups?
Access • Same levels of access to any service / product?
• Different levels of use
• Social / physical barriers to participation (e.g. language,
format, physical access/proximity)
Outcomes • User experience?
• Are some groups more likely to achieve positive outcome
from your product / service than others?
• Do the outcomes differ over time?
Specific needs • Do particular groups have different needs (e.g. people
with sensory or learning disabilities)?
Perception • Is project is viewed more or less favourably by particular
groups of people / communities?
As you revisit the SWOT analysis, think about:

14. Strengths
– Positive impact for BME and gender
– Strong quantitative database on CHD and risk factors for the BME population
Weaknesses
– Targeting only one segment of a group of people (i.e. only BME taxi drivers) may result
in those of a different ethnicity or gender feeling that their needs are being deliberately
excluded.
– Lack of qualitative data – looking beyond the statistics
Opportunity
– Could open up to all taxi driver community and / or other occupational groups
– Could reach to the wider community via the taxi driver population
Threats
– Difficulty of engaging with a group that is transient by nature and whose job may
interfere with their participation in the scheme
– Dependency on success of NHS walk-in centres?
– Successfully engaging the local GP community who may perceive that project interferes
on their own ability to effectively engage with patients.

15. Evidence-based planning
Your plan should detail how the project will move forward or
mitigate against the identified strengths (e.g. positive impacts),
weaknesses (e.g. negative impacts), opportunities (e.g. to
reduce health inequality) and threats – and importantly, who will
do it! It might also consider plans to:
• Strengthen data collection (e.g. taking into account your
own experience or speaking directly to affected groups
• Ensure project complies with statutory regulations
• Incorporate lessons learnt in equality and health inequality
from related projects
Record approach
in:
Project initiation
document
Risk/issue register
Plan
Benefits
management
strategy / realisation
plan
Stakeholder
engagement strategy
Communications
plan
TIP: When allocating project resource to equality, tasks should
be proportionate to the impact of the project / programme on
reducing inequalities / promoting equality.

16. Effectively engaging your stakeholders is key to the
success of any project
Consider whether you have identified and spoken to the
right people to help you make an informed assessment
of equality and health inequality issues. Engagement
may range from running public consultations or focus
groups to actively involving stakeholder groups in
shaping how the project can meet their needs, including
the decision making process. You will need to be open
and honest about the type of engagement that you are
expecting.
Depending on your project, think about using:
• Staff or staff networks
• Trade unions
• Voluntary groups / third sector
• End users
• Patient and community groups

17. Input into project plan
– Wider engagement sessions (e.g. focus sessions
with the taxi driver community)
– Scope role of community „health champions‟
– Activity to engage local GP community
– Open approach to wider taxi driver community
Project risk register
– Transient nature of taxi driver community means
project messages may not get through
– Dependency on success of local NHS walk-in centre
– Risk that GPs will not support initiative due to
perceived impact on their lists

18. Record approach
in:
Risk/Issues
register
Plan
Products of the
project /
programme
Quality Log
Plan the work…work to the plan!
Remember that the duties on reducing health
inequalities and advancing equality should be
considered as on-going process, with continuous
review and monitoring.
This includes reviewing the potential risks and costs to
the organisation, service users or employees if planned
actions are subject to change.
Keep a record of any quality checks you use to ensure
equality and health inequality is kept integral to the
project‟s design and implementation.

19. Mitigation Confirm approach with Council (taxi licencing authority) to
encourage participation and ensure any identification of ill health
resulting from the scheme could not affect their employment
Project issue!
After initial enthusiasm for the project, our taxi drivers have
started to withdraw from the scheme after a rumour circulates
that taxi drivers found to have ill-health during the healthchecks
may have their licence revoked. If not addressed, this risks
upsetting the entire approach….
Opportunity!
Taxi drivers keen on formalising the role of „community health champion‟.
Project Board agrees a change to the project to include a two-day
training course for the health champions, to cement learning in:
• heart health
• getting healthy and staying fit
• Delivering health messages to family and friends

20. Evaluate
Was equality and health inequality sufficiently considered
within the project / programme?
What went well or could have gone better? Can you
make any future recommendations for others embarking
on similar work?
Communicate
Communicate the details of your analysis and any
recommended follow-up actions to those who will become
responsible for the project / programme as it moves
towards „business as usual‟.
Strengthen good practice by sharing the equality findings
of your work with staff, service users and communities.
Record approach
in:
Lessons learnt
log
End project
report / end
programme
review
Project handover
documentation

21. Evaluate
– Additional health champion training builds capacity to
work with local health workers to better address needs
of taxi drivers as a group.
– More health messages delivered amongst taxi drivers,
their families and communities than NHS could have
achieved alone.
– Care needs to be taken to ensure you promote an
inclusive approach
Communicate
– Lessons learnt shared with local commissioners and
equality leads

22. Comments?