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 & Diversityjames.glover@nhslothian.scot.nhs.uk+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