Welcome to the NICE Equality Forum 2013

Objectives

• Summarise NICE’s progress on equality since last year and invite feedback

• Seek the forum’s advice on:– equality issues and opportunities to advance equality that may

arise in the development of NICE guidance on new public health topics

– how NICE guidance can best support Public Health England, local government, and voluntary and community organisations to make the case for local public health strategies and programmes that focus on advancing equality and tackling health inequalities

NICE’s equality programme in 2013

Nick DoyleClinical and Public Health Analyst

About NICE• We produce guidance on improving health and preventing

and treating ill health, and on social care• We’re a non-departmental public body (since April 2013) and

no longer part of the NHS• Local authorities are an increasingly important audience – for

guidance on public health and social care• We still provide:

– guidance for the NHS on drugs, clinical care, interventional procedures, medical devices, and diagnostics

– Performance indicators for the GP quality and outcomes framework (QOF) and for clinical commissioning groups (CCGs)

– online access to evidence through NICE Evidence Services– advice on medicines and prescribing

Socio-economic

Special groups

People sharing protected

characteristics

•Age•Disability•Gender re-assignment•Pregnancy & maternity•Race•Religion or belief•Sex •Sexual orientation

•Age•Disability•Gender re-assignment•Pregnancy & maternity•Race•Religion or belief•Sex •Sexual orientation

For example:•Homeless people•Looked after children•Asylum seekers

For example:•Homeless people•Looked after children•Asylum seekers

•Social exclusion•Area-based deprivation•Other social and environmental factors

•Social exclusion•Area-based deprivation•Other social and environmental factors

NICE’s approach to equality analysis

Features of the equality analysis process

• Each item of guidance treated as a separate policy• Consideration of equality impact progressively shapes

the guidance – from scoping stage to recommendations• Evidence from patients, carers, service users, the public

and interested organisations essential in identifying potential impacts on equality

• Aim of diversity in advisory body membership• Equality analysis findings recorded and published• Annual reporting of equality issues analysed and impact

on recommendations

Equality programme developments in 2013

• NICE’s first equality objective:– Research on what helps and hinders the participation

of disabled members on advisory bodies completed• NICE’s second equality objective:

– Good progress on improving quality of monitoring data on NICE staff

– Poor results in the annual report lead to new plan on monitoring data on advisory body members

• Initiatives on involving children and people with learning disabilities in NICE guidance

Equality programme developments in 2012/13 – continued

• New policy on communicating guidance to groups with particular communication needs

• Compulsory e-learning programme on equality and diversity for all NICE employees

• Specialist training for guidance staff on Equality Act duties

• Report of the 2012 Equality Forum’s workshops on potential equality impacts of social care guidance topics circulated to all guidance staff

The public health delivery system

NHS trusts and foundation trusts

Public health; other council services; social care; voluntary, community, mutual, private sector providers

Department of Health

NHS EnglandPublic Health England (PHE)

Department of Communities and Local Government (DCLG)

PHE’s 4 regionsNHS England’s 4 regions

Other government departments: DfE, DfT etc.

National

Supra-local

Local

Chief Medical Officer

PHE’s 15 centres

NHS England’s 27 local area teams

Local authorities

Health and wellbeing boards

Clinical commissioning groups

NICE

Local Healthwatch

Directors of PH

Primary care

NICE Public Health Guidance: promoting equality and addressing health inequalities

Kay NolanAssociate Director, Centre for Public Health

Aims

• Brief overview of NICE public health guidance development process

• How we promote equality during guidance development

• How we address health inequalities during guidance development

Centre for Public Health at NICE

• Produce evidence-based guidance and advice for health, public health and social care practitioners– Best quality– Value for money– Reducing inequalities and variation

• Local Government Briefings

Audiences for public health guidance

• The NHS

• Local government

• The workplace

• Education

• The utilities

• Industry

• Retailers

• DH and other government

departments

• The public

• National policy makers

Public sector equality duty - 2010

• Public authorities must, in the exercise of their functions, have due regard to the need to:– Eliminate discrimination, harassment, and victimisation– Advance equality of opportunity between persons who share a

protected characteristic and persons who do not share it– Foster good relations between persons who share a relevant

protected characteristic and persons who do not share it

• Public sector equality duty: protected characteristics:

Age Race

Disability Religion or belief

Gender reassignment Sex

Pregnancy and maternity Sexual orientation

What are health inequalities?

• Differences in health state or status between people due to social, biological, geographical or other factors

• Differences can result in huge variations in expected length and quality of life

• Some differences, such as ethnicity, are fixed. Others we can tackle . . .

• Evidence tells us that those in more disadvantaged circumstances are likely to experience worse health

only those in least deprived circumstances are likely to

have any disability-free retirement

Equal impact for all

A public health intervention where all are affected equally means, everyone’s health state

improves equally…

BUT

The gradient remains the same and health

inequality has not changed.

Proportionate universalism

A public health intervention where the intensity of effort is

signified by the size of the arrow and determined by the needs of

the group…

The gradient flattens and health inequality has reduced..

AND

Everyone in the population has had health gains.

Guidance Development Process

• Topic Selection

• Scoping

• Development Phase

• Validation

• Implementation

Topic Selection

• Identify and prioritise which approaches to the promotion and protection of health and the prevention of ill health should be the subject of NICE guidance

• Topic is suggested – NICE produces a briefing paper• NICE convenes a Topic Advisory Workshop• Refinement of potential referrals – DH• DH prepare submission to ministers• Secretary of State for health make formal referral to

NICE

Scoping

• Sets parameters for the guidance• Specify which or what types of interventions,

strategies or activities are covered, key considerations for committee

• NICE team prepare draft scope• Consult on draft scope• Refine produce a final scope• Complete an Equality Impact Assessment

Development Phase • Identification of evidence for review and

consideration and development of draft guidance• Reviews – consider equality issues in

development of review questions• Type of review conducted – e.g. barriers and

facilitators review• Addressing gaps in the evidence• Call for evidence• Expert testimony

Validation

• Consultation with stakeholders on draft guidance

• Fieldwork

• Revision of the guidance

• Equality Impact Assessment

How does the equality scheme affect public health guidance?

• Equality impact assessment at key stages• Involvement of a broad range of stakeholders • Guidance committees that are more representative of the

population’s diversity• Chairs responsible for consideration of equality issues

and putting it on record• Ensure the evidence reviews have addressed areas

identified in the scope as needing specific consideration• Ensure recommendations are formulated to avoid

unlawful and harmful discrimination and promote equality

Key questions in developing NICE public health guidance

• Are there different burdens of a disease or problem? (topic selection)

• Are there different baseline risks? (topic selection, scoping, reviewing the evidence)

• Are there plausible reasons for anticipating differential effects for particular groups (issues of access?)

(reviewing evidence, drafting recommendations)

• Are there particular cultural factors at work? (reviewing the evidence, drafting recommendations)

Reducing differences in the uptake of immunisation

• Immunisation – need to increase vaccination coverage across whole population to prevent outbreaks– National Immunisation Programme delivered through

Primary Care

Consider home visits to discuss immunisation with parents who have not responded to reminders, recall invitations or appointments. Offer to give their children vaccinations there and then (or arrange a convenient time in the future). Such visits could include groups that may not use primary care services, for example, travellers or asylum seekers.

Preventing type 2 diabetes - risk identification and interventions for

individuals at high risk• Evidence shows link between ethnicity and risk of

diabetes.• South Asian population groups are at equivalent risk of

diabetes to the white population at lower BMI• Ethnicity is fixed• Focus on prevention and early identification to reduce

progression of diabetesTrained healthcare professionals should offer venous blood tests to adults with high risk scores (stage 2 of the identification process). They should also consider a blood test for those aged 25 and over of South Asian or Chinese descent whose body mass index (BMI) is greater than 23 kg/m2

The NICE field team and public health

Steve Sparks Associate Director, Field Team

NICE Field Team

• Implementation Consultants

• Team of 7 aligned to NHS CB regions

• 1 in Northern Ireland

• Responsible for a geographical territory

• Field based

• Provide local connectivity

Keeping up to date

• Sign up for the NICE News• Log on to the website and register

your details at www.nice.org.uk• Email steve.sparks@nice.org.uk• @SteveSparks

BREAKOUT GROUPS

Q1 Key issues – Equality

• Group A – social deprivation, cultural norms (cooking traditions, attractive body types), physical and learning disabilities, mental health issues. Recommendations need to be individualised at a practitioner level

• Group B – inflexibility of services, lack of integration, not designed around person’s needs

• Group C – lots of issues: partly depend on which chronic conditions, and vary by employment sector, seniority, gender etc. too

Q2 Key issues – Development of NICE guidance

• Group A – encouraging stakeholders to register when they wouldn’t ordinarily consider participation. Explain why topic is relevant for them

• Group B – 1. Scoping and mapping exercise: current practice, definitions. 2. Stakeholder engagement early on – get the right advice and buy-in for uptake.

• Group C – importance of data/evidence disaggregation (by different characteristics)

Q3 Key issues – Uptake of NICE guidance

• Group A – new PH bodies made more aware of NICE guidance and how they can utilise it to maximise benefit

• Group B – joint strategic needs assessment • Group C – Right Information, Right format, Via

right channels, at the Right time!

Q4 Key issues – Uptake of NICE guidance

• Group A – dissemination of PH messages to the public & empowerment for them to take this forward with practitioners

• Group B – [see Q2: stakeholder engagement throughout]

• Group C – Importance of regional networks and 3rd sector links to them, and role for dissemination and evidence collection for older workers (especially who don’t use the Internet)