Equality and Diversity Annual Report 2020

This report sets out how NHS Portsmouth Clinical Commissioning Group (CCG) has
demonstrated due regard to the Public Sector Equality Duty of the Equality Act during 2010.

This report refers to equality and diversity information that is contained within other published papers and reports. These are: Health and Care Portsmouth, Portsmouth Health and Wellbeing Strategy 2018-2021, A Blueprint for Health and Care in Portsmouth, Annual Report and Accounts 2018/19, Portsmouth CCG’s Equality and Diversity Strategy 2018-2021, CCG workforce reports and patient and public engagement reports.

In order to provide organisational context, background information is provided from published papers relating to system-wide plans to improve the health and well-being of local populations through partnership working and joint decision-making.

The legal context on which this report is based is described in Appendix 1.

Established on 01 April 2013 we are responsible for commissioning (Planning, buying and ensuring the quality of) healthcare services in Portsmouth including hospital care, primary care (local GP surgeries), urgent and emergency care and most community health services, including mental health and learning disabilities. We commission for a population of around 231,000 people spending around £341 million per annum. Our geographical boundaries match those of Portsmouth City Council.

We are a membership organisation, led by five local GPs elected to represent all the GP practices in the city.

Health and Care Portsmouth is an ambitious programme that continues to change the way we plan and provide health and social care in the city, bringing together the CCG and the Council and a wide range of other providers of services in a way that is positive and proactive. In effect, we are working together to support people to live healthy, safe and independent lives by offering health and social care services that are joined up and provided in the right place, at the right time.

We recognise that in order to improve the health and life experiences of the people the city, we need to work as part of wider partnerships and systems. The city of Portsmouth forms part of the Portsmouth and South East Hampshire (PSEH) Integrated Care Partnership (ICP). The aims of this are to support the delivery of local new models of care set out in a number of NHS publications including the NHS Long Term Plan, 5-Year Forward View, and deliver the objectives and key work programmes set out in A Blueprint for Health and Care in Portsmouth in 2015.

As at December 2020 we employ 104 whole time equivalent staff (84.71 full time equivalent). We are therefore not required to publish detailed information relating to our workforce (as described in Appendix 1) in accordance with the Specific Duties of the Equality Act 2010.

We recognised that circumstances can change as individual members of staff begin or cease to identify with one or more protected characteristics such as pregnancy. Staff are able to self-administer this information through the Electronic Staff Record (ESR). Used collectively and anonymously, these records inform internal workforce monitoring and ensure no protected characteristic is disadvantaged in the experience of the workforce. It is also used to inform external reporting against the Indicators of the NHS Workforce Race Equality Standard (WRES).

Our Human Resources Policies govern our employees’ rights not to be discriminated against at work. A Staff Handbook provides information on policies and contact details of Human Resources staff. The Staff Handbook and all CCG policies are available on the staff intranet. CCG policies relating to employment are as follows:

• Absence Management
• Adoption Leave and Pay
• Annual Leave
• Buying Annual Leave
• Disciplinary
• Disclosure and Barring
• Employee Over Payment and Underpayment
• Exit Interviews
• Flexible Working
• Grievance, Bullying and Harassment
• Guidance on Working Time Regulations 2019
• HR Framework
• Maternity Criteria Table
• Maternity Leave and Pay
• Maximising Success and Potential Individual Performance Review
• Occupational Health Guidance
• Organisational Change Policy
• Paternity Leave and Pay
• Pay Progression CCG guidance
• Recruitment and Selection
• Redeployment
• Redundancy Procedure
• Reimbursement of Travel Costs Guidance
• Relocation Policy
• Shared Parental Leave and Pay
• Special Leave
• Staff Learning Agreement
• Statutory and Mandatory Training
• Substance Misuse
• Travel Loans
• Whistleblowing Policy Freedom to Speak Up 2020

On recruitment staff undertake essential training on equality and diversity through an e-learning programme. Owing to additional pressures during the COVID-19 pandemic the safeguarding team has been unable to continue lunch and learn sessions during 2020. There are plans to re-start these sessions which cover topics related to equality and diversity in 2021. (Please also see section 9 below.)

Staff also undertake equality and diversity training relevant to their posts. This includes completion of equality impact assessments (EIAs). A centralised system to record individual non-statutory and mandatory and continuing professional development is currently being investigated.

Our Staff Engagement Group has been meeting virtually via MS Teams during the CCG office closure due to COVID-19 pandemic. Staff are able to raise concerns directly with their team staff engagement representative via email. A designated staff engagement inbox has also been created during the pandemic to add another route via which staff may contact the Group.

Two surveys were managed by the Staff Engagement Group during 2020. These were conducted via email and results and actions published on the staff intranet. One survey related working practices following office closure and has informed the CCG’s plans on future ways of working. The other asked staff how they would prefer to receive their payslips. As a result of this second survey, SBS, the CCG’s payroll provider, has turned off paper payslips. Staff now have a user name and password to access payslips, P60s and pension information electronically via a payslip and pension portal.

We completed annual assessment (2019/20) against the Indicators of the NHS Workforce Race Equality Standard (WRES). An action plan was approved by our Clinical Executive Group for the coming year. The findings were reported externally as part of national reporting requirements through NHS Digital. So that we comply with Data Protection legislation, the information contained within the report is not in the public domain.

In preparation for the introduction of the NHS Workforce Disability Equality Standard (WDES) to CCGs in 2021, we have completed a baseline assessment against the Metrics of this Standard. We recognised that to complete assessment against the WDES metrics and also the WRES Indicators consideration needs to be given to the development of an annual staff survey. This survey would also inform assessment against the NHS Equality Delivery System 2 (please see section 11 below).

We serve a population of around 231,000. There are slightly more men than women across all age bands, but more women aged 70 years and older.

Outside London, Portsmouth is the most densely populated unitary local authority area in the United Kingdom. It is also one of the 20% most deprived districts/unitary authorities in England. Life expectancy for men and women is lower than the England average.

Life expectancy for men is 7.8 years lower for men and 6.0 years lower for women in the most deprived areas of Portsmouth than the least deprived areas. 20.4% of children live in low income families. Electoral wards with high deprivation levels also have high concentrations of ethnic minority residents.

Black, Asian and ethnic minorities (BAME) account for 16.0% of the city’s population. As a group White other accounts for 3.8% of the population. The largest BAME communities in the city are Bangladeshi or British/Bangladeshi (1.8%), African (1.4%), Indian or British Indian (1.4%), Chinese (1.3%), Mixed White and Asian (1.2%) and Polish (0.8%).

English is the main language (93.0%). Other languages spoken are Polish (1.0%), Bengali (0.8%), Chinese (0.6%), Arabic (0.5%), Kurdish (0.3%), French (0.3%), Tagalog (0.2%). Some residents do not speak English very well (1.0%) or not at all (0.2%).

The main religion is Christian (52.2%) followed by Muslim (3.5%), Buddhist (0.6%), Hindu (0.6%), Sikh (0.2%), and Jewish (0.1%). Other religions account for 0.5% of the population. A significant percentage of residents record no religion (35.0%), and do not state religion (7.3%).

Day-to-day activities are limited a lot for 25.1% and a little for 18.9% of residents. The main impacts on health are cardiovascular disease and cancer. Early death from cancer is significantly higher than the England rate. Smoking, diet and being overweight or obese and drinking alcohol to excess account for 34.0% of cancers. The suicide rate in the city is high (13.3%) compared with that in Hampshire (10.5%).

Unpaid carers, that is those who provide care for a relative or friend, may be found in all age groups. 2011 Census data recorded 8.4% of the population as carers. 52.6% provided between one and 19 hours of care a week, 10.9% 20 and 49 hours and 18.4% 50 or more hours. A national carers’ week survey in May 2020 estimated that during the COVID-19 pandemic the number of carers in the United Kingdom rose significantly and were more likely to be in the younger age groups.

Currently there is no best source of information on sexual orientation or gender re-assignment. In the South East Region 2.2% of the population is estimated to be lesbian, gay or bisexual (LGB). Young LGBT are at risk of homelessness because of family rejection. One in 10 LGB people and one in 19 transgender people experience domestic abuse from a partner.

*References

• Public Health England (2019) Local Authority Health Profile
• Portsmouth City Council Equality and Diversity Strategy 2014-2017
• Hampshire County Council 2011 Census Headline Facts and Figures – Portsmouth
• Carers’ Week, May 2020, Research Report: The rise of the number of unpaid carers during the coronavirus (COVID-19) outbreak.

Completion of equality impact assessments (EIAs) is integral to our project management procedure. During 2020 Commissioning Project Planning Guidance was updated to include new planning procedures to support system working across partners in Portsmouth and South East Hampshire.

The 2020 Planning Guidance covers all aspects of the project planning process including completion of EIAs, Quality Impact Assessments (QIAs) and Privacy Impact Assessments (PIAs). Impact assessment forms are provided as appendices with signposting for additional support to appropriate leads. All completed forms are uploaded to our electronic project management system, Pentana, which is administered by our Planning and Performance Team. These will be found within the Planning directory on Pentana which the team ensures all documents are saved.

Equality impact assessments (EIAs), Quality impact assessments (QIAs) and Privacy Impact Assessments (PIAs) for all Covid-19 related projects are collated and saved within the Planning directory on Pentana.

Our equalities lead meets monthly with the Planning and Performance Team administrator to review projects and plans and follow up with individual members of staff as required.

Over much of the past 12 months, undertaking any form of engagement activity has been difficult, given the impact of the COVID-19 pandemic. NHS organisations have had to operate in major incident mode for several months and this has affected how some elements of the CCG’s business has been conducted.

Engagement activity has been less widespread, particularly over the spring and summer months. That said, as some form of normality begins to resume, the need for patient and public engagement is even more important as we embark on a programme of restoration, reflection and renewal.

Fundamentally, though, nothing has changed in terms of our commitment to engagement, and where required, consultation. We continue to believe that health and care organisations that are serious about delivering the best possible treatment and support must always be in ‘listening mode’.

This work is supported by a range of digital tools. The Health and Care Portsmouth website and newsletter continues to be a key mechanism for engaging with local people. After a hiatus during the pandemic, the Health and Care Portsmouth newsletter was restarted in November 2020. This newsletter is delivered through a platform that is suitable for those using assistive technology. Both the Health Care Portsmouth and CCG social media channels are being re-launched this year to enable better digital reach.

Our website will also be re-launched shortly on a platform that better meets accessibility requirements that came into force in September 2020. The new website will host a range of documents and corporate information.

Essential projects delivered this year via online surveys have been:

• Your Big Health Conversation – a large scale programme focused on gathering views on large-scale service transformation projects in the wider Portsmouth and South East Hampshire health system, this will continue to contribute to commissioning discussions in the months to come. All of the feedback we received has been summarised and remains available on our website.
• PositiveMinds – a new mental health service for those struggling to cope – including veterans and their families. This was launched at the end of 2019. Service users and voluntary groups have been involved in the concept and design of the service. A service user group helped shape promotional materials.
• Long-term conditions hub – a new type of service for patients with diabetes and respiratory conditions to improve the quality of support, education and testing received by patients, no matter where they live in the city. The project involved working with a strategic co-production working group. This has been a useful learning exercise for the CCG, confirming that this model of engagement works well and should be used for projects in the future.
• Non-Emergency Patient Transport Service (NEPTS) – working with colleagues across the Hampshire and Isle of Wight system, we have sought the views of local people who use this valued service, or are a carer for someone who uses the service. This has included an online survey for service-users publicised on all CCG websites in Hampshire, the acute hospital trusts, community hospitals, outpatient clinics, the renal department at Portsmouth Hospitals NHS Trust and GP practices. It was also promoted by the South Central Ambulance Service (SCAS) on its texting service.
• NHS 111 First – using feedback gathered from extensive research, a pilot scheme was run in the Portsmouth and South East Hampshire area.
• Practice mergers – supported the merger of Devonshire Practice and the Southsea Medical Centre, and the May 2020 merger involving Hanway Medical Practice and the Portsdown Group Practice.
• Improving end of life care – A survey was developed with patients and carers, and an initial data gathering exercise has been started to hear from patients, carers and staff what they think works well, and where improvements could be made. These initial findings will then help to inform workshops including patients and carers.
• School nursing provision for young people with SEND – work is underway to gather insights to develop this service.
• We have also contributed to two major pieces of engagement work lead by Portsmouth City Council:

o Imagine Portsmouth, a large scale consultation programme to capture people’s aspiration’s for the city for 2040 which will be used to inform the activity of key organisations in the city.

o Coronavirus resident research, a rolling programme of engagement to capture information on how the pandemic has affected people and how they access key services, including primary care.

In the earlier part of the year, the communications and engagement team supported a range of face-to-face activity including:

• University of Portsmouth Freshers’ Fair, gathering feedback on primary care and sharing information about NHS digital services, sexual health, wellbeing and mental health services.
• Time to Talk Day, supporting Time to Change Champions with lived experience of mental illness as they met with members of the public.
• City-wide PPG meetings were held at the start of the year at which members took part in discussions around new developments in information technology in support of primary care services and how we are using digital and social media to support our engagement activity through the Health and Care Portsmouth programme. Work is underway to get these meetings up and running again.

Portsmouth City Council manages the complaints process on our behalf. Complaints and concerns are signposted to the relevant NHS provider organisation involved. The provider will then respond to the complainant.

Should a complaint directly relate to a service commissioned by us, it is logged and a response made in line with our complaints policy. In terms of equalities monitoring, the team will send a monitoring form to the complainant with the response.

During 2020, examples of complaints we have investigated have included:

• A patient complained about a delay in a decision being made in relation to an application under the Individual Funding Request (IFR) procedure IFR. This was upheld due to an administrative oversight.
• In another complaint, the Ombudsman found fault with governance arrangements between the Council and the CCG in relation to Section 117 of the Mental Health Care Act 1983 which relates to Aftercare. These arrangements are currently being reviewed.
• A complaint from a parent about commissioning of a sensory assessment for her daughter which was partly upheld due to a breakdown in communication.
• A complaint about a data breach which was upheld due to an administrative error.
• Other complaints managed and including IVF funding policy were not upheld.

We have a combined safeguarding and quality team. The Director of Quality and Safeguarding and Head of Safeguarding work closely with provider organisation safeguarding leads and with colleagues in the in the Portsmouth Multi-Agency Safeguarding Hub (MASH). We are currently in the process of recruiting a full time Safeguarding Nurse Specialist to join the safeguarding team.

Inequalities managed by safeguarding nurses are associated with drug and alcohol misuse, issues around domestic abuse and mental health. As a port Portsmouth has some specific challenges regarding inequalities facing refugees and asylum seekers and unaccompanied asylum seeking minors (UASM). Portsmouth has seen a significant increase in the UASMs over the last four years and subsequently the Local Authority has taken the difficult decision to stop accepting UASMs as they were concerned that were no longer able to safeguard them effectively. This is only a temporary measure and we are currently working with Commissioners to ascertain how we can meet this cohort of children’s health needs, in a timelier manner. The Safeguarding Team supports GP practices and other health providers in fulfilling their responsibilities regarding the Prevent agenda. The head of Safeguarding also sits on both the Chanel panel and prevent board.

Our equalities lead works with colleagues in the quality and safeguarding team on concerns that may be raised through provider organisations. As a team we facilitate lunch and learn sessions for CCG staff which have included training on Mental Capacity Act/Deprivation of Liberties and Independent Child Trafficking & Post 18 Service. Unfortunately due to COVID-19 lunch and learn training has been placed on hold, but will resume when we return to office based working.

Our re-assessment against the Goals and Outcomes of the NHS Equality Delivery System 2 (EDS2) in 2020 was postponed due to the COVID-19 pandemic. This was because it would not have been possible to undertake robust consultation and engagement of patients, the public and stakeholders including staff necessary for effective re-assessment and development of new organisational equality objectives.

However, there has been continued progress made against existing equality objectives as part of business as usual and in response to the COVID-19 pandemic.

Objective 1: Improve access to healthcare for everyone routinely and when they need medical help fast but it is not a life-threatening situation.

Our work with partner organisations on new models of care to remove traditional boundaries between primary care, community health, social care and hospital services has continued.

During 2020 the following initiatives have been rolled out to improve appropriate care pathways for patients and to respond to the Covid-19 pandemic:

• The national NHS 111 First project was piloted in Portsmouth and rolled out across Hampshire by December 2020. Through this initiative patients seeking emergency care speak to a GP within thirty minutes for assessment. The GP has access to the patient’s primary care records which provides for accurate assessment of their clinical needs. If the Emergency Department (ED) or an Urgent Care Centre (UTC) is considered the best place for the patient to receive care then an appointment is arranged for the patient.
• Recruitment of social prescribers across all Primary Care Networks plays a vital role in connecting vulnerable people in a healthcare setting with community and voluntary sector.
• New End of Life patient transport process and policy agreed and rolled out across Portsmouth and South East Hampshire
• Multi-disciplinary Enhanced Care Home Team provision provide proactive review and reactive care to care home residents
• Programme of work identifying and coding BAME population to improve healthcare to this cohort
• Using technology to enable fast and effective care when it is preferred by patients or face-to-face appointments are not available

o Virtual GP appointments
o Airedale technology in care homes

Objective 2: Strengthen our consultation and engagement to ensure all protected characteristics have a voice in our work.

Please see (8) above: Consulting and Engagement with Patients and Local People.

Objective 3: Strengthen commissioning and partnership working so that the communities we service feel informed and supported to be as involved as they wish to be in decisions about their care.

The following initiatives have been taken forward during 2020:

• End of Life consultation across Portsmouth and South East Hampshire. Workshops and Surveys have been completed with end of life patients, as well as their friends/family to help shape the End of life Strategy
• Portsmouth CCG and Portsmouth City Council have strengthened working relationships by aligning and integrating our senior teams, this will enable us to improve services by working towards one health and care system
• Sought the views of local people on their use of NHS digital solutions during COVID-19
• Engage service users, stakeholders and champions to be an equal member of boards, consultation and strategy development
• Reviewing bereavement support in response to COVID-19, and exploring how the BAME community can be further supported
• Tailoring communications to ensure that information is clear and appropriate to the audience that is readily available to include Easy Read and visual communications
• Sought the views of patients who have used the NHS 111 First Service to inform roll out of this initiative across the local health economy
• Continued to support Primary Care Networks with a focus on primary care access and winter resilience
• Collaborating with local partners to protect Clinically Extremely Vulnerable patients during COVID-19. Health, Local Authority and Voluntary Sector.

Objective 4: Ensure staff are aware of the availability of family friendly arrangements in line with the Equality Act 2010 and the range of HR mechanisms and support available to ensure everyone feels fee from abuse, harassment, bullying and violence from any source.

The Staff Engagement Group continues to be consulted on human resources policies as these become due for renewal and/or updates of human resources. Individual Staff Engagement Group members in turn consult their teams so that all staff have an opportunity to be involved in this process.

Each policy renewal or revision is finalised at the Staff Engagement Group and approved by the CCG’s Clinical Executive Committee. Approved human resources policy updates are notified to staff via the intranet which also provides electronic access to all CCG policies and procedures. The CCG’s executive team will also cascade information and updates to their teams.

Compliance with the Public Sector Equality Duty of the Equality Act 2010 is an important element in the monitoring of our contracts with NHS organisations from which we commissioning services for our population. Equality metrics are included in annual review of contracts and reports and updates are received and discussed as part of formal monthly and quarterly contract review meetings. The main providers are:
• Portsmouth Hospitals University NHS Trust
• Solent NHS Trust
• Portsmouth Primary Care Alliance
• Practice Plus Group (formerly Care UK) which runs St Mary’s NHS Treatment Centre
• South Central Ambulance Service NHS Foundation Trust

Equality Act 2010
The Equality Act 2010 (the Act) simplified, strengthened and harmonised previous equality legislation into one single Act. The Act provides a legal framework to protect individuals from unfair treatment and promote a fair and more equal society.
The Act introduced the Public Sector Equality Duty (to be referred to forth with as “the equality duty”). The equality duty changed the emphasis of equality legislation from rectifying cases of discrimination and harassment after they occurred to preventing them happening in the first place. The equality duty also moved the obligation to positively promote equality rather than just avoiding discrimination from individuals to organisations. The purpose of the equality duty was to integrate equality and good relations into daily practice, organisational policies and service delivery. The equality duty consists of a general duty and specific duties.

The General Equality Duty of the Equality Act 2010
The general equality duty applies to public authorities and public, private or voluntary organisations carrying out public functions. In the exercise of their functions public authorities must have “due regard” to the need to:

• Eliminate unlawful discrimination, harassment and victimisation
• Advance equality of opportunity between different groups by:
  • Removing or minimising disadvantages suffered by people with a protected characteristic due to having that characteristic
  • Taking steps to meet the needs of people with protected characteristics that are different from people who do not have that characteristic (including taking account of a disability)
  • Encouraging protected groups to participate in public life and in any other activity where participating is disproportionately low
• Foster good relations between different groups by:
  • Tackling prejudice
  • Promoting mutual understanding

Compliance with the equality duty may involve treating some people more favourably than others.

There are nine protected characteristics under the Act. These are:

• Age
• Disability
• Pregnancy and maternity
• Religion or belief
• Race
• Sex
• Sexual orientation
• Gender reassignment
• Marriage and civil partnership (but only for the first aim of the duty to eliminate unlawful discrimination, harassment and victimisation)

The Specific Duties of the Equality Act 2010
The specific duties require public bodies to publish relevant proportionate information showing how they meet the General Equality Duty by 31 January each year. In addition, they require public bodies to set specific measurable equality objectives by 6 April every four years from 2012.

Public authorities with 150 or more employees are required to publish information on how their activities as an employer affect people who share different protected characteristics. Public authorities with less than 150 employees should collect workforce information to help develop organisational objectives and assess the impact of employment policies on equality.

Health and Social Care Act 2012, Part 1, Section 13G
Related to equalities legislation is the CCGs’ duty to have regard to the need to:

• Reduce inequalities between patients with respect to their ability to access health services; and
• Reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health service.

Health and social Care Act 2008 (Regulated Activities)
Regulations 2014: Regulation 13
The intention of this regulation is to safeguard people who use services from suffering any form of abuse or improper treatment while receiving care and treatment. Improper treatment includes discrimination or unlawful restraint, which includes inappropriate deprivation of liberty under the terms of the Mental Capacity Act 2005.

To meet the requirements of this regulation, providers must have a zero tolerance approach to abuse, unlawful discrimination and restraint. This includes:

• Neglect
• Subjecting people to degrading treatment
• Unnecessary or disproportionate restraint
• Deprivation of liberty.

Providers must have robust procedures and processes to prevent people using the service from being abused by staff or other people they may have contact with when using the service, including visitors. Abuse and improper treatment includes care or treatment that is degrading for people and care or treatment that significantly disregards their needs or that involves inappropriate recourse to restraint. For these purposes, ‘restraint’ includes the use or threat of force, and physical, chemical or mechanical methods of restricting liberty to overcome a person’s resistance to the treatment in question.

Where any form of abuse is suspected, occurs, is discovered, or reported by a third party, the provider must take appropriate action without delay. The action they must take includes investigation and/or referral to the appropriate body. This applies whether the third party reporting an occurrence is internal or external to the provider.
CQC can prosecute for a breach of some parts of this regulation (13(1) to 13(4)) if a failure to meet those parts results in avoidable harm to a person using the service or if a person using the service is exposed to significant risk of harm. We do not have to serve a Warning Notice before prosecution. Additionally, CQC may also take any other regulatory action. See the offences section for more detail.

CQC must refuse registration if providers cannot satisfy us that they can and will continue to comply with this regulation.

Cited reference: https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-13-safeguarding-service-users-abuse-improper