Achieving Age Equality in Health & Social Care
Equality Commission for Northern Ireland
25 September 2012
Helen Bowers – Head of Policy & Research, NDTi
www.ndti.org.uk
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The National Review
Jan Ormondroyd
Chief Executive
Bristol City
Council
Sir Ian Carruthers
Chief Executive
South West SHA
Terms of Reference of the review
The national review of age discrimination made recommendations on the
following areas:
 the timetable for implementation of the ban on age discrimination;
 where it is objectively justifiable to retain age-based differentiation in
services;
 how to support the health and social care system to implement the
public sector equality duty in respect of all age groups;
 which key actions health and social care bodies should take to make
demonstrable progress in meeting their obligations as quickly as possible.
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Contexts & outcomes of the review
Took account of key
contexts and realities:
Personalisation
Financial crisis
Whole system
approach
What currently exists
to address inequality
and discrimination
Multiple discrimination
and inequality
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Supported proposal in the
(then) Bill to ban age
discrimination against adults in
provision of services & exercise
of public functions
Supported proposal to create a
public sector equality duty
covering all protected
characteristics
Made specific
recommendations to make this
happen in health and social
care
Different treatment by age is not always discrimination
It can be “good”
Age appropriate services
where these meet
people’s needs
Positive action - to
redress unfairness
Reflect physiological
characteristics in the
population rather than
individuals
It can be “neutral”
It can be “bad”
Differences in treatment
Direct discrimination is
may reflect natural variation
treating someone less
rather than be the result of
favourably because of
specific decisions
their age
Indirect discrimination is
when an apparently
neutral criterion places
people of a particular
age at a disadvantage
compared to others
unless the less favourable
treatment is justified
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The key test is, what does this mean for Joseph
and Alice?
Joseph is 77 years old. He went to the GP because he was
having problems with walking to the shops. The doctor said that
if he had been younger, then he would have referred him for an
operation on his knee, but at his age, what did he expect? His
daughter was present and she intervened and so the doctor
agree to refer and Joseph successfully had the operation.
Alice is 85 and lived in her own home with support from her daughter.
When the daughter became ill, the social worker and GP were concerned
about the level of support she would need to remain at home, even
though she strongly wanted to remain there. She was not offered the
option of direct payments. Alice was re-housed into residential care,
where she died six months later.
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There is clear evidence of age discrimination
In the care of
individuals and carers
In the organisation of
services for communities
• Ageist attitudes and comments
• Poorer access to investigations
and treatments
• Less comprehensive assessment
of individual and carer needs
• Lower expenditure on packages of
care
• In the organisation & delivery of
acute care, mental health services
and community health & social care
services
• Not including older people in
medical research (thus insufficient
evidence for some public health
programmes)
See the person not the age personal care that has dignity
and respect at its heart
Be explicit about the effect of
policies on different age groups
http://age-equality.southwest.nhs.uk/definitions-legal-framework-andimplementation.php
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A decade of progress but there is more to be done
2011- 2012
2010
Implementation
2009
2006
2001
Equality Act
A resource pack to support
local implementation
“a reduction in explicit
age discrimination …
except for mental health
needs… (and) poor
treatment that indicated
ageist attitudes or
practice”
“root out age
discrimination”
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“truly eliminate age
discrimination … and
ensure care is personal
and meets the needs of
each individual”
7
The solutions are to be found in existing policies BUT with
an explicit focus on age discrimination and age equality
1. Engaging
with the
public and
partners
2. Focusing on
personalisation
and patient
centred care
3. Delivering improvement in key
services
Dementia
Involvement
Putting People First
A focus on age
High Quality Care
for All
Prevention
Cancer
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Falls
Recommendation on timing
Recommendation: set the same commencement date
as in other sectors
October 2010: consolidation of existing equalities
legislation covering race, gender, disability etc.
April 2011: implementation of the new public sector duty
to have due regard to the need to advance equality
2012: implementation of the ban on age discrimination in
the provision of services and exercise of public functions
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Recommendation on “objective justification”
Recommendation – no wholesale exception but government should explore
targeted exceptions
Approach A
Age differentiation must be
“objectively justified” (i.e. a
proportionate means of achieving a
legitimate aim).
Members of the public can challenge
health and social care professionals
and organisations where they feel
they have been discriminated against.
Professionals and organisations will
need to show that their decision can
be objectively justified
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Approach B
Create one or two specific exceptions where
age differences are demonstrably of general
benefit.
Age differentiation in all other areas must be
objectively justified
Professionals and organisations will need to
show the difference can be objectively
justified or it meets the criteria in the
exemption.
Members of the public can challenge if they
feel that the exception is not applicable.
Recommendations on resources and
commissioning
The allocation process
- funding formulae for
PCTs and local authorities
Cost effectiveness and
prioritisation of decisions
Commissioning services
for populations
Charging for
social care
Commissioning care
for individuals
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Recommendations on behaviours and culture
“Seeing the person, not the age”
Shaping norms – the role
of the professional regulators
Being seen,
Being heard –
involvement
and feedback
Education and
training
Leadership and organisational
culture
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Recommendations on local implementation
A local implementation process (recommendation 19):
Joint audit of services, systems and processes across health and social care
Joint action planning
Work with NHS, LA, third and independent sector providers
Involve members of the public;
Use local scrutiny processes;
Agreement about local resource consequences
Build on existing approaches and policies but recognise that the age
provisions in the Act are a new requirement
A pack of resources, including good practice material, and whether there should
be designated national centres of expertise (recommendation 20)
Developing a joint assurance process for social care and health to
demonstrate progress, including links to the Equality and Diversity Council
(recommendation 22)
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Addressing age discrimination in health and
social care
Age discrimination has no
place in a fair society, which
values all its members and
the principles and values
which drive the NHS and
social care require us to treat
everyone fairly based on their
needs, whatever their age.
What should local
authorities & NHS
organisations do to
end age discrimination
and promote age
equality?
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Equality Act 2010
(1) In 2011 introduces a
new duty to promote
equality, including age
equality
(2) In 2012 bans age
discrimination in the
provision of services
A resource pack to support local
implementation
Age Equality Audit Tool
Enables partners to do a joint self-assessment and create a gap
analysis to highlight priorities for action and inform local
decisions and investments
Sector-specific practice guides, with information about how
and why age discrimination occurs and examples of good
practice to help address identified gaps and priorities
NHS practice guide
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Social care
practice guide
Available from mid May
The Achieving Age Equality Toolkit
http://age-equality.southwest.nhs.uk/
Agencies and communities work together to
review current services using evidence based
criteria to determine whether services are ‘age
discriminatory’ or ‘age equal’
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Getting Started & an “ideal process”
Assess your “readiness” for working together, and
with local communities, to review the current
situation and agree local priorities
Engage partners & stakeholders in an “Area Audit
Group”
Agree your local, tailored approach
Use the “ideal process” as a starter for 10
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Four sets of “AAE Criteria”
Organisational and system readiness
Acute care and treatment
Mental health & mental health services
Primary and community based health & social
care
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Age Equality Audit Tool
http://ageequality.southwest.nhs.uk/
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Implementation issues
Always intended to be a “must do”; never enforced
Scepticism and lack of engagement at strategic, leadership
levels – how best to tackle deep rooted ‘institutional
ageism’?
Lack of a strong voice among older people using health &
social care services – how best to increase, locally &
nationally?
Need to build into existing (ever changing!) systems for
quality, improvement, performance, regulation – which
ones?
Is there a place for a toolkit / learning network across all
public services?
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Drivers for implementation.....do these have traction
locally for health and social care leaders?
The law is coming into effect at the same time as unprecedented pressures
on health and social care budgets, so what are the local drivers for implementation?
The quality imperative – general work on quality improvement and transformation
will push organisations to take ending age discrimination seriously
The legal imperative –
the Equality Act adds a
new dimension to
implementation as
organisations will be
motivated to comply
with the law and
regulators will have
powers to enforce the
law
Local Action
to end
age discrimination
and
promote equality
The public imperative
– patients, service
users, carers and
members of the public
will push for
organisations to end
age discrimination and
individuals may take out
legal cases in the courts
The moral imperative - there is a strong commitment to quality among health and
social care staff which leads organisations to be motivated to ending age
discrimination
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Thank you & contacts
www.ndti.org.uk
Caroline.Bernard@ndti.org.uk
@ndtihelen / @ndticaroline
ndti.org.uk
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