Introduction
Central London Community Health Care NHS Trust is committed to providing an environment where all staff, service users and carers enjoy equality of opportunity. The Trust understands the importance of being compliant with the various pieces of equality legislation; and acknowledges the benefits and contribution that managing equality and diversity makes to the achievement of its business objectives in the areas of employment, service planning and service delivery.
There is no mandatory requirement for NHS Trust to have an Equality and Diversity Annual report; this report emphasis our commitment around promoting equality, embracing diversity and ensuring full inclusion for people who use our services is central to the values of the Trust. Promoting equal opportunities, preventing discrimination and valuing diversity are fundamental to building strong communities and services.
NHS England has found that health inequalities in access, patient experience and outcomes still exist.
By recognising that every patient has different needs due to their background, we can work to address those diverse needs and improve the health outcomes of our patients. This can also be achieved by valuing our staff’s diversity so they can provide high quality healthcare.
This report summarises the Trust’s achievements and progress in making sure that equality and diversity is integrated in all aspects of our healthcare services and in getting the best out of our diverse workforce. The Trust Equality and Diversity (E&D) function is to encourages our staff to take simple steps to improve the health services we provide to patients from equality groups: whether that’s due to their culture, age, race, gender, sexual orientation or disability. It also supports our diverse workforce through a number of staff networks, training, and advocacy.
These activities are detailed in the first section of the report. In the second section, the activities undertaken by the E&D function are listed to ensure that the Trust meets its Public Sector Equality
Duties under the Equality Act 2010. The final section outlines our priorities for 2014/15.
DIVERSITY IN DELIVERING HEALTHCARE
Alternative and accessible information - In response to requests from health professionals, we have written a communication guide on how to make information more accessible, jargon free and easier to read. This includes translating information into an easy read format and using a dyslexia friendly design. This is available on the communication pages of the intranet and promoted through training.
We help facilitate requests from the services on easy read information e.g. in the past 12 months the
Clinical strategy has been produced in an easy read format for patients.
“Keeping your information safe” is an information leaflet produced by the Information Governance team to inform patients why we collect their data and how it will be used. The leaflets have been translated in to Arabic, Bengali, Cantonese, Farsi, and Portuguese; and are made available in braille.

Improving access
We have printed an accessibility sign for all reception areas. The sign states “if a patient has extra needs or requires support, they should inform the receptionist”. For example, if a patient is deaf, the health professional will be informed and will find the patient rather than expecting them to hear their name being called out. Or if a patient has a learning disability, help will be given to complete any required forms.
Case Study – Ensuring that our services are accessible with clear signage for our patients.
“Walk Around Groups” with patients have been taking place in our walking centres.
The Estates and Facilities team have worked with the Equality and Diversity team delivering Patient
Walk Around Groups in Parsons Green Walk In Centre to revaluate the current signage and accessibility of the building. This review has helped the Estate and Facilities team come up with an action plan together to make relevant changes for the site
A” walk around exercise” was undertaken in collaboration with CBU Managers to identify those sites that were not suitable or accessible to the service users identified.
Disability Communication Training
Training sessions were commissioned to improve how our front-line staff communicated with disabled patients. This training need was identified by the Mystery Shopping project. A local disability group, ADKC devised and provided the training for approximately 15 staff (an e-learning package is planned for 15/16). The training was based upon the premise that by removing attitudinal and physical barriers, accessibility of services for disabled people would be improved. The training helped our staff to be creative at looking at these barriers and to take small steps in improving their service.
School Nursing
Case Study - CLCH’s School Nursing service has been successful in developing good relationships with faith communities. Previously we have had experience of negative attitudes around the HPV vaccine from Catholic, Jewish and Muslim schools at the start of the campaign, due to the association of the
HPV vaccine with girls being sexually active.
From our experience, some parents do not give consent for their daughters to have the vaccine because of their concerns about this association. We have learnt that the promotion of the vaccine needs to be tailored for each school population with the fact that the vaccine protects against cervical cancer given prominence. Our experienced Immunisation Lead visited such schools and provided an evidence based information session which acknowledged the specific challenges and sensitivities for each school. The information given to parents was also revised to exclude any reference to Sexually Transmitted Infections and focused on the cervical cancer prevention for the school’s literature.

Sexual orientation equality for patients
We have continued to work with Stonewall (Stonewall has previously been a Lesbian, Gay Bisexual
(LGB) charity until February 2015 were it will be aiming to included Trans with in its specialism of work). For the purpose of the report we have a separate section on Trans equality
1.
Training for staff on working with older LGB patients and the reasons why we monitor this equality data.
2.
Identifying the Soho Centre as flagship gay-friendly health center to demonstrate to patients that CLCH is a gay-friendly health provider. We are working towards ensuring that the Soho
Centre’s services and environment is inclusive and welcoming for our LGB patients. This would communicate that while all our services are gay-friendly, the Soho centre has had additional support to meet the needs of LGB patients and families.
3.
A Different Families event was held by the Rainbow LGBT Network for healthcare professionals to discuss same-sex parenting, hear the experiences of parents who had used ante-natal services and our health visiting services, and to highlight other forms of ‘different’ families such as surrogacy.
4.
Outreach work with 56 Dean Street, attending patient groups to hear about patients experiences of CLCH services
5.
Outreach work with Soho LGBT forum network, to talk about our services and look at how we can meet the needs of our LGB patients.
6.
Work with Guys and St Thomas healthcare Trust to the share the learning and progress that the function has achieved.
As a result of the actions listed above and following an assessment, we were placed 18 th in the
Stonewell’s Health Equality Index. This means we are in the top 20 most gay-friendly health care
providers in England.
Patient Engagement
As a public authority CLCH needs effective ways to engage with equality groups to understand their diverse health needs. CLCH continues to play an active role with the BME Health Forum which is a partnership of statutory, voluntary and community organisations. This forum operates to improve health and reduce health inequalities for BME communities in the inner London boroughs. They have an email list of 540 which we regularly use to publish activities and events.
We have also engaged with lesbian, gay, bi-sexual and transgender (LGBT) local groups to help us meet the needs of LGBT patients. For example: recently working with the Soho LGBT+ Community
Forum to ensure that the Soho Walk-in centre is engaged with the PRIDE group to reduce disruption to the service during the Pride Festival. We have also worked with the Metropolitan police on the recording of hate crime.

Our MSK service takes an innovative approach to working with ethnic minorities that reflects changing demographics and immigration. Current estimates are that 7.8 million people in the UK suffer from chronic pain. Only 14% of sufferers have seen a pain specialist. CLCH’s MSK Service sees a greater proportion of ethnic minority groups (more than any other group) when compared with census data (CLCH Patient Equality Data Report 2011). As a result of this finding, we set up a pain management group for Arabic speaking women. The group uses an Arabic interpreter with a specific interest in complex pain. As well as graded physical activity and basic relaxation there is an element of education and health promotion. Since May 2011, we have run 7 groups with a total of 49 patients. The financial savings are £24,588 compared to the cost of running one to one sessions, which equates to 86% savings. Patient feedback also showed significant positive changes.
Complaints
The Equality Act 2010 requires us to record the equality data of complainants (e.g. ethnicity, sexual orientation etc.). However, there continues to be a low recording of this data.
We recognise this is a sensitive time to be collecting the complaints protected characteristics information; therefore we have provided training for the customer services team, revised their equality monitoring form for complainants and advised on the timing of requesting the information from complainants. We also helped within the Equality and Diversity function advising on complaints that have had discriminatory elements.

VALUING OUR DIVERSE WORKFORCE
Dignity at Work
NHS Employers found that in the annual NHS staff surveys the greater the proportion of BME staff who report experiencing discrimination at work, the lower the levels of patient satisfaction.
Dignity at Work workshops was delivered to teams who had reported higher rates of bullying & harassment in the 2013 Annual Staff Survey. A small number of interactive workshops allow teams
(without their line managers) to report on any issues or situations that made them feel they were being bullied, harassed or discriminated against and then help them to devise solutions. This information was then reported back to the Senior Manager with recommendations e.g. sign posting them to help from the Organisational Development team or recommendations on how to improve communication. Teams came up with personal pledges about treating their colleagues better
Mandatory Equality and Diversity Training
Research has shown that factors which can predict higher absenteeism in NHS Trusts include not having Equality and Diversity Training in the last 12 months 1
During 2014 we have delivered 50 Equality and Diversity training sessions for the mandatory refresher training to over 1250 staff. An E-learning package has also been developed for new starters as part of their induction process.

Understanding the business and healthcare need for practising equality and diversity.

Unconscious bias training and how this affects the decision we make when we are treating our patients and the judgments we make about our colleagues.
Workforce equality: treating colleagues with dignity and respect and expected. behaviours.
For the first time the Board Members had Equality and Diversity training. This included Members of the Board making personal pledges to support the Equality and Diversity agenda. Since this training
2 members of the board become mentors to members of staff from a BME background
Maternity returners
In order to support our female employees to return to work after maternity leave, we have undertaken some targeted work when they attend their maternity meeting. A number of women have been supported with their flexible working requests by the E&D team whilst on maternity leave. The number of women returning to employment after maternity leave has decreased from
82% in 2013 to 75.3% in 2014 there was a drop with maternity leaves. We have identified this is a change trend depending on the year so in 2015/2016 we are going to do more detailed analysis to find out what are the trends
1 NHS Staff Management and Health Service Quality, Lancaster University Management School and the Work
Foundation (2011)

Under-representation of Black Minority Ethnic (BME) staff
The KPI was set is to increase the number of BME staff at bands 7 and above. We delivered a number of activities and training to support our BME staff at lower and middle salary bands.
However, the 2014 statistics show there has been limited short term impact upon improving the representation of BME staff at a senior level. We recognise that this KPI will be a long term objective to achieve. The breakdown below gives the BME representation at bands 7 and above by each division.
We have commissioned an empowerment programme for bands 6 and 7 to take place in 2015.
And looking at succession management to help BME staff developed and stay employed at CLCH
The workforce report which will be published in June 2015 which outlines a more detailed analysis of the workforce
Salary Band
Band 1
Band 2
Band 3
Band 4
Band 5
Band 6
Band 7
Band 8A
Band 8B
Band 8C
Band 8D
Band 9
Medical and Dental
VSM
Unknown
White
50%
32%
37%
53%
46%
59%
62%
73%
71%
94%
91%
90%
51%
100%
BME 2015
50%
66%
58%
43%
50%
38%
34%
24%
29%
3%
0%
10%
42%
0%
9%
0%
7%
0%
3%
0%
3%
4%
2%
3%
0%
3%
5%
4%
Unknown
2015
Number of staff by salary band
11
10
69
5
150
51
33
2
187
423
214
469
572
560

CLCH workforce 2013
BME
White
Not Known
42%
57%
1%
2014
42%
55%
3%
2015
43%
53%
4%
Total 2974 2940 2756
Empowerment Leadership programme
The Empowerment Leadership programme is a five day training course primarily targeting BME staff at bands 2-7 but is open to all CLCH staff at these bands. We delivered the sixth programme in late
2014. From the total 89 participants, over a third has been promoted and 2 participants have
‘broken through’ to the band 8a level.
The programme aims to move the participant’s out of their ‘comfort zones’ and to challenge the way they think, communicated and behave. Other outcomes include: returning to university education to train to be clinicians; secondment to clinical research projects; short term secondments to transformational projects; and volunteering for national medical charities. Managers’ report that after the programme participants are more confident, productive and motivated.
The Diversity & Inspire Network
As 43% of our workforce is from a BME background it is important that our BME staff have a voice.
The staff network for BME staff is called the ‘Diversity & Inspire Network’ and during 2014/15 the group’s activities included:

Making suggestions on ways to improve staff engagement and communication across CLCH.

Inputting into the draft HR policies for Disciplinary, and Sickness Absence to check they are fair and equal; making a formal response to the consultation of the restructuring proposals.

Peer support is provided by members of the network

Support and a confidential place for BME staff to talk One of CLCH employee was announced on the HSJ BME pioneers list in November 2014
The actions CLCH are taking to address the under-representation of BME staff include:

Continue to work with the Board and Executive Leadership team to increase senior BME representation amongst our workforce.

2 senior BME staff have been mentored by the Executive Leadership team. .


Deliver the Action Plan / Strategy on improving BME staff representation.

Continuing to fund and deliver the Seventh Empowerment Programme. This is a leadership development and five day training course, which primarily targets BME staff at bands 2-7.

Run an additional targeted empowerment programme for bands 6-7

Ensuring that any downsizing or re-structuring proposals affecting staff are assessed for their impact upon BME staff. This assess whether BME staff are disproportionally affected by proposals.

Improving the recruitment methods / assessments for senior positions and working with our corporate transformational team to ensure that change management practices are fair and inclusive.

Improving the brief provided to Executive Search companies used in recruitment of senior posts to widen the talent pool they head hunt within.
LGBT workplace Equality
There is a strong business case for ensuring an inclusive workplace for people who are gay, lesbian, or bi-sexual. The Rainbow Staff Network (Lesbian, Gay, Bi-sexual and Trans) launched in February
2012. The network now has a core membership of 40 members. The network’s key achievements include:

We entered the stonewall workplace index at number 40 climbing 89 places. A significant amount of work had been carried out to deliver this fantastic achievement representing CLCH at the London Gay Pride March and marched with other NHS Trusts;

Advising on ways to improve how our services work with LGBT patients;

Setting up a “Straight Allies” programme for straight staff to support LGB equality and challenge homophobia in our workplaces.

Guidance for mangers how to work with LGBT staff.

Training delivered at team meetings.

Message included in the pay slips for all staff around same sex benefits
Transgender work
The Equality Act 2010 includes the protected characteristic of gender reassignment. A ‘Trans Staff
Equality’ Policy has been revised which sets out the process for any staff member who is undergoing or has undergone gender reassignment. The Equality and Diversity team provided support to staff that underwent gender reassignment which included working with their teams and managers to make sure their transition was carefully managed to support the staff member. As an organisation we used this as an opportunity to provide training by GIRES (Gender Identify Research Education
Society) to these teams to improve their understanding of gender reassignment. This provided a safe and confidential environment for team members to understand the science behind why someone

would want to change their birth gender and have a have an opportunity to ask questions. The Trans employ that has been support was named on the first HSJ LGBT role models list in 2014
Support for disabled staff and those with long-term conditions
During this year we have provided one to one support for staff with a disability as many staff still feel unable to disclose their disability status to mangers. We know that there is a hidden group of staff who have a disability but have not disclosed this to their managers. Up to 15% disclosed it in the staff survey over recent years but our internal disclosure rate is 3.8%. This means that this staff may not be accessing reasonable adjustments (for example, equipment, flexible working or change of roles).
A new disability staff network has been set-up. We have revised the Disability and Long Term conditions policy with information on getting funding from JobCentre Plus for reasonable adjustments for our disabled staff.
Pan-London engagement
Following the demise of NHS London, the Equality and Diversity Function at CLCH provided facilitates the Pan-London Equality & Diversity leads Network The network consists of the Equality and
Diversity (E&D) leads in London’s NHS Trusts and meets quarterly and discusses best practice and joint working. We work closely with E&D leads in CNWL, Chelsea and Westminster and the Royal
Marsden.
PUBLIC SECTOR EQUALITY DUTIES
The Equality Act 2010 requires us to have ‘’due regard’’ to eliminate discrimination on grounds of patients’ and staff’s protected characteristics. The following details how the Trust met its public sector duties.
1.
Equality information
As a public authority, the Equality Act 2010 requires the Trust to record, analyse and publish (on the
CLCH website) every year our staff and patient’s protected characteristics. It is important we analyse our patient’s equality information as we know that factors such as ethnicity, mental health, disability, gender and age contribute towards the burden of ill health within more deprived communities 2 .
The Patient Equality report (January 2014) analysed the age, gender and ethnicity of our patients.
Our patient data has been compared to local population data 3 and national health inequalities. The report found:

Women make up 85% of CLCH workforce but female representation starts to decrease towards the senior bands (women represent 69% at 8b and above).

BME staff are disproportionately represented in disciplinary cases (76% of investigations and
50% of written warnings), and disabled staff (20% of the formal capability cases).
2 Health Inequalities Framework, NHS Kensington & Chelsea
3 Census 2011 data.


HR business partners will discuss with Equality and Diversity if are concerned with any of the case they are working on
These workforce results contribute towards our priorities in 2015/2016. There are a number of activities to tackle the issue of disproportionate number of BME staff including: training podcast of managing diverse teams, having representative panels of hearings to ensure fairness; and holding focus groups with staff and line managers from BME backgrounds.
2.
Equality Analysis
All our restructuring proposals and transformational programmes undergo an equality analysis assessment. This seeks to ensure that no groups of staff or patients are disproportionately affected by the changes based upon their protected characteristic. All the restructuring consultations affecting staff are analysed for any possible negative impact upon staff from equality groups. Actions are then put in place to reduce this impact for example, robust recruitment processes rather than automatically slotting staff into posts.
In 2015/16 we will be ensuring that Equality Analysis Assessments are completed for all our transformational programmes.
Conclusion
The increasing financial pressures within the NHS and CLCH have resulted in lower resource in the
Equality and Diversity team than in previous years. However, as shown in this report, we have made significant progress on the equality and diversity agenda within the Trust in 2014 and the aim for
2015/16 will be to maintain this progress and need to check equality and diversity implications for all business planning and decision-making. It will be important going forward that the resource maximises its impact by working with others and embedding Equality and Diversity as a Trust wide issue.
At a time of considerable change and financial challenges we must ensure that staff and patients from diverse backgrounds are not disproportionately affected. Equality and Diversity must be considered at the being of a change process.
The main priorities for 2015/16 include:
1.
Improving the recording of our patients’ equality data and rolling out the recording of sexual orientation, religion and disability for most of our patients.
2.
Considering equality and diversity in all business planning, transformational projects and decision-making by undertaking an Equality Impact Assessment.
3.
Raising awareness of providing information in accessible and alternative formats.
4.
Stay in 100 Stonewall Workplace Equality Index to ensure Lesbian, Gay and Bi-sexual equality in the workplace.
5.
Meeting the Board target for improving BME staff representation at a senior level (band 7 and above). Delivering an action plan to look at the long term goals on delivery of this KPI

6.
Delivering on the Race Equality Standard
7.
Implementing the Equality Delivery Scheme
8.
Addressing the higher reporting of bullying and harassment in the staff survey 2014 results and co-ordinating with the Compassionate Leadership programme.
9.
Equality and Diversity going forward will report in to Divisional Director of HR and Organisational
Development.
Appendix shows the position in relation to 2014/15 priorities and Appendix Two shows the Action
Plan to achieve these 2015/16 priorities.
Recommendation
The Board are asked to note
The contents of the report and the achievements made in 2014/15
The action plan of priorities for 2015/16

Appendix 1: 2014/2015 priorities
Improving the recording of our patients’ equality data and rolling out the recording of sexual orientation, religion and disability for most of our patients
Considering equality and diversity in all business planning, transformational projects and decision-making.
Raising awareness of providing information in accessible and alternative formats
This is a target that hasn’t been delivered on however with the roll out of system one the function for capturing the protected characteristic in
2015/2016
All business changes have to go through an equality impact assessment the E&D function has to signed off on them Equality and Diversity
A guide was produce for services to be understand the importance of information being produce in easy read and accessible formats for our patients
This was achieved and CLCH was placed at number 40 climbing 89 places Getting into the top 100 Stonewall Workplace Equality Index to ensure LGB equality in the workplace.
Meeting the Board target for improving BME staff representation at a senior level (band 7 and above).
Addressing the higher reporting of bullying and harassment in the staff survey
2013 results and co-ordinating with the Compassionate Leadership programme.
This target hasn’t been met; however a more detailed long term action plan on how we can achieve this target will be developed for 2015/16.
In 2014, less was carried out by the Equality and Diversity function in this area. There will now be a detailed action plan with an Organisational development lead

Appendix 2: Action Plan for 2015/16 priorities
Priority Actions Lead
Through the new system one system
Improving the recording of our patients’ equality data and rolling out the recording of sexual orientation, religion and disability for most of our patients.

Ensuring that relevant fields are available on System One patient recording system.

Start to pilot recording of sexual orientation, religion and disability with certain services.

Look at ways to collect the equality data through discharge paperwork.

Continue to train staff on understanding why and how to ask for equality data from patients.
IT
Equality and Diversity lead
Considering equality and diversity in all business planning, transformational projects and decision-making.

Ensure that transformational programmes including clinical and corporate projects complete an EIA signed off by the E&D team.
Directors of Transformation

Supporting service lead and mangers to complete the Equality impact assessment Highlighting this is a part of CLCH mandatory requirements
Equality and Diversity lead

Continue to analyse the equality impact of Board papers.
Staying in the stonewall 100 Workplace
Equality Index to ensure LGBT equality in

Clear action plan to deliver the Equality and Diversity Lead

the workplace.

Straight Allies programme

Awareness raising events

Mentoring scheme

Role models

LGBT local champions

PPE activities

Speaking at stonewall national conference

Submit to the stonewall team in September 2015
Meeting the Board target for improving
BME staff representation at a senior level
(band 7 and above).

Empowerment leadership programme

Piloting the diversity talent pipeline (using internal staff to deliver short term projects)
Equality and Diversity lead
Recruitment / ELT

Consistent recruitment / selection methods to ensure fairness and equality

Within briefs to recruitment agencies including the need to recruit from wide and diverse talent pool.

Running a one of specific Empowerment programme for bands
6 and 7 to help with career development
Race equality standard

To identify CLCH priorities

To agree Executive lead for the workforce equality standard

Agreed action plan with ELT by end of May 2015
Equality and Diversity lead

Working with the organisation development team to address bullying and harassment



Look at the staff survey and identify the hot spots
Setting up focus groups which will lead to action plans
A range of solutions depending on individual issues with in the identified hot spots
Equality and Diversity lead
Organisational Development lead