At the start of 2023, the NHS Leadership Academy placed special emphasis on the importance of equality, diversity and inclusion (EDI) throughout the NHS and the wider integrated care systems, stating: “We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for – the NHS is a universal service and we are committed to developing a leadership community which is representative of the groups that we serve.”
In this article, we will be exploring the various practical and ideological ways in which three integrated care systems are working to cultivate a more equal, diverse and inclusive culture – focusing on South East London ICS, Mid and South Essex, and Leicester, Leicestershire and Rutland ICS.
South East London ICS
This year, South East London ICB published their Annual Equality Report detailing the goals and outcomes of the ICS over the last 12 months.
The document begins by outlining the ICS’s established equality objectives, which include:
- Develop a culture of EDI with needs assessments in place to demonstrate accountability.
- Cultivate an organisation that is inclusive, free from discrimination with all able to fulfil their potential.
- Board members and senior leaders should demonstrate commitment to equality, diversity and inclusion in the development of SEL ICB vision – building assurance and accountability for progress.
- Build strong relationships with the diverse communities, better understand the needs and experiences of the population across SEL and adjust the ICB’s approaches accordingly.
- Improve the fair access experience of protected patient groups across healthcare services.
Throughout 2022, the ICS geared their approach towards working with people and communities, in order to build relationships with South London’s seldom heard voices such as Somali women, the Afghan community, the LGBTQ+ community, the homeless population and other marginalised groups. Engagement exercises with these groups included webinars as well as chat forums and an ideas board on the ICS online engagement platform, Let’s Talk Health and Care in South East London, a mechanism to help the ICB broaden their reach.
Alongside this, the ICB developed an Engagement Assurance Committee which is comprised predominantly of members of the public, in order to accurately represent and reflect South East London’s communities.
Looking at elective care, the ICS have been working with the Acute Provider Collaborative to address health inequalities through the equalisation of waiting times across trusts. An elective health inequalities dashboard has also been developed to better understand patient characteristics of the waiting list.
The ICS is continually developing and refining maternity and neonatal pathways to ensure continuity of care for women and birthing people from ethnic minorities, those living in deprived areas and those most vulnerable within the local population.
Mid and South Essex ICS
Mid and South Essex ICS has placed the Public Sector Equality Duty (PSED) at the heart of their long-term aim to create a more inclusive and equitable culture. The PSED is underpinned by three equality aims:
- To eliminate discrimination, harassment, victimisation and any other prohibited conduct.
- To advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it.
- To foster good relations between people who share a relevant protected characteristic and people who do not share it.
One of the ways the ICS will achieve these outcomes is by applying the NHS England ‘Core20PLUS5’ framework, focusing on reducing inequalities by targeting efforts at the most deprived 20 percent of the national population alongside PLUS populations, who can experience the greatest health inequalities. The ICS will also be focusing efforts on specific conditions where there is the opportunity to accelerate prevention work to improve outcomes.
Population PLUS groups will be identified at a local level; the ICS will work with local alliances to regularly review and update the local characteristics which form their priority PLUS groups. They will also work to identify a specific cohort group of approximately 5,000 households experiencing poor health and care outcomes and develop, with the aim of developing a plan to better understand and support their needs.
Equality and diversity features prominently in Mid and South Essex’s ICS strategy, which sets out a “common endeavour of reducing inequalities together. Working together to eliminate avoidable heath and care inequalities by creating a broad and equal partnership of individuals, organisations, and agencies, focusing on prevention, early intervention and providing high-quality, joined-up health and social care services, when and where people need them.”
Leicester, Leicestershire and Rutland ICS
In 2021, LLR released their Equality, Diversity and Inclusion strategy which covers the ICS’s goals and plans for the next five years.
Along with the established protected characterises, the strategy identifies carers, rural communities, armed forces communities, asylum seekers/refugees and deprived/homeless communities as other vulnerable groups it aims to support.
Looking at workforce, the ICS has developed “robust policies and procedures” to ensure all staff are treated fairly and with dignity and respect. The Executive Management team reviews a workforce dashboard on a quarterly basis to measure the workforce composition, including gender, BAME and staff with a disability – with the aim of ensuring that the ICS is enabling equal opportunities for all.
LLR is currently working to address the ‘registration gap’ in the area, wherein there are higher numbers of people not registered with GP practices. Leicester City CCG has recruited two GP Registration Officers as a way of supporting primary care providers to identify unregistered patients within the region, focusing on pre-determined groups such as homeless people, the BAME community, the travelling community and people of different religious beliefs.
The ICS have also established a Citizens Panel which proactively engages with people to “reflect the diverse demographic make-up of society in the LLR area.” It is mainly an online group which provides Better Together partners with an “additional systematic approach to gather insight and feedback on a range of health and care issues from a representative sample of our population.”
Going forward, LLR will continue to review the objectives and development of their strategy based on analysis and evaluation of the insights and business intelligence gathered through partner engagement across local communities.
What does equality look like?
Having dissected three ICS methods of fostering a more diverse and inclusive culture, it is clear that a multifaceted approach is not only important – but absolutely necessary in order to drive systemic change at both a local and strategic level.
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