Our healthier south east London (OHSEL) is a far-reaching programme which promises to transform health and care for more than a million people, across a complex, varied, innovative and dynamic health economy.
The programme is led by a consortium of commissioners, with strong clinical leadership and partnerships across six boroughs.
Characterised by some NHS providers facing real challenges, alongside ‘world class’ academic links and a strong community spirit, south east London also experiences real health inequalities – and is home to some of the most diverse communities in the UK.
Equalities impacts are sometimes considered late in the process when health service change programmes are developed, or as an ‘add-on’ to other engagement work.
But for OHSEL, it was essential that equalities should be ‘built-in’ to the design of the programme from the start – with the ambition not only to meet, but to exceed, the Public Sector Equality Duty (PSED).
Verve had previously undertaken an Equalities Impact Analysis in the planning phase for the programme, and were invited back to stocktake on progress, challenges and next steps.
We designed a process which brought together equalities assessment of emerging plans, as well as insights developed through testing these with external expert stakeholders, and our own experience working at community level to support large change programmes.
This included an exhaustive audit of plans for individual service areas, which enabled us both to propose principles for service design and also for future engagement to ensure that the programme meets – and continues to meet – the equality duty.
Working with specialists and lead officers across the partnership, our recommendations built on existing work and local insight – and we did not ‘reinvent the wheel’.
It was also essential that the ‘provider side’ view was also balanced with external perspectives. The Equalities Steering Group was enormously helpful to ensure that the views of patients and representative groups were able to set the agenda for the assessment, and provided a clear link to the programme governance.
And through Verve’s strong network of expert advisers we were able to offer best practice and lessons from elsewhere to make the exercise as practical as well as comprehensive.
Our report provided a clear summary of the PSED, and documented whether – and how – it could be met going forward.
An in-depth listening and structured analysis process, coupled with Verve’s specialist expertise, enabled practical recommendations in 14 areas across the programme.
We mapped of communities and groups sharing ‘protected characteristics’ by geography and service, and this information, together with Verve’s expertise in engaging seldom heard groups enabled us to advise on effective engagement and mechanisms for representation.
As with any equalities assessment, it is essential that insight and involvement can also inform and shape decisions, so we also made recommendations based on experience of NHS change programmes to enable responsive and effective governance processes.
Above all, we were able to work with the programme team to think through the requirements of the PSED, and assure and inform the programme for the future.
The Director of Communications and Engagement for the programme, Rory Hegarty, said:
"For a programme considering ambitious changes to the NHS in SE London, equalities is a critical consideration. We resolved to look at equalities prior to any options or far-reaching proposals being developed, so that we were able to take equalities considerations into account in considering options for change. We did this both because we wanted to meet and exceed our obligations under the Equality Act 2010 and because we believe it is the correct thing for the NHS to do.
"From the outset, Verve showed a very clear understanding of the challenges involved in carrying out an equalities assessment before any actual proposals or options for change have been developed. In our early meetings, they sought clarity over what materials and principles they could use to guide their work, so that the task did not become so unwieldy as to be undeliverable. They met on two occasions with the programme’s Equalities Steering Group and were very receptive to its advice, whilst having the expertise to provide their own guidance as to how to approach the task and what the challenges would be.
"The timescale was shorter than we would have liked, but Verve got to grips with the job quickly and with impressive drive. Their expertise in communications was of course an enormous advantage, as good communication is central to successful equalities work. As public service specialists, Verve were able to see different perspectives and quickly understand the complex nature of health services and service-users.
"They offered an excellent approach based on local knowledge, qualitative research and subject matter expertise, which was exactly what was needed. They were able to build and draw on relationships across our patch and produced a report which offered sensible, proportionate recommendations, considerable encouragement and some creative ideas for how we might develop this work across SE London in future.
"We are delighted with the work, which was exactly what was needed by the programme to ensure that equalities considerations remain central to our thinking as we move towards options development."