The need to save money, as well as to improve the quality of care, has brought a new focus on cohorts of people who typically have long-term conditions, a mix of health, social and lifestyle challenges, and can be difficult to engage as patients.
It is true that equalities impact and the Public Sector Equality Duty have rarely been scrutinised as closely as other elements of NHS change programmes.
However, things are changing fast. The new driver is the financial challenge facing local public services, coupled with the imperative to work more closely with partners, particularly from local government.
A good example is frail older people. They “are likely to have multiple co-morbidities, polypharmacy, sensory and cognitive impairment – all of which are associated with an increased incidence of healthcare-associated harm” (Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts, Tadd, Hillman, Calnan).
Just think of the potential if you could streamline this pathway.
The King’s Fund report, The care of frail older people with complex needs: Time for a revolution, provides some figures.
Then there are younger patients, homeless people and groups more likely to fail to attend appointments, or to use urgent care inappropriately.
Other examples include people with disabilities, those facing exclusion for cultural or other reasons, and people less able to access services because of lifestyle, health or other challenges.
What do these groups have in common? They overlap enormously with people sharing protected characteristics under the terms of the 2010 Equality Act.
And they are of interest to those designing services because shaping services around their needs promises to:
- Keep them healthier and independent for longer and so transform their lives
- Keep them out of hospital and so save money
- Engage them better and make it easier for them to attend appointments and keep to treatment regimens and so waste less NHS staff time.
On this last point – perhaps the most important – remember that failure to engage or comply is rarely about quality of services. It is usually about the associated care. And for that read “how well my experience of this service – or access to it – was shaped around my needs”.
So if you are still reading, I assume you agree that getting equalities right should not just be a tick-box process. It should be at the heart of service design.
It should also be a rigorous and challenging process. It is not easy, and depends heavily on high-quality listening, two-way dialogue, and a focus on solutions.
Here are five tips based on our experience:
- Use robust and rigorous research methodologies – particularly make efforts to hear from people who are not ‘the usual suspects’
- Integrate properly with your decision-making and governance structures, ensuring there are solid processes through which you can use the insight gained to inform and, most importantly, to challenge decisions and plans
- Ask service users about their priorities before you develop plans – what you learn might surprise you and give pointers to low-cost improvement
- Use the exercise as an opportunity to build relationships for the longer-term
- Work with partners to get ‘beneath the radar’ – intermediaries may be the only way to reach some communities and groups.
And if you would like to discuss how we might support your programme to do this well, we would be delighted to see if we can help!