Equality and Diversity

The Equality Act (2010) is based on the principles of the Human Rights Act 1998 (as amended 2007). The  Act imposes a general equality duty on all 'public authorities' including the Trust to have due regard to the need to:

• Eliminate discrimination, harassment, victimisation, and any other conduct that is prohibited by or under the Act.
• Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it.
• Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

To ‘have due regard’ means that in making decisions and in its other day-to-day activities an organisation must consciously consider the need to do the things set out in the general equality duty. 

The Act identifies three main areas that should be considered in relation to the need to ‘pay due regard’, these include: 

• Removing or minimising disadvantages suffered by people due to their protected characteristics.
• Taking steps to meet the needs of people from protected groups where these are different from the needs of other people.
• Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

Equality and Human Rights Commission, 2021

 

The Equality Act (2010) must be implemented with consideration to the Health and Social Care Act, 2012; the Mental Health Act 1983; the Mental Health Units (Use of Force) Act 2018; and the  Mental Capacity Act 2005(as amended, 2019) are based. 

The Equality Act (2010) outlines the following ‘protected characteristics’:

• Age
• Disability
• Gender reassignment (trans*)
• Marriage and civil partnership (in relation to eliminating unlawful discrimination, harassment, and victimisation in employment)
• Pregnancy and maternity 
• Race
• Religion or belief
• Sex
• Sexual orientation.

*Trans. The Equality Act 2010 says that you must not be discriminated against because you are transsexual, when your gender identity is different from the sex assigned to you when you were born. In the Equality Act it is known as gender reassignment, which is a term of much contention (EHRC,2021, Stonewall, 2022). To ensure the language we use is as inclusive as possible we have chosen to use the term trans rather than gender reassignment in all our communications. 

The Equality Act (2010) Public Sector Equality Duty (PSED) places three specific duties on the Trust these include:

1. Gender Pay Gap. To publish gender, pay gap information on their employees.
2. Equality Information. Publish information to demonstrate their compliance with the general equality duty. 
3. Equality Objectives. Publication of one or more equality objectives which it thinks it should achieve to do any of the things mentioned in the general equality duty.

The Trust is subject to these duties as a service provider and as an employer and information should be reported and published on an annual basis (EHRC,2021).

In line with the Equality Act 2010 (Gender Pay Gap Information Regulations 2017), Greater Manchester Mental Health NHS Foundation Trust publishes an annual gender pay gap report. 

• GMMH Gender Pay Gap Report 2023 (PDF)

As an inclusive employer we aim to develop and implement plans to eliminate pay gaps.  Our intention is to review our Gender Pay Gap Reporting and develop an action plan which includes recommendations on future reporting and monitoring on intersections between disability, gender, race, and sexual orientation by October 2023. 

This will include recommendations published in the NHS equality, diversity, and inclusion improvement plan.

Link to the plan NHS England » NHS equality, diversity, and inclusion improvement plan

•    Previous Gender Pay Gap Reports 
 

NHS England oversees and maintains two national workforce equality data collections to promote equality of career opportunities and fairer treatment in the workplace. These are a requirement for NHS Organisations through the NHS Standard Contract. These collections are the:

Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES)

These frameworks compare staff experience between those who identify as Ethnic Minority and White (WRES) and our Disabled and Non-Disabled staff (WDES). Year on year comparison of a set of equality indicators enables NHS organisations to demonstrate progress in creating cultures of belonging and trust that will improve staff retention, ensure recruitment from the widest possible talent pool, and improve service user outcomes.

At GMMH, we recognise that people may belong to more than one of these groups and that when we make improvements for one group of people, we often see benefits for all. To this end, we have a combined action plan for our Workforce Equality Standards and you can see that, plus all the data relating to the WRES and WDES indicators in this report.

 Workforce Race and Disability Standards Report 2024 (PDF)

Our Advancing Equity and Inclusion Strategy sets out the actions we will take to ensure we are compliant with the general equality duty. Within this strategy we have committed to reduce inequalities in health and employment by using data and intelligence to assess impact, guide activity and monitor performance.

• Improve the quality of our equality data and develop equality data dashboards which will include metrics that will guide activity and monitor performance through the business planning process.
• Work in partnership with the Greater Manchester Integrated Care System (GM – ICS) and identify how we use data and intelligence to advance equality and drive improvement through the application of the NHS Equality Delivery System V3 2022 (EDS 2022).
• Develop systems and processes that will improve the way we use data and intelligence to conduct health equality impact assessments of our polices, our services and our environments.

The immediate action we will take includes: 

• A review of our Board Assurance Framework and ensure performance metrics are disaggregated by ethnicity and indices of multiple deprivation (NHSE, 2022; NHSE, 2023).  December 2023 
• Outline an 'Equality Data Quality Improvement Plan' making year of year improvements with an overall ambition to have 95% accurate data on all protected characteristics across both our services and workforce (NHS Digital 2022, NHSE, 2023). October 2023
• Develop guidance on using the internal clinical audit process to interrogate local Data Quality Maturity Index (DQMI) information related to data quality of protected characteristics and other vulnerable groups and identify actions to improve the accuracy of our data where it falls below 95%.  To focus on accommodation status, disability, ethnicity, gender identity and sexual orientation.  October 2023
• Outline a proposal to develop a set of equality data dashboards for our workforce which is aligned to the NHS National Dashboard, that will help prioritise action and monitor progress through local business plans. (NHSE, 2023) ​​​December 2023
• Development of a set of Mental Health Act data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Draft Mental Health Bill 2022 and monitor and tackle racial inequalities in mental health services and provide stronger safeguards for people with learning disabilities or autism (UK Parliament, 2023). June 2023 
• Development of a set of Restrictive Practice data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the implementation of the Mental Health Units (Use of Force) Act 2018 or ‘Seni’s Law’ that came into force in 2022.  Date TBC.
• Development of a set of Core 20 Plus 5 data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Core20PLUS5 approach to reducing healthcare inequalities. Date TBC.​​​​​​​
• A review of our routine outcomes monitoring data for adults, children, young people and perinatal (including inpatient) mental health services and disaggregated the data by ethnicity to highlight any areas for concern and inform future priorities (CQUIN: 2023/24 guidance). October 2023 ​​​​​​​
• ​​​​​​​Implement the NHS Equality Delivery System 2022 in partnership with the Greater Manchester Integrated Care Board (GM – ICB) and the GMCA Equalities Panels with a focus on CYP Services, and Interpretation Services for 2023/24 (NHSE, 2022 Core 20 Plus 5). February 2024
• A review of our 'Annual Equality Information Report' and structure future reports around the three domains outlined in the Equality Delivery System (2022), focusing on inclusive leadership, tackling physical and mental health inequalities in service delivery, and inequalities in our workforce, ensuring it supports action on tackling health inequalities through the Core 20 Plus 5 approach, Advancing Mental Health Equalities Strategy and the NHS Equality, Diversity, and Inclusion Improvement Plan October 2023
• A review of our Workplace Race Equality (WRES); Workplace Disability Equality (WDES); Our Gender Pay Gap Reporting and develop an action plan which includes recommendations on future reporting and monitoring on intersections between disability, gender, race and sexual orientation (NHS, 2023).  October 2023
• To develop guidance on using the internal clinical audit process to interrogate local data on annual health checks for people accessing our services who experience racial inequalities which are living with severe mental illness and where this fall below 60% identify actions to engage with community partners, experts by experience and experts by profession to increase uptake (Core20PLUS5 (adults) – an approach to reducing healthcare inequalities). March 2024

This report is structured around two of the three domains outlined in the Equality Delivery System (EDS 2022), and focuses on equality information related to inclusive leadership, and workforce diversity, wellbeing and inclusion.  It considers the outcomes identified in the EDS 2022 and draws on our most recent Workforce Disability Equality Standard (WDES), Workforce Race Equality Standard (WRES) and Gender Pay Gap (GPG) data submissions.   This report will form part of our Annual Equality Information 2024 report which will be structured around all three domains outlined in the Equality Delivery System (EDS) and include equality information related mental health services commission and provided by GMMH.

 

In consultation with our staff network groups we have reflected on the data presented, explored a set of recommendations and identified actions that will improve on the differential outcomes identified and monitor and manage equality related performance and risks, taking into consideration the NHS Equality, Diversity, and Inclusion Improvement Plan – Workforce (2023).   In this report we use these abbreviation’s to be consistent with the reporting in the Workplace Race Equality Standard (WRES) reporting. [1]  We acknowledge that ‘language is powerful and can help to shift attitudes and behaviours’ and we are working with our Race Equity Staff Network Group to reflect on this topic further and co-create further guidance.  The table below provides a summary of the recommendations and targets proposed to advance equity and inclusion in our workforce making reference to the table within the main document that contains the associated actions.

Summary of the recommendations and targets

Recommendation	Target	Actions
Inclusive Leadership
Every member of our board and executive team will identify and be accountable for a set of equality objectives which will be aligned to their business plans and monitored through the Equity, Diversity, and Inclusion Committee.  ​This should be supported by a series of Board development sessions on inclusive leadership outlining their roles and responsibilities highlighting key issues to consider.	All business plans to evidence progress against at least one equality objective related to reducing health inequalities, advancing equity in mental health services, and promoting inclusion in the workforce by 2025.	Table 4
Improve the quality of our equality data and align future monitoring and reporting to the national dashboard of key equality, diversity, and inclusion metric[2], including pay gap reporting[3]taking a wider intersectional approach.  This should expand reporting to include at a minimum sex and sexual orientation and should be supported by an awareness raising campaign on how information is stored, its use and the importance of accurate equality information.	An annual decrease the % of unknown data to a maximum of 5% for ethnicity and disability by 2025.	Table 7
Workforce Health and Wellbeing
Create and implement a workforce management plan to improve the diversity of senior leaders in bands 8a + by attracting, retaining* and supporting ** diverse staff groups in bands 5+[4].  This should be supported by guidance and training on inclusive recruitment practices and developing existing members of our workforce into senior roles through a reciprocal mentoring programme.	An annual increase in the % of BME staff in bands 5 and above in both clinical and non-clinical roles until they are reflective of the communities in GM.	Table 21
Eliminate the conditions in which bullying, discrimination, harassment and physical violence at work occur through active bystander interventions.  This should be delivered through our Inclusive Cultures Programme which offers a range of training and development opportunities which aim to create a culture where people feel safe to speak up in confidence or anonymously though our new Speak Up and Get Support form.	An annual increase in the % of staff who feel the organisation responds effectively to incidents of bullying, harassment, discrimination, and abuse by 2025.	Table 27
Consider the Royal College of Nursing’s Cultural Ambassador Programme and co-produce a proposal with our staff network groups on how best to establish and support a capacity-based network of bias observers* who can support recruitment, disciplinary and grievances processes. This should be supported by appropriate training and ongoing support and co-ordination.	An annual increase in the % of BME and Disabled staff who feel the organisation acts fairly in relation to recruitment and disciplinary proceedings.	Table 29
To review the flexible working and wellbeing policies and identify systems and processes that will support managers to understand what adjustments can be put in place to support staff in relation to short- and long-term disabilities, religious observance, caring responsibilities, and people experiencing menopause symptoms supporting work life balance helping them to stay in work.	An annual increase in the % of people who feel there are opportunities for flexible working patterns.	Table 33

 

This report has been the People Delivery Group, the Workforce Development Committee, and the Workforce Partnership Forum for consideration.  It will be presented to the Board through the Equity Diversity and Inclusion Committee in November 2023 for consideration and ratification. 

Workplace Equality Report 2023

1. Reduce inequalities in health and employment by using data and intelligence to assess impact, guide activity and monitor performance.
   1. Improve the quality of our equality data and develop equality data dashboards which will include metrics that will guide activity and monitor performance through the business planning process.
   2. Work in partnership with the Greater Manchester Integrated Care System (GM – ICS) and identify how we use data and intelligence to advance equality and drive improvement through the application of the NHS Equality Delivery System V3 2022 (EDS 2022).
   3. Develop systems and processes that will improve the way we use data and intelligence to conduct health equality impact assessments of our polices, our services and our environments.
       
2. Reduce health inequalities by working with community partners, and experts by experience and profession to co-produce inclusive integrated services that improve outcomes.
   1. Increase access to community mental health services for people who experience inequalities by co-producing inclusive culturally appropriate integrated care pathways through the Mental Health Community Transformation Programme.
   2. Reduce racial inequalities in the use of the Mental Health Act by working with community partners, experts by experience and experts by profession to co-produce culturally appropriate services.
   3. Reduce inequalities in the use of force including physical, chemical restraint, or the isolation of a patient, by integrating knowledge about identity and cultural competence into trauma informed approaches to care.
       
3. Reduce workforce inequalities by working collaboratively to create a culture of conscious inclusion where diversity is valued and nurtured.
   1. Increase the percentage of staff who feel we are compassionate and inclusive by creating cultures of psychological safety where civility and respect is modelled through collective leadership.
   2. Elevate the impact of our staff networks providing them with the support and resources required to support them to contribute to and inform decision making processes demonstrating measurable change.
   3. Increase the percentage of staff from Black Asian and other Minority Ethnic backgrounds in bands 6 and above, in clinical and non-clinical roles, by nurturing a diverse talent pool through the co-production of positive action initiatives across the employee lifecycle.
       
4. Increase people’s sense of belonging by creating inclusive and accessible environments where people feel respected and safe.
   1. Increase the percentage of staff who feel we offer a safe and healthy place to work by implementing initiatives which address unacceptable behaviours such as bullying, harassment, discrimination, hate and violence.
   2.  Increase the number of people who feel able to report unacceptable behaviours by developing effective report and support systems and processes for those who experience or witness them.
   3. Ensure we provide digitally inclusive accessible information by working with people and communities that experience inequalities to co-design systems, processes and resources that improve their experience.

The Health and Social Care Act, 2012 introduced a duty to have due regard to ‘reduce inequalities between people of England with respect to the benefits that they can obtain from the health service’.

The NHS Contract stipulates that providers should have a named executive board-level lead for tackling health inequalities.   The Trusts Director of Human Resources and Deputy Chief Executive is the named executive board-level lead for tackling health inequalities and advancing equality (NHS, 2022).  They are also a member of the Advancing Mental Health Equalities Taskforce and the Patient and Carers Race Equalities Framework (PCREF) Steering Group.

Core20PLUS5 is a national NHS England approach to inform action to reduce healthcare inequalities at both national and system level. The approach defines a target population – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement.

There is an approach adult, and an approach for children and young people.

• Core20PLUS5 (adults) – an approach to reducing healthcare inequalities
• Core20PLUS5 – An approach to reducing health inequalities for children and young people.

We have committed to working with the GM Integrated Care Board and using the Core20PLUS5 approach prioritise the reduction of health inequalities experienced by people who use our services.  Core20PLUS5 is NHS England’s approach to reducing health inequalities at both national and system level.  The approach sets out an approach for adults - Core20PLUS5 (adults) – an approach to reducing healthcare inequalities and another for children and young people - Core20PLUS5 – An approach to reducing health inequalities for children and young people.

 

Core20PLUS5 Health Inequalities Programme

The health Inequalities programme is designed to provide healthcare professionals with a better understanding of the differences in the care that people could receive and the opportunities that they have to lead healthy lives – both of which can contribute to their health status and outcomes.  NHS England have developed an online course containing four sessions that takes approximately 2 hours to complete. Health Inequalities - elearning for healthcare (e-lfh.org.uk)

What immediate actions will we take?

• To develop guidance on using the internal clinical audit process to interrogate local data on annual health checks for people accessing our services who experience racial inequalities which are living with severe mental illness and where this fall below 60% identify actions to engage with community partners, experts by experience and experts by profession to increase uptake (Core20PLUS5 (adults) – an approach to reducing healthcare inequalities). March 2024
• Development of a set of Core 20 Plus 5 data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Core20PLUS5 approach to reducing healthcare inequalities. Date TBC.
• Implement the NHS Equality Delivery System 2022 in partnership with the Greater Manchester Integrated Care Board (GM – ICB) and the GMCA Equalities Panels with a focus on CYP Services, and Interpretation Services for 2023/24 (NHSE, 2022 Core 20 Plus 5). February 2024

Some people might be asking what it means to be an anti-racist organisation. These two short videos from John Amaechi, talk about privilege and the difference between being not racist and anti-racist:

What is white privilege?

Not-racist v anti-racist: what’s the difference