​​​​​​​Equality and health inequalities

On this page we cover a number of areas:

 

What are health inequalities?

Health inequalities are the differences in the health of different parts of the population. We are committed to addressing health inequalities and understand that some groups of people, including people with protected characteristics` experience different access, experience and outcomes when they use NHS services. The impact of this can be inequalities that affect broad groups of patients, families and carers. Being a member of certain groups e.g. those with a physical disability or a mental illness, Black and Minority Ethnic (BME) groups and the homeless also play a part, due to social marginalisation, poor access to services and likelihood of income deprivation.

The causes of health inequalities are complex, and include lifestyle factors, discrimination and also wider determinants such as poverty, housing and education. Health inequalities exist between socioeconomic groups, ethnic groups and between men and women.

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Demographic information of the Vale of York population and how we use data to influence our work

Life expectancy and other measures of health can vary strongly between different geographical areas and York has two areas ranked in the 10% most deprived in England.

Our population:

  • 357,000 registered patients, an expected  3.1% increase by 2025
  • Higher proportion of 15-24 year olds (due to two universities) and those over 50
  • Seven of the 206 (20%) most deprived areas in England are within York: In Selby West, Selby East, Westfield,  Clifton and Guildhall wards
  • 15.8% of the population have a long-term health problem or disability, which is 54,300 people

On 13 February 2019 Dr Victoria Turner (PHE Consultant) who is on secondment with NHS Vale of York CCG gave a talk on our Vale of York population. She talked about its health needs, needs of individual wards and how this impacts upon planning and improving the health of our population. She also supplied data sources and useful tools. This information is used when planning services for the Vale of York.

Population health presentation – understanding our Vale of York population, useful resources

Our annual report 2017-18 also displays information about our population on pages 58-68 about our population.
 

Using data in our planning and shaping of services

Examples of where we have used data in our planning and shaping of services to meet the needs of our population:

North Locality – planning care around vulnerable and frail patients

We are aware that the north of our patch (up to Easingwold, Helmsley and Pickering) has a larger proportion of over 85 year olds than the rest of the Vale of York.

When talking to our population in this area through drop-in sessions, they have told us that rurality and travel is an issue.

As a result we have implemented a North Integrated Care Team, to provide a multidisciplinary team approach and joined-up care for vulnerable and frail patients. We are also about to start a pilot for a Community Consultant Geriatrician, to help review frail, elderly and end of life care patients.

The aim of the project is to:

  • Improve population-based health care outcomes
  • Put service users at the centre
  • To improve quality and equity of health care

More information about the aims of the project can be found in our Primary Care Commissioning Committee papers (page 16-18).

 

Documents which illustrate our use of population data and conversations with our community to inform commissioning.

 

Some examples of our work through forums to improve engagement with those that have the worst health outcomes:

 

Data sources and information on the Vale of York population

Vale of York CCG population health profile:

This document  provides an overview of our health population within the Vale of York.

 

Who is our population?

We have a population of 357,000 people

Age

% of population

Under 5s

4.6

5 to 14

10.2

15-24

14

25-64

51.6

65-84

17

85+

2.6

 

Conditions

% of population

diabetes

5.6

heart disease

3.4

high blood pressure

13.4

cancer

3.1

dementia

0.8

depression

9

asthma

6.1

had a stroke

2.1

long term illness

15.8

 

Others

% of population

obese adults

24.6

obese children (year 6)

15.6

smokers

13.5

binge drinking adults

28.8

long term unemployment

1.3

healthy eating adults

28.2

children growing up in relative poverty

11.2

 

Life expectancy (male)

80 years

Life expectancy (female)

83.6 years

 

York population profiles

North Yorkshire

Data sources

 

 

Our 2017 Public Sector Equality Duty report provides further demographic information for our population, and includes information on health inequalities experienced by protected groups. Please refer here for further information http://www.valeofyorkccg.nhs.uk/data/uploads/governing-body-papers/5-january-2017/item-11-annex-a-psed-report-2016-17.pdf.

Promoting equality is not about taking away from one group to give to another. In the context of health, it’s about ensuring that access to good quality and appropriate services are available to all groups in our population, not just a privileged few.

The University of York is working with the NHS to develop how to measure health inequality and how this can be supported by the indices of deprivation.

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Aligning engagement and equality

Promoting equality and effective community engagement should complement each other. Systematic community engagement is an essential element of partnership working to promote equality. The engagement and involvement of patients, carers, partners and other stakeholders, including local people is intrinsic to the commissioning and procurement of services

We are therefore, committed to being proactive about seeking the views of all groups in our community; this in turn will help demonstrate we are promoting equality.  

We are committed to working in partnership with both our local communities and statutory providers and partners to ensure that different groups should not experience barriers to accessing services or, have less opportunity to live a longer healthier life due to factors beyond their control, specifically the nine protected characteristics.

We have created a range of engagement and involvement opportunities to gather the views of patients, service users and other stakeholders. This information is rich in personal experience and helps us to shape commissioning decisions, service specifications and improvement programmes.

Patients, carers and members of the public are represented through a number of channels including:

Our equality strategy

Underpinned by our vision, mission and values our Equality Strategy supports our guarantee to promote equality throughout the planning and development of service commissioning whilst respecting the diversity of our local community and staff.

We remain committed to addressing the health inequalities and understand that some groups of people, including people with protected characteristics experience different access and outcomes when they use NHS services.

We try to take a holistic approach to reducing health inequalities by:

  • considering the impact on health inequalities in every decision we make and every policy we deliver;
  • allocating our resources to where they are needed most;
  • working in an integrated way for individuals and communities who suffer poorer health outcomes;
  • working with individuals/communities to develop community based solutions to improving the health and wellbeing of our population.

    More information can be found in our Equality, Diversity and Human Rights Strategy (pgs 235 – 244).

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    Ensuring equality and reducing health inequalities through our decision making

    We want to be sure that the decisions we take make a real, positive difference to our population.

    As a CCG we should be able to demonstrate how we have tried to ensure:

    • Participation activity reaches diverse communities and groups with distinct health needs and those who experience difficulties accessing health services, including inclusion health groups.
    • People who have characteristics that are protected under the Equality Act 2010 are involved.

    Carrying out an equality and health inequality analysis can help identify people who experience the greatest health needs, those who face barriers to accessing services and to participation, and those groups of people with protected characteristics under the Equality Act 2010 who may be affected by a particular plan, proposal or decision. (NHSE 2017)

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    Equality Impact Analysis (EIA)

    An Equality Impact Assessment is undertaken on major strategies, policies and changes to services to ensure that they do not have a differential impact on any community group.

    In order to help support our staff to consider the equality impacts across protected characteristics, we have a matrix of questions that they can use as a tool. We also encourage our staff to complete a  quality and equality impact assessment (QEIA).

    We measure the equality impact of our decisions to carefully consider how they affect the local population. To view EIAs on our policies click here. To view EIAs on our Governing Body papers, please click here.

    We also carry out Equality Impact Assessments as part of our Quality Impact Assessment when reviewing strategies, services, projects and policies.

    Here are a few examples of some of our latest EIAs:

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    Health inequalities toolkit and training for our staff

    We have designed a toolkit to help leading on engagement to define their involvement activities and scope the activities required for each commissioning intention. This process includes tools such as a stakeholder mapping process, guidance for equality impact assessments and a template to address if the legal duty needs to be applied.

    Click here to see the full engagement toolkit

      We provide regular updates to our staff and have invited in external facilitators to hold a session in 2017 and in November 2018.

      The aim of the session was to increase understanding and knowledge of the connection between equality  engagement and health inequalities duties within the NHS. 

      Objectives: 

      • To raise awareness of the Equality, Engagement and Health Inequalities duties
      • To increase awareness and understanding of equality and health inequality data and how this informs an effective Equality Impact Analysis 
      • To increase understanding of the connections between engagement and equality and how engagement activity can help to fill data gaps 
      • To apply learning to role 

      Resources:

      For more infromation about how we ensure equality runs through our decision making, visit our dedicated equality and diversity page

       

      Quality and equality impact assessment (QEIA) toolkit

      NHS Vale of York CCG uses a quality and equality impact assessment (QEIA) tool assess and measure the potential impact of proposed service changes or reviews.

      The QEIA enables our staff to follow a simple process to carry out a quality and equality impact assessment. 

      The tool covers five key areas.

      • Safety – Rating the impact of the proposal on patient safety
      • Effectiveness – Rating the impact of the proposal on the clinical effectiveness of patient care
      • Experience – Rating the impact of the proposal on the patient experience of care delivery
      • Other impacts – Rating the impact of the proposal on other services, patient groups, staff or reputation of the organisation. This includes consideration of if the legal duty to involve patients and the public applies.
      • Equality and diversity – Rating the impact on those in a specific group as outlined in the Equality Act 2010 and also including other hard to reach groups.

      The CCG also uses the tool to consider the benefits of, and identify if there is a need for patient and public participation in their commissioning activity and if required help them plan for a level of participation which is ‘fair and proportionate’ to the circumstances.

      If it is agreed that public and patient involvement is required, it triggers the need for a patient and public involvement form to be completed.

      NHS Vale of York CCG uses a quality and equality impact assessment (QEIA) tool assess and measure the potential impact of proposed service changes or reviews.
       

      Toolkit:

      We provide our staff with a suite of forms to help them in their decision making.