Corporate report

Equality in 2018: how DHSC complied with the Public Sector Equality Duty

Published 21 March 2019

1. Introduction

The Department of Health and Social Care (DHSC) helps people to live more independent, healthier lives for longer. We lead, shape and fund health and care in England, making sure people have the support, care and treatment they need, with the compassion, respect and dignity they deserve. As guardians of the health and care system, it is our job to ensure that the system delivers the best possible health and care outcomes for the people of England.

The Public Sector Equality Duty (PSED) in section 149 of the Equality Act 2010 is a key lever for ensuring that public bodies, like DHSC, take account of equality when shaping policy and delivering services. Policy makers and decision makers, including Ministers, must have due regard to the following three equality aims in the duty when developing or changing any policies or services that impact people:

• eliminate discrimination, harassment and victimisation and any other conduct that is prohibited by or under the Act
• advance equality of opportunity between people who share a relevant protected characteristic and people who do not share it
• foster good relations between people who share a relevant protected characteristic and those who do not share it

Documentation detailing how decisions have been reached is required to demonstrate compliance under the duty, including a record of how a policy was considered under the specific matters set out in section 149 of the Act.

Advancing equality of opportunity involves considering how our decisions can remove or minimise disadvantages suffered by people due to their protected characteristics; take steps to meet the needs of people who share a particular protected characteristic, where those needs are different from the needs of those who do not share that protected characteristic; and encourage people with particular protected characteristics to participate in public life or in other activities where their participation is disproportionately low.

The protected characteristics covered by the Equality Act are:

• age
• disability
• gender reassignment
• pregnancy and maternity status
• race
• religion or belief (including lack of belief)
• sex
• sexual orientation
• marriage and civil partnership status (only in respect of eliminating unlawful discrimination).

The equality duty aims to embed consideration of equality into the day-to-day business of public authorities. It requires organisations to consider how they could positively contribute to the advancement of equality in the design of policies and the delivery of services. This makes good business sense as organisations that can meet the diverse needs of its users and employees are likely to achieve their objectives more efficiently. Decisions taken without considering their impact on different groups are unlikely to have the intended effect and lead to greater inequality and poor outcomes. Proper consideration of equality issues on the other hand, are more likely to result in increased user satisfaction with services that are also more efficient and cost-effective.

The Equality Act (Specific Duties) Regulations 2011 imposed further duties on certain public bodies to help them to meet the duty more effectively. The specific duties in England commenced in September 2011 and require relevant public bodies to publish information to demonstrate their compliance with the Public Sector Equality Duty at least annually from January 2012, and to set and publish equality objectives at least every four years from April 2012.

This publication provides information on the delivery of equality objectives published in 2015. It explains how DHSC has complied to the Public Sector Equality Duty in delivering its services and functions in 2018-2019. Equality information about the Department’s workforce is published in a separate report which can be found on the equality and diversity pages of our website.

2. Equality objectives 2015 to 2018

To support the aims of the equality duty, objectives should address the key equality challenges facing a public authority. The department, therefore, set itself a comprehensive set of objectives in 2015. It is critical to our success that advancing equality of opportunity and eliminating discrimination are central to the Department’s work to ensure equitable policy making and improved health outcomes.

2.1 Objective 1: DHSC will ensure that the Public Sector Equality Duty is embedded in directorate business plans and reflected in our corporate priorities and is an integral part of any priority setting for our organisation.

The Public Sector Equality Duty is a key priority for the Department and is reflected in Directorate objectives. The department has a Public Sector Equality Duty Functional Plan which sets out our commitment for overseeing an effective and efficient framework to build capability across the department, identify and improve equality information that the Department holds and ensure the department complies with the duty. This is achieved by:

• building the Public Sector Equality Duty into the department’s policy making through embedding it into relevant corporate and policy documents. Key policy documents accessible to all staff, link to the guidance and materials to support staff to consider implications throughout the policy cycle

• continuing to build and develop our relationships with stakeholders, including internal staff and external groups such as the Equality and Human Rights Commission

• running capability building sessions throughout the year – these sessions continue to run on a quarterly basis and staff are encouraged to seek guidance from the Protected Characteristics Deputy Director network group, lawyers or Governance and Accountability team

2.2 Objective 2: We will continue to build and develop our relationships with stakeholders and the public, including those that represent groups with protected characteristics, to improve our functions and services.

The department has a range of stakeholders that it continues to develop its relationship with. Internally, there are Deputy Director leads for each of the protected characteristics. The network meets monthly and their purpose is to promote good practice and give visibility to equality issues, help develop departmental approaches to governance and assurance and, where necessary, act as coordinators for cross departmental work.

The Governance and Accountability Team have an assurance and oversight role so continuously build relationships with staff by offering advice to individuals/teams and by delivering training. The team also work with other government departments by sharing information for cross government work and learning from their processes.

The Department has worked closely with the Government Equalities Office on the response to the National lesbian, gay, bisexual, and transgender (LGBT) survey. This includes creating the first ever National Adviser to lead improvements to LGBT healthcare. The Adviser will be hosted by NHS England and will advise on how health and care services can better meet the needs of LGBT people.

We know that LGBT people are more likely to engage in various risky behaviours, such as smoking. As part of a Section 64 grant to support delivery of the department’s Tobacco Control Plan, DHSC have commissioned Action on Smoking and Health to work with the LGBT Foundation to support more LGBT smokers to quit.

NHS England is about to appoint three LGBT advisors and DHSC will work with them and stakeholders such as Stonewall to ensure their work targets the areas of most need.

The department continues to develop its relationships with A:gender and Stonewall and other groups to ensure policy and briefing on gender identify and transgender issues is well-informed.

2.3 Objective 3: We will ensure that it is clear, throughout the policy development process, how we have paid due regard to the Public Sector Equality Duty.

Following the launch of the Ethnicity Facts and Figures website in October 2017 the department has continued to work closely with Cabinet Office, our arm’s length bodies (ALB) Partners and stakeholders for instance:

• The department and many of its ALBs have signed up to the new Race at Work Charter which commits businesses to a bold set of principles and actions designed to drive forward a step-change in the recruitment and progression of ethnic minority employees.

We have confirmed our support for an overarching ambition to increase the representation of ethnic minorities in the public sector workforce, particularly at senior levels. NHS England have an ambition for the NHS to reach leadership equality by 2028. This ambition is stretching but achievable, and would mean that the proportion of Very Senior Leaders in NHS Trusts and CCGs from a Black, Asian and Minority Ethnic (BAME) background will fully reflect the proportion of BAME staff in the NHS overall.

Every submission to Ministers is accompanied by a checklist that requires policy officials to demonstrate they ha e considered the Public Sector Equality Duty. During 2018, we reviewed our assurance processes and made enhancements to provide oversight on compliance. The department has implemented a second line assurance process that will review and assess the quality of Public Sector Equality Duty consideration in Ministerial submissions and provide feedback to policy teams on their assessments.

Staff are encouraged to complete Equality Impact Assessments using the template on the intranet and GOV.UK to ensure they are thinking about the impacts on people with protected characteristics and using evidence to justify their policy decisions.

The Governance and Accountability Team provide one on one advice to policy officials when needed to help guide them through what is required and expected of them to pay due regard to the Duty.

There has been a big push in the department to upskill staff so they are equipped to confidently comply with the Public Sector Equality Duty. New guidance and materials have been published on the intranet, quarterly training sessions are provided in all sites and further opportunities are being explored for more frequent informal drop in sessions.

An example of where we have paid due regard to the Duty is where Black and Asian people are more at risk of illnesses that require an organ transplant, such as high blood pressure and diabetes. However, the organ donation consent rate from families in these communities is only 35% compared to 66% in the white population, and people from black and Asian backgrounds are waiting on average 6 months longer than a white patient.

There is a sustained engagement campaign at grassroots level to embed behaviour change. NHSBT, which has a statutory responsibility to promote organ donation, and expertise in developing social marketing in organ donation, has planned the campaign.

The campaign is based around establishing a framework of local volunteers, peer educators and outreach work for a range of communities with some media amplification. This reflects that the BME community is made up of a number of different population groups, different religious and cultural aspects influence decisions around organ donation.

Another example follows the Prime Minister’s announcement to move consent for organ donation to an opt out basis, where Public Sector Equalities Duty analysis identified the changes would have an impact on some protected characteristics, including race and religion. Following consultations and a multi-faith event chaired by Jackie Doyle Price, the department developed a new option on the Organ Donor Register to allow users to highlight their faith and the donation should be discussed with their family first. Nurses specialising in organ donation will receive updated training to discuss faith issues with the family. NHS Blood and Transplant also developed faith-specific organ donor cards in partnership with faith organisations to help them promote organ donation in their communities. The department is continuing its engagement with faith groups by working with Human Tissue Authority to set up a faith roundtable that will allow religious groups to give their input on the guidance given to medical professionals.

The department introduced a remedial order in December 2018 to address an inequality identified in the Human Fertilisation and Embryology Act 2008. The order changed the primary legislation to provide for a sole applicant (in addition to couples) to apply for a parental order, in order to transfer legal parenthood after a surrogacy arrangement.

2.4 Objective 4: As stewards of the health and social care system, we will build on our strengths in knowledge and intelligence by improving the information we hold and collect. We will reflect back this intelligence to our partners, in order to improve the health and well-being of the whole population.

We use our knowledge and intelligence to support our stakeholders by sharing information, some examples include:

• we provided briefing on a number of policy issues based on the Elimination of All Forms of Discrimination Against Women for Government Equalities Information.
• we welcomed Is Britain Fairer? 2018 report and are taking forward the recommendations
• we contributed to the Equality and Human Rights Commission’s publication on access to healthcare for people seeking asylum

2.5 Objective 5: We will seek to improve accessibility and ease of understanding of any information and policies we produce. We will seek to improve the accessibility of the information that we provide to the public and stakeholders.

On our intranet, GOV.UK and other external platforms, the digital communications team makes sure that information is expressed in clear and easy-to-understand language.

The digital communications team ensure that all platforms meet or exceed accessibility requirements to make sure that people who use assistive technology can access the content.

The team are also doing pioneering work on improving consultations to make them easier to understand and engage with.

The department publishes guidance on complex areas of law that are designed to improves accessibility and understanding. An example of this is the guidance on The Surrogacy Pathway for parents and surrogates in England and Wales.

2.6 Objective 6: We will improve our internal business processes so that equality and diversity is an integral part of everything we do. Our drive to increase value, efficiency and productivity will always consider the needs of people with protected characteristics, internally in DHSC and in our externally facing functions.

We launched our revised DHSC Diversity and Inclusion strategy in 2017. This sets how we will achieve our vision to be a diverse and inclusive place to work where everyone can achieve their potential. The five themes of our strategy are:

• culture – creating an inclusive culture where difference is valued, the power of diversity is harnessed and everyone has equal opportunity to achieve their potential
• capability – to build diversity capability and confidence across our workforce to ensure DHSC is a trusted, diverse organisation for which people are proud to work and leaders are inclusive by instinct
• data and insight – we encourage everyone to provide diversity information to support more evidence based solutions to our diversity
• talent – we identify and act to remove barriers to progress to ensure everyone has equal opportunity to fulfil their potential
• social mobility – we take action to support improved diversity and social mobility in our workforce

The Diversity and Inclusion strategy has been communicated and promoted within the department. This was celebrated in December 2018 through a Diversity Day organised by the staff networks. This day event comprised of a variety of events and a marketplace to promote the range of staff networks available in the department. Over 180 people attended one or more event during the day.

We are transforming the way we recruit people. We have implemented a new careers website, and have integrated the new Civil Service Success Profiles into our recruitment approach – evidence from the pilot phase of the Success Profiles programme suggests that they increase diversity right across the recruitment cycle. We completed a deep dive into both our recruitment data, and our recruitment processes, which identified areas that we can improve, including the introduction of diverse interview panels which we are trialling from Spring 2019. Improving the diversity of our workforce is a central factor in all of our resourcing plans.

In addition to standard recruitment, we also offer several other recruitment initiatives which provide opportunities for people who may not normally consider the Civil Service as a viable career option. We had 33 apprentices start in 2018, as well as 3 care leavers and 10 summer diversity internships. These schemes provide excellent experience and allow participants to develop valuable skills, no matter their background.

2.7 Objective 7: We will ensure we have a motivated, diverse and engaged workforce who live our behaviours of respect for each other and experience equality in the workplace regardless of their positioning in the organisation

We have made good progress against the Diversity and Inclusion strategy since it was launched, with focus on creating an inclusive culture. Inclusion is central to our new values and behaviours, launched in 2017 which underpin all our expectations of each other at work.

We have in place robust diversity and inclusivity governance structures to ensure the department is making progress in all areas. The DHSC Diversity and Inclusion Champion is a Director General, supported by a further 7 senior Champions, 5 of which sit on the Executive Committee. Champions cover Race; Disability; LGBT; Faith and Belief; Age; Trans and Gender Identity; Social Mobility; and Parents, Carers and Flexible Working. Senior Champions work closely with staff networks to raise the profile of diversity and inclusion in the department.

DHSC has 15 diversity related staff networks, 5 of which are related to grade and 10 related to various protected characteristics. Staff networks are active in organising events, writing blogs and raising awareness in the department. For example, in 2018 the Muslim Network ran a session focussing on fasting, Hajj and other aspects of pilgrimage to celebrate the end of Ramadan.

The department participates in targeted Cross Civil Service positive action schemes to help strengthen talent pipelines, the main one being the Positive Action Pathway. The department supported 22 employees, ranging from AO/EO to G6/7 to take part in the 2018 PAP schemes. This scheme was open to women, BME, LGBT and individuals who have a disability.

Our talent team also supports high potential G6/7 employees and Deputy Director’s through Civil Service talent schemes with a good diversity spread for applicants and successful candidates from the department building year on year – some participants from our cohorts are further supported through META and DELTA schemes. The META development scheme is specifically for high potential leaders from a BAME background. The recently launched DELTA scheme will offer a similar development opportunity for leaders declaring a disability. Our DHSC talent team also provided 11 places in 2018/19 on the Leadership Summit (a gender focussed) external talent scheme.

Providing management and leadership training is integral to building an inclusive culture. Our Leading and Managing with Confidence programme was rolled out to 406 grade 6 and 7 employees last year and this included a one-day comprehensive workshop on inclusive leadership. Also last year, a pilot of 53 HEO/SEO’s also experienced this element as part of the Stepping into Management programme.

The department uses a range of measures to track progress, including trends in staff survey (our People Survey) data. Our Engagement Index Score continues to increase (63% in 2018, an increase of 18 points since 2016) and 72% of respondents agreed that “Equality, Diversity and Inclusion are actively practised in the department”, an increase of 3 points from 2017.

We successfully launched and ran a Reverse Mentoring scheme in 2018, led by the DHSC Diversity and Inclusion champion and the Equality Matters (BAME) staff network. The first cohort had 16 participants in 2018 and the larger second cohort is due to begin in Spring 2019. This scheme enabled mentors to discuss their race and/or background and experiences directly with our most senior leaders.

In 2018 the department was named as one of the Business in the Community’s best Employer for Race. The Race network, Equality Matters, organises events during the year, including events during Black History Month 2018. In 2018 events included an event with ‘B Positive Choir’ focused on blood and organ donation from the BME community, and this resulted in 90 new donors registered on the day.

We have internal support available to employees, through staff networks, 26 Diversity Allies and 10 Speak Out Advisors.

3. Requesting further information

If you would like to find out more about how the department met its equality duty in respect of a policy or decision, you can make a request under the Freedom of Information Act 2000 by using the online form or by addressing your correspondence to:

Ministerial Correspondence and Public Enquiries
Department of Health and Social Care
39 Victoria Street
London
SW1H 0EU