Equality, diversity and health inequalities

The Equality Act of 2010

The Equality Act of 2010 was introduced to create a fairer society by protecting people from being discriminated against in all aspects of their daily lives due to their ‘protected characteristics’. These are defined as their:

age
gender reassignment
being married or in a civil partnership
being pregnant or on maternity leave
disability
race including colour, nationality, ethnic or national origin
religion or belief
sex
sexual orientation.

The Act protects everyone in Britain because we all have ‘protected characteristics’, and extends to protect people who could experience discrimination because of their close link to a person with a protected characteristic, for example, a friend or family carer of an adult with a disability.

The Public Sector Equality Duty – creating a fairer society

To support the aims of the Equality Act, our ICB has legal responsibilities under the Public Sector Equality Duty to promote equality in every aspect of our day-to-day business. We do this by having ‘due regard’ to the three equality aims of the Public Sector Equality Duty, which are:

to put an end to unlawful behaviour that is banned by the Equality Act 2010, including discrimination, harassment and victimisation
to advance equal opportunities between people who have protected characteristics and people who do not
to foster good relations between people who have a protected characteristic and people who do not (although this doesn’t apply to the marriage and civil partnerships characteristic).

We work closely with local people, patients, providers of NHS services, staff and voluntary organisations to help further equality and eliminate discrimination within our services and working environments through:

the decisions we make
the internal and external policies we agree
the way we procure goods and services
the services we provide to the public
the way we recruit, promote and performance manage our employees.

Understanding the needs of our population

Population health information

To ensure that we understand the needs of our population, including their protected characteristics and the challenges they face to living healthy lives, the ICB uses data to enable us to plan services which deliver the best impact on health outcomes and inequalities. This is called a ‘population health management’ approach. We make this information freely available through the population health management section of our website. This helps to further the understanding of everyone working to improve the health and wellbeing of identified groups or communities in our area, including targeted work to reduce inequalities.

As well as giving a general overview of the health of our entire population, information is also provided about geographically smaller groups of residents, including by GP practice, as well as being broken down in some cases by protected characteristic, or health needs.

To help GP practices in Hertfordshire and west Essex to use this information to take positive and proactive action to improve health and wellbeing, our teams provide packs of data and analysis through our website to primary care networks, together with practical advice for practice staff on how to identify patients most at risk using clinical systems, and offer them treatment and advice.

Joint Strategic Needs Assessments

Another way in which we understand the needs of patients across both Hertfordshire and Essex is through the Hertfordshire Joint Strategic Needs Assessment and the Essex Joint Strategic Needs Assessment. These assessments of health needs are designed to help inform the work of Health and Wellbeing Boards, which are responsible for the development of joint local health and wellbeing strategies.

Our area’s Joint Strategic Needs Assessments (JSNAs) break down their findings by protected characteristic, to help inform policy makers and commissioners or services so that decisions can be taken which reduce health inequalities.

Case study – improving the health monitoring of people with learning disabilities

The 2023 ‘Ageing Well’ JSNA for Hertfordshire identified that in the county, the average life expectancy for people with learning disabilities was just 57.5 years, compared with an average of 82.5 years for the general population, with the leading cause of early death being disorders of the respiratory system.

The ICB has responded to this identified inequality by prioritising the take up of annual health checks for people with learning disabilities in our area, encouraging GP practices to boost take-up from 72% in 2021-22 to 81.7% in 2023-24. This exceeds the national 75% target and is helping with the early identification of issues which affect the health, wellbeing and quality of life of our residents with learning disabilities.

Listening to and learning from residents

As well as using data to inform our work, the ICB seeks out the views and experiences of our residents in a number of ways to promote health equality and reduce discrimination.

Our ICB’s guide and approach to working in partnership with people and communities follows the 10 best practice principles set out by NHS England. This document contains case study examples of good practice against each principle. The principles are embedded in the ICB’s constitution and are used when developing and maintaining arrangements for engaging and communicating with communities. We publish an annual Patient engagement report which summarises the patient engagement work we have undertaken each year.

As outlined in the report, the ICB works very closely with Healthwatch Hertfordshire and Healthwatch Essex and we commission them to undertake focused engagement with groups of residents, including those with protected characteristics, to ensure that we are listening to and learning from the experiences of our residents.

Over the past two years, the ICB’s Primary Care directorate has commissioned a number of reports from Healthwatch partners in order to obtain feedback which was used to support and inform the Primary Care Strategic Delivery Plan, which was approved by the ICB Board at the end of July 2023. One of the key objectives within the Strategic Delivery Plan is the importance of primary care’s role in preventing ill health and tackling health inequalities in partnership with health and care partners, as well as the Voluntary, Community, Faith and Social Enterprise (VCFSE) sector.

Examples of reports that have been commissioned from Healthwatch include:

GP access – including access for children and young people
experiences of community pharmacy
support for carers
heart health
Chronic Obstructive Pulmonary Disease and other respiratory and lung conditions
neurodiversity and accessing health
understanding how adults with a learning disability are supported by GP services
menopause
diabetes
cervical screening.

You can find these reports on the Healthwatch Essex website and Healthwatch Hertfordshire website.

Recommendations from completed reports are reviewed and a response to these is taken to the ICB’s Primary Care Transformation Committee meetings in public. Report recommendations taken to these committee meetings are published on the ICB website as part of the meeting papers for the Primary Care Transformation Committee.

A further source of information from which the ICB can learn more from residents with protected characteristics is through our annual report of complaints. The publication of a Complaints Annual Report is a legal requirement for ICBs. While recent reports do not segregate findings by protected characteristics, the ICB is actively working toward this.

Equality Impact Assessments

An Equality Impact Assessment (EIA) is a tool that helps us to place equality, diversity, cohesion and integration at the heart of the ICB’s decision making. Carrying out an EIA involves assessing the likely or actual positive or negative effects of proposed policies on those with protected characteristics, and removing or mitigating negative impacts. For example, a 2023 EIA on a proposed new integrated diabetes service considered the advantages of the service for pregnant women and those with diabetes.

We do not currently routinely publish all equality impact assessments, although they are available on request. Our process for assessing equality impacts is also available on request. The ICB’s Governance Handbook makes clear the importance of assessing equality impact and the roles of our committees and governance in this.

The ICB’s equality objective – for our residents

Our ICB is a key member organisation of the Integrated Care Partnership in Hertfordshire and west Essex, and we are closely aligned with the strategies and plans which guide work in our area, including:

the Integrated Care Partnership strategy, which guides the work of all the public sector and voluntary, community, faith and social enterprise organisations which have a role to play in improving health and wellbeing. The strategy has six priorities which reflect the widely acknowledged health needs of people with protected characteristics
the Health and Wellbeing Board strategies for Hertfordshire and Essex, which are informed by the Joint Strategic Needs Assessments for those counties
our own Joint Forward Plan, a plan for the local NHS system for the next five years, which aims to reduce health inequalities across our population and across all services and settings, by narrowing the avoidable and unfair differences in health between different groups in society. The ICB has published a Joint Forward Plan: Delivery Plan with measurable outcomes and progress indicators to accompany the Joint Forward Plan. This delivery plan will be updated on a yearly basis
targeted health and care strategies, such as our:

Please see these strategies for more information about the ways in which people and communities with protected characteristics have helped to shape their aims and objectives.

Through our medium term plan our ICB has established five short-term priorities which are aligned with these system strategies and plans. These are:

Reducing inequality, with a focus on cardiovascular disease and hypertension (high blood pressure).
Reducing waiting times for children’s services.
Reducing the demand for urgent and emergency care by delivering more anticipatory and same day care.
Providing better care to people in mental health crises.
Continuing to reduce waiting times for non-emergency/urgent surgery and diagnostic tests.

The first of these medium term plan priorities – ‘reducing inequality, with a focus on cardiovascular disease and hypertension’ – is our ICB’s equality objective for our population. This is because, if they are not diagnosed, these conditions can increase the risk of many serious health conditions, including heart disease, stroke and kidney failure.

We will measure our success at delivering this objective against the following metrics, which you can find in our Joint Forward Plan: Delivery Plan. We will know if we have made a difference if by March 2026 we have:

increased the hypertension diagnosis rate for patients in our GP practices by hypertension by 2% by March 2026 (QOF prevalence)
increased the percentage of patients with GP recorded hypertension in whom the last blood pressure reading was within target range to 77%
increased the age standardised prevalence of diagnosed hypertension in the most deprived 20% of the ICB population from 17.6% to 19% by March 2026
more than 90% utilisation of our locally and nationally commissioned weight management services for children and adults.

Case study – identifying high blood pressure

The population health management data pack provided by the ICB for a Welwyn Garden City-based group of GP practices identified that local residents are more likely than the ICB average to have undiagnosed hypertension (high blood pressure) which can cause significant and life-changing illness. The pack shows that people with the following protected characteristics are more likely to be at risk from hypertension:

• men more than women
• people aged 50+
• people who are black/black British or Asian/Asian British ethnicity.

To tackle this health inequality, patient-focused hypertension campaign materials, case study advice and resources aimed at reducing the health risks faced by people with these protected characteristics were included in the data packs for relevant areas. The ICB also launched an area-wide hypertension publicity campaign, featuring people from these at-risk groups, encouraging people to take up blood pressure checks at local pharmacies.

Early results show a significant increase in the numbers of people taking up blood pressure checks at pharmacies before and after the campaign launch, from 3,129 checks before the campaign was launched in March 2024, to an average of 5,376 checks per month from June 2024 onwards, a 72% increase in take-up.

The ICB’s equality commitment – to our own workforce

In common with the national NHS workforce profile, Hertfordshire and West Essex ICB is staffed by people from diverse backgrounds and with a range of protected characteristics. We value the diversity of our workforce, and recognise that as part of the wider population, our staff are subject to the same inequality challenges. We need a well-supported, well-motivated workforce to serve the Hertfordshire and west Essex population.

Our ICB is committed to ensuring that the three equality aims of the Public Sector Equality Duty apply equally to our own staff as they do to our work on behalf of our population:

to put an end to unlawful behaviour that is banned by the Equality Act 2010, including discrimination, harassment and victimisation
to advance equal opportunities between people who have protected characteristics and people who do not
to foster good relations between people who have a protected characteristic and people who do not.

We monitor, analyse, and publish equality, diversity and inclusion data on our employees as part of our commitment to the Public Sector Equality Duty. Information must be published which covers the protected characteristics of our staff, as defined by the Equalities Act of 2010.

Our latest annual workforce equality data report meets our legal and NHS reporting requirements. These are that all NHS organisations, including Integrated Care Boards and healthcare providers, must use the Workforce Race Equality Standard and the Workforce Disability Equality Standard to measure the experiences in our workforce of minority ethnic and disabled employees, through data and through information reported in the annual staff survey. This information is included in our annual workforce data report, as is information on our gender pay gap. Read the Hertfordshire and West Essex 2024-25 Gender Pay Gap report.

Equality strategy and action plan

The ICB has developed an equality strategy and action plan in response to the data and information we gather. The strategy and plan is shaped by the findings of the range of equality data and information we are required to gather and publish, including our annual Equality Delivery System improvement report, which helps us to:

understand and fulfil our equality and diversity duties
deliver better outcomes for patients and communities
create better working environments for staff.

Some examples of positive action taken in our organisation to advance equal opportunities in the workforce include:

Reverse mentoring – all members of our Executive have a ‘reverse mentor’- they are paired with volunteer members of staff from Black, Asian, or other minority ethnic backgrounds. This has proved to be positive for both mentor and mentees, and Executive members have continued the relationships after the agreed period of mentoring and asked that we look into extending the scheme to other managers in the ICB.
Staff support networks have been established, including a Race Equality and Inclusion Network, and a Neurodiversity Network for staff and supporters of people who are neurodiverse.
Fertility workplace ambassadors – who can provide one-to-one support for staff and line managers and information on what the ICB offers in terms of workplace support and signpost to both internal and external support services.
Mental Health First Aiders – who are trained to help staff by being available to talk to when colleagues are feeling low – listening and signposting to the right support and guidance.
Training sessions on ‘allyship’ have been run to equip staff members to understand and support colleagues from diverse backgrounds.
A menopause policy has been agreed to support women in our workforce who are going through the menopause, and training has been delivered on the menopause for all staff, including line managers.
Our successful Inclusive Career Development Programme report has supported dozens of staff from across our health and care system, including our own staff body. Aimed at underrepresented groups across the nine protected characteristics working across Hertfordshire and West Essex ICS, the programme was designed to enable individuals initially from Black, Asian and Minority Ethnic groups and disabled people to make better progress in their careers.

Report library

Next steps

We will continue to review and develop the information we provide on this site to show how we are promoting equality and meeting our legal responsibilities under the Public Sector Equality Duty, incorporating the feedback we receive from the Equality and Human Rights Commission.

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