Can the quality of care we deliver improve when we put a focus on equality, diversity and inclusion? Joan Saddler, associate director at the NHS Confederation and co-chair of the NHS Equality and Diversity Council speaks with Lucy Wilkinson, equality, diversity and human rights manager at the Care Quality Commission (CQC).
Joan: Why is looking at equality, diversity and inclusion important when CQC is assessing care quality?
Lucy: We expect providers to provide good care for the whole of their population. They will only be able to do that if they consider equality issues, whether that is enabling people to have equal access to their services, an equally good experience when using services or equal health outcomes from their treatment. We know there are big inequalities across a range of issues – so we need to look at that in our regulatory work. And this sits within the context of our human rights approach too – as equality is a human rights principle relevant to all.
Joan: What do you think the link is between equality, diversity and inclusion and are NHS trusts well led?
Lucy: There are two aspects. Firstly, there is a body of academic work now that shows that when staff are treated equally and feel valued and included, this is very positively correlated with care quality – and the converse is true. So, looking at workforce equality through a range of areas such as the WRES is a very good signifier for us as to the culture of a trust. Secondly, while staff on the frontline can do a lot to improve equality for patients, this also needs leadership attention to look at trust-wide issues and to ensure good engagement with a diverse range of people using services.
Joan: How does CQC look at equality, diversity and inclusion in inspections of NHS trusts?
Lucy: We look at equality for patients using services in our ‘responsive’ key question, such as whether people’s cultural needs are met, whether reasonable adjustments are made and whether NHS trusts are implementing the Accessible Information Standard. In our ‘well-led’ inspections we look at workforce equality and leadership around the equality agenda, such as use of WRES and the Equality Delivery System which is an NHS mandatory improvement mechanism.
Joan: What is the biggest challenge?
Lucy: Getting the evidence to make judgements. NHS trusts are complex organisations. Even with WRES, which has robust trust-wide data collection, our inspection teams might miss a serious race equality issue affecting a particular specialty, unless staff come forward and tell us about it. We recognise that this can be difficult for staff to do. We are working on ways to improve our engagement, to plug this gap.
With other equality matters, such as equal access to services for patients, there are even greater challenges because there are no agreed national metrics and therefore poor data collection. We rely heavily on hearing from people using services, their families and friends and staff. Again, we need to improve our evidence base – not just CQC, but as a whole system.
Joan: Why did CQC decide to publish Equally outstanding: Equality and human rights – good practice resource?
Lucy: Part of our purpose is to encourage services to improve. We were finding outstanding health and social care services – of all types – that were using equality and human rights-based work to improve care quality. Often these approaches are relatively low cost, for a big improvement, so this is an approach which can reap rewards even in times of financial constraint.
Joan: What are the main messages?
Lucy: Firstly, there are ethical, business case, economic and legal reasons to focus on equality and human rights to improve care. Secondly, there are some common features of outstanding providers who have done this successfully. Thirdly, we cannot ignore the financial pressures services are under but looking at equality and human rights can help to mitigate some of the most negative potential consequences of these pressures. Fourthly, a whole system approach to equality and human rights is needed – it is not just the job of providers - and within this the empowerment of people using services must be central.
Joan: How do you hope that Equally outstanding will make a difference to care quality?
Lucy: I hope it will help people in a spectrum of roles involved with service improvement – including frontline staff and board members – to reflect more on equality and human rights and then to take some action. The resource includes an e-learning module and a set of case studies, as well as a more traditional document. I am really pleased that this was co-produced with eight partners, including the NHS Confederation, so I would like to ask you, in return, why the NHS Confederation became a partner organisation in Equally outstanding?
Joan: The NHS Confederation has prioritised equality, diversity and inclusion, recognising that people working in the NHS are busier than ever providing necessary services for a diverse population with increasingly varying needs. Additionally, those using services need to access great care in the right place at the right time. The power of equality, diversity and inclusion as a service improvement agenda is underused, undervalued and can be easily misunderstood. Services can be transformed, made more efficient and safe for patients when governed through human rights principles. Equally outstanding is a wide-ranging resource for anyone wishing to seriously tackle and improve organisational performance.
Joan Saddler is associate director at the NHS Confederation and co-chair of the NHS Equality and Diversity Council. Follow the confederation on Twitter @nhsconfed
Lucy Wilkinson is equality, diversity and human rights manager at the Care Quality Commission. Follow the organisation on Twitter @carequalitycomm