Equality Strategy 2013 – 2016

1. Equality Strategy 2013 – 2016 Review date: June 2016 STRAT-0027-v1

3. CONTENTS Forward Page 4 Equality Objective 6 Page 14 Introduction Page 5 Equality Objective 7 Page 14 The Trust’s Approach to Equality and Diversity Page 6 The Trust’s Strategic View of Equality Page 15 Protected Characteristics and Health Inequality Page 7 Equality Analysis Page 16 Our Continuing Commitment to Equality Page 8 Equality and Diversity Training Page 17 Working in Partnership with Local Communities Page 9 Valuing our Diverse Workforce Page 18 How we Developed our Equality Objectives Page 10 The Staff Compact and the TEWV Staff Survey Page 19 Equality Objective 1 Page 11 TEWV Equality and Diversity Steering Group Page 20 Equality Objective 2 Page 12 Reporting and Monitoring Arrangements Page 21 Equality Objective 3 Page 12 Glossary and Useful Links Page 22 Equality Objective 4 Page 13 Contact Details Page 23 Equality Objective 5 Page 13 Equality monitoring enables us to gather information about who uses our services and how people view them, which is essential when planning and reviewing services.

4. FOREWORD BY THE DIRECTOR OF NURSING AND GOVERNANCE • The objectives in this strategy drive and support positive organisational change which contributes towards better patient care, patient experience and better health outcomes. I am sure you will agree that it is essential that we all consider the value and importance of having and sustaining good mental health and wellbeing within all of our communities. • This can only be achieved by working together to eliminate inequality wherever it exists and to promote fairness and inclusion in everything we do. This includes: • Access to Trust services • Provision of Trust services • Delivery of Trust services • Employment • We will make sure that our strategy is planned and supported in an effective way so that Trust staff can play their part. Making sure the Trust achieves the equality objectives published in this strategy is the responsibility of everyone who is employed by or has association with the Trust. Tees, Esk and Wear Valleys NHS Foundation Trust is delighted to launch its Equality Strategy 2013 - 2016. This three year strategy continues to develop and improve upon the work the Trust began back in 2009 and sets out the Trust’s continuing commitment to embed Equality, Diversity and Human Rights into everything the Trust does. The delivery of the strategy’s ideals and principles will rely on the significant contributions made each and every day by Trust staff. Valuing the hard work, dedication, diversity and commitment of all our staff remains of paramount importance to everyone including the Trust, its staff, service users, their carers and our stakeholders. Chris Stanbury Director of Nursing and Governance 4

5. Introduction The Equality Act 2010 requires all public sector organisations, including Tees, Esk and Wear Valleys NHS Foundation Trust, to publish equality objectives every four years. The Trust has to publish details of engagement work that has taken place to develop and evidence the Trust’s Equality Objectives and also how the Trust will measure its progress against them. www.tewv.nhs.uk/equalityanddiversity The purpose of this strategy is to provide an overview and information on the Trust’s approach to equality and diversity and to inform you, our staff, about our equality objectives. We will also provide some background information which will explain how we formulated our equality objectives. We believe the Trust’s equality objectives will make a real difference to some of the most pressing issues facing protected groups in our society. What works for one community will not necessarily work for another – the needs of an African Caribbean man who is afraid to engage with services are different from the needs of an Asian woman who may think that having a mental health problem is shameful. (Delivering Race Equality in Mental Health Care: A Review 2009) 5

6. The Trust’s Approach to Equality and Diversity Tees, Esk and Wear Valleys NHS Foundation Trust is committed to actively recognising and promoting Equality and Diversity. The Trust believes in making every effort to be a fair and unbiased organisation. Further to this, the Trust aspires to be an organisation that embraces and values people, recognising the benefits that diversity brings to the Trust both as an employer and in the delivery of services. Negative behaviour can have a direct impact on patient experience. A lack of compassion, poor attitude or bullying is a destructive element within any team or organisation where it exists. It also contributes significantly to workplace stress. As a public body within the NHS the Trust expects a continuous and exemplary commitment from all of its staff regardless of pay grade or position, taking a proactive approach to Equality, Diversity, Human Rights and the Care Quality Commission’s Essential Standards of Quality and Safety. As an employer the Trust is developing an organisational culture in which diversity is valued and staff are able to promote equality and challenge unlawful harassment, discrimination and bullying. The Trust’s Equal care for all campaign launched in 2012 We do this to ensure that staff, service users and their carers receive fair and equal treatment throughout their employment or their care. A white mental health staff worker is no less equipped to provide a culturally responsive service for BME (black and minority ethnic) clients than a Black or Asian staff worker. Competency and commitment will cross all ethnic boundaries. (Positive Steps – NHS 2007). 6

7. Protected Characteristics and Health Inequality • The Equality Act 2010 applies to all organisations that provide a service to the public or a section of the public (service providers). It also applies to anyone who sells goods or provides facilities. • It applies to all Trust staff, whatever their role and responsibility and to anyone else who carries out a public function. It applies to services, whether or not a charge is made for them. • The Act protects people from discrimination on the basis of one or more ‘protected characteristics’ (these used to be called ‘grounds’). • The relevant characteristics for services, public functions and employment are: • age • disability • gender reassignment • marriage and civil partnership • pregnancy and maternity • race • religion or belief • sex • sexual orientation People from protected characteristic groups can experience a combination of exclusion, alienation, bullying, and harassment, isolation and may also have problems accessing public services. There is mounting evidence that stigma, prejudice, and discrimination create a hostile and stressful social environment that can lead or contribute to mental health problems. Health inequalities are avoidable as well as unjust, unfair and unlawful. If a patient needs special equipment or help because of their disability the hospital must make reasonable adjustments to provide this. (Government Equalities Office) 7

8. Our Continuing Commitment to Equality • The Trust believes in making a real positive difference in everything it does. The Trust knows that the vast majority of staff share the Trust’s core value to be treated with ‘respect’. • So, what will the Trust do? • The Trust will publish an Equality Strategy every four years • The Trust will publish equality information that is accurate • and will ensure that this information is updated on a regular • basis • The Trust will continue to embed equality and diversity into • our organisation and recognises that it is a key element • of the Trust's business, service provision and employment • The Trust will deliver on our commitment through our • equality objectives • The Trust will publish and achieve our equality objectives • The Trust will review its equality objectives to ensure that they • remain current and challenging • *If you would like to see our implementation plan in full please see the section on further information at the back of this document. “From our experience in tackling race, gender and disability inequalities, we know that relying on individuals taking discrimination cases is not enough. Tackling entrenched discrimination needs proactive leadership within institutions to build effective policies, practices and a strong internal culture of equality, dignity and respect”. (Beyond tolerance – Equality and Human Rights Commission 2009) 8

9. Working in Partnership with Local Communities • The Trust is working in partnership with people who have disabilities and has undertaken disability access audits to ensure that the Trust can identify any barriers to accessing Trust services. • The Trust had five listening and involvement events in 2011 that took place in Durham, Stockton, Scarborough, Northallerton and Harrogate to ask local people about what matters to them in relation to equality and the provision of mental health, learning disability, substance misuse and eating disorder services. • The Trust asked local residents, individuals, voluntary groups and staff: • why each of the protected characteristics is • important • why the Trust needs to take equality seriously • how equality can make a difference • what key messages need to be taken on board by • the Trust The Trust continues to host events on fair and equal access to Trust services, including a recent event held in Scarborough which focused on deafness and spirituality and a planned future event that will look at how the Trust can meet the needs of LGB&T people. The Trust believes that it is important for staff to work together and in partnership with other agencies and with local communities. It is a significant opportunity to improve access, tackle stigma, prejudice and remove barriers that can still inhibit people from protected groups from accessing mental health and learning disability services. Feedback from these events has contributed towards the Trust’s equality objectives. There is at least twice the risk of suicide attempts in lesbian, gay and bisexual people compared to heterosexuals (NIMHE 2007) 9

10. How we Developed our Equality Objectives • The Trust considered: • The diversity of Trust staff and local communities and • their different needs • Which groups access Trust services and which groups • access less often • Gaps that were identified in the collection of equality • data (information) and the quality of that data • Equality issues raised by staff and issues and complaints • raised by service users and their carers • Areas where the Trust could make a meaningful • improvement which was more than minor or trivial • The Trust has recognised that some objectives need • more time to complete than others. The Trust has • identified this in its equality objectives • Feedback from communities at listening events • held around the Trust Where English is a second language, accessing mental health services can be very difficult. Language is a key contributing factor to incidences of misdiagnosis, as well as low referral for psychotherapy and counselling. (Positive Steps – NHS 2007). 10

11. Equality Objective 1 • Our Equality objectives are made up of service objectives and employment objectives. • Service objectives focus on : • Making sure services are inclusive and accessible to all • protected groups • Raising awareness around groups that often find it • difficult or hard to access services • Making sure that services meet people’s needs • Improving patient experience • Employment objectives focus on : • Recruiting and maintaining a diverse and skilled • workforce that is representative of its communities • Improving the working environment for all its staff • Making sure that everyone has the opportunity to reach • their full potential. Background Information The Trust has identified from consultation with people from protected groups that its clinical staff need to develop cultural competency particularly around ethnicity, sexual orientation and gender reassignment awareness. Objective 1 By March 2016, the Trust will develop and deliver cultural competency training to all clinical staff, to provide assurance that the needs of the Trust's diverse service users are met and to increase the proportion of BAME (black, Asian and minority ethnic) and LGBT (lesbian, gay, bisexual and transgender) patients reporting satisfaction with services to the same level as those of white British and heterosexual patients. This will be monitored through the Trust’s patient experience questionnaire. 11

12. Equality Objective 2 Equality Objective 3 Background Information The Trust has identified through engagement with its communities that the role of religious and spiritual needs in relation to mental health must be recognised and supported. This will be monitored through the feedback from the Spirituality Pathway Implementation Group. Objective 2 By March 2016, the Trust will have put systems in place to meet service users’ religious and spiritual needs by ensuring that 100% of patients have their religious and spiritual needs addressed through their care plan by the development, pilot and implementation of a spirituality pathway. Background Information The Trust has identified through engagement with its staff, communities, third sector and statutory partners that there is a considerable under representation of the Gypsy Roma Traveller population amongst the Trust’s service users. This has been confirmed by a survey of community teams in North Yorkshire. Objective 3 The Trust will implement a focused work plan to improve the access to Trust services for the Gypsy, Roma and Traveller communities. The work plan will be initially piloted on a site in North Yorkshire and a site in County Durham in 2012/13 and aims to improve access for this community by 50% by March 2016 from the access baseline in March 2012. 12

13. Equality Objective 4 Equality Objective 5 Background Information Like all NHS organisations the Trust participates in the National NHS Staff Survey. This provides valuable information about how our staff feel and their opinions about the Trust as an employer. The staff survey results tell us that staff who experience long term health conditions are less satisfied than staff that do not. The Trust monitors the staff survey and has identified three indicators that require further improvement. Objective 4 By March 2016, to decrease by 50% the number of indicators in the staff survey where staff who have long term health conditions have statistically significantly less favourable scores. Background Information The staff survey results tell us that there may be groups of staff that are less satisfied than average. It is important to look in detail at the staff survey results to understand more about why this might be the case. Objective 5 By March 2016, to identify indicators in the staff survey where staff who share protected characteristics score worse than staff in general and to develop appropriate actions. This will be monitored on an annual basis through the staff survey with the results being reported to the Trust Board of Directors. 13

14. Equality Objective 6 Equality Objective 7 Background Information Through consultation with the staff, service users and carers accessing the Learning Disability (LD) services it has been recognised there is further improvement required to enhance the experience of and ease of access to services. Objective 7 By March 2016 the Trust will have monitored and further developed the planned access through the Green Light Access to Healthcare plan. This objective will be monitored by the performance measures for the Green Light action plan, the patient experience feedback from LD service users and complaints/incident reports. Background Information It is essential that the Trust monitors the level of pay staff receive to ensure it is fair and transparent. The best way of doing this is to undertake an equal pay audit. This is where the level of pay for staff from different groups is compared to that of other groups and the national average. If differences are identified further analysis will be undertaken to try and work out why the differences exist. Objective 6 By March 2013, to undertake a Trust wide equal pay audit. This will be monitored by the Trust Board of Directors 14

15. The Trust’s Strategic View of Equality • The Trust looks for different ways to implement its strategic view on Equality. This includes being committed to taking part in the NHS Equality Delivery System, completing Equality Analysis, providing Trust Staff with Equality and Diversity Training and participating in the Stonewall Workplace Equality Index. • The Equality Delivery System (EDS) was designed for the NHS to help organisations improve equality performance and embed equality into mainstream NHS business. • The EDS is seen as a way for NHS organisations to meet the requirements of the Equality Act 2010. • The EDS is based on a set of 18 outcomes grouped into four goals: • Better health outcomes for all • Improved patient access and experience • Empowered, engaged and included staff • Inclusive leadership at all levels These outcomes focus on the major priorities for patients, carers, the public, local communities, NHS staff and Boards. On completion of the EDS and the outcomes the Trust’s performance is analysed and graded and the final grades are approved by Health Watch. The EDS enables the Trust to define equality objectives which are supported by an action plan which is implemented by staff across the Trust. Performance and progress in relation to these objectives are then assessed on an annual basis. The EDS was implemented in April 2012 the details of which can be viewed on the Trust website. Carers of disabled and older people are protected by law. (The Equality Act 2010) 15

16. Equality Analysis • The Trust has an Equality Analysis Toolkit which helps support the review of Trust polices, procedures, strategies, functions and services in order to establish the impact on Equality by the Trust. • The Equality Analysis Toolkit supports the Trust and its staff to work towards fulfilling the legislative requirements of the Equality Act 2010. Part of normal day to day decision-making for all public sector bodies should involve assessing in so far as is relevant and proportionate, the impact they have on equality in our society. • An equality analysis must be completed: • For all new polices, procedures, functions, • strategies, services and business plans, codes of • practice, projects and guidance • Dynamic assessment for all Trust Board decisions • and proposals. The Trust Board of Directors will not • ratify any document or proposal that has not • had an equality analysis • Reviewed as a minimum every three years for all • existing policies, procedures, functions, strategies • and services • Reviewed when significant (more than minor/trivial) • amendments and changes are made • The Trust’s Equality Analysis Toolkit can be found on the Trust website at: www.tewv.nhs.uk/policies or by copying and pasting this link below into a web browser. • http://www.tewv.nhs.uk/About-the-Trust/Policies/Corporate/ People are also protected from being discriminated against because of lack of religion or belief, so they cannot be treated less favourably because they do not follow a certain religion or have no religion or belief at all. (Government Equalities Office) 16

17. Equality and Diversity Training Equality and Diversity Training is essential, it supports the development of empathy, compassion, understanding and knowledge. It enables staff to put equality and diversity into practice within their role, regardless of their position in the organisation and helps to ensure the Trust remains compliant with the Equality Act. The Trust uses a variety of different training methods which include sharing patient stories, face to face training and e-learning. These different approaches promote good practice and encourage empathy. Members of staff with good levels of E&D awareness are more likely to demonstrate higher levels of emotional intelligence, tact and professionalism. Equality and Diversity Training is mandatory for all Trust staff. Some other examples of where equality and diversity is embedded within the training are: • Trust Board of Director Seminars • Corporate Induction • Leadership and Organisational Development Training • Trust Values Training • Recruitment and Selection Training • Hospital Managers Training • Equality Analysis Training • Bullying and Harassment Training • Equality Act and Human Rights Act Seminars • Complaints Investigation and PALS Team Training • The Trust is working in partnership with other organisations to deliver the following specific awareness raising training sessions. • Asylum Seeker Awareness Training • Deaf and Visual Awareness Training • Deaf and Mental Health Awareness Training • Gender Sensitivity Training • LGB Awareness Training • Investing in Equality and Diversity training leads to competent staff that are able to deliver services that meet peoples needs. People enjoy life more if they are treated fairly. (Government Equalities Office) 17

18. Valuing Our Diverse Workforce Employees that are treated fairly and with respect perform better, are more likely to deliver excellent services and continue working for the Trust. Diversity in the workplace recognises the different skills, knowledge, abilities that our staff bring to the Trust, whatever their position in the organisation. The Trust has a number of ways of showing staff they are valued for what they do: We run an annual staff awards programme (the Making a Difference awards). There are ten award categories and staff, service users and their carers can nominate team or individuals that they feel have made a real different to the care and/or support they have received. Our values provide the guiding principles for how we want our staff to behave and to reflect the importance we place on these the Chairman presents a bi-monthly Living the Values Award. The Executive Management Team also choose a Team of the Week to recognise those that have gone that extra mile to achieve great outcomes. We also recognise staff for their long service to the NHS, presenting those with over 25 years service with a certificate and high street vouchers.  Women are more likely to seek help from and disclose mental health problems to their primary health care physician. 18

19. The Staff Compact and the TEWV Staff Survey The staff compact describes the 'psychological' contract that exists between staff and the Trust. Within the Equality Strategy, the compact plays a supporting role in helping staff to provide the best possible patient experience of safe and effective care, whilst ensuring that their own needs for support, development and the resources to do the job are made available. Trust staff are accountable for their behaviour in the workplace towards their colleagues, service users and their carers and when they carry out any public function. An example of how we monitor the Trust ‘s performance in relation to staff satisfaction is through the national NHS staff survey. This takes place annually and is used by the Trust improve the safety, working environment and the relationship that the Trust has with its staff.  The Trust uses the results from the staff survey to develop corporate and directorate action plans to ensure improvements are made. The Trust performs favourably when compared with other similar NHS organisations (in the top 20% for 20 out of 28 indicators in 2013) Non discriminatory practice is a legal requirement of all public sector employees Depression affects one in five older people. (Mental Health Foundation) In person centred mental health care, culture, ethnicity and faith should be central to care. They should not be sideline issues. (Colour Mind) 19

20. TEWV Equality and Diversity Steering Group The group reports to the Quality and Assurance Committee and is chaired by a Non Executive Director supported by the Executive Director who has Board level responsibility for Equality and Diversity and Human Rights. The group has representation and membership from each of the clinical and corporate directorates, this includes service leads. In order for the Equality and Diversity Steering Group to achieve its objectives, it works with clinical and corporate service management teams. • The TEWV Equality and Diversity (E&D) Steering Group meets quarterly to: • Develop and performance manage the systems to monitor and improve Equality, Diversity and Human Rights within the Trust with particular reference to ensuring the Trust meets its responsibilities • under the Equality Act • Develop an annual work plan to progress the delivery of Equality, Diversity and Human Rights to ensure the Trust meets its legal responsibilities under the Equality Act • Ensure that systems are in place to provide assurance that demonstrates compliance with all legislative and quality requirements • Monitor incidents of breach of Equality, Diversity and Human Rights legislation and monitor and audit the dissemination of learning • lessons and feedback from action • Oversee any procedural and policy development and review • Ensure that systems are in place to provide evidence of the Trust’s compliance with the expectations of any external regulatory bodies • and their standards Non Executive Director, Barbara Matthews chairs the Trust’s Equality and Diversity Steering Group Men are more likely to seek specialist mental health care and are the principal users of inpatient care. 20

21. Reporting and Monitoring Arrangements The TEWV Equality and Diversity Team reports to the Trust Board of Directors directly three times a year. In addition to this there is also an annual publication of information. The E&D Lead reports to the Quality and Assurance Committee (QUAC) three times a year and submits an annual report of progress as part of the reporting cycle. The Workforce Lead reports to the Workforce and Development Group. Both the E&D Lead and the Workforce Lead report to the Executive Management Team (EMT) as necessary and in accordance with Trust requirements. Health care discrimination against trans people has included the refusal of care such as smear tests, breaches of confidentiality and the practice of placing trans women on male wards, and trans men on female wards. (Trans People’s Health - Department of Health 2007). Older people’s sexuality generally is not often talked about and this is even truer of people who are gay, lesbian or bisexual. (Perspectives on ageing: Lesbians, Gay Men and Bisexuals - S. Knocker 2012) 21

22. Glossary and Useful Links TEWV Equality Strategy Implementation Plan 2012 – 2016 TEWV Published Equality Statistics TEWV Equality Delivery System www.tewv.nhs.uk/equalityanddiversity If you would like a printed copy of any of the above information please contact us on 0191 3336542 / 6267 or by email @ TEWVEandD@nhs.net Care quality commission essential standards of quality and safety www.cqc.org.uk Equality and Human Rights Commission www.equalityhumanrights.com Government Equalities Office – Home Office www.homeoffice.gov.uk/equalities NHS Equality Delivery System (EDS) http://healthandcare.dh.gov.uk/equality-delivery-system/ Stonewall www.stonewall.org.uk 22

23. Contact Details If you would like to know more about how you can get involved please contact us by email at TEWVEandD@nhs.net Or by telephone Chris Stanbury – Director of Nursing and Governance 0191 3336533 Lesley Mawson – Associate Director of Nursing and Compliance 0191 3333589 Sarah Jay – Equality and Diversity Lead 0191 3336267 Simon Marshall – HR Manager 07799132145 Depression during pregnancy can affect about 15 out of every 100 women (News England July 2011) Suicide rates show that British men are three times as likely to die by suicide than British women. (Mental Health Foundation) 23