(Big) Health & (In)Equality

1. (Big) Health & (In)Equality Shakirah Ullah Diversity & Access Coordinator January 20th, 2011

2. Introduction • Greater Manchester Voluntary Sector Support • Diversity Steering Group • Equalities and Human Rights Parliament • Pan equality / human rights-based approach to inequality • GMCVO • 3 core values: Locality, Equality and Collaboration • Predisposed towards people / communities who are disadvantaged • Equal treatment / equal worth

3. Changing landscape… • Health inequalities • Marmot review: Fair Society, Healthy Lives • National Equality Panel:An Anatomy of Economic Inequality in the UK • The Spirit Level: Why More Equal Societies Almost Always Do Better • Restructuring the NHS • Radical shift: regulated industry (Ofhealth / Ofsick…?) • Secretary of State “no powers to intervene” • Health providers to stand or fall on their own • Wider implications of this • Will ‘non-profitable’ services continue to be delivered?

4. Equality Law • Specific Duties – anti-discrimination legislation • Race Relations (Amendment) Act • Gender Equality Duty (GED) • Disability Discrimination Act • All had strong specific duties - (EqIA) & duty to consult, etc. • Southall Black Sisters (SBS) • Used the RRA to challenge Ealing local authority

5. Equality Act 2010 • October 2010 • 90% provisions enacted • 9 ‘protected characteristics’ + Carers • Extending discrimination law • Direct, Indirect, Associative, Discrimination by perception, Harassment, Harassment by 3rd party, Victimization • Disability duty • Extends discrimination grounds • Extends ‘reasonable’ adjustments

6. Equality Act 2010 • General Duties • Public authorities must have ‘due regard’ for: • Elimination of unlawful discrimination, harassment, victimisation • Advancement of equality of opportunity between people from different groups • Foster good relations between people from different groups • Specific Duties • April 6, 2011 – Schedule 19 • Race, Disability and Gender specific duties rescinded • Underpins the general duties (framework) / help to meet GD • Requires SMART ‘equality objectives’ • Publication of information (July 31, 2011) to show how the general duties have been met – ‘transparency’ • EqIAs will stay but not a legal requirement

7. EA - Continued • Procurement • £220 billion + pa • Extended ‘equality’ considerations • Sub-contracted organisations would / might be required to meet equality obligations set out in the GD dependant on the ‘service’ • But no additional ‘duties’ – ‘light touch’ / reducing the burden • Enforcement • Equality & Human Rights Commission • Assessing compliance • Enforcing general and specific duties • Can apply for compliance orders / judicial review • EHRC or group of ‘people with an interest’

8. Public Law • Public Law • Set of principles that public bodies must adhere to when making & communicating decisions • Public bodies MUST act fairly, lawfully, reasonably (maladministration) • Southall Black Sisters • RRA ‘specific duties’ & Public Law • Interim remedy / injunction • If challenged a PA cannot withdraw or stop funding until the matter is resolved – no loss in service • Can also be used to challenge PAs over ‘value for money’ (Thurrock VCS)

9. Human Rights Act 1998 • European Convention on Human Rights • Political and civil rights • UK HRA ‘enshrines’ the ECHR in domestic law • Public authorities must respect Convention rights • Must act compatibly with Convention rights unless statutory provision prevents it • Human Rights must be part of all policy making • Provide a benchmark (in theory…) • PAs must have human rights principles in mind when making decisions • British Institute of Human Rights: www.bihr.org.uk

10. What are the challenges? • Assumptions: • Individual self-sustainability – ‘empowered communities’ • Existing health inequalities • Tesco-isation of service delivery • ‘pile ‘em high, sell ‘em cheap’ • Generic services / cessation of specialist services • Responsibility and accountability • Transparency agenda – one form of accountability • Where does the buck stop? • Prime contractor models • Specialist providers left with ‘crumbs’ but opportunity for ‘niche’ services • Merlin standard – fair shares policy

11. Q1: what are the challenges faced by? • Commissioners • Understanding (EA duties) • Pressure to get services right – general duties • Avoiding challenges – Equality Act / Public Law • Saving money • Service Providers • Strict criteria in place • Capacity for small providers to compete in a competitive market • Mission drift for voluntary organisations / collaboration (good and bad) • Service users • Unmet needs • Inequity / ‘fairness’ – voice and influence : what about the ‘poor, powerless & marginalised’?

12. Q. 2: Procurement: How do we ensure equality needs are met? • How will this address equality in real terms? • How much will ‘fairness’ overshadow equality? • How can we ensure that procurement ‘enshrines’ equality & diversity? • Anti-discrimination law – ‘superficial’: How can an equality culture be established? • What about diversity? • Co-design / co-production • Role of the voluntary sector reaching the so-called ‘hard to reach’ • How can the co-design /production model be best promoted? • What should the specification look like?

13. Shakirah Ullah Diversity & Access Coordinator Email: shakirah.ullah@gmcvo.org.uk Phone: 0161 277 1012