(Big) Health & (In)Equality

Shakirah UllahDiversity & Access

Coordinator

January 20th, 2011

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

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?

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

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

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• Race, Disability and Gender specific duties rescinded• Underpins the general duties (framework) / help to meet GD• Requires SMART ‘equality objectives’• Publication of information (July 31, 2011) to show how the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

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’

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)

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

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

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’?

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?

Shakirah UllahDiversity & Access Coordinator

Email: shakirah.ullah@gmcvo.org.uk

Phone: 0161 277 1012