(big) health & (in)equality shakirah ullah diversity & access coordinator january 20 th,...
TRANSCRIPT
(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• Race, Disability and Gender specific duties rescinded• Underpins the general duties (framework) / help to meet GD• Requires SMART ‘equality objectives’• Publication of information (July 31, 2011) to show how the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?