The EDS is an improvement tool supporting NHS organisations to review and develop their approach to addressing health inequalities related to access, experiences, impact and outcomes in conversation with patients, public, staff, community groups and trade unions. It is mandated that organisations use the tool and evidence of this is included in CQC lines of enquiry.
The EDS has three domains as follows:
- Domain 1: Commissioned or provided services
- Domain 2: Workforce Health and Wellbeing
- Domain 3: Inclusive Leadership
Across these three there are eleven outcomes where evidence is considered, scored and weighted, leading to an overall rating, designed to provide assurance or point to the need for improvement. Our focus is on Domain 1, and we will take into consideration the following four outcomes:
- Outcome 1A: Patients (service users) have required levels of access to the service
- Outcome 1B: Individual patients (service users) health needs are met
- Outcome 1C: When patients (service users) use the service, they are free from harm · Outcome 1D: Patients (service users) report positive experiences of the service
These outcomes are assessed by understanding how a service understands the needs of its users as defined by:
- The nine protected characteristics enshrined in the Equality Act 2010:
- age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, ethnicity, religion and belief, sex sexual orientation
- The following health inclusion groups (i.e., defined as those who suffer health inequalities):
- Deprivation/homeless, substance misuse, asylum seekers/ refugees/migrants, sex workers, victim of modern slavery, people in contact with the justice system
Each outcome is scored based on the evidence provided and then added together to gain domain ratings, designed to identify gaps and areas requiring action. The ratings are as follows:
- Undeveloped: score 0 for each outcome
- Developing: score 1 for each outcome
- Achieving: score 2 for each outcome
- Excelling: score 3 for each outcome
See the appendix for full details of the rating, score and evidence required.
Learning from experience
Recent experience from work undertaken by the BLMK ICS Inequalities Working Group has highlighted the challenge of using the EDS productively to ensure it is:
- A useful improvement tool that can make a positive impact on delivery
- Not burdensome or bureaucratic
- Not perceived as an ‘inspection’ tool creating a sense of unproductive and defensive anxiety among those involved
- Connects productively with related areas of work, e.g., QI, the Patient and Carer Race Equality Framework (PCREF) and equality impact assessments
- Used collaboratively
Next steps
Following discussions with the QI team, it was agreed that there is potential to link usefully with existing projects. It is suggested therefore to engage three of these teams to participate in a face-to-face workshop to explore how we can use the EDS constructively across ELFT.
The workshop would be chaired by the Head of EDI with support from another corporate colleague and a People Participation representative. For each service, a small group including a lead practitioner, a service user or carer and a partner (e.g., from another Trust, other public sector or voluntary sector service) would present their self-assessment conclusions for 15 minutes.
Before the workshop, the teams would be asked to consider the rating, scoring and evidence template as outlined in the appendix and prepare a presentation explaining how they address the four outcomes of Domain 1 with a short case study to illustrate their work and an initial self-assessed score.
There would be a group discussion about the evidence and the scoring to achieve a consensus. Crucially however the aim would be to agree on how effective the process is and, most importantly, how it might have a positive impact across the Trust. Recommendations would then be made to the Equalities Programme Board about a further rollout. It will be important to encourage participation by working with the services to prepare for the workshop. This will include establishing a culture of collective and collaborative enquiry.
The intention is to organise the workshop in April, lasting for approximately three hours followed by lunch.
Initial actions
- Confirm teams to participate and agree with them on what is required and how to prepare
- Identify individuals to participate both from the teams themselves and the corporate group ensuring a cross-section of voices – practitioners, service users/carers and partners
- Clarify links and overlaps with other existing EDI work
- Organise the logistics for the workshop itself