Why we need to change

Our 4 step journey to develop our equity and fairness strategy

West Yorkshire Health and Care Partnership has co-designed the content of the strategy with the people and health and care workforce of West Yorkshire. To see how we carried out our involvement, go to Building a new equity and fairness strategy for West Yorkshire.

Step 1 - What you told us

Thank you to everyone who took part in the involvement process which helped us create our new Equity and Fairness Strategy.

We heard how it can make you feel if you are treated differently.

Summary of engagement and involvement

Goals of the involvement were to:

hear from a broad cross section of the people of West Yorkshire by using multiple methods
understand what equality, diversity and inclusion means
know what success would feel like, and ideas on how we might get there

"The most important thing is to get the communication right and making communication accessible to people."
- Podcast panel member.

Our approach to involvement

Phase 1 - using existing channels and networks to reach people

Initial stakeholder event attended by communities, staff and leaders.
Focus groups with communities (led by West Yorkshire Voice - Healthwatch).
Public and staff surveys to capture broad views, experiences and ideas.

Phase 2 - review participation in phase 1 to identify groups to focus efforts on in phase 2

Live-streamed, interactive podcast to reach out to people who may not engage through traditional methods. This was available to people to continue to watch and still participate after the original broadcast.
Following demographic analysis, reaching out to communities and groups that we had not reached in phase 1 activities. To support discussion groups through trusted relationships.
Sharing the emerging themes, priorities and ideas with existing networks, meetings and forums within the West Yorkshire Health and Care Partnership.

We need to be better at meeting people at the point of their cultural needs.
- Podcast panel member.

We also heard your ideas on how we can make it easier to access services. The main themes you shared with us were:

The idea of fairness was important. The difference between equitable treatment and equal treatment was also important.
There was a focus on the logistical barriers diverse communities experience when trying to access services (e.g. language barriers, inappropriate communication methods, poorly used interpretation services). Being treated differently can lead to mistrust, delay in attendance, and a reluctance to attend services for fear of being belittled, patronised or on occasion humiliated.
Not being listened to and included meaningfully in many different aspects of health and care has a detrimental effect on whether people access services, when they access services, and how they feel as a result.
There were three key skills gaps that have been highlighted for our workforce:
- communication training
- the use of translation and interpretation resources
- cultural sensitivity and awareness of other people’s backgrounds and needs.
“You can’t be what you can’t see” is testament to the need for health and care staff to reflect the communities they serve.
There can be an element of suspicion towards this field of work, or feelings it can be disingenuous and insincere. Any plan or strategy needs to be more than words and needs to demonstrate action and results.

"People aren’t hard to reach, we just aren’t reaching people."
- West Yorkshire Voice member.

Key themes heard from our engagement were as follows:

Through the stakeholder event

At the stakeholder event on 9 July 2024, you told us:

language is important and needs to be consistent - you told us you prefer talking about ‘equity’ rather than ‘equality’
people want justice not just inclusion
these are challenging times for some - we need to give people hope
we need more lived experience examples and voices in the strategy
people want to know what the actual difference will be
people want us to stop talking about it, and just get on with it

"It was one of the most inspirational days of my life and a real boost and it just makes me more determined than ever to use my lived experience as an autistic, transgender, person with disabilities, as well as my knowledge of dementia to bring about transformational change."
- Stakeholder event attendee.

Through a series of focus groups in collaboration with Healthwatch

West Yorkshire Voice, which is co-ordinated by Healthwatch, was asked to lead several focus groups to help develop the new equity and fairness strategy. People were invited to share their feedback and ideas about what should be included in the strategy. See their Equality, Diversity and Inclusion report for full details.

Through our more targeted involvement with groups we hadn’t heard from

Summary of phase 2 involvement

The feedback heard echoed many of the findings of phase 1. In addition:

Equity and fairness need to be a ‘golden thread’ that runs through all our work. Principles or priorities should align with existing work, rather than in addition to, or that run alongside.
Visibility is important. Some communities are represented in our workforce and leadership. However there are groups where more support, and innovation of adaptation is required to improve representation.
Training and support is needed for people to understand the different needs and adaptations required to make health and care more inclusive. The biggest area being communication and taking the time to explain.
We need to share good examples of adaptations; to enable people using services and receiving support, as well as adaptations for people to work in health and care.

Working together for equity and fairness – involvement timeline

Involvement (phase 1)

9 July 2024. In person stakeholder day in Bradford.
9 to 31 July 2024. Six Healthwatch West Yorkshire focus groups.
17 July to 11 August 2024. Sent out online surveys that anyone could complete as an individual or as a group.
July to August 2024. Partnership wide communications through existing channels such as e-newsletters, podcasts and social media posts.

Test learning

28 August 2024. Feedback sessions online to those involved to date.

Analysis

July to August 2024. Analysis of all findings and who took part.

Sharing

September, October and November 2024. Sharing versions of the strategy at different meetings across West Yorkshire.

Involvement (phase 2)

September, October and November 2024. Reach groups and cohorts not yet heard from.
16 October 2024. Live podcast.

Finalising

4 and 12 December 2024. Ensure clear and accessible strategic objectives in place.

Sign-off

21 January 2025. New strategy and joint commitment agreed at Partnership Board.

Step 2 - What we know about our population, people and communities

Tackling inequalities in outcomes, experience and access is one of the four key purposes of Integrated Care Systems. Within the Integrated Care Systems, Integrated Care Boards (ICBs) have a statutory duty to reduce health inequalities in relation access to services, service experience and related service outcomes.

In West Yorkshire, we focus on health outcomes that can be improved through health care intervention and specifically where there are unequal or unjust differences in these outcomes across the West Yorkshire population. These inequalities are owned by the whole system.

Data for population, people and communities

Please see the following links to information and data on population and patient access, experience and outcomes:
Health Academy web page
Inclusion Health strategy
Health inequalities discussions at ICB Board including deep dives on:
- children and young people (agenda item 6)
- older adults (agenda item 14)
Health inequalities annual report – pages 77 to 89 of the West Yorkshire Health and Care Partnership Annual Report and Accounts 2023/24
Population demographics from West Yorkshire Combined Authority - demography direct link

What we know about our workforce

Our partnership is made of the people in it. Our workforce in the West Yorkshire Health and Care Partnership is spread across many different organisations in the health and care sector, including the voluntary community and social enterprise (VCSE) sector and through the estimated 400,000 unpaid carers (many don’t access formal support) - all contributing to our workforce.

Equity and fairness - what the data tells us

Staff from ethnically diverse backgrounds are more likely to experience harassment, bullying or abuse from colleagues than white staff. Data source: staff survey results 2023.
The percentage of board members from ethnically diverse backgrounds across all NHS trusts ranges from 6% to 33%. Data source: locally collated Oct 2024 from 10/11 NHS trusts.
It is more likely that white staff are appointed from shortlisting than staff from ethnically diverse backgrounds at most of the NHS trusts in West Yorkshire. Data source: WRES Results 2023.
Staff with long-term conditions face more discrimination from members of the public and colleagues than staff without long-term conditions. Data source: staff survey results 2023.
Staff with long-term conditions face more harassment, bullying or abuse from colleagues compared to staff without long-term conditions. Data source: staff survey results 2023.
Staff with long-term conditions experience more musculoskeletal issues, work related stress and pressure to attend, even when unwell, than staff without long-term conditions. Data source: staff survey results 2023.
There is a significant number of staff choosing not to declare their disability. Data source: staff survey results 2023 and ESR 2023.
Unwanted behaviour of a sexual nature is experienced more by women than men. Data source: staff survey results 2023.
Unwanted behaviour of a sexual nature is experienced more by staff who are lesbian, gay, bisexual or other sexuality compared to heterosexuals. Data source: staff survey results 2023.
Unwanted behaviour of a sexual nature is experienced more by white staff compared to staff from ethnically diverse backgrounds. Data source: staff survey results 2023.

"We need to care for the people who care for the people."
- Podcast panel member.

Step 3 - What we must do

We have a duty to look after the health of our population, people and communities

All public bodies, including the NHS, must adhere to the Equality Act 2010 which includes the Public Sector Equality Duty. Under the Equality Act 2010, we have a duty to consider the needs of people with protected characteristics.

We know that other groups have worse health outcomes too, so we will not restrict this strategy to the nine characteristics protected by law, but will include other groups, for example people who live in a deprived area, people who are carers or people who are not working.

We also have a duty to look after our workforce

NHS organisations must comply with a number of standards and frameworks that relate to equity, diversity and inclusion, such as the NHS EDI Improvement Plan, the NHS Workforce Race Equality Standard, NHS Workforce Disability Equality Standard and the NHS Equality Delivery System 2022. Similar standards and frameworks are used in public sector organisations and in the VCSE sector.

We aim to create spaces for open conversations, where staff feel psychologically safe and comfortable taking interpersonal risks at work.

Beyond what we must do in West Yorkshire, we want to commit to fair access, positive experiences and good outcomes for all our people, communities and staff.

Step 4 – Building on current initiatives

We also need to build on the good work that is already going on.

West Yorkshire’s health and care partners are united in their commitment to the principles of equity, equality, diversity, and social justice.

Significant progress is already being achieved through the efforts of individuals, teams, organisations and collaborations at both local and system-wide levels. We aim to build on this excellent work by identifying and sharing best practices to ensure these benefits are accessible to everyone across West Yorkshire.

Independent Race Review – 2024 evaluation

In 2024, we welcomed Professor Dame Donna Kinnair to assess the progress made in implementing the recommendations from the 2020 Independent Race Review.

Four evaluation sessions took place from October to December 2024, with further recommendations provided by the panel to develop our efforts in establishing a truly inclusive and anti-racist partnership. Reflecting on the findings, Professor Dame Donna Kinnair stated:

“The West Yorkshire Partnership has demonstrated a commendable commitment to addressing issues of racial equity, which fills me with both appreciation and hope. Despite operating within a challenging financial climate and navigating numerous other priorities, the West Yorkshire Integrated Care Board and its partners have made substantial progress in delivering on our initial recommendations. Their impressive outcomes set a benchmark for others, positioning them as one of the highest-performing Integrated Care Systems (ICSs) in this area. The Partnership should take pride in its achievements to date. However, it is clear that significant work remains to be done.”

While notable progress has been achieved, the journey toward racial equity continues. For more information, please see this web page: West Yorkshire and Harrogate review report to tackle health inequalities for Black, Asian and minority ethnic communities and colleagues.