NICE and NICE’s equality programme in 2012 Nick Doyle Clinical and public health analyst

Ground to be covered About NICE Where NICE fits into the health, public health, and social care system NICE’s approach to equality analysis Developments since the last Equality Forum The impact of our equality analyses on guidance recommendations NICE’s equality objectives Our priorities for 2013/2014

What does NICE do? NICE provides guidance on promoting good health and preventing and treating ill health NICE guidance is about: –Clinical practice (clinical care for diseases and conditions) –Public health (preventing disease and improving the population’s health) –Health technologies (drugs and other treatments) –Interventional procedures, medical devices and diagnostic tools But it also includes: –Quality standards for the NHS, social care, and public health –Quality and Outcomes Framework (QOF) indicators for primary care –Commissioning outcomes framework (COF) indicators for measuring the impact of commissioning by clinical commissioning groups NICE runs: –NHS Evidence, giving Google-like access to high quality evidence –The Medicines and Prescribing Centre (MPC), providing NICE good practice guidance on use of medicines

NICE in the health and social care system Central Local Department of Health NHS Commissioning Board Secretary of State for Health NICE Housing, transport, environment, leisure etc Social care Public health NHS healthcare Primary care Community health services Some public health Local authorities adult/children’s social care, public health, housing, transport, environment etc Local authorities adult/children’s social care, public health, housing, transport, environment etc Public Health England Cabinet Sub-Committee on Public Health Ofsted CQC Clinical commissioning groups Health & wellbeing boards Dept for Education Dept for Communities Dept for Transport etc Dept for Education Dept for Communities Dept for Transport etc

Equality and diversity Health inequalities and inequity Socio-economic Special groups People sharing protected characteristics Age Disability Gender re- assignment Pregnancy & maternity Race Religion or belief Sex Sexual orientation Age Disability Gender re- assignment Pregnancy & maternity Race Religion or belief Sex Sexual orientation For example: Homeless people Looked after children Asylum seekers For example: Homeless people Looked after children Asylum seekers Social exclusion Area-based deprivation Determinants of health inequalities Social exclusion Area-based deprivation Determinants of health inequalities NICE’s approach to equality analysis

NICE’s equality analysis process Assessing the evidence Scoping Draft guidance, quality standard or indicator Involvement of stakeholder organisations Involvement of patients, carers and the public Involvement of stakeholder organisations Involvement of patients, carers and the public Final guidance CharacteristicYN age disability gender reassignment pregnancy and maternity race religion or belief sex sexual orientation socio- economic other

Developments since the last Equality Forum NICE’s annual equality report: –Compares the diversity of NICE’s workforce and advisory bodies with that of other organisations – the Department of Health, the CQC, the EHRC, and health, social care and ‘other’ public bodies –finds a smaller proportion of people describing themselves as disabled among NICE staff and new members of NICE advisory bodies than in the ‘benchmark’ organisations –finds a marked rise in rates of non-disclosure of monitoring information among new members of NICE advisory bodies NICE’s equality objectives – focusing on diverse advisory body membership and effective participation Our response to the 2011 Equality Forum’s suggestions: –An immediate change – we now consult at the scoping stage of NICE quality standards –A number of areas for longer-term development Patient and Public Involvement Programme project on engagement with children and young people

Impact of equality analysis on guidance recommendations in 2011/12 Equality analysis of 158 items of guidance: 286 equality issues found, 99 (35%) having an impact on recommendations: Protected characteristic Number & % of equality issues found Number & % of issues with impact on recommendations Rate of impact of issues found Age60 (21%)17 (17%)28% Disability50 (17%)20 (20%)40% Gender reassignment6 (2%)2 (2%)33% Pregnancy & maternity6 (2%)4 (4%)67% Race52 (18%)21 (21%)40% Religion or belief12 (4%)7 (7%)58% Sex22 (8%)6 (6%)27% Sexual orientation0 (0%) 0% Socioeconomic33 (12%)10 (10%)30% Other45 (16%)12 (12%)27% Total286 (100%)99 (100%)35%

What are NICE’s equality objectives? Objective 1: The reasons for this research objective: –We need advisory bodies that are representative, and we also need specialist knowledge and understanding of equality –We need to do better in recruiting people with disabilities but also from other protected groups –But it’s not just about numbers, it’s about achieving effective participation of people with disabilities and others The research findings should help us get the maximum benefit from the involvement of people from protected groups They may be of interest beyond NICE To evaluate the most appropriate forms of advisory body participation by people with disabilities to ensure NICE meets its responsibilities under equality legislation.

What are NICE’s equality objectives? Objective 2 The reason for the objective: –We need more complete equality monitoring information from people who want to work at NICE and, especially, from people who want to be members of advisory bodies –There are growing gaps in monitoring information about advisory body members, so it’s difficult to set useful objectives for diversity Work on this objective should result in better quality monitoring information and more effective recruitment policies To explain more clearly to prospective employees and members of advisory bodies why we collect data on age, disability, race, religion or belief, sex, and sexual orientation, to better inform their decisions on whether or not to declare this information in our monitoring forms.

Equality priorities for 2013/14 Complete work on NICE’s equality objectives Review and update NICE’s equality scheme and transfer it into the National Institute for Health and Care Excellence Continue to make improvements where we can to NICE’s methods for equality analysis Maintain NICE’s compliance with Equality Act duties