CDE Appendix 1 Literature Review - Central East Local Health ...

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The Culture, Diversity and Equity Project: Literature Review It is moreover advisable, in the interests of accountability and compliance, that health equity policy statements are adjoined with concrete action plans and guidelines for implementation that clearly articulate the means (strategies and plans) by which such policy goals and objectives are to be realised, as well as the expected strategic outcomes of each action plan initiative. The more fully and transparently such corresponding action plans and desired outcomes are elaborated and explained in relation to policy goals and objectives, the more able are stakeholders to monitor and debate the feasibility and ‘fit’ of such plans as a means of achieving the espoused goals and objectives. Strategic action plans, moreover, should go into detail about what will be done, by when and by whom, clearly listing, in this latter respect, the responsibilities of each relevant stakeholder accountable and responsible for ensuring policy implementation and compliance. The Plan should thus: • Set dates on when you will do the things such as monitoring, reviewing procedures, training and guidance; • Expand on how these will be done and by whom; • Clarify what will be your measures of success and how you will evaluate these (including how and when you will review the overall working of your policy) (ACAS, 2009). Clearly articulating the objectives and corresponding action tasks to be performed, as well as the lead role holders having carriage over such tasks, is essential to ensuring that the policy is accountably advanced. It is also important, as mentioned above, that a process and timeline is agreed upon for regularly reviewing and updating the policy, in light of incoming information on progress or lack thereof. Policies should also be supplemented by explicit strategies for making the policy known to all stakeholders. Dissemination of policy initiatives within and beyond the organisation in question is essential, not only because of the public’s right to know, in the case of public health policy, but because bringing such policies into public light makes it that much more difficult to get away with doing nothing in support/pursuit of it. It is useful, in this respect, to develop policy guidelines to further elaborate and explain policy goals, objectives, strategic plans and desired outcomes to concerned stakeholders in more detailed form The process of policy development is as critical to its success in implementation as the content of the policy. The policymaking process should not only involve knowledge experts, but also all affected and interested stakeholders, including, importantly, members of the public, in particular members of vulnerable communities who may be targeted by the policy. Aside from the intrinsic value of such public/stakeholder involvement in a democratic society, such engagement may increase public (and thus political) and staff ‘buy-in’, and help prevent resistance, backlash, and subversion at implementation phases (see Sabik & Lie, 2008 for more on the importance but also challenges of stakeholder involvement in policymaking processes). Policy decisions and outcomes should be transparently communicated to stakeholders at all phases of the policy development process. Such transparency in itself helps to increase accountability, since it is much easier to ‘drop the policy ball’ when no one is aware of the policy or applying pressure for ‘results’ (Sabik & Lie, 2008). Training initiatives in support of the policy are also critical to ensuring compliance, as such initiatives help to equip those responsible for implementation with the appropriate skills and competencies required to do so effectively. 78
The Culture, Diversity and Equity Project: Literature Review Box 4.1: NHS London Strategic Plan 2009-2013 In the UK context, Strategic Health Authorities (SHAs) most resemble the LHINS in terms of their role, function, structure and place in the overall UK National Health System (see Appendix 2: The structure of the new NHS in England for more on the configuration of the UK health system). Strategic Health Authorities have three main functions: (1) developing and implementing strategy for health and healthcare (2) holding local organisations to account for the quality of the care which they provide; and (3) ensuring capacity through the development of the workforce, technology and buildings (NHS London, 2007, p.6). NHS London, one of 10 national strategic health authorities in England, was formed in July 2006 when the five previous London Strategic Health Authorities were combined, bringing together the North West London, North Central London, North East London, South East London, and South West London authorities into a single strategic body. NHS London covers 32 London Boroughs with a population of approximately 7.2 million and rising. NHS London has overall responsibility for the performance of 31 primary care trusts (PCTs), 22 24 acute trusts (hospitals) 23 , three mental health trusts 24 and the London Ambulance Service. NHS London’s commitment to reducing health inequalities is reflected in its vision and mission statement and strategic goals. The NHS London Vision statement for instance reads: Our vision is world-class health and healthcare for Londoners. Achieving our vision will mean: • improved health as a whole for Londoners • reduced health inequalities by delivering greater improvement for the most disadvantaged groups • higher quality services and enhanced clinical safety for patients • sustained financial stability (NHS London, 2008). 22 Primary Care Trusts (PCTs) are responsible for the provision of health services to the local community across England. Primary care services include general medical practitioners (GPs), dentists, pharmacists, opticians, district nursing and numerous other services. PCTs receive budgets directly from the Department of Health and commission (i.e. purchase) services from providers, putting in place their own service agreements (see Appendix 1: The structure of the new NHS in England for more on the organization of the UK health system). Since April 2002, PCTs have taken control of local health care while strategic Health Authorities (SHAs) monitor local performance and standards. SHA’s also commission highly specialised services for rare conditions through its National Commissioning Group (NCG) http://www.london.nhs.uk/your-nhs-inlondon/structure-explained, Retrieved March 3, 2009). 23 NHS acute trusts are responsible for running many NHS hospitals. 24 “Mental health trusts oversee mental health services which can be provided through a General Practitioner, other primary care services, or through more specialist care in NHS hospital trusts or local council social services departments” (Retrieved March 3, 2009 from http://www.london.nhs.uk/your-nhs-in-london/structure-explained). . 79
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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HEALTH EQUITY LITERATURE REVIEW INT
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REFERENCES ACAS [Advisory Conciliat
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