Barts Health Equality and Human Rights Impact Assessment Report

EDS Goal 1: Better Health Outcomes for AllBarts Health Equality and Human Rights Impact Assessment ReportMerger issuePositiveimplicationsof the mergerNegative implications of the mergerMitigation/opportunitiesfor merged TrustImplications forcompliance with PublicSector Equality DutyImplications forprotection andpromotion ofhuman rights1a) CAGs haveset clinicalstrategicprioritiesCAGs have aclear mandatefor respondingto healthinequalities.The FullBusiness Case(FBC) includesuseful andtargetedguidance forCAGs andstresses theimportance ofleadership inembedding theprocess ofequality inanalysis inpolicydevelopment.Lack of evidence on health inequalities (as it affectspeople with different protected characteristics) meansthat this may not have fully influenced development ofinitial clinical strategic priorities.Data of this type is included in a summarised form asan appendix in the FBC. Most focus in the main body ofthe report is given to ‘health inequalities’ in terms ofgeography (comparing different parts of the catchmentarea to each other and to national averages). There isa risk that this will be the dominant approach to thinkingabout health inequality as CAGs develop. Healthinequality, as it affects different groups, runs the risk ofbeing seen as an ‘add-on’ and ‘ghettoised’ in the workof CAGs. The current lack of available datadisaggregated by protected characteristics may serveto compound this.Also it is not clear from FBC how inverse care law willbe addressed fully. Those in most need can be theleast likely to be able to access and receive services.There is a risk that this will not be considered in a‘routine’ way as part of CAG decision-makingprocesses on health inequality because there are gapsin data about who needs services most and who isunable to receive them (disaggregated by protectedcharacteristics).Mainstreaming issues ofequality (in terms ofprotected characteristicsand other areas likepoverty) into broader workon health inequalities iscritical to success. In theFBC, Trust Equality andHuman Rights Leads havestarted to identify how theycan support CAGs toachieve this. These planswill need to be developedfurther and sufficientresource provided tosupport specialist input (andsufficient authority/leadership support toensure equality and humanrights advice is acted upon).Having due regard to needto advance equality ofopportunity involvesconsidering need toremove/ minimisedisadvantage and meetneeds of people withprotected characteristics.So far, there is not muchevidence of how this hasbeen done in developingCAG clinical strategicpriorities. FBC includesproposals for how this willbe done more thoroughly inthe future with support fromEquality Leads.Fostering good relationsinvolves tackling prejudiceand promotingunderstanding betweenpeople who share aprotected characteristic andothers. A lack of publicunderstanding about howclinical priorities aredeveloped (particularlywhen they favour oneparticular group) can leadto competition betweenRisk ofinfringement ofArticle 14 of theHuman Rights Act(prohibition ofdiscrimination) as itrelates to otherarticles (e.g. Article3: prohibition oftorture, inhumanand degradingtreatment).The UKGovernment isobliged under theICESCR to‘progressivelyrealise’ economic,social and culturalrights (includingright to health).This means publicbodies shouldalways be seekingto improveprotections in thisfield.191