Introduction

The Equality Delivery System (EDS) helps the NHS improve services for local communities, and provides a framework for better working environments, free of discrimination, for NHS staff. As an NHS trust, we are expected to annually assess our progress against the EDS outcomes to ensure we are delivering in the best possible way for our people and communities. 

The EDS process allows us to demonstrate our ‘due regard’ for the for Public Sector Equality Duty enshrined within the Equality Act 2010.

Across the EDS framework, there are eleven outcomes which need to be assessed. They are grouped into the following three domains:
Domain 1: Commissioned or provided services
Domain 2: Workforce health and well-being
Domain 3: Inclusive leadership

This evidence pack highlights work undertaken across the organisation in the last year for the benefit of patients and staff, in an inclusive way – meeting the needs of the diversity of communities who we serve and those who work for us.

The evidence will be assessed by a panel of internal and external stakeholders, against the criteria set out in the Framework. The outcomes of the grading exercise will be shared with the Trust Board and NHS England.

Glossary

1. BME – Black and Minority Ethnic (NHS England definition)
2. ICC – Integrated Contact Centres
3. EOC – Emergency Operations Centres – control centres
4. HRBP – Human Resources Business Partners
5. L&OD – Learning and Organisational Development
6. MDT – multi-disciplinary team
7. OH – Occupational Health
8. PES – Paramedic Emergency Services

PTS – Patient Transport Service

EDS Outcomes

Domain 2: Workforce health and well-being

2A: When at work, staff are provided with support to manage obesity, diabetes, asthma, COPD, and mental health conditions

2B: When at work, staff are free from abuse, harassment, bullying and physical violence from any source

2C: Staff have access to independent support and advice when suffering from stress, abuse, bullying, harassment, and physical violence from any source

2D: Staff recommend the organisation as a place to work and receive treatment

Domain 3: Inclusive leadership

3A: Board members, system leaders (Band 9 and VSM) and those with line management responsibilities routinely demonstrate their understanding of, and commitment to, equality and health inequalities

3B: Board / Committee papers (including minutes) identify equality and health inequalities related impacts and risks and how they will be mitigated and managed

3C: Board members, system, and senior leaders (Band 9 and VSM) ensure levers are in place to manage performance and monitor progress with staff and patients

2A: When at work, staff are provided with support to manage obesity, diabetes, asthma, COPD, and mental health conditions

Evidence provided by: HRBP Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

The trust’s wellbeing offering, whether that be through Occupational Health or internally, is fully accessible to all employees regardless of group. 

We can now see a greater level of MI data with insight into age and gender but we are limited to the characteristics data gathered by Occupational Health and their MI data does not expand currently beyond age and gender.

All interactions with our OH provider comes with a feedback request following treatment to allow us to identify issues that may arise with any specific individual of (protected) characteristic group. 

We are also conscious from a male/female perspective there is a marked higher uptake of mental health support. This is being reviewed with consideration of a project working with a university to launch a BALM trial to targeted male populations within our workforce.

The reasonable adjustments procedure recently developed also allows for conversation and consideration of accommodating issues that specifically relate to individual characteristic groups.

Wellbeing calendar of activity provided by Optima relates to key calendar events that also include celebratory days of protected characteristics

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

The majority of the work surrounding this outcome relates heavily to the Occupational Health contract as well as our internal Health and Wellbeing team. Over the course of the reference period we have been through a full retendering exercise to select and transition in a new provider.

In relation to the outcome and also its impact on protected characteristic individuals the new OH contract has brought benefits in:

MI data availability around age and sex

Fully fledged wellbeing platform with self help support on a number of conditions (examples provided in the evidence) these guidance and support documents are not only tailored to the employee seeking help but give manager support on workplace considerations and how to support the employee

Review of health surveillance leading to increased surveillance – respiratory surveillance now in HART – breathing apparatus. This can help identify respiratory issues early and input control measures

Mental health/counselling offering – moved to a CBT model rather than talking based therapy. Quick access and triage process to ensure the right treatment first time. Available via self and manager referral. Good response to provide decompression following Southport and also C&L incident. Treatment as confidential as employee wants it to be.

£10k royal funding for mental health 

BMI removed as an assessment criteria and support provided to people who wish to lose weight

We have also seen some great impact from our wellbeing team this year with events held across the trust focusing on both mental and physical health. In day to day support for our employees the Wellbeing Hub was re-developed and streamlined wellbeing conversations were added to the leadership training package which has helped managers have supportive conversations particularly in relation to mental health.

The launch of a recognised reasonable adjustment procedure has also given employees greater access to support and workplace adaptions to manage a number of these conditions. A new OH policy has also just been signed off.

Obesity: The Trust’s wellbeing offer provides signposting to a range of information and services relating to obesity i.e. fitness, heart health and healthy eating. The OH service also provides advice and guidance to staff in relation with obesity.

Diabetes: Staff who are diabetic are provided with access to storage facilities for medication and can take time to take/administer medication and attend medical appointments. Support and advice is also provided on healthier lifestyle changes to help begin to reverse or ward off the possibility of type 2 diabetes due to diet.

Support to manage Asthma/COPD: Staff with asthma and COPD conditions are supported with access to OH services, time to attend medical appointments and through the wellbeing offer. In high risk environments with exposure such as workshops and HART, annual health surveillance is undertaken.

Support for mental health conditions: We recognise that mental health is our biggest absence driver. It is noted to date (April to September) that 566 mental health referrals have been made, many of these leading to low intensity CBT counselling and a large volume of complex counselling services (EMDR/hi intensity CBT) have been authorised. The provision has also increased to 6 sessions in 12 months per employee. Specific support and counselling has been provided with some individuals newly diagnosed with neurodivergent conditions such as autism and ADHD.

3. What have been the drivers for delivering this outcome?

People plan objective:

Proactive support for people to stay at work and be healthy through improved Occupational Health Provision

Staff survey data on employee wellbeing

New MI data available to us from OH

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

Transitioning to a new OH provider, ensuring fit for the organisation and appropriately integrating & accessible, embedding and building familiarisation with the service

Although improved MI data there is a lack of specific data on obesity, diabetes, asthma. Asthma is potentially captured in respiratory referrals

Although improved MI data, it does not specifically identify protected groups and trends however this was also somewhat limited in the DPIA

2B: When at work, staff are free from abuse, harassment, bullying and physical violence from any source

Evidence provided by: HRBP Team

What the Staff Survey 2023 results tell us

Over 98% of staff indicated they had not experienced physical violence from managers of colleagues, but more than 1 in 10 said they had experienced harassment, bullying or abuse in work. Also, for the first time in 2023, the Survey asked about unwanted sexual behaviour – the results show that around 8% of you have experienced unwanted behaviour of a sexual nature from your colleagues. This rises to more than 1 in 10 staff in PES, and is higher for female and LGBT+ staff. 

Disabled staff are more likely to experience abuse in some form from the public, compared to non-disabled staff. 

Around 1 in 5 disabled staff have experienced some type of abuse from colleagues, but the likelihood of non-disabled having these negatives experiences is 1 in 10.

BME staff and male staff are considerably less likely to report their negative experiences, as only a third indicated that they did so compared to nearly half of White staff, LGBT+ staff, and female staff.

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

The trust has a dignity at work policy in place which ensures that employees have a way to positively address workplace conflict. It also provides an avenue for allegations of bullying or harassment to be dealt with fairly and effectively and at the earliest opportunity.

Our Occupational health provider has a number of avenues that help support NWAS employees through:

Suite of self access resources on their wellbeing platform for both managers and employee which is focussed on providing an healthy workplace environment free from the above but also spotting signs and symptoms in order to act quickly to support

Access to OH referrals via management or self referral. These appointments are an opportunity to talk confidentially. This can often be an opportunity to gain advice on how to deal with experiences such as this and how best to report. 

Access to counselling and mental health treatment  

1. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

Sexual safety in the workplace

Following on the work of the SS Steering group which commenced in August 2023, 

In April we launched our SS toolkit and in May 2024 the Trust launched its sexual safety campaign  – ‘Stop, speak, support’, followed by a series of roadshows touring emergency departments and stations to talk to staff about our the SS initiative and highlight the collective responsibility of all staff to make NWAS a safe place to work.

In August 2024 we launched by stander guidance to sit alongside the SS Toolkit,

Currently working on a SS policy which will be launched in the new year

Suicide prevention

In May 2024 we officially launch the action cards for dealing with Significant illness, injury, suicide attempt, suicide or death in service. These were implemented to improve our internal management of the above scenarios and support  those involved or those effected by assisting leaders to optimizes care and compassion for our people, 

In September 2024 – updates were made to the Datix system to enable the trust to report and record at a central point staff incidents involving Significant Self Harm / Suicide Attempt / Suspected Suicide. This will ensure relevant stakeholders such as Head of HR, Trust Mental health lead and safeguarding leads  are aware of any incidents and will enable us to monitor for any emerging trends and take proactive measures.

Dignity at Work (DAW) policy is currently been reviewed and will be presented to policy group for discussions/agreement in the new year. HR masterclass for managers around DAW is also being produced and will be launched in early 2025

2. What have been the drivers for delivering this outcome?

Staff Survey – We want all staff to come into work and feel both safe and happy. This is underpinned by our people strategy. 

Workforce data – has identified that there are incidents of V&A which have been aggravated through hate. 

Trends arising from employee relations case work.

National focus on civility in the workplace, sexual safety in the workplace.

The introduction of The Worker Protection Act (amendment of Equality Act 2010 in October 2024 

3. Provide an overview of challenges (if any) which have affected delivery of this outcome

Data quality – non reporting of issues. 

Sexual Safety campaign requires a culture shift across the organization around thoughts, feelings and behaviours which will take time to change and embed.

Evidence provided by: Violence Prevention and Reduction Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

Improvement of data accuracy to understand the impact of Violence and Aggression of Protected characteristics groups. Reporting now allows staff to report on any incident whether they felt a protected characteristic was an aggravating factor to the incident.  

Reporting data is mapped to understand where there is heightened risk to violence and aggression to our staff is so the VPR team can implement both supportive and preventative strategies going forward but to also identify those who are repeat offending and work with our partners to ensure that we proactively stop this behaviour from happening with methods such as prosecution, mental health support, community support, education. 

VPR team sits on network groups to discuss initiatives and incidents that have impacted those with protected characteristics. Networks are given the opportunity to voice to VPR team how they would like to be supported and are offered involvement in initiatives. This empowers staff to be part of the process and makes initiatives valued across the trust.

1. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

Recruitment of a team dedicated to Violence and Aggression that will also focus on the impacts that V&A has on those in groups of protected characteristics. Change of reporting form on DCIQ now allows reporter to state whether they felt a protected characteristic was an aggravating factor to V&A – Transgender identity has been an additional field to this. 

Sexual Safety Roadshows rolled out throughout the trust to give education, advice and support to all staff. 

Planned Hate crime initiatives for ICC – to give staff education on hate crimes and reporting.

Body Worn Video Cameras – BWVC provided to staff to help better capture evidence to assist in prosecution. 

VPR updates through comms on social media platforms, bulletins and onsite/network  visits from newly established VPR team.

Partnership working with Violence reduction networks across the trust to identify areas of concern and partnership working established to reduce and prevent this. 

Training – staff are given an appropriate level of conflict resolution training to reduce incidents of V&A

2. What have been the drivers for delivering this outcome?

Staff Survey – We want all staff to come into work and feel both safe and happy. This is underpinned by our people strategy. 

Workforce data – has identified that there are incidents of V&A which have been aggravated through hate. 

Trends arising from employee relations case work.

National focus on civility in the workplace, sexual safety in the workplace.

The introduction of The Worker Protection Act (amendment of Equality Act 2010 in October 2024 

3. Provide an overview of challenges (if any) which have affected delivery of this outcome

Dedicated VPR team will only be fully established NOV 2024.

Recording and reporting inaccuracies have made it difficult to appropriately map data and understand risks and incidents associated to EDI.. 

Partnership working needs to be better established across the trust to ensure that we are providing staff with appropriate support and outcomes to incidents. 

Risk Management Marker System on people needs to be overhauled so they are put on the nominal not an address. All Markers will need to be reviewed in this process.

2C: Staff have access to independent support and advice when suffering from stress, abuse, bullying, harassment, and physical violence from any source

Evidence provided by: Chaplain for Staff Wellbeing

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

The Chaplain for Staff Wellbeing, Reverend Karen provides a confidential listening and support service in times of change, challenge, and distress. Engagement with the chaplaincy service provides the opportunity to explore issues of faith and spirituality and how they impact both personally and in the workplace.

The Chaplain offers pastoral care to people of all faiths and none, and regardless of background, or any protected characteristic group.

1. Pregnancy and Maternity
2. Race
3. Disability
4. Sexual Orientation
5. Sex
6. Religion or Belief
7. Marriage of Civil Partnership

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

The chaplain is fully embedded within the organisation. The chaplain has attended most of the Network Days during the past year and plans to continue to do so in the coming months. There is often cross referral from the Networks to the chaplain and vice versa.

1) The chaplain attended the Women’s Network and Racial Equality day which focused on maternal health and pregnancy. She has also had a number of 1-1 conversations with staff who are off the road due to pregnancy and provided pastoral support when needed.

2) Has active links with the Race Equality Network. Has provided 1-1 and group pastoral support for staff who have experienced anxiety and verbal aggression due to heightened societal ,racial, tensions. Also focused a staff induction session that acknowledged the tensions and highlighted avenues of support available.

3) Staff have sought 1-1 pastoral support sessions to discuss the implications of their disabilities and how to manage some discrimination that they have experienced as a result.

4) The chaplain attended Liverpool Pride and a number of other events held by the LGBT+ Network. She is recognised as an ally by many within the LGBT+ community within the organisation. She wrote an article, circulated by Corporate Communications to highlight the relevance of Pride.

5) Pastoral support was delivered by the chaplain at the Women’s Network event that focused on sexual safety. She also attended the Sexual Safety Road Show events. Both of these resulted in the chaplain providing 1-1s for staff to explore their experiences within the workplace and experiences outside the workplace that impacts on their work.

6) NWAS provides a Religion, Belief and Culture Forum which is an opportunity for staff to develop their knowledge base with regards to different religions and cultures. A forum was held in the summer that focused on the needs of Jehovah’s Witness patients and staff. Others are planned. The next one will focus on the Gypsy and Roma Communities.

7) In the time frame,3 members of staff (1 gay, 2 straight) have sought advice from the chaplain on Marriage and Civil Partnership.

3. What have been the drivers for delivering this outcome?

Trust objectives and priorities have significantly informed the work of the chaplain, particularly with regards to joint initiatives such as the work on Sexual Safety and menopause.

1. sessions have been shaped by the presenting needs of staff, sometimes influenced by external forces, such

as the conflict between Israel and Palestine.

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

The geography of the trust footprint can be challenging in providing face to face support, but video calls are utilised to good effect.

Evidence provided by: Freedom to Speak Up Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

We track the percentage of our concerns where reporters wish to record a protected characteristic. Currently this is done by disability, ethnicity, gender and sexual orientation. We compare the percentage of concerns where reporters highlight a protected characteristic, against wider trust level workforce data to see if we have comparable rates of reports coming from our diverse range of staff. A comparison table can be seen on slide 4.

We engage proactively with our staff networks to ensure that staff network members are aware and can promote the FTSU system either themselves, or within their teams and service lines.

We continue to try and make speaking up easy for people and have a range of accessible methods available to in order for staff to speak up, tailoring the offer to ensure that whatever the preferred method is, some form of option is available to them. This includes email, text, phone, written post, online form, social media

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

Freedom to speak up guardians are embedded and empowered within the organisation. During the current financial year, the trust has agreed to expand the provision of FTSU guardians from 1 to the equivalent of 3 whole time posts. This represents a clear commitment to expanding the capacity for its workforce to speak up when they face challenges in the workplace.

FTSU guardians have been working with key internal and external stakeholders to ensure that speaking up is being normalised within the organisation, and to give a clear message that speaking up is a positive thing and not to be seen with any negative connotation. This has included speaking at trust inductions, service line SMT meetings, student inductions, and staff forums across the trust.

We have also started tracking the percentage of concerns that are raised anonymously across the organisation to see if there are correlating trends with the volume or nature of concerns and reassuringly we have seen no correlation at all. This can be seen on the images on next slides.

We have also changed our processes with respect of concern visibility and sign off. Whereby previously, the sign off and closure of concerns was down to the guardian assigned to the concern, it is now with the respective area or service line director. This means that we are striving for consistency in response, and while resolution will be found with the most appropriate local leader, the closure will be seen by the director, with monthly assurance meetings now held with the executive. This consists of the CEO, the Medical Director, Director of Operations and Director of people. This allows for senior scrutiny of concerns, themes and trends in cases and triangulation of other intelligence to support proactive work on resolutions.

The FTSU team have also joined the newly established Regional Clinical Learning & Improvement Group (RCLIG) which has been established to identify patient safety incident learning projects that would be best led regionally. The attendance of the FTSU team means that further triangulation and information sharing at that regional forum can bring learning and change from FTSU into the wider organisation in order to really embed change from concerns that could affect the entire workforce.

We continue to see inappropriate attitudes and behaviours as one of the key reasons people approach FTSU and concerns by type can be seen on images on next slides (Q1&2 current fiscal year)to evidence that across service lines. We continue to engage proactively with workstreams across this area, including the sexual safety steering group.

3. What have been the drivers for delivering this outcome?

The completion of the recommendations from the National Guardians Office review, listening to workers, published February 2023 has driven the need for investment in additional FTSU resource during 2024 and we intend to complete the review of recommendations by understanding our need for a network of ambassadors, or champions during Q4 of the current year.

This was referenced in the trust annual planning cycle for 2024/25 and is currently reported against for assurance purposes via the strategic planning group for oversight.

We continue to support the delivery of the recommendations of the national review into Ambulance Service culture, which was published by NHSE in summer 2024, detailing results and recommendations for cultural improvement.

We continue to review staff survey results in key questions to look at confidence in speaking up, and issue resolution across the trust, service lines and by geography to work with local leadership teams to identify areas for improvement.

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

We are seeing lower rates of staff with protected characteristics speaking up to FTSU than the trust rates against the workforce data. This needs to be further understood before conclusions are made. We need to establish if this is replicated across other methods of speaking up such as DATIX, or formal HR processes and the reasons for that. We have just started reporting this in our assurance report to trust board which will receive this in November and we are hopeful that we will receive support to start looking into this in the future. This will need cross organisational resource to correlate the data.

Staffing has been a challenge during the start of Q3 with the previous guardian moving on to a new role and the recruitment for their backfill taking longer than anticipated. However, we will see additional resource by the end of Q3 and into Q4 which will allow the FTSU team to begin more engagement and proactive work going forwards.

F2SU data

2D: Staff recommend the organisation as a place to work and receive treatment

Evidence provided by: Staff Experience Team

What the Staff Survey 2023 results tell us

Disability

• Just under half of staff who have a disability said they would recommend NWAS as a place to work compared to 56% of non-disabled staff.
• 6 in 10 Disabled staff would recommend the standard of care provided by NWAS, compared to 7 in 10 non-disabled staff.

Age

• The 16-20 & 21-30 & 66+ age groups were more likely to recommend NWAS as a place to work.

• Over 70% of 16-20 and 66+ staff would recommend the standard of care provided by NWAS.

Gender

• Female staff responded more positively that they would recommend NWAS as a place to work compared to male colleagues (difference +5.8%). However, only 3 in 10 staff who prefer to self describe their gender state they would recommend
• More than 70% of female staff would recommend the standard of care provided by NWAS compared to 66% of male staff.

Ethnicity

• BME staff were likely to recommend NWAS as a place to work compared to white colleagues.
• Almost 7 in 10 of both White and BME staff would recommend the standard of care provided by NWAS.

Religion

• 7 in 10 staff who stated their religion is Hinduism said they would recommend NWAS as a place to work, followed Christian staff (nearly 60%).
• At least 60% of respondents in all faith groups (including no faith) said happy with the standard of care provided by NWAS.

Sexuality

• Nearly 60% of LGBT+ staff would recommend NWAS as a place to work, compared to Heterosexual/Straight staff at 54.9%.
• 6 in 10 LGBT+ staff would recommend the standard of care provided by NWAS, compared to 7 in 10 Heterosexual/Straight staff.

Staff Survey Responses 2023

Evidence provided by: HR Corporate

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

Exit Interview

The exit interview moved onto Microsoft Forms in June 2024, improving its accessibility via screen reader functionality, high colour contrast and keyboard navigation.

Multiple sources were used to draft the new questions, including ESR, exit interviews across the sector and liaising with the NWAS Staff Networks and Learning & Organisational Development Team.

NHS Staff Survey (NSS)

The NHS Staff Survey (NSS) is administrated by Picker, an external organisation, on behalf of NHS England. The NSS website is accessible via speech recognition software, keyboard navigation, the ability to change contrast levels and up to 500% zoom.

The NSS questions have been developed through identifying high quality questions used in other surveys, extensive engagement with experts and stakeholders, and testing with staff from a range of backgrounds and roles. Key stakeholders include the Freedom To Speak Up and National Guardians Office, Equality and Health Inequalities Team, NWAS Staff Networks and local People Promise Manager.

The aggregated survey results are published as official statistics, providing a detailed and robust source of data that is used to inform understanding of staff experience locally, regionally and nationally. At NWAS, we use this data to inform annual planning, such as the EDI Annual Plan, and the multi-year People Strategy. The data from the survey also informs other local reporting, such as the Workforce Race Equality Standard and Workforce Disability Equality Standard.

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

NHS Staff Survey (NSS)

Following a low NHS Staff Survey (NSS) response rate of 33% in 2022, a £5.00 coffee voucher initiative was launched for the 2023 survey to drive uptake. This was successful, and we achieved our highest ever response rate of 48%, resulting in more robust data gathered.

In 2022, 46.4% of staff stated they would recommend NWAS as a place to work (q25c) This increased to 54% in 2023. Moreover, where in 2022 60.8% of staff said they would be happy with the standard of care provided by NWAS if a friend or relative needed treatment (q25d). This increased to 67.5% in 2023. Demographic responses were broadly similar for both q25c and q25d. For example, the ‘female’ response to q25c was 57.5% and the ‘male’ response was 51.7%.Further data on other protected characteristics is available on Slide 4.

Exit Interview

Over the past 18 months there has been a review and refresh of the organisation’s exit interview process. The form, questions, process and guidance have all been updated following a successful business case, and the new exit interview has been live since June 2024. This work has seen the completion rate of exit interviews rise in the first half of 2024 from 10% (April) to 29% (September).

A key difference in the process is to encourage staff to complete the exit interview with their manager, thereby creating an immediate feedback loop which empowers both the staff member and manager. An average of 71% of exit interviews have been completed with a manager since the launch.

Responses from the exit interviews indicate that 67% of respondents would work for NWAS again in the future, with 62% of staff feeling valued by the organisation. Based on equalities monitoring data collected from exit interviews for the period of June to September 2024, there are no demographics with disproportionate responses to whether they would work for NWAS again in the future. An example of this is the ‘disability’ response at 70% compared to the ‘no disability’ response at 68%. Further data on other protected characteristics is available on images in upcoming slides.

People Promise Exemplar

Since May 2024 NWAS has been part of the NHS People Promise Exemplar. A People Promise Manager was appointed and has been working with NHS England to deliver some of the ideas and interventions set out in the national People Promise. This work has included engagement with staff across the service to prioritise action around three of the seven People Promise themes: working flexibly, having a voice that counts, and reward and recognition. Future plans for 2024/25 include improving organisational attitudes around flexible and agile working.

3. What have been the drivers for delivering this outcome?

NHS Staff Survey (NSS)

The annual NHS Staff Survey (NSS) collects staff views about working at NWAS and compares it against the sector and wider NHS. The results are used to improve local working conditions and improve patient care. As an annual survey, we have the ability to review our progress against previous years and identify areas of improvement and success.

Two of the new questions introduced in the 2023 survey were q17a ‘not experienced unwanted behaviour of a sexual nature from other colleagues’ (79.6%) and q17b ‘not experienced unwanted behaviour of a sexual nature from other colleagues’ (92.2%). The responses to these questions from female staff were lower than the overall response: q17a was 75.2% and q17b was 90.5%.

NWAS has used this information to drive improvement across the organisation. A focus throughout 2024/25 has been on increasing sexual safety, which has been achieved through signing the NHS England Sexual Safety Charter. AACE Consensus Statement on reducing misogyny and improving sexual safety and engaging in organisation-wide roadshows. The same questions are being asked in the 2024 survey, and we anticipate improved scoring in this area. This project contributes to the development of NWAS as a great place to work.

Exit Interview

Improving exit interview uptake and data drives improvement across the organisation, providing rationale for staff attrition and direction on developing opportunities to retain staff. This data can be triangulated with NSS, WRES and WDES data to understand if there are unique difficulties faced by specific demographics and enact preventative measures.

4. Provide an overview of challenges (if any) which have affected delivery of this outcome?

The most challenging barrier to NHS Staff Survey, National Quarterly Pulse Survey and exit interview completion is time. Whilst incentives, rationale, anonymity and outcomes of surveys can be managed and promoted, the impact of national operational pressures fundamentally reduces the opportunities for operational staff to engage in non-service delivery activities.

The existence of these pressures affects employee morale and contributes to ‘improved work/life balance’ as one of the top reasons for leaving the organisation. To support staff, NWAS continues to develop and deliver the health and wellbeing priorities throughout the year, such as the launch of the Wellbeing Hub in May 2024. By acting on results from the exit interview and staff surveys, NWAS will drive further improvement in staff recommending the organisation as a place to work and receive treatment.

3A: Board members, system leaders (Band 9 and VSM) and those with line management responsibilities routinely demonstrate their understanding of, and commitment to, equality and health inequalities

Evidence provided by: Corporate Governance Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

The refreshed EDI priorities 2024-2026 were approved by the Board of Directors in July 2024.

Priority 1: We will embed fair and inclusive recruitment and progression processes to improve the diversity of the workforce at all levels.

Priority 2: We will educate and empower our workforce and leaders to promote a positive psychologically safe culture, to support a reduction in the experience of bullying, harassment, discrimination and an improvement in retention.

Priority 3: We will reduce health inequalities for our patients.

This was also accompanied by the EDI Annual Plan 2024/25 developed to monitor progress against the actions within the three areas which identifies the focus of the improvement goals, how they will be delivered and the measures of success for each priority.

Health Inequalities – Mental Health

The new mental health response vehicle model went live in April 2024 and has been developed in conjunction with mental health trusts and the ICB, alongside the NHS Long Term Plan and supports patients by reducing unnecessary conveyance to ED and signposting to more appropriate pathways of care. Once telephone triage has been completed, and a face-to-face response required, the vehicle is dispatched by the Complex Incident Hub

Introduction of NHS 111 Press 2 went live on 30 April 24 – a new way for patients to access crisis mental health support across the region, when connecting the mental health crisis option, they are connected to their local NHS urgent mental health helpline based locally

EDI

Achieved Gold standard for the third consecutive year in the Employers Network for Equality & Inclusion (ENEI) Talent, Inclusion & Diversity Evaluation (TIDE) accreditation. Third highest out of 185 global entries – measures EDI intentions and performance against other organisation and a range of sectors.

Equality Impact Assessments – carried-out at the same time as the review of an existing or proposal service, policy or activity and should be carried out at the beginning of the decision making process to properly engage with diverse groups and in order to comply with the Public Sector Equality duty.

Race

First ever Iftar dinner held on 27 March 2024 to commemorate the holy month of Ramadan

Race Equality network – theme #ListenActChange

Black History Month & World Menopause day – 18 October – a join event to raise awareness, particularly the experiences of ethnic minority women

Sex

Introduction of a Menopause Policy & Procedure and introduced Menopause Champions. Menopause coffee mornings and menopause natter café – also open to males to share their experiences of wives, daughters, mothers and colleagues

Disability

Disability/Race Equality network Event – World Sight Day 10th October, a virtual event for eye health

Creation of a Learning disability & autism Plan 2023 – 2026, guided by people with learning disabilities and/or autistic people, families, careers, health and care professional and third sector partners such as local learning disability network and the national autistic society. Co-ordinated a number of focus groups with the patient and public panel

Disability Pride Month – July, to raise awareness about disabilities and celebrate the diversity within the disabled community. Disability Pride Flag red = physical; yellow = cognitive & intellectual; white = invisible & undiagnosed; blue = mental illness; green = sensory perception and the black background represent disabled people who have lost their lives not only to the illness but also to negligence or suicide.

Age

World Elder Abuse Awareness Day 15/6/24 – theme ’spotlight on Older Persons in Emergencies’. Estimated that 1 in 6 older adults experience abuse worldwide. Older people more at risk due to additional vulnerabilities, isolated or frail, have an age-related illness such as dementia. Elder abuse – physical, emotional, sexual or financials (scams), violation of rights or neglect

Dementia Awareness Training, through mandatory training

Safeguarding of children Under 18

Gender

Policy on supporting Trans, non-binary, Gender Fluid and Non-Cisgender staff updated and republished October 24.

All staff have the option to display their pronoun in email signatures and on ID badges

Religion – Religion, Culture & Believe Forum July 24

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

The Board, together with VSM leaders are committed to leading, promoting and demonstrating their commitment to improving equality and health inequalities outcomes across the Trust. This is through partnership working by engaging with ICBs as part of the system working, Healthwatch and other provider trusts. There are clear links between staff experience and patient experience so it is vital for the Board to show visible leadership on matters of diversity. Part of this commitment is for the Board of Directors to develop their understanding of the barriers facing different groups of patients and staff through Patient and Staff Stories at Board meetings.

All Board members, system leaders and staff with line management responsibilities continue to support a large number of events and programmes to promote and raise awareness of relating to equality and health inequalities.

Directors continue in their Executive Champion roles aligned with networks or particular equality strands. Champions are accountable for supporting network objectives, acting as allies and advocates and for bringing the perspective of their equality strands to decision making.

The Trust has five network groups set up to discuss issues related to protected characteristics:

• Armed Forces Network
• Disability Network (Disability)
• LGBT Network (Gender reassignment/civil partnership/sex/sexual orientation)
• Race Equality Network (Race)
• Women’s Network (Gender reassignment, marriage and civil partnership/pregnancy and maternity/sex/sexual orientation)

For 2024/25, the Board Assurance Framework includes a strategic risk: There is a risk that the Trust does not work with our partners in the health and care system to shape a better future leading to poor effects on our communities and the environment. This strategic risk recognises the requirement for area teams work closer with partner organisations to shape external service delivery and ensuring dialogues are constructive and at the right level. The Knowledge Vault is a key source of assurance for senior managers to understand discussions that have taken place across the trust.

The governance structure includes the Diversity and Inclusion Group provides assurance that the Trust maintains a strategic overview of the Trust’s activities in the area of diversity and inclusion, aligned to either the People Strategy, Quality Strategy or the National People Plan, which helps to guide, steer and challenge progress in the delivery of the Trust’s EDI strategic priorities and objectives. Assurance is reported via a 3A Report to the Trust Management Committee for oversight.

The Trust has a mental health team who work at a strategic level with organisation and externally to engage ICBs, mental health partners and other system partners to improve the prehospital response to mental health. The LD&A Plan 2023-2026 aligns to the Trust’s overarching EDI priorities and supports the principles of the Quality Strategy to ensure services are patient centred, safe and appropriate.

Section 1 provides a summary of the updates provided by the CEO to the Board of Directors during 2024/25, all work is fully endorsed by the Board.

3. What have been the drivers for delivering this outcome?

Results from Staff Survey.

WRES, WDES data and gender pay gap data.

Trust priorities: EDI, regulatory and statutory EDI workforce data requirements

Learning from FTSU processes

Areas of focus from Network groups

Trust’s Strategy

Trust Annual Planning processes

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

There is a vast amount of work being undertaken by the Trust to address this outcome, it is important for the Board and senior leaders to listen to staff feedback and improve any barriers experienced. There are a large number of external meetings at system level designed to tackle health inequalities, it is important the Trust has the right resources for this work to continue.

5. Any other comments relating to this outcome

The Board aims to lead from the front to support the work undertaken to progress the equality, diversity and inclusion agenda. The Board aim to keep the conversation fresh with continuous education relating to these topics.

The Board through the Committee assurance structure will continue to receive assurance and annual reports, with further opportunity to become further involved to support developments.

The Chairman is the Non-Executive champion for equality, diversity and inclusion and will continue to drive this agenda forward.

Objectives relating to equality and diversity are implemented into the objectives of senior managers to provide visible leadership around the diversity and inclusion agenda. This continues at Board level who are leading from the front in order to promote equality and equity across the organisation. Board members are also required to comply with the NHS Leadership Competency Framework for Board members to promote equality and inclusion, reducing health and workforce inequalities and completes a self assessment – see next page.

Looking forward into 2024/25, strengthened processes have been introduced at an operational level to attend Accountability Reviews presenting data on a number of areas including EDI data together with their engagement at with their local systems.

3B: Board/Committee papers (including minutes) identify equality and health inequalities related impacts and risks and how they will be mitigated and managed

Evidence provided by: Corporate Governance Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

Examples of reports and information provided to Board that show the outcomes are as follows :

Information CEO Report: April/May

• Iftar Dinner to celebrate the breaking of the fast – attended by more than 100 colleagues and families – an opportunity learning about Ramadan and celebration of the holy month
• First Networks Development Day – exploring further opportunities for the networks to work together
• launch of new campaign, Stop Speak Support setting out expectations around sexual safety and sexual harm

June/July

• attended NHS confederation Expo in Manchester Addressing Health Inequalities – working with health and social care partners to make sure our services are accessible for everyone
• PRIDE month
• Disability Pride – start positive conversations and celebrate the diversity within the disabled community
• Racism – welcoming address at the National Ambulance Black & Ethnic Minority Forum – highlighted the drivers for change. Attended workshops sharing best practice. Two speakers from NWAS. Good representation from NWAS Race Equality Network (REN)

August/September

• Manchester Pride – unacceptable homophobic comments on the FB page, outweighed by the number of positive responses
• Sexual harassment – Sky news report re 3 female ambulance service employees (not NWAS) faced sexual harassment at work
• ENEI – third consecutive year the trust achieved the gold standard in the ENEI’s Talent Inclusion & Diversity Evaluation (3rd highest overall globally)
• HSJ – won the Mental Health Safety Improvement Award – for a questionnaire module which allows for a timely upgrade and response to patients who have overdosed on high-risk drugs

Trust Management Committee Papers / Minutes

Work Plan: Equality & Diversity Regulatory Indicators presented in May 24 & scheduled January 25

D&I Group Assurance Reports presented in June & November 24 and Feb & scheduled March 25

April – Mental Health Annual report 23/24 presented. Concerns re 111 and 999 MH calls flagged to the ICB and senior leaders

May – Trust Strategy Refresh – a full EIA will be completed in an equitable and consistent way

Complaint reporting 23/24 – demographic information is to be a development for 24/25

Oliver Gower Mandatory training for all staff introduced in 2023 – to ensure staff have a better understanding and training for how to interact appropriately with people with a learning disability and autism – next phase is face to face by those with lived experience

Mental Health response vehicles live on 15 May

June – Safeguarding Annual report 23/24 presented – referral system is continually monitored to ensure positive engagement with social care partners

Mental Health Strategic plan 23/24 presented – commitment to training staff in a comprehensive way to ensure priority of esteem to value mental health equally with physical health and Mental Health Response Vehicle Operational Manager approved for recruitment

Diversity & Inclusion 3A report presented – EDI risk to be linked to the trust strategic priorities

July – Dress code policy , supplementary paper re the wearing of wrist watches – an EIA to be completed

September – From October 24 employers will have a legal duty to take all reasonable steps to prevent sexual harassment of workers, including from third parties

Carry Chairs – an EIA is required to ensure the chairs are suitable for Bariatric use

Strategic mental health plan represented – the EIA to be checked for alignment with the refined key priorities

Diversity & Inclusion Group 3A report presented

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

Any recognised Equality related impacts are a key focus of the reporting processes to the Board of Directors, Committees and Groups. Specifically, reports/proposals are expected to highlight whether any specific staff or patient groups would be impacted by any decision made by the Board and where possible how this can be mitigated.

The completion of an Equality Impact Assessment (EIA) is an evidence-based approach, designed to help the Trust ensure that policies, practices, events and decision-making processes are fair and do not present barriers to participation or disadvantage any groups, with protected characteristics, from participating. The EIA process assesses the impact to these group compared to those not from the 9 protected characteristics and other linked/similar groups.

EIAs are required to be carried out at the beginning of any decision making process to allow engagement with diverse groups as part of any policy development/proposal.

This is an essential element of the Boards decision making and demonstrates compliance with the Public Sector Equality Duty.

The Corporate Governance Team support this work through the use of report templates and ensuring policy authors have engaged with the Inclusion Team in relation to completing an EIA to accompany policies and strategies.

Risks are discussed: both the broader aspects of approaches and the impact on individual groups

All report templates feature a section for authors of reports to indicate whether there are any impacts relating to equality or sustainability. Any identified impacts are required to be reported within this section setting out what mitigations are in place, should there be any.

This section of the report is a key focus for the Board and authors consider the equality related impacts. Some more comprehensively than others and seems to be improving. This again is as a result of the focus on equality and health inequalities being undertaken by the Trust. Board papers can be viewed on the Trust website to identify this www.nwas.nhs.uk

The Board receives information about the staff survey and information about the responses of different staff groups. Directorates are requested to submit their local people plan in response to the results of the staff survey to improve those areas where performance may have been low or where improvements to working practices have been identified.

The Resources Committee receive an overview of workforce data that the Trust is required to publish in relation to WRES, WDES and Gender Pay Gap. This report details the actions in places to address inequalities in the workplace and areas of focus. For example: WRES data includes experiences of colleagues from black and minority ethnic backgrounds (BAME), headcount of BAME staff, work being undertaken to develop a representative workforce.

The Board review and approve the Equality, Diversity and Inclusion annual report for publication on the Trust’s website. This report details all the work undertaken during the last financial year.

The Committees receive the Board Assurance Framework (BAF) strategic risks that are aligned to areas of work. In addition, D&I Group receives the EDI risk register providing the Group with an opportunity to discuss, identify the controls/gaps that require further assurance to mitigate these risks i.e. mental health/patients with disabilities.

3. What have been the drivers for delivering this outcome?

Results from Staff Survey.

WRES, WDES data and gender pay gap data.

Trust priorities: EDI, regulatory and statutory EDI workforce data requirements

Learning from FTSU processes

Areas of focus from Network groups

NWAS People Plan

Trust’s Strategy

Trust Annual Planning processes

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

Failure to identify any equality related impacts through non completion of an EIA as a result of not engaging with relevant group that might be considered to be impacted. This further delays the assurance/decision making process until a completed EIA is received to ensure protected characteristics are considered.

5. Any other comments relating to this outcome

Delivery of an EIA for any strategy/policy and consideration of the equality impacts within reports that come before Committees/Board is essential. The Board need to understand whether any decisions they make impact on staff or communities that can be identified within the 9 protected characteristics.

3C: Board members, system, and senior leaders (Band 9 and VSM) ensure levers are in place to manage performance and monitor progress with staff and patients

Evidence provided by: Corporate Governance Team

1. In delivery of this outcome, how have the needs of protected characteristics groups been considered and met?

The refreshed EDI priorities 2024-2026 were approved by the Board of Directors in July 2024.

Priority 1: We will embed fair and inclusive recruitment and progression processes to improve the diversity of the workforce at all levels.

Priority 2: We will educate and empower our workforce and leaders to promote a positive psychologically safe culture, to support a reduction in the experience of bullying, harassment, discrimination and an improvement in retention.

Priority 3: We will reduce health inequalities for our patients.

This was also accompanied by the EDI Annual Plan 2024/25 developed to monitor progress against the actions within the three areas which identifies the focus of the improvement goals, how they will be delivered and the measures of success for each priority.

2. Please provide a summary of the work that has been undertaken in the past year relating to this EDS outcome

There are a number of mechanisms for the Board to manage performance and monitor progress as follows:

July 2024: the Board received assurance through the Annual Equality, Diversity and Inclusion Annual Report 2023/24. The report shows progress and updates on the EDI priorities, around attraction, recruitment and progression, developing a culturally competent organisation and addresses health inequalities. It also provides an overview of the statutory regulatory data reporting including WRES, WDES, delivery of community and patient engagement and the work of the Staff Networks who make a positive contribution to the culture of the organisation.

April 2024:Board received presentation relating to the culture review.

July 2024: the Board received the EDI Priorities 2024-2026 and EDI Annual Plan.

May 2024: Resources Committee received the Culture Review providing a background to the publication of the Culture Review of ambulance services in February 2024.

July 2024: Regulatory and Statutory EDI Workforce Report for 2023/24.

• WRES/WDES Data
• Gender Pay Gap.
• Workforce Equality Data Monitoring

-Diversity and Inclusion Group provides assurance to Trust Management Committee on progress of its work through the 3A Reports. The work programme for the Group identifies when assurance against the three EDI priorities are scheduled during 2024/25.

-Workforce Indicator Report to Resources Committee provides bi-monthly assurance against sickness levels; mandatory training and performance against targets; appraisal completion rates against targets;, turnover; vacancy position; casework; disciplinaries. Assurance is provided to the Board via the Resources Committee Chairs Assurance Report.

-Bi-monthly Integrated performance Report to Board: .this report provides bi-monthly data to the Board in relation to a set of metrics required by the Single Oversight Framework relating quality, effectiveness, operational performance, finance and workforce data. A review of the data against protected characteristics to understand and improve patient experience is undertaken by the Diversity and Inclusion Group.

3. What have been the drivers for delivering this outcome?

Results from Staff Survey.

WRES, WDES data and gender pay gap data.

Trust priorities: EDI, regulatory and statutory EDI workforce data requirements

Learning from FTSU processes

Areas of focus from Network groups

Trust’s Strategy

Trust Annual Planning processes

4. Provide an overview of challenges (if any) which have affected delivery of this outcome

There are many diverse communities within footprint of NWAS, need to offer bespoke avenues of support for areas with specific needs not only for patients but also for staff

Unable to commit to permanent resources rely on third parties to assist the trust in this work.

Large amount of work being undertaken across the Trust in relation to EDI

Contact: Staff Experience Team – [email protected]