Lynda Gordon

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Lynda Gordon Head of Equality Assurance Unit
Craigavon Banbridge Community HSS Trust
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Presentation Outline
Setting the Scene Role of the Unit and Trust.
Background to the Provision of Domestic and
Catering Services.
C O N T E N T S
Strategic Context
EQIA Process and the Benefits of Mainstreaming
Conclusion
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Equality Assurance Unit
Armagh Dungannon HSS Trust
Craigavon Banbridge Community HSS Trust
1990 staff
3053 staff
2657 staff
Equality Assurance Unit
Newry Mourne HSS Trust
Craigavon Area Hospital Group HSS Trust
C O N T E X T
4 staff
Southern Health Social Services Board
Southern Health Social Services Council
3281 staff
260 staff
Included in Board staff count
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Craigavon and Banbridge Community Health Social
Services Trust
Promoting health and wellbeing by providing
quality services within resource limits, close to
or in the homes of people who have a health
and/or social care need.
C O N T E X T
Trusts population 123,900.
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Provision of Catering and Domestic Services
Hotel services (i.e. domestic catering) viewed
as non core services. In line with the then
Government Policy these services were subjected
to CCT/Market Testing.
Consequently, domestic and catering services were
provided via a hybrid arrangement of in-house
and contracted out services i.e 50 of contract
was outsourced.
1 April 1995 contract awarded to Gardner
Merchant, expiry date of 31/3/2000 (included an
option to extend for further 2 years). NB this
contract included the provision of services to
both this and CAH Group Trust.
B A C K G R O U N D
February 2000 Gardner Merchant changed its name
to Sodexho. The option of the 2 year extension
was availed of, taking the contract to March 2002.
Publication of Circular HSS (F) 27/2001 extended
the timeframe by a further year (March 2003).
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Management Requirement to Market Test
Management requirement to market test support
services first introduced in Circular HSS (C1)
1/88 dated 26 July 1988.
The requirement was reiterated in Circular HSS
(F) 12/94 dated 24 June 1994 which also restated
the requirement in the White Paper Competing for
Quality (CM 1730 November 1991) for the HPSS to
market test a wide range of services.
DHSSPS Circular HSS (F) 27/2001 Market Testing
Assessment of Equality Implications and other
Related Matters confirmed the decision to remove
the requirement with immediate effect. It also
set out principles to be applied by HPSS bodies
in securing the future provision of hotel
services. Further, it required the equality
implications to be assessed for those services
which had been previously subjected to market
testing.
S T R A T E G I C C O N T E X T
The Management Requirement or compulsion to
market test hotel services has been withdrawn by
the Minister, Ms Barbre de Brun. It is therefore
no longer compulsory for Boards, Trusts and
Agencies to market test the specified services,
or to expand market testing into other areas.
However, this does not remove the requirement on
HPSS bodies to seek out efficiencies and make
savings.
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Core Principles Circular HSS (F) 27/2001
Chief Executives must ensure that hotel services
are provided economically, efficiently and
effectively.
Chief Executives must secure quality services at
the best value for money consistent with legal
obligations regarding equality i.e. conduct
equality impact assessments (EQIA) on those
services previously subjected to market testing.
S T R A T E G I C C O N T E X T
Chief Executives should engage staff, service
users, service providers in discussion concerning
the specification of standards and the monitoring
of outcomes.
Relevant trade unions should be engaged regarding
the future provision of services when work
commences to renew or change an existing service
level agreement/contract.
Chief Executives must forward the Equality Impact
Assessments (EQIAs) to the Department of Health,
Social Services Public Safety (DHSSPS).
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Considerations
Establish Trusts legal position re. the
extension of the current contract by up to 12-18
months to work through the issues outlined - was
unlikely to constitute an infringement of
competition law.
Develop a vision for the future provision of
support services that-

• Enhance the life experience and environment of
  all of its clients.
• Treat staff delivering these services fairly and
  equitably.
• Demonstrate value for money and reflects best
  industry practice in terms of cost and quality.
• Are responsive to the changing needs of the
  Trust.
• Promote a homely environment.

T H E W A Y F O R W A R D
Inform the DHSSPS of the programme for reviewing
the support services contract.
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EQIA Process
A thorough and systematic analysis of a policy.
The primary function of an EQIA is to determine
the extent of differential impact upon the
relevant groups and in turn, whether the impact
was adverse. This process involved conducting a
full EQIA.
In conducting the EQIA the Trust took cognisance
of Equality Commission for Northern Irelands
(ECNI) Practical Guidance on Equality Impact
Assessment together with the commitments as
outlined in the Trusts Equality Scheme. The
seven stages of an EQIA are-
C O N D U C T I N G A N E Q I A

• Consideration of Available Data and Research
• Assessment of Impacts
• Consideration of measures which might mitigate
  any adverse impact or alternative policies which
  might better achieve the promotion of equality of
  opportunity
• Formal Consultation
• Decision by the Trust
• Publication of the Results of the EQIA
• Monitor for Adverse Impact in the Future and
  Publication of the Results of Such Monitoring.

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Defining the Aim of the Policy
Key stage before embarking on an EQIA is to
determine the policy aim.
To ensure the provision of a catering and
cleaning service which meets the required
standards in an economical, effective and
efficient manner which is based on best
contemporary practice and provides a service
based on the promotion of equality of opportunity.
C O N D U C T I N G A N E Q I A
While the consideration of equality issues is
integral to the decision making process, it had
to be balanced with other significant impacting
issues such as affordability, human resource
implications and quality issues Clean
Hospitals circular issued by the DHSSPS refers.
Equality
Economical Effective Efficient
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Key Stage 1 - Consideration of Available Data and
Research
Relevant, reliable and up-to-date information is
essential. Statistics alone do not provide
reasons or explanations for differences.
Trust project group utilised both quantitative
and qualitative data when comparing the equality
implications of either subjecting domestic and
catering services to market testing or to return
these services to Trust management.
Quantitative data was supplied by Sodexho (NI)
as far as practical in relation to the 9
categories. Reflecting on the previous analysis
re. the impact of CCT, conducted by the then EOC
(NI), information was gathered regarding the
range of pay and terms and conditions of service
provided by Sodexho and compared with the Trust.
C O N D U C T I N G A N E Q I A
There was a recognition of the degree of
commercial sensitivity that surrounded the Trust
providing discrete data in the public arena that
may present an advantage to Sodexhos potential
competitors in an open market situation. To
maintain commercial confidentiality a data range
of external employee numbers and contract costs
were been used for indicative purposes at the
formal consultation stage.
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Key Stage 1 - Consideration of Available Data and
Research
Qualitative data was sought through the use of
service users (patients, clients, staff and
carers) surveys to gauge the level of
satisfaction re. quality, cleanliness etc.
Further qualitative information was sourced from
various research reports e.g. Out of the
Shadows, An Action Report into Families, Racism
and Exclusion in Northern Ireland (NI Council
for Ethnic Minorities) and Racial Equality in
Health Good Practice Guide (DHSSPSNI and ECNI).
C O N D U C T I N G A N E Q I A
Pre-consultation was also undertaken with key
stakeholders to ascertain any adverse impact of
either proposing to market test or to return
domestic and catering services into Trust
management.
We need to ask our service users, staff and
other interested parties what they think of our
performance and the priorities we set
benchmarking our performance against the best.
(Barbre de Brun, NI Minister for Health)
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Key Stage 2 Assessment of Impacts
The public authority must use the information
gathered in Stage 1 to decide whether there is
likely to be a differential impact, whether
direct or indirect, upon the relevant group(s).
Comparison of the composition of the contracted
out staff and Trusts own staff was drawn with
the 1991 Census figures for the Craigavon
Banbridge areas to determine if any disparities
in inequality were apparent. These statistics
were used only as a guideline as it was
acknowledged that changes in the population had
taken place since 1991.
C O N D U C T I N G A N E Q I A
The Trust allocated between 400k - 500k per
annum to catering and domestic services linked to
this contract.
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Key Stage 2 Assessment of Impacts
While an EQIA must address all 9 categories, it
is not intended that each category will be
afforded equal emphasis throughout the assessment
process instead the EQIA must be responsive to
emerging issues and prioritised accordingly.
Terms and Conditions of Service
Adverse
Men and Women generally
Terms and Conditions of Service
Adverse
Persons with or without dependants
C O N D U C T I N G A N E Q I A
Marital Status
Adverse
More likely to have dependants elderly or
children
Religious Belief
No evidence of adverse impact
None
Age
No evidence of adverse impact
None
Political Opinion
No available data
Racial Group
No available data
Sexual Orientation
No available data
No available data
Persons with or without a disability
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Key Stage 2 Assessment of Impacts
CURRENT PROVIDERS PERSPECTIVE
Sodexho felt the Trust should consider that a
status quo situation remain an option in the
belief that this would enable all interested
parties to work towards a new partnership/stakehol
der agreement that would allow the development of
services with the potential of greater reward for
staff.
C O N D U C T I N G A N E Q I A
The current provider, having been involved with
the Trust for a number of years, felt they were
best placed to develop such partnership
arrangements between all parties and to meet the
Trusts requirement under Section 75, Northern
Ireland Act.
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Key Stage 3 Consideration of Measures
The consideration of mitigation and alternatives
are crucial elements of the process. Options
must be developed which reflect different ways of
delivering the policy outcome.
In this phase of the work the Trust explored the
range of available options for the future
provision of catering and cleaning services that
would satisfy both the vision developed by the
Trust and the requirements of the equality
legislation Circular HSS (F) 27/2001 refers.
C O N D U C T I N G A N E Q I A
An initial list of options were developed and the
key advantages/ disadvantages of each option
considered against service pressures being
experienced by the Trust and each options
ability to meet the benefits criteria and
desirable service improvements.
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Key Stage 3 Consideration of Measures
SERVICE PRESSURES
There were a number of succinct pressures facing
any Trust in the provision of catering and
cleaning services. These included-

• New direction on market testing from the DHSSPS
  no longer compulsory.
• Ability to demonstrate value for money in the
  provision of these services.
• Advent of Section 75, NI Act 1998 i.e.
  requirement to screen policies and consider
  EQIAs.
• Increasingly uncertain market may limit number of
  contractors wishing to tender thus reducing the
  true competitive nature of any market testing
  programme.
• Increasing political and social expectation for
  standards of cleaning and catering to increase.
• Recruitment difficulties in this area due to low
  rates of pay and as such any new service contract
  was likely to cost more.

C O N D U C T I N G A N E Q I A
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Key Stage 3 Consideration of Measures
BENEFITS CRITERIA
For each option under consideration, each in turn
were assessed against the following criteria-

• Acceptability to staff side
• Recruitment/retention of staff
• Access to capital
• Quality of service
• Management time
• Political acceptability
• Disruption of change
• Trust overheads
• Acceptability to management
• Compatibility with equality legislation
• Customer satisfaction

C O N D U C T I N G A N E Q I A
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Key Stage 3 Consideration of Measures
OPTION APPRAISAL
The Trust explored a number of options available
and assessed the key advantages and disadvantages
of each option in the current political and
financial climate-

• Do nothing
• Market test with an in-house team
• Market test without an in-house team
• Bring services back in-house
• Complete a Best Value exercise prior to market
  testing

C O N D U C T I N G A N E Q I A
There were a number of other options but the
above options were considered the most
appropriate and realistic.
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Key Stage 3 Consideration of Measures
OPTION 1 DO NOTHING
This option involved maintaining the status quo
and keeping the current service provider as
currently configured.
OPTION 2 MARKET TEST WITH AN IN-HOUSE TEAM
This option involved the full Market Testing of
the services through an OJEC Procurement process
and the Trust identifying an appropriately
skilled qualified team to develop an in-house
tender.
C O N D U C T I N G A N E Q I A
OPTION 3 MARKET TEST WITHOUT AN IN-HOUSE TEAM
This option is the same as Option 2 with the
notable exception that it does not include an
in-house team due to the lack of an available
structure.
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Key Stage 3 Consideration of Measures
OPTION 4 BRING SERVICES BACK IN-HOUSE
This option involved the rejection of the OJEC
Procurement process in favour of a negotiated
contract with staff side to return all the
services to an in-house team. Strengths-

• Comparatively low cost option excludes any
  tendering/ evaluation/in-house costs.
• Potential to receive staff side support and be
  politically acceptable.
• No profit element to be paid to external
  provider.
• Potentially least expensive in terms of cost and
  time.
• Process could be resolved within shorter time
  frame.

C O N D U C T I N G A N E Q I A
Weaknesses-

• Required capital investment e.g. equipment and
  uniforms etc.
• Did not reflect current pressures for increased
  standards in service provision.
• Unlikely to address labour costs/skills
  shortages, recruitment and retention
  difficulties.

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Key Stage 3 Consideration of Measures
OPTION 5 COMPLETE A BEST VALUE EXERCISE PRIOR
TO MARKET TESTING
This option entailed maintaining the status quo
and working with staff side re. a negotiated
return in-house of services, whilst exploring the
opportunity to address and resolve staff related
issues such as recruitment and retention. Strength
s-

• Low cost option - it excluded tendering/evaluation
  /in-house costs.
• Likely to be acceptable to staff side.
• Minimum of disruption to clients and service
  users.
• Ability to identify capital implications in
  advance.
• Likely to address labour costs, skill shortages,
  recruitment retention issues.
• Allowed the Trust to complete its own Best
  Value exercise based on new standards, costs and
  quality benchmarks.

C O N D U C T I N G A N E Q I A
Weaknesses-

• Potential to be politically unacceptable.
• Without agreement with staff side re. generic
  grades, it was unlikely to address the labour
  costs, skill shortages, recruitment and retention
  difficulties.

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Key Stage 3 Consideration of Measures
WEIGHTING AND SCORING

• The project group undertook a weighting and
  scoring exercise against the benefits criteria
  referred to earlier to determine the preferred
  option.
• Each benefit criteria was given a weighted score
  and the ability of each option to provide that
  benefit was scored.
• Two options scored very closely option 4
  Bring Services Back In-House and option 5
  Complete a Best Value Exercise.
• Based on the scoring exercise alone option 4
  was the preferred option.
• Key difference for the Trust with these options
  was that while option 4 was acceptable option 5
  had the potential to offer a large range of
  qualitative benefits such as the potential for
  introducing a generic support grade which would
  enhance flexibility within the workforce improve
  the quality and consistency of service provision
  particularly within residential facilities.
• A financial analysis was undertaken of option 4
  initially using Whitley Terms and Conditions
  which showed a net saving of 30K per annum.

C O N D U C T I N G A N E Q I A
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Key Stage 3 Consideration of Measures
PREFERRED OPTION

• Short presentation made to Trust Board August
  2002 outlining progress to date and indicating
  that Option 4 was preferred at present.
• Approval was sought to undertake further work in
  partnership with the trade unions on a Best
  Value exercise, the outcome of which would be
  referred back to the Trust Board for a decision
  on an overall preferred option (after
  consultation had taken place).
• In addition to the return of hotel services
  in-house, the Trust Board wished to avail of the
  opportunity to enhance the quality of service
  provision within its residential facilities by
  examining the potential to re-profile the grade
  mix of support staff.

C O N D U C T I N G A N E Q I A
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Key Stage 3 Consideration of Measures
PREFERRED OPTION
At that time, the mix of support staff was as
follows-

• Care Assistants
• Catering Assistants
• Domestic Assistants

As was the case with other HPSS Trusts in the
province, the Trust was experiencing increased
recruitment and retention difficulties with the
above, and other, grades of staff.
In addition, the traditional job demarcations
associated with these support grades in small
residential facilities had limited the extent to
which facility managers could deploy their
available staffing resources to maximum benefit.
C O N D U C T I N G A N E Q I A
In summary, the Trust believed that agreement
could be reached with trade unions for staff in
these grades to be deployed to undertake a
diverse range of support tasks e.g. catering,
domestic as well as personal care duties.
Although the preferred option was to return
services in-house with Sodexho staff being
offered Whitley terms and conditions, the Trust
Board believed there was merit in further
examining Option 5 Complete a Best Value
exercise prior to market testing.
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Key Stage 3 Consideration of Measures
THE BEST VALUE PROCESS
The Best Value process is a methodology for
identifying, discussing and implementing methods
of service delivery that can enhance service
quality within the most cost-effective financial
envelope.
In this instance, the aim of the Best Value
exercise was to examine the potential for
bringing catering and domestic staff currently
with Sodexho back in-house and to develop new
grades of staff which would encompass the roles
currently undertaken by both Sodexho and Trust
staff.
C O N D U C T I N G A N E Q I A
The Trust used the Best Value process to enable
all parties to discuss potential areas of
conflict and/or disagreement within an overall
plan of attainment thus providing an opportunity
to review and assess areas of best practice and
to review the big picture.
As an initial step, terms of reference and key
action points were developed for the Best Value
Group. This included start/finish date for best
value programme disagreement procedure
sign-off procedure financial framework of
affordability agree the cost and service
parameters e.g. rates of sickness and overtime
management, supervisory and monitoring structures
etc.
This provided an opportunity to mainstream
quality and equality considerations into agreed
outcomes.
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Key Stage 3 Consideration of Measures
THE BEST VALUE PROCESS
UNISON listed a number of issues to be considered
in the creation of new specifications for the
future provision of catering and cleaning
services as part of the Best Value process-

• A need to meet requirements of the new standards
  for environmental cleanliness.
• A concern about training with requirements
  including induction training machinery training
  and manual handling standards and the
  specification and patient interaction and care.
• Uniform requirements needed to be strengthened
  and hygiene standards closely monitored.

C O N D U C T I N G A N E Q I A
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Key Stage 4 Consultation
Consultation must be carried out with relevant
interest groups as well as the ECNI, other public
bodies, voluntary, community, trade union and
other groups with a legitimate interest in the
matter.
From inception and throughout the process,
leading to the final decision, the Trust engaged
with those that had a legitimate interest.
C O N D U C T I N G A N E Q I A
At an early stage it engaged with the ECNI,
DHSSPS, trade unions, service provider and
service users in keeping with the Ministers
statement.

• In keeping with the commitments in our Equality
  Scheme the consultative document was issued
  directly to key consultees and we advised the
  general public of the availability of the formal
  consultation document via press adverts, press
  releases and a postal drop to all those on our
  master consultation list (650).

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Key Stage 5 Decision by the Trust
Legislation requires that in making any decision
with respect to a policy adopted or proposed to
be adopted by it, that the public authority shall
take into account any EQIA and consultation
carried out in relation to the policy.
Options 4 and 5 were presented to the Trust Board
In February 2003. Based on the impact
assessment, Best Value exercises and view of
consultees, a recommendation was made to accept
Option 5.
C O N D U C T I N G A N E Q I A
Agreement was reached with trade unions which
included the introduction of two new generic
grade of staff (RFSS and FSS) which the Trust
believed would allow staff to work flexibly
through both domiciliary and residential care.
It was believed that this would improve
recruitment and retention difficulties, improve
the quality of service provided and provide added
benefits for staff and clients in that managers
can deploy available staff resources in
accordance with the day to day needs of clients.
It was hoped that job satisfaction would also
increase in that it gave staff the opportunity to
gain a range of competencies which would, in
turn, enhance their career prospects.
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Key Stage 6 Publication of EQIA
Legislation (Schedule 9, para 9) requires public
authorities to publish the results of their
EQIAs.
Copies of the results of the EQIA were available
on request from the Director of Human Resources.
In addition, the results were also published in
the Trusts annual progress report to the ECNI
and in its own annual report.
C O N D U C T I N G A N E Q I A
The Trust also informed the general public about
the availability of the EQIA results through a
press release in the local media.
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Key Stage 7 Monitoring for Adverse Impact in
the Future
A system must be established to monitor the
impact of the policy in order to find out its
effect on the relevant group.
Through regular surveys and unannounced
spot-checks the Trust monitors cleanliness and
hygiene standards agreed in the specification as
well as the extent of service user satisfaction.
C O N D U C T I N G A N E Q I A
Staff who have been placed on the new generic
grade are monitored under the Trusts Staff
Development and Performance Review scheme which
would highlight areas such as job satisfaction,
personal development needs etc.
The decision to return services in-house paid due
regard to the need to promote equality of
opportunity as well as satisfying the core
elements of Circular HSS (F) 27/2001 economic,
effective and cost-efficient services.
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Benefits of Mainstreaming
The (re)organisation, improvement, development
and evaluation of policy processes, so that an
equality perspective is incorporated in all
policies at all levels and at all stages, by the
actors normally involved in policy making. ECNI
Guide to the Statutory Duties
In this instance the application of the EQIA
process provided for a better informed decision
by utilising techniques of systematic policy
appraisal/impact assessment in that it allowed
the Trust to make a decision on fuller
information about the effects of their decisions
on the relevant groups.
C O N C L U S I O N
It encouraged greater openness and transparency
in the decision making process since it engaged
the key stakeholders and those with a legitimate
interest and at an early stage of the decision
making process. As such, this encouraged greater
participation and led to greater accountability
in decision making.
It assisted the Trust to efficiently and
effectively address the issues of equality, at
the same time satisfying other imperatives such
as providing a Best Value service.
The Trust satisfied all legislative requirements.
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For further information-
Mrs Lynda Gordon Head of Equality Assurance
Unit Craigavon and Banbridge Community Health and
Social Services Trust The Bungalow Lurgan
Hospital Site 100 Sloan Street, Lurgan Co.
Armagh, BT66 8NX Tel [phone] Fax
028 3831 6675 E-mail lynda.gordon_at_cbct.n-i.nhs.
uk
C O N T A C T I N F O