This equality impact assessment relates to changes that we propose in our consultation on improving how we make judgements and award ratings.
It aims to identify and assess the impact and any risks from our decisions on specific groups of people. It also aims to improve how we identify any good or outstanding practice within a service that results in more equitable access, experience or outcomes for groups of people.
Potential impacts to consider
We look at the potential risks, opportunities and impact for people with protected equality characteristics in the following areas, and people in other specific circumstances:
Age
- People who use health and care services of all ages, including children, who have additional vulnerabilities or needs.
- Any equity issues for people of different ages who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to age, which could affect fairness for providers.
Disability
Disabled people, including people with mental health needs.
- People who use health and care services who have additional needs because of disability, who have a right to reasonable adjustments or who may face discrimination.
- Any equity issues for disabled people who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to disability, which could have an impact on fairness for providers.
Gender reassignment
Trans people and non-binary people.
- People who use health and care services who have additional needs because of gender reassignment or gender identity, or who may face discrimination.
- Any equity issues for trans or non-binary people who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to gender reassignment, which could have an impact on fairness for providers.
Although the regulations do refer to the Equality Act 2010, CQC does not set national policy on issues such as single-sex care provision, and we are not the primary regulator of the Equality Act 2010.
The Supreme Court has ruled that the legal definition of a woman and a man under the Equality Act 2010 is based on biological sex. Following this ruling, we will review the impact of this decision on our regulation, taking into account any national policy decisions from other bodies and any future statutory guidance from the Equality and Human Rights Commission.
CQC recognises that everyone – whether working in health and social care services or using these services – has the right to be treated with kindness, dignity and respect, free from harassment and discrimination. This includes on the grounds of gender reassignment, religion and belief, or sex. This is important in how we regulate services.
Pregnancy and maternity
- People who use health and care services who have additional needs because of pregnancy or maternity.
- Any equity issues for pregnant women or women with maternity protection who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to pregnancy or maternity, which could have an impact on fairness for providers.
Race
People from ethnic minority backgrounds, people of different nationalities.
- People using services who face racism in accessing or using health and social care services. This includes people with needs connected to ethnicity, such as people who use health and care services who may not speak English as their first language.
- Any equity issues for people from ethnic minority backgrounds who work in health and social care services, such as workplace racism, which might have an impact on the quality of care. This includes employees at risk of modern slavery.
- We also need to assess the impact of any decisions about our assessment approach that relate to race, ethnicity or nationality, which could have an impact on fairness for providers.
Religion or belief
People with different religions and/or beliefs or no belief.
- People who use health and care services who have additional cultural needs because of their religion or belief, or who may face discrimination because of their religion or belief.
- Any equity issues for people with different religions or beliefs who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to religion or belief, which could have an impact on fairness for providers.
Sex
Either male or female, or a group such as women or girls, men or boys.
- Ensuring services meet the needs of both men and women, unless they are a single-sex or separate-sex service
- Any equity issues for women or for men who work in health and social care services, which might have an impact on the quality of care.
- We also need to assess the impact of any decisions about our assessment approach that relate to sex, which could have an impact on fairness for providers.
Sexual orientation
People who are heterosexual, gay, lesbian or bisexual.
- People who use health and care services who have additional vulnerabilities or needs because of their sexual orientation, or who may face discrimination because of their sexual orientation.
- Any equity issues relating to sexual orientation for people who work in health and social care services, which might have an impact on the quality of care.
Carers
People with caring responsibilities.
- People who use health and care services who have additional needs because of their caring responsibilities.
Socio-economic
People from lower socio-economic backgrounds.
- People who use health and care services who have additional vulnerabilities or needs because of their socio-economic background.
Intersectionality
Includes any other relevant information relating to the intersection of any of these protected groups and any other cross-cutting issues.
- People who use health and care services who have additional vulnerabilities or needs because of the intersection of protected characteristics or other cross-cutting issues.
Wider issues of inequality
Health inequalities, inclusion health groups, cross-cutting issues.
- People who use health and care services who have additional vulnerabilities or needs because of wider issues of inequality. For example, access to good quality housing, education and transport, green space and clean air.
- Any specific issues for people from inclusion health groups, for example the NHS duty to refer homeless people, ensuring access to health care for vulnerable migrants, and following the NHS Inclusion Health Framework.
Human rights
We need to ensure that the regulatory model and assessment framework supports our commitment to promoting human rights and preventing human rights breaches, including our duties as a National Preventive Mechanism (NPM) body. Our NPM duties occur whenever we inspect or visit a service where people are deprived of their liberty – including under the Mental Health Act or those who have Deprivation of Liberty safeguards applied to them.
We need to follow NPM national guidance on a preventive approach to monitoring ill-treatment, especially the guidance on methodologies for visits (which will include assessment inspection activity). This includes:
- proactive regular visiting, including unannounced visits, which can take place at any time, even when there is no apparent problem
- visits that are informed by intelligence and consider:
- existing information about a facility
- concerns that have been raised or are ongoing
- the inherent risks of ill-treatment due to the specific needs of detained people
- any other relevant factors
- enabling monitors (such as Mental Health Act Reviewers) or inspectors to access all information on the number of detained people, their location, their treatment and the conditions in which they are held
- giving monitors or inspectors unrestricted access to the place of detention and enabling them to visit all its facilities
- enabling monitors or inspectors to:
- meet and interview in private people who are detained
- ask open questions
- show sensitivity in interviewing
- adopt different methods of interviewing
- take into consideration how people they interview are protected against reprisals
- enabling monitors or inspectors to make recommendations and other communications based on their visit
- using human rights standards and principles such as safety, dignity, respect, equality and non-discrimination, which help to identify cultural risk factors for ill-treatment of those who are detained
- ensuring the methodology captures people who are at increased risk of ill-treatment, and the points and practices in the detention process that increase the risk of ill-treatment, for example greater risk due to protected characteristics
- that methodologies and processes need to be adaptable and flexible to be fit for purpose.
Any proposed changes to the model and framework also need to ensure that we can identify and assess:
- risks to the human rights of people who use health and care services or employees in a service
- good practice within a service in protecting and promoting human rights.
Action plan
1. Engage and consult
Issue identified
We need to ensure that internal and external engagement, co-production and consultation on this work specifically includes a wide diversity of voices from minoritised and under-represented communities.
Action
- Undertake a range of engagement opportunities and outreach methods, following guidelines such as the Race and Health Observatory’s anti-racism principles and CQC’s approach to becoming an anti-racist organisation.
- Ensure that the approach to consultation proactively includes hearing from minoritised and under-represented groups.
2. Accessibility and language
Issue identified
We need to ensure that the assessment framework and its supporting guidance meets CQC’s accessibility standards and writing guidance on using clear, plain English language and terminology.
Action
- Ensure that all outputs follow CQC’s accessibility standards and internal guidance and terminology for people in protected characteristic groups and others. When a specific population group is mentioned but others are not, ensure there is a rationale for including it.
- Ensure that the draft assessment framework and associated guidance on assessments receives thorough testing with different groups of people who will be using them.
3. Name
Issue identified
We need to ensure that we can use the assessment framework to identify and name racism and other discrimination where we find it, to ensure that we address it through our regulatory activities.
Action
- Ensure that evidence in the People’s experience evidence category, and evidence from staff feedback has appropriate weight within the assessment framework. This is to support us in tackling epistemic injustice, which can arise if we pay more attention to evidence from providers and service leaders rather than people who use services and frontline staff.
4. Assure
Issue identified
We need to ensure consistency and confidence that equity and human rights are considered in the assessment process.
Action
- Ensure that the equity-focused quality statements (Equity in access; Equity in experience and outcomes; Workforce equality, diversity and inclusion; Listening and involving people; and Providing information) remain as priority topics in the assessment of services in all sectors.
- Ensure that evidence in the People’s experience and Observation evidence categories continues to have balanced weighting in the assessment and scoring of relevant quality statements, including those that are equity-focused (see above) and those that are likely to identify human rights abuses (Assessing needs, Person-centred care, and Independence, choice and control).
5. Systems
Issue identified
We need to ensure that the framework tackles inequalities in outcomes, experience and access at a system level.
Action
- Review the framework from a system perspective, ensuring it refers to tackling individual, institutional and structural discrimination and inequalities in outcomes, experience and access at a system level – for assessments of both providers and local authorities.
6. Legislation
Issue identified
We need to ensure that the framework consistently and correctly references equality and human rights legislation.
Action
- Review the content of the framework to ensure that equality and human rights legislation is referenced consistently and correctly, and that we are making the appropriate linkages to enable us to take preventative action where necessary and support rights-respecting care.
7. Fairness
Issue identified
We need to ensure that the framework will not inadvertently result in any unfairness for providers from particular equality groups, for example GP practices or adult social care services led by people from racialised minority backgrounds.
Action
- Consider this in testing and piloting both the regulatory model and assessment framework, and in analysing feedback from the consultation.
8. Human rights
Issue identified
We need to ensure that the model and framework meets National Preventive Mechanism guidance on a preventive approach to monitoring ill-treatment.
Action
- Consider this in developing, testing and piloting both the regulatory model and assessment framework, and in analysing feedback from the consultation.