Commissioning has a central role in monitoring the performance of services against outcome indicators and evaluating them more broadly to: understand how services are functioning; establish the impact of any changes made; and swiftly identify emerging issues that may require service modification. However, though there are large infrastructures devoted to monitoring performance at local and national levels within the NHS, these have rarely had a focus on ethnic, or indeed other, inequalities.
The EEiC project found that outcome indicators were rarely specified in terms of ethnicity and available levers within contracts, such as general statements around ensuring equitable access, were rarely used to support service improvements for minority ethnic people. This in turn meant that prompts for active, ‘transformational’ commissioning work were primarily efficiency (i.e. ‘more for less’) or quality driven, rather than being driven by equity concerns.
EEiC tools and resources to support this area of work:
- Common service issues for consideration – prompt sheet
- EEiC mini case study: making Equality Impact Assessments work
- Promising practices in this and other stages of the commissioning cycle are documented in EEiC briefing paper no. 2.
Other resources and links
Guidance on Equity Audits are given on the strategic planning page.
In Oxleas a CQUIN was used to prompt action to increase understanding of BME experience of mental health services by engaging service users from minority backgrounds in the evaluation of services.
The Gradient Evaluation Framework is an action-oriented policy tool that can be applied to assess whether policies will contribute to greater health equity amongst children and their families. GEF provides a framework for the evaluation and implementation of policy-actions at each stage of the policy cycle and can be applied to a wide range of policies. It requires the mobilisation of data, evidence and knowledge to inform the process.