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The Rumsfeld take on Equalities

Helen Jones's picture
By Helen Jones |  February 19, 2012 |

“There are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know.”

But there are also unknown unknowns – there are things we do not know we don’t know.

United States Secretary of Defense Donald Rumsfeld

Leeds GATE chair, Eileen Lowther, and I went to an event at Quarry House in Leeds last week. The Department of Health is introducing a new quality assurance system called the Equality Delivery System (EDS). The event was a ‘train the trainers’ session for professionals who will have to introduce the EDS to their teams or services.

Donald RumsfeldFor those not familiar with quality assurance, the EDS amounts to a series of questions about how the organisation accommodates equalities and diversity into its structure, leadership, service delivery and employment practices. The health provider or commissioner responds to each question with a grade (undeveloped, developing, achieving, excellent). The grades the health provider assesses itself are then checked with people involved in the services including patients, advocates, patient group representatives and staff, until an overall grade is arrived at.

Although Eileen doesn’t read she knows all about quality assurance because we were externally accredited for PQASSO (a charity commission endorsed quality assurance system) last year. So the idea of cross checking the quality of everything you do and how you do it is familiar.

Eileen and I gave a short presentation on the Leeds Baseline Census of Gypsies and Travellers. Eileen was one of the census enumerators. Although Gypsy and Irish Traveller health outcomes are still tragically poor in Leeds, we were able to describe the way that data gathered by local Gypsy and Irish Traveller people had aided the local health people to taken on board that something needs to be done. If they were to do an EDS assessment on themselves at NHS Leeds they could definitely score themselves as ‘achieving’ recognition of the health needs of these vulnerable people. Indeed they could point to the Gypsy and Traveller Health Needs Assessment which is currently being devised as evidence of good practice, perhaps even excellence.

The Department of Health will not use the EDS to castigate its providers when they are scored as ‘undeveloped’ in the first year. Instead there is a really positive approach to the EDS which I think will really encourage health providers to be honest about where they need to develop their equalities practice. The EDS will also help organisations greatly to check and evidence where they are compliant with legislation. Where they are not they will be able to recognise it and put action plans in place.

So will it be any good? I could be cynical but I’m honestly not. I think if everyone (particularly patients, advocates and representatives) can learn about EDS and support their local health providers to implement it; the EDS could be an equalities game changer that is good for all of us.

But we all know that quality assurance is always in danger of being a ‘tick box’ exercise involving the usual suspects ie infrastructure organisations or ‘old faithful’ representative groups. How can this be avoided? My advice is to ask the ‘Donald Rumsfeld Question’. Rumsfeld spoke famously of “known/unknowns and unknown/unknowns”, so the most important questions for EDS to be successful are “how can we find the unknown/unknowns?”, or in other words, ‘who might we have missed out? who are the people who we are not hearing from?

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