The Equality Measurement Framework: Latest findings using the Adult Inpatient Survey

Vizard, Polly Ann (2014). 'The Equality Measurement Framework: Latest findings using the Adult Inpatient Survey' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.


The Equality Measurement Framework is a new indicator based tool that is used to monitor equality and human rights in Britain. The Framework has been developed in partnership with the British Equality and Human Rights Commission (EHRC), which has a general statutory duty to promote equality and to protect human rights in England, Scotland and Wales, as well as specific duties to report to Parliament on progress towards equality and human rights using indicators. The EHRC also has responsibilities to promote international human rights standards, including the UN Convention on Rights of the Child (CRC), in its role as a 'National Human Rights Institution' (NHRI). The EMF has been developed to assist the EHRC in discharging these duties.


The EMF has its conceptual roots in Sen's idea of capabilities and applies the analytical framework for operationalizing the capability approach proposed in Burchardt and Vizard (2011). This covers 10 critical domains (life; health; physical security; legal security; education and learning; standard of living; productive and valued activities; individual, family and social life; identity, expression and self-respect; and participation, influence and voice). Evidence is built up on the distribution of capabilities of amongst different population subgroups using a system of 'spotlight' indicators and through systematic disaggregation using a list of 'equality characteristics'  (gender, disability, ethnic group etc.) which is grounded in equality and human rights standards. The EMF indicator set aims to put the 'spotlight' on a range of key equality and human rights concerns (rather than adopting a single composite summary indicator approach). It includes a balance of objective and subjective indicators and gathers information on three critical aspects of inequality (functionings, treatment and autonomy).


The proposed paper examines latest EMF findings against two health domain indicators: treatment with dignity and respect during hosptial stays; and support with nutritional needs during hospital stays. Specifically, the paper uses the Adult Inpatient Survey to build up a new quantitative evidence base on older people's experiences of dignity and support with eating during hospital stays in England. The paper begins by reporting findings on the proportion of older people who report that they are not treated with dignity and respect, or that they did not receive the help that they need with eating, during hospital stays. Older people's risks of poor treatment are then compared with those for other population subgroups; and the impact of additional characteristics such as gender and disability are examined. Trends in the proportion who report that they did not receive help with eating during a hospital stay (if it was needed) are evaluated over the period 2004-2012. The effects of individual characteristics (such as age, gender and disability) and 'journey through hospital' (e.g. emergency versus planned admission and the number of wards a person stays in) as well as individual trust level effects are examined using multivariate analysis. Various different versions of a multivariate logistic regression model for 'not receiving help with eating when it is needed' are reported. These are specified as including different independent variables; with and without interaction effects between age and disability; and using both standard logistic regression techniques and multilevel logistic regression techniques. Finally, conclusions are drawn about the ways in which the new quantitative findings add to other evidence in this area, such as pre-existing qualitative evidence and inspection and monitoring evidence gathered by the Care Quality Commission.


The paper informs current and ongoing discussions about the treatment of older people in healthcare in Britain. Concerns about older people's treatment in healthcare, including older peopel's experiences of dignity and nutrition during hospital stays, have moved up the public, political, healthcare and policy agendas in recent years. In 2007, the Joint Committee on Human Rights agenda-setting report The Human Rights of Older People in Healthcare (JCHR 2007) raised concerns about poor treatment, neglect, abuse, discrimination, lack of support for eating and drinking, and malnutrition and dehydration. Age UK highlighted lack of detection and treatment of malnutrition in hospital as a 'national disgrace' and called on the Government to introduce compulsory monitoring of malnutrition (Age UK 2010). Patients Association (2011) examined sixteen accounts of poor hospital care focusing on care-communication, lack of access to pain relief, lack of assistance with toileting, and lack of help with eating and drinking. Lack of assistance with eating and drinking was also raised as a key concern in investigations by the Health Service Ombudsman into NHS care of older people (HSO 2011). Further concerns were highlighted in the Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust 2010, and the subsequent full public inquiry which examined the failure of commissioning, supervisory and regulatory bodies to identify poor practice (the Francis Inquiry).


Specific engagement with the capability approach will be achieved in several ways. First, as noted above the Equaltiy Measurement Framework provides an operationalisation of the capability approach and the conceptual and methodological basis of the EMF in the capability approach will be discussed. Second, the paper reports specific quantiative findings on inequalities in the capability for health in Britain. Third, current discussions in the literature concern the role of dignity within the capability framework. The paper engages with these discussions by considering the feasibility and nature of developing survey measures of dignity and respect.

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