Frequently asked questions

The NHS Equality Delivery System (EDS) is a tool designed to help NHS organisations, in partnership with local stakeholders, to review and improve their performance for people with characteristics protected by the Equality Act 2010, and to support them in meeting the Public Sector Equality Duty (PSED). Full details of how to deliver the EDS are set out in the EDS Technical Guidance document.

‘Everyone counts’ is a key principle that applies to everyone served by the NHS and is at the heart of the NHS Constitution. The EDS is structured to generate regional and local conversations about what is working well and what is not working so well, enabling organisations to make necessary improvements, with lessons being learnt more widely. It assists local NHS organisations, in discussion with local partners including local populations, to review and improve their performance for patients, service users and the broader public.

The updated EDS supports the outcomes of the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES), by encouraging organisations to understand the connection between those outcomes and the health and wellbeing of staff members. This will support organisations to build a healthier and happier workforce by recognising the physical impact of discrimination, stress and inequalities, which will in turn increase the quality of care provided for patients, service users and broader populations.

Moreover, the EDS provides a ready-made way for the NHS to respond to the requirements of the PSED.


The NHS is managing a time of major change. It is essential that fairness lies at the heart of the decision making of the new systems and structures. The implications for staff and patients of poorly considered change could be substantial. NHS organisations should ensure that all decisions should be taken with due regard to the PSED to ensure that decisions are fair, transparent, accountable, evidence-based and consider the needs and rights of the workforce and different members of the community. Fairness will lie at the heart of our work; this will aid, not hinder, building a leaner NHS fit for the future.


Yes. All NHS organisations are expected to use the EDS to help them improve their equality performance for patients, communities and staff, as well as helping them to meet the requirements of the PSED.

From 2015/16 onwards, the NHS standard contract has stated that all provider organisations are required to complete the EDS. The NHS System Oversight Framework requires the completion of the EDS for indicator 51 (166a: Compliance with statutory guidance standards of patient and public participation in commissioning health and care).

NHS organisations should implement the EDS faithfully and robustly in-line with the guidance document

The new EDS has been split across 4 separate documents: Ratings and Score Card Guidance, the Technical Guidance, the Supporting Information Guidance and the new Reporting Template. The documents have specific audiences (highlighted on the front of each document) and are designed to encourage consistency and clearer information

The updated EDS has been constructed with input from 117 operational EDI (Equality, Diversity and Inclusion) leads from across the NHS system, in addition to 71 other individuals which include senior managers, chaplaincy staff and trade union representatives. In addition, further work was undertaken by a working group of 30 people which included trade union representatives, the Care Quality Commission, EDI colleagues and human rights colleagues.

Using this input, the updated EDS has been constructed to reflect changes in the system, as well as taking the impact of COVID-19 into account.

The main changes within the update of the EDS are within Domains 2 and 3. The update is streamlined with fewer indicators and stronger guidance surrounding the evidence required for grading. This in turn will reduce variation across organisations when grading.
The overarching changes can be seen in the table below:

Patients Focused on equality for patients ​ Focused on equality for patients ​
Staff Focused on equality for staff and the collection of data ​ Focused on workforce health and well-being, encouraging organisations to use data generated from tools such as WRES and WDES, rather than repeat their purpose​
Leadership Focused on the accountability of leaders Focused on the accountability of leaders and now requires leaders and board members to show evidence of how they personally commit and contribute to the EDI and health inequalities agenda within their organisations, and the use of relevant tools​

Following feedback we received when creating the updated EDS, we have reduced the number of indicators across the three Domains. Users of the previous EDS felt that some of the 18 indicators were repetitive. The remaining 11 indicators have been strengthened, either by rewording them, or through the grading process, reducing the reporting burden.

The feedback about the previous version was that the grading was complicated. It was also highlighted that the grading was being delivered differently across systems, leading to wide variations in the delivery of EDS. The new Scoring and Ratings guidance supports those individuals who are grading for the Domains making it easier to understand and reducing the chance of variation across organisations. Providing the grading information in a separate document also improves ease of navigation for EDS users,

The grading guidance now includes information on the evidence required to achieve scores, both standardising and strengthening the EDS process.

It is advised that Domain 1 in the EDS should be delivered alongside a partner organisation within a local footprint. Those organisations should apply the EDS to a service they deliver together, from the point of commissioning to the point of delivery. In particular, we recommend that integrated care systems (ICSs) work together alongside their provider organisations.

Domains 2 and 3 have been designed to be delivered within individual organisations, although a staff group can be targeted from one of the services you have applied the EDS to within Domain 1. Information and data collated for Domains 2 and 3 should be used to compare progress alongside partner organisations, and organisations within a local footprint.

Further support and guidance on how to apply the EDS can be found in the Technical Guidance. Supporting guidance on how to apply the EDS during the test period (which will run from March 2022 to March 2023) can be found in the Test Period Guidance.

The overall responsibility for the EDS lies with the executive board within the organisation. Day-to-day delivery maybe discharged to EDI staff or senior responsible officer within the organisation, but board members should retain overall responsibility and oversight.

The collation of evidence for, and the delivery of, Domain 1 will normally sit with the EDI lead/team (or equivalent) but must be assisted by managers who sit within relevant service areas. Implementation of improvement actions for Domain 1 will normally sit with the leadership/management of the services of which the Domain 1 was applied to.

Collating the evidence for, and the delivery of, Domains 2 and 3 will normally sit with the EDI lead/team or equivalent but should be assisted by boards, secretariats, senior leadership teams, human resources and organisation development teams. Responsibilities for the implementation of improvement actions for Domains 2 and 3 sits with the human resources, organisational development and senior leadership teams within organisations.

EDI leads who carried out the review process/deliver the EDS should not be responsible for implementation of improvement actions but can have responsibilities surrounding monitoring and reporting for performance management purposes. A list of stakeholders required to be involved in each Domain can be found in the Ratings and Scorecard Guidance on page 7.


Organisations who wish to transition and are part way through an EDS cycle, or near the end of a cycle, may use the updated EDS Reporting template for publication. Organisations who chose to take this route will need to explain the transition when publishing their EDS outcomes.