Equality Act Compliance Report. January 2017

Transcription

1 Equality Act Compliance Report January 2017

2 Contents Foreword 5 CNWL Equality Act Compliance Report Introduction 1.1 Report Structure Legal framework Meeting the public sector equality duty About CNWL National NHS Equality Programmes NHS Equality Delivery System NHS Workforce Race Equality Standard (WRES) Accessible Information Standard NHS Workforce Disablity Equality Standard (WDES) CNWL s 4 Year Equality Objectives Equalities and Diversity within CNWL 2.1 Board of Directors E&D Structure and processes Policies and Guidance Information Systems Foundation Trust Membership Workforce actions and initiatives to meet the Public Sector Equality Duty 3.1 Learning and Development Recruitment Staff Relations Staff Networks Reasonable Adjustments for Disability Pregnancy and Maternity Service Delivery actions and initiatives to meet the Public Sector Equality Duty 4.1 Race and Ethnicity Interpreting and Translation Disability Gender Religion or Belief Sexual Orientation Age Gender Re-assignment Pregnancy and Maternity Marriage or Civil Partnership The Homeless Corporate Functions 5.1 Complaints Safeguarding Peer Support Workers 53 2

3 5.4 CNWL Recovery & Wellbeing College Communications Freedom of Information Next Steps 58 Appendix A. Workforce Profile and 2014 Staff Survey Results A1. Workforce Profile 60 A1.1 Ethnicity 61 A1.2 Age 65 A1.3 Gender 66 A1.4 Disability 68 A1.5 Religion or belief 70 A1.6 Sexual Orientation 71 A1.7 Gender Reassignment 73 A1.8 Pregnancy and Maternity 73 A1.9 Marriage and Civil Partnership 73 A2. Staff Survey Results 74 3

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5 Foreword DRAFT FORWARD I am pleased to write the forward for this, the Trust s sixth annual report which demonstrates how Central and North West London NHS Trust is complying with the Public Sector Equality Duty of the Equality Act The Trust continues to expand in terms of geography and the range of services being delivered and as a consequence this increases the work needed to ensure the continued quality and equality of the clinical services provided. The Trust continues to operate under considerable financial constraints and it is increasingly important that we ensure that the services we provide are delivered fairly and equitably on the basis of clinical need. This financial year, , the Trust is being required by the local commissioners to report on progress regarding a series of Equalities and Diversity initiatives. Some on an annual basis, such as the Workforce Race Equality Standard, others, such as the implementation of the NHS Equality and Delivery System, quarterly. We welcome this scrutiny and hope that the information provided informs the commissioners in their roles. The Workforce Race Equality Standard (WRES) has proved to be a particularly useful vehicle for progressing race equality within CNWL. I chair the Trust s action group which has brought together representatives from Human Resources, operational management, Staff Side and black and minority ethnic (BME) staff to address those areas where we identified differentials in the employment experience of BME staff. The structure of the WRES allows us to easily measure our progress from the results of the annual Staff Survey and from routine HR data. This year has also seen the roll-out of a significant patient information IT system SystmOne - to replace three systems inherited from previous organisations when services joined CNWL. Once teething problems are overcome, it is expected that recording rates of equalities characteristics will increase as several of the systems it replaces did not allow for the recording of some of the categories. Robyn Doran Chief Operations Officer Executive Lead for Equalities & Diversity 5

6 CNWL Equality Act Compliance Report Introduction 1.1 Report Structure This is the Trust s sixth Equality Act Compliance Report. In this Report we present data and set out actions that have been, and are being, taken since the last Report in January 2016 to ensure that the Trust is meeting the legal requirements of the Equality Act 2010, including the Public Sector Equality Duty (PSED). Many actions are continuing year on year, and we are not repeating everything in each new Report so there is a focus on either new initiatives, or actions which have been brought to the notice of the Equality & Diversity Team within the last year. This Equality Act Compliance report has a section describing Equalities and Diversity structures within CNWL. This is followed by two sections providing detailed descriptions of actions and initiatives being taken within the Trust to further the aims of the public sector equality duty in terms of employment practice and service delivery. There then follows a section describing actions and initiatives within particular corporate functions of the Trust. Appendix A contains a summary of Workforce Equalities Demographics and results of the 2014 Staff Survey. As in previous years, we have not specifically structured this Report around the three requirements of Public Sector Equality Duty. Many of the actions described in this report span the duty to have due regard to eliminate discrimination, harassment and victimisation, advance equality of opportunity, and promote good relations between different groups. We believe that presenting the evidence contained within this report by protected characteristic makes it more readable and accessible to patients and the public. 1.2 Legal framework The Equality Act 2010 (Specific Duties) Regulations 2011 require the Trust to publish information to demonstrate compliance with the duty imposed by section 149(1) of the Equality Act 2010 not later than 31st January 2012, and subsequently at intervals of not greater than one year beginning with the date of last publication. The Regulations further require that the information a public authority publishes must include, in particular, information relating to persons who share a relevant protected characteristic who are, (a) its employees; (b) other persons affected by its policies and practices. The publication of information is required to be in such a manner that the information is accessible to the public. The information can be published within another document. The duty imposed by section 149(1) of the Equality Act 2010 is the Public Sector Equality Duty (1) A public authority must, in the exercise of its functions, have due regard to the need to (a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; (b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; (c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. 6

7 1.3 Meeting the public sector equality duty The following section provides highlights of some of the ways in which CNWL complies with the Public Sector Equality Duty. More comprehensive information is contained under the relevant protected characteristics within sections 3 and 4 of the Report. Due regard to the need to eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act The Trust s Staff Lesbian, Gay, Bisexual and Transgender Support Network continues to provide an Advice, Information and Support Service for LGB&T staff and continues to deliver training to clinical staff on LGBT awareness and equality as part of regular site clinical training sessions. Work is being undertaken to increase the Trust s position in line with the Workforce Race Equality Standard (WRES) particularly around decreasing the disproportionate number of BME staff entering the formal disciplinary process, compared to that of White staff. Due regard to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; Staff within the Trust s Intermediate Care Services wear name badges which are black writing on a yellow background. The colour contrast is easier to read than black and white both for patients with reduced sight and for patients with dementia. Staff within the Learning Disability Service, based at Kingswood Centre in Brent, are being taught to use Makaton signing. An Occupational Therapist colleague is sending them one sign at a time as a Sign of the Week which they then incorporate into their communications with service users. Work is being undertaken to address the ethnic profile of the workforce regarding increasing the proportion of black and minority ethnic (BME) staff within senior positions (Band 8a and above) as part of the National Workforce Race Equality Standard (WRES). 18,400 face-to-face interpreting sessions have been provided in 94 languages. Additionally, 2,422 telephone interpreting sessions were also provided in 51 languages. Teams are delivering clinical and educational sessions in the evenings and at the weekend to increase the accessibility of services to working people. Due regard to the need to foster good relations between persons who share a relevant protected characteristic and persons who do not share it. Clinical services being delivered in an outreach manner to individuals from minority groups within premises which they feel more comfortable using than CNWL clinical sites thus improving relations and overcoming stigma. Examples include Sexual Health s work with sex workers, Talking Therapies Service working with black-led churches and Addictions Services working within local colleges. Rainbow coloured branded lanyards have been rolled out to all staff on request who wish to be identified as a safe listening ear for LGBT patients, colleagues and students on placement. Around 1,200 lanyards have been issued to staff right across the organisation along with support literature including LGBT organisation contacts and tips on being an LGBT Ally. Feedback received from patients and staff indicates that the wearing of the lanyard has enabled trust to be built up between clinician and LGBT patient much more quickly than was the case before. 7

8 1.4 About CNWL Central and North West London NHS Foundation Trust is one of the largest health service providers in London and the South-east of England with over 6,400 employees serving more than 100 sites and services. It serves a highly diverse population of 2.5 million across a total of nine London boroughs as well as providing services in Milton Keynes, more widely across Buckinghamshire, Surrey and Hampshire. Within the Trust s catchment area are some of the most affluent, and some of the most deprived, areas in London. It is also an area having particular diversity features: Brent the most ethnically diverse local authority in the country.* Camden has the highest rate of alcohol-related hospital admissions in London at 462 per 100,000 people.* Harrow The most religiously diverse Borough within London * as well as being home to the largest Afghani community in the UK. Hillingdon Migrant populations entering our catchment area via Heathrow and a significant Traveller community. Islington the second highest number of lone-parent families in England and Wales (at 45%)* Kensington & Chelsea A large, well established, Arabic-speaking population of various national origins. Most marked health inequalities than anywhere else in the UK when comparing life expectancy of the richest and the poorest. Milton Keynes One the fastest growing populations outside London. A younger age profile than England (21% of the population is under 15), and a relatively small older population. There is a broad demographic spectrum with a number of minority groups, none of which are significantly larger than the others. Westminster the highest proportion of Buddhist residents in the country*, and the centre of the UK Chinese Community in Soho. Students from all over the world attending London universities. A significant Lesbian, Gay, Bisexual and Transgender population that is attracted to central London from across the UK and from abroad. A high number of foreign nationals within the Offender Care System. * Facts taken from London Councils Ten Interesting Things About London Boroughs, 2009 In 2016, the Trust provides in-patient, rehabilitation and community Adult and Older Adult Mental Health services, Child and Adolescent Mental Health Services (CAMHS), Learning Disability services within three London Boroughs (Brent, Harrow and Hillingdon); Addiction Services within six boroughs (Brent, Harrow, Ealing, Hillingdon, Barnet and Hackney), Community Health Services within the London Boroughs of Camden and Hillingdon; Community Health and Mental Health Services within Milton Keynes; an Eating Disorder Service, a Forced Migration Trauma Service, and mental health and substance misuse services within a number of prisons and other detention facilities within London, Buckinghamshire, Kent, Surrey, and Hampshire. 1.5 National NHS Equality Programmes There are several equality-based programmes and standards developed by NHS England which CNWL is required to implement as part of the contracts that it has with both local NHS commissioners (CCGs) and directly with NHS England. Progress regarding their implementation is reported to the local commissioners (CCGs) on a quarterly or annual basis. 8

9 1.6 NHS Equality Delivery System Background The Equality Delivery System was launched in November 2011 as a voluntary framework by which local NHS organisations, in discussion with local partners including local people, review and improve their performance for people with characteristics protected by the Equality Act The System was refreshed in 2013 as the Equality Delivery System 2 (EDS2) and since 2015 has been the mandatory framework around which NHS Trusts develop their equalities actions. In addition, since April 2016 the Trust has been required to report progress quarterly to its local commissioners regarding implementation of the EDS2. The aim of EDS2 To lead to positive outcomes for groups protected under the Equality Act 2010 and decreased differential experience between groups. In the assessment of the Trust s services, we are asking ourselves How well do people from each protected group fare compared with people overall? Assessment of Evidence Assessment is carried out internally assessing the services under 4 goals, with 18 specific outcomes. These are shown in the table below. Goal Better health outcomes Description of outcome 1.1 Services are designed and delivered to meet the health needs of local communities 1.2 Individual people s needs are assessed and met in appropriate and effective ways 1.3 Transitions from one service to another, for people on care pathways are made smoothly with everyone well informed 1.4 When people use NHs services their safety is prioritised and free from mistakes, mistreatment and abuse 1.5 Screening, vaccination and other health promotion services reach and benefit all communities Improved patient access and experience 2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on reasonable grounds 2.2 People are informed and supported to be involved as they wish to be in decisions about their care 2.3 People report positive experiences of the NHS 2.4 People s complaints about services are handled respectfully and efficiently A representative and supported workforce 3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels 3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations 1 A Refreshed Equality Delivery System for the NHS 2013: 4 9

10 Goal Description of outcome 3.3 Training and development opportunities are taken up and positively evaluated by staff 3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source 3.5 Flexible working options are available to all staff consistant with the needs of the service and the way that people lead their lives 3.6 Staff report positive experiences of their membership of the workforce Inclusive leadership 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations Grading of Evidence Gradings are applied as shown below: 4.2 Papers that come before the board and other major committees identify equality related impacts including risks and say how these risks are to be managed 4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination. Excelling Achieving Developing Under developed All (9) groups are Most (6-8) groups are Some (3-5) groups are No / few (<2) groups are or where there is no evidence for any protected group Engagement with stakeholders The plans to address the prioritised area will involve internal and external stakeholders as appropriate. Typical external stakeholders comprise: patients, carers, local community groups, local voluntary organisations, Foundation Trust members and other members of the public. Staff engagement includes NHS staff, representatives of staff side organisations and members of the staff networks. Implementation and Reporting The EDS2 guidance gives a nine step implementation plan. Progress is reported every quarter to the local commissioners (CCGs). 10

11 1.7 NHS Workforce Race Equality Standard (WRES) In 2014 a report, commissioned by NHS England, entitled The Snowy White Peaks of the NHS found that Black and Minority Ethnic (BME) staff were treated less favourably than White staff: in recruitment, including to Boards, in access to career development and in disciplinary processes. They were found to be bullied more and were victimised more seriously if they were whistle-blowers. In response to this, the Workforce Race Equality Standard (WRES) was launched by the NHS Equality and Diversity Council in April For each of its 9 metrics the WRES seeks to prompt local inquiry to better understand why BME staff often receive much poorer treatment or opportunities than White staff so that these gaps in treatment and experience can be closed. The 9 workforce metrics are detailed below along with the CNWL positions in April 2015 and April The definition of BME is as provided by the Equality and Diversity Council and constitutes all non-white groups. The White group comprises staff of White British, White Irish and Other White backgrounds. WRES Metric 1 % of BME staff in bands 8-9 and VSM compared to the percentage of BME staff in the overall workforce Figures from CNWL HR databases CNWL April 2015 CNWL April % staff in senior positions BME 38.1% of workforce overall BME 19.1% staff in senior positions BME 38.3% of workforce overall BME 2 Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff across all posts 3 Relative likelihood of BME staff entering the formal disciplinary process compared to that of White staff, as measured by entry into a formal disciplinary investigation. 4 Relative likelihood of BME staff accessing non-mandatory training and CPD compared to White staff White: 1.67 BME: 1.00 White staff 1.67 times more likely to be appointed after shortlisting White: 1.00 BME: 2.89 BME staff 2.89 times more likely to be in formal disciplinary processes than White staff White: 1.00 BME: 1.29 This is just for nonmandatory training booked through LDZ, as it was not possible to capture all locally held data. White: 1.42 BME: 1.00 White staff 1.42 times more likely to be appointed after shortlisting White: 1.00 BME: 2.71 BME staff 2.71 times more likely to be in formal disciplinary processes than White staff Data not available for this report as attempting to include locally held data for

12 WRES Metric 5 Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months 6 Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 7 Percentage believing the Trust provides equal opportunities for career progression or promotion 8 In the last 12 months have you personally experienced discrimination at work from Manager / team leader or other colleagues? From the national staff survey comparing the survey responses from White and BME staff CNWL April 2015 CNWL April 2016 White BME Difference White BME Difference White BME Difference White BME Difference WRES Metric % BME April 2015 April Boards are expected to be broadly representative of the population they serve. Exec Directors: 0 13% Non-Exec Directors: 25% 14% CNWL Board overall: 13% 13% Population served by CNWL: 42% CNWL London BME population: 46% Milton Keynes BME population: 20% CNWL has developed a WRES Action Group chaired by the Chief Operating Officer, the Executive with the lead for this portfolio. Membership includes operational management, Staff Side (unions), the BME Staff Network, Human Resources and the Equalities and Diversity Team. Meeting six-weekly, the group has devised targets for four prioritised WRES metrics to achieve by July 2017 and group members each lead work streams to achieve these. The priorities and work streams, which were accepted by the Trust Board in September 2016, are detailed in the table below. The data shown in the table below is taken from HR databases either on 31 st March of each year or pertains to the financial year 1 st April-31 st March of the previous year. The Trust is required to report progress against these nine metrics to NHS England annually, so the next update will be completed in July The Trust also reports progress to the local commissioners (CCGs) annually. 12

13 WRES Metric Percentage of BME staff in Bands 8-9, VSM (including executive Board members and senior medical staff) compared with the percentage of BME staff in the overall workforce 18.1% staff in senior positions BME 38.1% of workforce overall BME 19.1% staff in senior positions BME 38.3% of workforce overall BME Differential in 2016 Improvement from 2015 Target for July % 0.8% 21.2% (2% improvement) Actions taken in 2016 Joint Mentoring of Band 7 to 8d staff by Associate Directors, Divisional and Service Directors and Executive Board members 2 Relative likelihood of BME staff being appointed from shortlisting compared to that of White staff being appointed from shortlisting across all posts. White: 1.67 BME: 1.00 White: 1.42 BME: 1.00 White staff 1.42 times more likely to be appointed after shortlisting (improvement on 1.67 times in 2015) (0.2% improvement) 2a. Interview panels to have a trained BME member on each interview panel at Band 8 and above appointments. Specific training will be provided via HR to support this work. 2b. Development of a specific internal BME staff programme for Band 3-6 to develop confidence and increase job prospects by creating job opportunities by developing soft skills including interview techniques, CV writing, 360 appraisals and personality testing. 3 Relative likelihood of BME staff entering the formal disciplinary process, compared to that of White staff entering the formal disciplinary process, as measured by entry into a formal disciplinary investigation* *Note: this indicator will be based on data from a two year rolling average of the current year and the previous year. White: 1.00 BME: 2.89 White: 1.00 BME: 2.71 BME staff 2.71 times more likely to be in formal disciplinary processes than White staff (0.5% improvement) Training for line managers in understanding Unconscious Bias and having the skills to conduct Clean Conversations around performance with staff from a BME background. 3b Each formal disciplinary case should be reviewed with a senior HR Business Partner and a Senior Staff side member and outcomes to be verified by HR Director and or a Director of Nursing. This process is to eliminate unconscious bias. With an active plan to engage with experienced people to support those individuals.

14 WRES Metric Differential in 2016 Improvement from 2015 Target for July 2017 Actions taken in Relative likelihood of BME staff accessing non-mandatory training and CPD as compared to White staff 1.29:1 Data not available for this report as attempting to include locally held data for 2016 Able to report on this from the 3 operational divisions and HQ Devise a mechanism by which data on access to locally agreed / funded training is collated 5 KF 18. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months White: 26% White: 27% The differential of experience is 7% higher for BME: 32% BME: 34% BME staff 1% No target set for KF 19. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months White: 20% White: 21% The differential of experience is BME: 23% BME: 23% 2% higher for BME staff 1% No target set for KF 27. Percentage believing that the Trust provides equal opportunities for career progression or promotion White: 92% White: 91% The differential is 16% lower for BME staff BME: 78% BME: 75% 2% BME staff 80% (5% improvement) 7a BME Staff Network undertook a detailed survey to ascertain reasons behind BME staff beliefs on this matter. Feedback from the survey has helped the network tailor quarterly events to improve staff perception, e.g. BME Career Panel event in June. 7b. BME Staff Network and Communications Team to profile BME role models from within CNWL staff pool within internal publications and at open staff events throughout the year. 7c. Organisational Learning to re-launch the staff coaching database with more BME coaches and with the facility for staff to choose coaches on the basis of their ethnicity as well as gender, age and professional background. 14

15 WRES Metric Differential in 2016 Improvement from 2015 Target for July 2017 Actions taken in Q23. In the last 12 months have you personally experienced discrimination at work from any of the following? b) Manager/team leader or other colleagues White: 5% White: 5% The differential is 7% higher for BME staff BME: 11% BME: 12% 1% No target set for Boards are expected to be broadly representative of the population they serve All Directors: 88% White 13% BME Total CNWL population: 58% White 42% BME All Directors: 88% White 13% BME Total CNWL population: 58% White 42% BME 29% BME under representation No change No target set for 2017 Training for the Board on Unconscious Bias The WRES Report and Action plan presented to the Trust Board in Sept 2016 by the BME Staff Network Co-chairs. London population: 56% White; 46% BME. Milton Keynes population: 80% White 20% BME London population: 56% White; 46% BME. Milton Keynes population: 80% White 20% BME 33% BME under representation 7% BME under representation No change No change 15

16 1.8 Accessible Information Standard From 31 July 2016 onwards all NHS trusts were required to follow the Accessible Information Standard, which is part of the Health and Social Care Act (2012). The purpose of the Accessible Information Standard is to make sure that medical information and records are given to patients, users and carers in an accessible manner. This includes the provision of alternative format materials to meet their needs - such as braille, large print, or audio. There are five basic steps which make up the Accessible Information Standard: 1. Ask: identify if an individual has any communication/information needs relating to a disability or sensory loss. 2. Record: record these needs in a clear, unambiguous and standardised way; electronically or using paper records (administrative systems or documents). 3. Alert/flag/highlight: ensure recorded needs are highly visible. Whenever a service user s records are accessed by other staff members, they should be prompted to take action to communicate appropriately with the service user. 4. Share: include information about a service user s communication needs as part of existing data sharing processes and in accordance with existing information governance frameworks. 5. Act: take steps to ensure the service user receives information they can access and are able to understand, because it has been delivered in the way that was requested. A short term group was set up to make sure we can record this work as easily as possible on SystmOne and our other patient IT systems or in paper format (when necessary). Actions have been incorporated into the SystmOne development schedule. 1.9 NHS Workforce Disability Equality Standard (WDES) NHS England commissioned Middlesex University and the University of Bedfordshire to undertake research with NHS Employees nation-wide to investigate the experience of disabled employees within the NHS. The report was published in Dec Following this, a series of Metrics have been developed, similar to the nine WRES Metrics described in section 1.7 which will use data from the NHS annual staff survey and look at areas such as workforce representation, reasonable adjustments, employment experience and opportunities for NHS staff with disabilities. These have been were consulted upon nationally during 2016 and in June, A member of the NHS England WDES national steering group held a workshop at CNWL to consult with our staff members with a disability on the proposed metrics and also to promote the forthcoming standard to Human Resources and Operational Managers. The National Implementation plan is that the WRES will become mandated via the NHS Standard Contract in England from April Within CNWL we are currently waiting for the publication of the finalised WDES metrics to be able to start our benchmarking processes CNWL s 4 Year Equality Objectives These are being rewritten during as part of the implementation of the Equality Delivery System (EDS2) and therefore will be finalised at the end of that consultation process. However the areas that the Trust will be concentrating on, in broad terms, are: Improving recording rates for service users regarding their religion, disability and sexual orientation across all the different patient administration systems and databases. Increasing understanding of individual services regarding the local populations that they serve through the developing and strengthening of connections with third sector community organisations and analysis of data on patient access.

17 Re commissioning of a professional interpreting services for face-to-face, telephone and signed interpretation. Implementing progress against the prioritised metrics of the Workforce Race Equality Standard (WRES) - see section 1.7 Implementation of the Workforce Disability Equality Standard (WDES) see section 1.9 Development of a formal support network for employees who are carers - as part of the CNWL Health and Wellbeing Plans. Development of formal support mechanisms for employees who have lived experience of mental health - as part of the CNWL Health and Wellbeing Plans. 17

18 2. Equalities and Diversity within CNWL 2.1 Board of Directors The Equalities and Diversity function is represented at Board level by the Trust s Chief Operating Officer and the Trust s Director of People and Human Resources. Both have an Executive lead responsibility for Equalities and Diversity. 2.2 E&D Structures, Processes and Reporting Within CNWL, Equality and Diversity is function of the corporate Quality Directorate alongside Patient Experience, Mental Health Law, Safeguarding, Safety, Infection Prevention & Control and Clinical Effectiveness. The Equality and Diversity Corporate Team comprises a one full-time Equality and Diversity Manager and a full time Equality and Diversity Advisor. The Trust s clinical services sit within one of three operational divisions, headed by a Divisional Director, Divisional Nursing Director and Divisional Medical Director and supported by a Senior Divisional Management Team. E&D developments within the divisions are taken forward by the Divisional Director of Nursing and the Divisional Quality Lead within each of the three divisions. They in turn liaise (within their divisions) with the various Heads of Services, calling upon the skills of divisional support staff from Human Resources, Performance and Information, and Clinical Practice Improvement. The three operational divisions were responsible for the clinical services in 2016 as shown below. Jameson Division Goodall Division Diggory Division Adult Mental Health in Westminster Adult Mental Health in Kensington & Chelsea Adult Mental Health in Brent Adult Mental Health in Hillingdon Adult s & Children s Community Services in Hillingdon Adult s and Children s Community Services in Camden All Mental Health Services in Milton Keynes Adults & Children s community services in Milton Keynes Sexual Health Services in Camden & Hillingdon Adult Mental Health in Harrow Learning Disability Services across Brent, Harrow, Westminster, Hillingdon and Enfield Psychological Therapies within Kensington & Chelsea In-patient Mental Health Rehabilitation Services across the 5 boroughs* and Epsom Child & Adolescent Mental Health Services (CAMHS) across the 5 London boroughs * Eating Disorders Service Palliative Care Service in Camden Psychological Therapies within Harrow, Westminster, Hillingdon, & Brent Community Priority Dental Services In Buckinghamshire and Hillingdon Addictions Services in Hillingdon, Harrow, Brent, Ealing, Barnet and Hackney. Offender Healthcare Services within the five London boroughs* and within Prisons, Youth Offending Institutions and Immigration Removal Centres in London, Hampshire, Milton Keynes, Surrey and Kent * the five London boroughs refers to Westminster, Kensington & Chelsea, Brent, Harrow and Hillingdon. 18

19 For certain Trust-wide equality developments, such as the implementation of the NHS England Workforce Race Equality Standard (WRES), a group has been convened that includes internal stakeholders from different parts of the organisation to take forward a specific action plan. As part of the NHS Core Contract, The Trust is required to report annually to the local commissioners regarding: Compliance with the Accessible Information Standard (more on this in section 5.9); Progress regarding the implementation of the Workforce Race equality Standard (WRES) see section 1.7; The Equality plans for the forthcoming year. In addition, the Trust is required to report quarterly to the local commissioners regarding: The implementation of the Equality Delivery System (EDS2); Evidence of taking into account the spiritual, religious, pastoral and cultural needs of Service Users. The Trust is also required to report annually to NHS England on progress to meet the requirements of the Workforce Race Equality Standard (WRES). There are a series of Staff networks who undertake work to progress the equality agenda through involvement in development groups and also act as a pool of experts for internal consultation purposes. Staff Network: Contributing to: Accountable to: Black and Minority Ethnic (BME) Staff Network Pride@CNWL LGBT Staff Network Staff Disability Equality Network WRES Action Plan Stonewall Workplace Equality Index action plan Delivering LGBT Training Workforce Disability Equality Standard (WDES) Equalities & Diversity Manager Equalities & Diversity Manager Equalities & Diversity Manager Staff Carers Network Health and Wellbeing agenda Chief Operating Officer Further information on the contribution of these groups and networks is provided later in this Report. Work continues by the ImROC (Implementing Recovery through Organisational Change) Team along with Human Resources and Occupational Health into the strengthening of processes around supporting employment of individuals with lived experience of mental health issues. Within 2016 these have not progressed to the point of creating a Lived Experience Staff Network; however, this is still a planned activity for

20 2.3 Policies and Guidance The Trust has a number of corporate equalities-related policies which provide a governance framework to ensure that staff actions address the equalities and diversity agenda in a positive way, whilst making clear which behaviours are unacceptable to the Trust. Equality and Diversity specific policies continue to be reviewed in in line with the Trust s Policy on Policies (review within 3 years). 1. Equality, Diversity and Human Rights Policy (Employment) 2. Equality, Diversity and Human Rights Policy (Service Delivery) 3. Zero Tolerance Policy 4. Disability Policy (Service Delivery) 5. Disability Policy (Employment) 6. Transgender Policy 7. Interpreting Policy 8. Gender Request Policy 9. Faith and Spiritual Support Policy The Trust also has a number of Human Resources Policies providing direction in different aspects of employee relations and behaviour. These include: 1. Dignity at Work Policy 2. Grievance Policy 3. Sickness and Absence Policy 4. Disciplinary Policy (which includes a staff code of conduct) 2.4 Information Systems Electronic Staff Record (ESR) Along with most other NHS Trusts in England, CNWL uses the national Electronic Staff Record (ESR), an electronic information system, to capture and report on workforce data. In terms of the equalities protected characteristics, ESR has the capacity to collect ethnicity, disability, gender, age, sexual orientation and religion or belief and marital or civil partnership status. It can also record maternity leave. It does not have capacity to record gender reassignment. Because it is a national system the Trust is limited by its functionality. The following table gives the staff recording rates as at 31 st March 2016 compared to previous years: Equality Characteristic % Recording rate (not Including preferred not to say ) % Preferred not to say (where option available) 20 % Not Known Ethnicity Disability Gender Age Religion or Belief Sexual Orientation Disability recording is much improved whereas recording of religion and belief has reduced. More staff have been asked to declare their sexual orientation but a greater number this year are choosing the prefer not to state. The Staff Census that was planned for 2016 will now happen in the first quarter of 2017 and this will include an update of the equalities data held for each employee on the ESR system. The LGBT Staff network will be involved in the promotion of this to encourage the declaring of sexual orientation.

21 Changes to the ESR system undertaken nationally mean that the non-gender defining title Mx is now available for employees to choose over Mr, Mrs, Miss or Ms. This news was gladly welcomed by members of the LGBT staff network, some of whom self-identify as non-binary in their gender. All staff members will be encouraged to redefine their preferred title during the forthcoming Staff Census Patient Administration Systems As well as using ESR for collecting workforce data, during the Trust used a number of Patient Administration Systems collecting service user data. These include: RiO which was used within Community Health Services in Camden, Hillingdon and Milton Keynes and also by Mental Health Services within Milton Keynes, was phased out in 2016 as a new system (SystmOne) was rolled out across these services SystmOne is already used by Healthcare Teams within all the Prison sites Improving Access to Psychological Therapies (IAPT) Teams use their specific national database IAPTUS Sexual Health Services within Camden and Hillingdon use a database called CELLMA Mental Health, Learning Disability Services, Addiction Services and Community-based Forensic Mental Health Teams use the Jade information system. Buckinghamshire Priority Dental Service uses Carestream. Some small, local patient and performance databases have been identified as used within: The Psychological Medicine Teams within various acute NHS Trusts within London The Wheelchair Service and Community Occupational Therapy Service within Milton Keynes (own local database) The Camden Diabetes Team (EMIS) The Primary Care Mental Health Liaison and Primary Care Plus Teams (EMIS) The Milton Keynes Community Paediatricians (Cerner Millenium) 2.43 Data collection rates (as of Dec 2016) The target is for 100% collection. The RIO system is a national NHS Patient Administration System that was being used independently by three services which merged with CNWL from 2012 onwards (Hillingdon Community Services, Camden Community Services and Milton Keynes Community Health). These services continued to use these separate versions of RIO, none of which were able to collect data around all the required equality characteristics and work was undertaken to increase their data collecting categories, however as a national system only minor amendments were found to be possible. From 2014 work was undertaken to develop a new patient system that would ultimately replace all of the different patient databases but initially to replace the three RIO databases. The roll out of this new system SystemOne started within Milton Keynes Services in 2016 and then continued through the year within Camden and Hillingdon Community Services. There have been teething difficulties regarding the collection of equalities data, firstly with the mapping across of data from one system to another, where the categories were not the same, there are on-going issues regarding the sexual orientation section being available to staff in Milton Keynes. It is anticipated that these difficulties will all be ironed out during

22 Ethnicity Disability Sexual Orientation Religion % Jade Camden RIO Hillingdon RIO Camden and Hillingdon Community Services (SystmOne) Milton Keynes RIO Milton Keynes SystmOne CELLMA (Sexual Health) SystmOne (Prisons) Carestream (Dental) Addictions Services Talking Therapies Services (IAPTUS) Foundation Trust Membership CNWL is a Foundation Trust (FT) with a total membership as at January 2017 of 15,480 members of whom 6636 are public members, 2341 service user and carer members, and 6503 staff members. During the constitution was changed to allow membership from the whole of England and Wales however the table below relates to the census ethnicity demographics of the London, since this is the area where our members are predominantly resident. Membership records indicate the following demographic information of non staff members: Gender - 41% of the FT membership are male and 58% are female which shows a higher interest in the Trust from women, compared to the population served and compared to service users accessing services. This is the same as last year. The gender distribution of staff members remains at 25% male, 75% female. Ethnicity FT members are recruited from all ethnicity groups and all have equal access to all opportunities for engagement. The membership database identifies the ethnicity of all members and this is reported as part of the Trust s FT monitoring process. Current FT membership at January 2017 has representation of members from all ethnicity groups (see table below). When compared to the ethnicity profile of London, the Trust membership is broadly representative across all ethnic groups however, we are aware that there is some under-representation of White Other and Other Asian groups compared to the demographics of the main London boroughs that the Trust services. 22

23 Ethnicity 2012 % FT Members 2013 % FT Members 2014 % FT Members 2015 % FT Members 2016 No. of FT Members 2016 % FT Members % Population (2011 census) White British White Irish White Gypsy or Irish Traveller White Other Mixed Indian Pakistani Bangladeshi Other Asian Black Caribbean Black African Black Other Chinese Other ethnic background Total numbers 8,797 8,950 9,049 9,078 8,515 23

24 3. Workforce actions and initiatives to meet the Public Sector Equality Duty The following section highlights a range of actions that contribute to the Trust meeting of the requirements of the Public Sector Equality Duty in its role as an employer 3.1 Learning and Development Training Training sessions within the Trust are made available with reasonable adjustments provided where necessary and access to space for prayer where attendees require this. The Learning and Development teams have supported student nurses during their clinical placements where they have notified the team of their dyslexia. We provided their clinical mentors with literature on how to support students with Dyslexia and sign posted them to relevant support services within the universities. For example, a district nursing team printed all documentation on green paper to help a student with their ability to read education documents. British Sign Language (BSL) interpreters are obtained by the Learning and Development Team for Deaf members of staff accessing internal training courses. The Trust has a portfolio of training options specifically to address discrimination, advancing equality of opportunity, and promoting understanding and good relations. 1. All new starters receive an information booklet entitled Introduction to Equalities & Diversity. This describes the CNWL approach to managing equality and diversity, includes an overview of Equalities legislation and contact details for the various relevant departments and staff networks. 2. The Trust's mandatory training 'Diversity in the Workplace' e-learning is also completed by staff within three months of starting and is retaken every three years. It contains a test which must be passed to gain certification. Allowing for staff leaving and joining the Trust, 95% compliance is aimed for across all mandatory training subjects and is this monitored monthly by the Learning and Development Team. Service % compliance with mandatory E&D training Service Corporate (HQ) Teams 95 Rehab MH and Psychological Therapies % compliance with mandatory E&D training Milton Keynes Mental Health 94 CAMHS & Eating Disorders 93 Milton Keynes Community 96 Westminster Mental Health Addictions 91 K&C Mental Health 93 Offender Care 95 Brent Mental Health 89 Sexual Health Services 97 Harrow Mental Health 96 Hillingdon Mental Health 98 Learning Disability Services 96 Hillingdon Community 98 Talking Therapies Services 96 Camden Community

25 3. Start to Sign training sessions, aim to improve the communication skills and confidence of staff who have regular contact with service users and staff who are Deaf and whose first language is British Sign Language (BSL), and provide basic signing skills. 4. An LGBT Equality and Awareness Training session is delivered to in-patient staff within the London mental health services and to other teams upon request. It is based upon the reported experience of LGBT patients within CNWL in-patient services. It is co-delivered by the Equalities and Diversity Manager and members of the LGBT Staff Network. In 2016, 10 sessions of this training were delivered at four acute mental health units. 5. Faith and Spirituality awareness sessions have been developed and incorporated into the Trust s Recovery College programme. Attendance at these sessions is open to staff, service users and their carers. In 2016 this session was run four times with a total of 32 attendees; 6 staff members and 21 service users/carers. 6. Learning Disability Awareness e-learning A Trust-wide e-learning awareness package is provided to complement staff awareness of Learning Disability (LD) issues relevant to the level of contact with LD service users. A classroom-based one-day training is also available which is designed to provide acute and community based mental health staff with an understanding of the issues involved when people with learning disabilities access mental health services. Shorter, one hour sessions, are also provided for community provider services and this also forms part of the corporate Trust Induction programme attended by all new employees. 7. In addition, within 2016 the Trust s Equalities and Diversity Manager also delivered an E&D based module within the Peer Support Workers Core training to 12 Peer Support Workers who had joined the Trust within the last 12 months Women into Management The Trust s Women into Management programme was run again in 2016 which provided an opportunity for eight female staff members to shadow senior staff up to Chief Executive across a range of corporate functions and areas of service delivery. This helps to empower female staff in their confidence and career development. The programme, which over the years has been much valued by staff, includes two ring-fenced places for black and minority ethnic female staff although this year s cohort comprised: Asian (4) 50% Black (2) 25% White (2) 25% The 2016 attendees reported that the programme: Improved their confidence; Increased their assertiveness; Assisted them in making better decision; Broadened their ambitions Assisted in the development of their emotional intelligence Raised their personal profiles within the Trust NHS Leadership Academy Programmes The Trust promotes and supports staff to undertake the development and leadership programmes run by the NHS Leadership Centre. This includes the Ready Now Programme for BME staff members at Bands 8a and above. 25

26 3.2 Recruitment CNWL continues to place great emphasis on ensuring that staff are recruited on the basis of a fair and consistent process. The Trust delivers recruitment and selection training to recruiting managers and interview panel members, including service user representatives. The training covers all aspects of recruitment best practice and Equal Opportunities legislation. Together with the recruitment guidance available to all staff on the Trust s intranet pages, these ensure transparent, fair and consistent recruitment decisions are made across the Trust. This includes our commitment to make reasonable adjustments at interview, where a candidate has stated on their application form that they consider they have a disability. NHS Jobs highlights applicants who have declared having a disability, these are raised by the Recruitment Team to recruiting managers, reminding them that if the candidate meets the essential criteria they are guaranteed an interview; this in turn supports our ongoing commitment as a Two Ticks Employer. The NHS Jobs system also continues to monitor the equalities information of applicants and provides strict controls to ensure recruiting managers are unable to view this data at any point in the recruitment process. The Trust s recruitment team follows the NHS Employment Check standards for all candidates offered employment with the Trust. In addition, CNWL are part of the London-wide Streamlining Employment Checks Programme, which includes the introduction of inter-hr factual references, removing the opportunity for subjective information being provided by referees. The Recruitment Team continues to request Occupational Health input only once a provisional offer of employment is made, ensuring that this information does not impact on recruitment decisions. Centralised assessment centres for nurses and health care assistants, continue to play a part in reducing the risk of inconsistent recruitment practice, and ensure consistency in responding to job applicants diverse needs, for instance, reasonable adjustments in relation to interviews. The assessment centre method of testing basic numeracy and literacy helps to ensure that we are selecting by basic ability rather than any other personal or professional bias. An increasing amount of bespoke assessment methods are taking place in various services across the Trust, offering managers and candidates a broad and thorough testing spectrum including group observation, scenario, role play and individual assessments. Within 2015 the Trust introduced values-based recruitment methods within these assessment centres to ensure staff are recruited in line with the Trust values - Compassion, Respect, Empowerment and Partnership - to deliver the best possible care to patients. 3.3 Staff Relations The Trust has a dedicated Employee Relations Team whose role is to ensure consistent application of all Trust Human Resource Policies across the service lines. This includes the management of all investigations under Trust Policies. The Trust has a comprehensive suite of HR policies embracing all aspects of HR. These are written to ensure clear communication and that all staff and Managers are clear what is expected of them. The Trust has an HR Policy Group which comprises of representatives from across the Trust including HR staff, Managers and Staff Side Representatives. All Policies are discussed and updated in this forum and then formally ratified by the Joint Negotiating and Consultative Committee. Policies are jointly signed off by the Director of People and Human Resources and the Staff Side Chair. 3.4 Staff Networks BME Staff Network The Trust BME Staff Network is led by black and minority ethnic (BME) staff but has a membership open to all, and is headed by two co-chairs who were nominated by the previous Chair, and the Executive sponsor. The Network is managed by a committee of BME staff, and is supported by the CNWL Equalities & Diversity Team and is accountable to the Executive lead for Equalities and Diversity. 26

27 Network Membership The total membership of the BME Staff Network in 2016 was 137, an increase from 86 in This is broken down by Division and Borough below: Division Corporate Services 29 Diggory Division 20 Goodall Division 13 Jameson Division 67 Unknown division 8 Borough Brent 31 Camden 39 Harrow 4 Hillingdon 5 K&C 24 Milton Keynes 9 Westminster 20 Not Known BME Staff Network Committee The BME Committee is a subgroup of the Network and is made up of Network Staff, representatives from Staff Side, and the Equality and Diversity Team. The group meet bi monthly, and serve the interests of the Network. The aims of the Committee are: To work in partnership with the Trust to help support the meeting of its statutory duties regarding race equality. To work with the Trust to remove barriers that black and minority ethnic staff face in recruitment, development and promotion. The Chairs set their focus on staff career development throughout 2016 which was a challenging area identified by network members BME Staff Network Events The Network hosts a minimum of three events per year, often inviting external speakers, and hosting workshops : In January 2016 Cecilia Amin CBE, President of The Royal College of Nursing President was invited to the network to speak about her career journey and how she overcame challenges along the way. The event was well attended and staff found her journey and the discussion positive and inspirational. In February 2016 Yvonne Coghill OBE, Director of Workforce Race Equality Standard Implementation came to the BME Network to speak about what the workforce race equality is, and how CNWL were performing against other Trusts. She also spoke about what was required of the Trust in order to improve BME staff experience of working in CNWL, and offered her support to the Network. 27

28 In June 2016 the network hosted an event called How to get ahead in your career. The event took the form of a panel discussion with questions asked by Trust staff. The panellists were all senior BME staff members. It was an opportunity for staff to speak honestly about their experiences within the NHS and share their stories. It came following the publication of the Trust s Workforce Race Equality Standard (WRES) report by NHS England, showing an under-representation of BME staff at management levels at the Trust. In July 2016 the Network invited BME staff and non BME staff to a WRES consultation event to discuss CNWL s Workforce Race Equality Standard (WRES) action plan, in order for staff views to be taken into consideration. Staff were fully engaged in discussions, and several views were taken forward which have been incorporated in the final action plan. In October 2016 the Co- Chairs hosted an event called The Power of Me which was attended by staff from across the Trust. The event explored the steps being taken by CNWL to support career progression for its BME staff, and also the steps that staff can take to advance their own careers Survey of BME staff members In June 2015, following the publication of the annual staff survey, the BME Network chairs undertook a project to further understand the reasons behind staff feedback in relation to the questions below, and workforce data which showed that up until Band 6, there is steady career progression for BME staff, however at this point job advancement appears to tail off. The questions that are included in the National NHS Staff Survey around this issue are: 1. Does your organisation act fairly with regard to career progression / promotion, regardless of ethnic, background, gender, religion, sexual orientation, disability or age? 2. In the last 12 months have you personally experienced discrimination at work from any of the following? a) Patients / service users, their relatives or other members of the public b) Manager / team leader or other colleagues A career survey was devised by the BME Committee, and sent out to all staff in CNWL, to which there were 157 responses (70% of whom were from a BME background). The following causes were cited as the biggest obstacles to career progression amongst BME staff: Workload pressures Lack of support from line managers or other managers in the reporting structure Lack of adequate coaching Lack of resources Lack of transparency around appointments In response to the question What have you done to progress your career in CNWL? A clear theme emerged around self- development, gaining qualifications and attending training. Staff said they had: Taken professional course Worked closely with directors Applied for new roles whilst at CNWL 28

29 Attended courses outside CNWL Personal reading Attended conferences Sought qualifications outside CNWL in a different discipline On-going training and development Self- funded training In response to the question What could be done differently? BME staff said: Building confidence in leadership skills, understanding emotional intelligence, organisations, and networking. More opportunities for secondments and shadowing or mentoring Succession planning and a career progression plan Support from line managers coaching/mentoring help with interview skills having More diversity (ethnic) on interview panels Audit of appraisals of BME staff who are stuck from Band 6 onwards Line Managers to gain experience in recognising potential, what to do with it and how to nurture and encourage talent. Create Associate Executive Board level posts for a short period for BME staff to gain Board level experience The results led to a number of initiatives which now make up the Trust s Workforce Race Equality Standard (WRES) action plan. More on the WRES is included in section Challenges for the BME Network Committee in 2017 Implementation of the WRES action plan, and availability of resource within the BME network to support its implementation Consistent engagement with the wider network members through events and communications Increased visibility of the Network across CNWL Bringing about improved results and outcomes for BME staff regarding their employment experience Staff Disability Equality Network The Trust has a Staff Disability Equality Network whose members have a role in advising the Trust on improving disability equality and disability access has seen the consultation, nationally, on an NHS England initiative the Workforce Disability Equality Standard (WDES). It was arranged for one of the national WDES steering group to run a workshop for members of the Staff Disability Equality Network as well as interested managers regarding their seeking feedback on the particulars of the proposed WDES and inspiring individuals to become involved in its implementation from April See section 1.9 for more on the WDES Lesbian, Gay, Bisexual and Transgender (LGB&T) Network Membership The CNWL LGB&T Staff Network is now in its sixth year of operation, being formed in January It aims to provide a Trust-wide forum to celebrate the diversity and contribution that LGB&T staff within CNWL make to the culture and ethos of the organization. The Network s primarily function is to act as a support to CNWL s LGBT staff, but the Network also provides advice, education and development concerning LGBT issues that affect CNWL and its staff. 29

30 The Network is specifically set up to be run by LGBT staff and is now headed by female and male co-chairs who are elected from the membership. The network is managed by a committee of LGBT staff and is supported by the CNWL Executive and the E&D Team and is accountable to the Executive lead for Equalities and Diversity. Full Network membership (on 31 Dec 2016) stands at 131 with 57 women and 74 men (up from 57 women and 74 men in 2015). The number of associate members (LGBT Allies) is 775, which has increased from 543 members in In 2016 the Network continued to meet formally on a quarterly basis to progress numerous initiatives that are actioned on a voluntary basis by Network members The CNWL Rainbow Lanyard Initiative The Rainbow Lanyard initiative which was launched in February 2015 to coincide with LGBT History Month has gone from strength to strength with over 1,000 members of staff wearing them. The idea has been picked up by other NHS Trusts, notably West London Mental Health NHS Trust who have implemented the same scheme with their staff. Following the roll out of the LGBT equality training and the rainbow lanyards, the audit of LGBT in-patient experience that was conducted in 2012 by The Advocacy Project was repeated Dec February 2016 and the results were astounding. Patients reporting that they felt that their care and recovery had been supported in relation to their LGBT status had increased by from 19% to 58%. Patients reporting that they felt that hospital staff respected their LGBT status had likewise had increased from 19% to 58%. Patients who felt that if they had any issues relating to their LGBT status that they felt able to disclose and discuss these with hospital staff increased from 13% to 33%. Some of the comments from the in- patient experience survey directly relating to the rainbow lanyards include: I think the rainbow lanyards are BRILLIANT. They make me feel instantly safe. It makes such a difference. But I think they should have a poster up explaining the meaning not everyone will understand it. It needs to be explicit. I haven t seen a lot of nurses or doctors wearing the rainbow lanyards but those that do, make me feel safe and reassured. It s comforting. I wish more staff would wear them. I appreciate the ones who do. It just makes me feel like I don t have to worry about homophobia as much, I can worry about being unwell and getting better. 30

31 I ve seen some staff wearing them but not on this ward. They support LGBT rights and any patients who may be of that orientation. I think it s a good idea and shows the NHS is open to different communities. It s not promoted enough on the ward though. Staff should talk to patients and have posters saying what they mean with the rainbow colours so people can know what it means. I ve noticed a ward nurse wearing the rainbow lanyard. Knowing staff support it makes me feel more comfortable talking about it LGBT Network Activities There have been many opportunities in 2015 for social and professional networking with fellow LGBT staff in formal work-based and informal social settings: Quarterly Network meetings open to all members with invitation of LGBT allies attendance at two meetings per year; Attendance of over 60 Network members, straight allies and family and friends as an official walking group at London PRIDE parade Pub social evenings following all quarterly Network meetings; A second Ten-pin bowling event with LGBT networks from other NHS Trusts, including Guys and St Thomas Hospital NHS Trust. There has been educational information about LGBT issues to the CNWL workforce, including communications across the entire Trust and to LGBT allies: The Network continues to produce and distribute a quarterly newsletter in two formats (one for PRIDE@CNWL full members and one for the LGBT Allies) Three members of the Network were involved along with the Equalities & Diversity Manager in the co-delivery of the LGBT equality training at the 10 sessions delivered to in-patient staff in LGBT History month in February was celebrated by a display of Famous LGBT People Through History which had been put together by a Network member and Committee member. This was displayed at the Trust headquarters at Stephenson House and at eight other NHS sites. National Coming Out Day on 11 th October was celebrated in Trust HQ by several members of staff both Network members and LGBT Allies, Coming Out about a hobby that they had not been previously shared widely with colleagues at work to highlight diversity amongst our staff 31

32 3.5 Reasonable Adjustments for Disability The Trust provides a range of reasonable adjustments to support staff who have a disability to undertake their roles. The Trust's Occupational Health Service makes appropriate recommendations through the referral process and can recommend general and specific adjustments that can be made for staff where required. The Service works closely with the Trust's managers to identify how best to respond to the needs of disabled staff where reasonable adjustments have been identified. The following are some examples of reasonable adjustments made for staff during the past year: Phased returns to work following periods of long term sickness Adjustments to duties Time off for members of staff with disabilities to attend disability-related appointments Allowing appropriate breaks to take medication Adjustment to trigger points where in normal circumstances absence management processes would be initiated to allow for certain amounts of time off relating to disability related condition Adjustments to shift roster Provision of appropriate equipment and IT support software Reductions to caseload/transfer of certain duties The Trust Occupational Health Department has a pro-active approach and case conferences are held with members of the HR team, Staff and Managers to agree a way forward in difficult cases where progress is proving difficult. In addition to the above, the Trust provides British Sign Languages (BSL) Interpreters for service users and staff. During 2016, 856 BSL interpreting sessions took place of which 66 were for Deaf staff which contributed to ensuring that equality of opportunity is advanced for Deaf staff. 3.6 Pregnancy and Maternity Staff are made aware of the policies relating to pregnancy and maternity leave and managers are expected to support staff with requests for Maternity and Paternity leave arrangements. Pregnancy Risk Assessments are carried out as appropriate throughout a staff member's pregnancy whilst still at work and action plans agreed to support the person through this period of their employment. This may include providing them with work in 32

33 other areas of the Trust by mutual agreement, as happens for pregnant staff working within prisons who are not allowed prisoner contact due to safety considerations. CNWL offers parents the option to take part of their salary (up to 243 per month) as Childcare Vouchers, meaning tax and national insurance is not paid upon that amount. Details of the child care voucher scheme are available via the Trust s Intranet (Trustnet). There are also policies specifically covering paternity and adoption entitlements. All policies are available for staff to read or download from Trustnet. Staff returning from maternity leave do so on a phased return and flexible working hours are discussed. 33

34 4. Service Delivery actions and initiatives to meet the Public Sector Equality Duty The Trust is experienced in managing the complexity of a diverse workforce providing a range of services to diverse service users across all of the Equalities characteristics. Understanding the needs of our service users and responding sensitively and appropriately is at the heart of high quality service delivery. Assessments include sections addressing individual needs as part of the drive towards greater personalised care. The initiatives recorded below are either newly developed in 2016 or existing initiatives which have not been reported upon in previous years. This report should therefore be read in association with those from previous years to build up a full picture of work being undertaken within individual clinical services. 4.1 Race and Ethnicity Culturally competent therapeutic practice and care There are several examples, given below, where services have modified their mainstream delivery to accommodate patient, or carers needs that arising from their race / ethnicity. The Talking Therapies Service is a national NHS programme increasing the availability of psychological services across England offering treatment for people with depression and anxiety disorders. CNWL operates Talking Therapy Services within the London boroughs of: Westminster, Kensington & Chelsea, Harrow, Brent and Hillingdon and also within Milton Keynes. Previously referred to as IAPT (Increasing Access to Psychological Therapies), one of the strategic aims of the programme was to increase access to psychological therapies by communities who traditionally had not accessed services, particularly those from black and minority ethnic (BME) groups. The service is operated as a Primary Care service and is accessed via the GP or via self-referral. CNWL IAPT services have carried out a comprehensive analysis of their services access compared to the relevant borough population (from the 2011 Census). The chart below demonstrates that there is a diverse client group engaging with the services that is representative of the borough population statistics. CNWL Talking Therapies Service Brent Harrow Hillingdon Central London West London Entering Entering Entering Entering Ethnicity Popn Entering Treatment Popn Treatme nt Popn Treatme nt Popn Treatme nt Popn Treatme nt % % % % % % % % % % African [N] Any other Asian background [L] Any other Black backgrond [P] Any other ethnic group [S] Any other mixed background [G] Any other White background[c] Bangladeshi [K] British[A] Caribbean [M] Chinese [R] Indian [H] Irish[B] Pakistani [J] White and Asian [F] White and Black African [E] White and Black Caribbean [D] Grand Total

35 * In the table above, Central London relates to the name of the health commissioning organisation (CCG) that covers Westminster and West London relates to the CCG within the Borough of Kensington & Chelsea and the Queens Park ward of North Westminster. The Kensington, Chelsea and Westminster FoCuS team, who work with ex-offenders with mental health problems within the community, are asking their service users to become involved in a PHD research project which is looking at the impact on BME service users mental health of living in a local BME population density area. They are hoping that they can incorporate the findings from this research in their clinical and practice. Over the past year, the Westminster Homelessness Prevention Initiative, part of the Westminster Joint Homelessness Team has continued to provide advice and training across the Trust on assessing and providing for the social care and housing needs of foreign nationals. This has helped to ensure that decisions regarding access to CNWL services are not based solely upon a person s country of origin and an assumption of lack of entitlement, but upon an assessment of needs, Human Rights and Treaty rights. The team also assists service users to access legal advice and support around their immigration status in the UK. Following feedback from one of their service users, the CNWL Neurological Conditions Clinical Specialist based in in Milton Keynes actively followed up with a national charity regarding the lack of non-white people in their literature and on their web-site. This had a positive effect and changes made mean that their literature and web-site now features a more diverse population The mental health in-reach team at HMP Coldingly, a men s prison in Surrey, have identified that prisoners from the traveller community have required extra support due to the disadvantages they face in accessing the services in the community. They are now have a therapy team offering counselling services which easily accessible to this group of service users in the prison. In October and November 2016 the Health Promotion Team within Sexual Health Services carried out sessions at the Migrant Centre, tested people for HIV and were able to refer them for on-going medication and support. The individuals that the team met during these sessions had a significant impact on them due to the complexity of their life journeys which have involved them being held in detention, crossing multiple national borders and being split up from their family members. Feedback from the Occupational Therapists across the CNWL services report modifying their practice to accommodate patient s cultural needs such as: The removal or covering of shoes, when carrying out home visits; Providing support around self-care; Therapeutic cookery sessions that include relevant recipes and culinary skills The CNWL healthcare teams within the Immigration Removal Centres at Heathrow have designed and produced a range of feedback/how to get in contact cards for the detainees which were then translated into nine different languages. This was put in place to support/encourage detainees to contact named healthcare staff to deal with enquiries and to avoid them using the already overused formal complaints route. The cards were inspired by the NHS Hello my name is initiative and aim to provide a more personalised approach to communicating concerns early and can be popped in the feedback boxes which are situated around the centre and are collected by staff daily Development of targeted services Where the needs of people from minority ethnic groups cannot be addressed by the modification of mainstream services and the addition of language support (interpreting), CNWL develops targeted services to aid specific communities, overcoming language and cultural barriers. 35

36 HMP Send, a women s prison in Surrey, have access to a Women In Prison Counsellor who works specifically with black and ethnic minority women. The Liaison Psychiatry Team in Harrow report that they have been working with a member of the traveller community and their family. The services access barriers that they have identified are similar to those encountered when working with patients from other minority ethnic groups, such as a lack of understanding of how health services work and the different roles of professionals. They also found a strong distrust of social care staff associated with the mental health team, which needed to be acknowledged and addressed. The Older People Healthy Ageing Community Mental health Team (CMHT) within Kensington & Chelsea carried out an extensive audit of their service access by ethnic group. This is reproduced in detail here to show the simplicity of the process: The investigator extracted recorded information on ethnicity from the electronic clinical system on January 8th, The total active caseload was 203 patients. The group of these individuals were compared with population data from the 2001 Census. It was found that the proportion of people from BAME backgrounds accessing our service was broadly in line with those populations in the Borough. The White Other group was slightly under-represented. Links with age groups need to be further investigated, as the reference population was not composed of older adults only. In conclusion, the K&C OPHA CMHT is successful in reaching out to BAME populations in our catchment area. The team felt that this demonstrated that their person-centred approach, and respect for diversity, was being successful in promoting access to local BME communities. The results were discussed in a multidisciplinary team meeting and it was agreed that the service will continue to make use of appropriate and diverse methods of working. They will continue to place emphasis on culturally sensitive third sector organisations to partner with in the community and further investigate the issues leading to under access by White Other groups Partnership working with BME community organisations Continued involvement of the Trust s Equalities and Diversity Manager (Alison Devlin) as a member of the Advisory Group of the BME Health Forum, which is a local third sector organisation governed by a partnership of statutory, voluntary and community organisations that aim to reduce health inequalities affecting Black and Minority Ethnic (BME) communities in Westminster, Kensington & Chelsea and Hammersmith & Fulham. The BME Health Forum is also commissioned to provide a quarterly public meeting where, under a different theme each quarter, health issues are presented and discussed by representatives of local BME community organisations as well as key health and social care providers from the statutory and third sectors. The themes for 2016 were: Domestic Abuse, Stigma, Mental Health Wellbeing and Migration & Homelessness. CNWL services frequently work in partnership with local black and minority ethnic (BME) third sector organisations which in Kensington & Chelsea include OREMI (African, Caribbean and Arabic mental health) Al-Hasaniya (Morrocan and Arabicspeaking women) and JAMI (Jewish mental health) Workshops and joint activities are being provided by individuals from these organisations within the mental health inpatient wards at St Charles Hospital. Westminster mental health teams also refer their patients to the Migrants Resource Centre based in Victoria and the Waterloo Counselling Service both of which offer counselling in a variety of languages. CNWL has built up relationships with these specialist third sector providers over the years. Working in partnership with the BME Health Forum, one of the Cognitive Behavioural Therapy (CBT) Therapists provides a monthly supervision group for mental health champions from BME organisations across Westminster - this covers organisations working with Chinese, Somali, Bangladeshi and Iranian populations amongst others. The team has also delivered training to develop further mental health community champions working for the Mosaic Community Trust which 36

37 offers support to Arabic and Asian populations. They are running a series of outreach therapy groups for several BME organisations and groups such as: A Bangladeshi parent's group in North Westminster; The Migrants Resource Centre Henna Asian Women's Group in Kilburn ; Hillingdon Asian Women s Group The Harrow Addictions Recovery Team, took part in a Harrow based multi-agency showcase in 2016 that was organised to target the large Afghan community in Harrow. In Brent the Talking Therapies outreach lead has made some specific links with a number of local Brent-based organisations including: Help Somalia Foundation Asian Womens Resource Centre The Vanik Association (an association of Jains) The Brent Talking Therapies team have delivered workshops on managing well-being and provided information about our service and the range of therapies on offer. One of the workshops was delivered in Gujarati by a member of the team who speaks the language. Indeed the Talking Therapies Service staff team is diverse and about a third of the team are able to deliver interventions in several languages including Tamil, Punjabi, Gujarati, Urdu, Spanish, Portuguese, Arabic, Italian, Russian, Hindi, Albanian and others. The Health Promotion Team within Sexual Health have also have teamed up with the NAZ Project who provide HIV support services to Black, Asian and Minority Ethnic communities in London. Together they delivered outreach in clubs attended by the BAME LGBTQ communities - in clubs Kali and Exilio. in November 2016 in Club Kali in Islington they performed 33 HIV saliva tests in one night. Some of the people tested at this session had heard of HIV but did not know how it was transmitted Community health education and outreach Links are maintained with local black and minority ethnic organisations in Kensington & Chelsea and Westminster through the BME Health Forum. Knowledge of local community needs and services are also developed through participation in a bi-annual Kensington & Chelsea wide service networking event which brings together mental health service users, carers, NHS teams, council teams and third sector organisations to share information The Health Promotion Team within CNWL s Sexual Health services target the black and minority ethnic (BME) communities and work towards de-stigmatising HIV testing by offering it as part of a routine health check, they also offer STI screening for Chlamydia and Gonorrhoea as part of their Clinic in a Box model. They attend a range of venues where BME groups socialize. These include hairdressing salons, churches, refugee centres, gyms and local pharmacies. The team also engages in regular outreach around Camden and Islington targeting African people and signposting them to services as well as providing advice, leaflets and condoms. In October 2016 for Black History Month the Health Promotion Team carried out a HIV testing session in the Rock Church Camden. 4.2 Interpreting and Translation Commitment to the provision of interpreting is a key feature of Trust services, thereby advancing equal access to services and treatment for people whose preferred language is not English. In 2016 over 18,400 face-toface interpreting sessions have been provided in 94 languages, in comparison with 2015 when there were 20,000 face-to-face sessions in 65 languages. Additionally, 2,422 telephone interpreting sessions were also provided in 2016 in 51 languages. This represents a significant investment by CNWL to ensure that equality of opportunity in service delivery is advanced for service users whose preferred language is not English. The 37

38 Trust also provides training to our staff in the use of interpreters in partnership with the interpreting supplier. Furthermore there were 159 instances of written translations provided by our supplier of Interpreting services in 30 languages. The Health Promotion Team are an integral part of the overall Sexual Health Team. As part of the work the team joins forces with clinical staff to deliver weekly clinics for Sex Workers at the CLASH (Central London Action Sexual Health). The clinic is used by patients from a large variety of ethnicities and many patients who attend the CLASH clinic do not speak English as a first language. Three of the most common languages spoken are Mandarin/Cantonese and Romanian so there are two professional interpreters working with staff in the clinic every Friday morning. This service is advertised to the patients and it is well used. The other languages spoken by the patients who use this service are varied e.g. Russian, Lithuanian, Italian, Spanish and German, staff use either face to face interpreters from Language is Everything or phone interpreting. The service has recently noted they are seeing more patients from the Dominican Republic and Columbia. The service monitors where clients are from and they work closely with the Trust s interpreting provider, to ensure that the interpreting needs are met for the patients who use this service. 4.3 Disability Accommodating the needs of service users with disabilities The healthcare staff at Winchester prison are working with the social care team and the prison officers to introduce a Buddy System for prisoners with mild physical or learning disability needs. OFSTED and the CQC jointly carried out a SEND (Special Educational Needs and/or Disabilities) inspection in Hillingdon during December 2016 to assess the outcomes for children with special needs. The LAC health team were verbally congratulated for the quality of the health assessments that had been undertaken. A full report is due but unavailable at the time of writing Modifications are made to the method of delivery or the site of the service delivery It was recognised by the CAMHS Services in Milton Keynes that some of their older buildings were not fully disability accessible so, if an initial appointment was being sent for one of these buildings, the appointment letter had the following message added to them Please note we are based on the first floor of an old building, the only access to our service is via stairs. If you have concerns around the restricted access please advise me as soon as possible prior to your appointment, so that I can try to re-locate your appointment to our other base at Eaglestone Health Centre. Various teams from across the Trust, who are based in community clinics, report that they routinely arrange to see patients at alternative Trust premises or at the patient s home where there is impaired mobility or where building access is a problem. Primary Care Psychological Therapy services within London and Milton Keynes are increasingly being commissioned to provide psychological therapy to patients with long term health conditions. These patients often have very limited mobility, through physical limitations or breathing difficulties. The services have had to review where these patients are treated, in terms of places closer to home which are accessible to their mobility limitations. Everyone who calls the CNWL Sexual Health Service is asked if they have a disability- physical or mental, and it is also forms part of their telephone message. They encourage patients to tell them as the service can then offer them their Bridge service where the patient can have more time with the clinician and we have easy read leaflets to explain intimate examinations. The Brent Talking Therapies Service actively attempts to engage people with disabilities by being flexible with the formats in which interventions are delivered. For example they offer telephone based interventions where appropriate and also use online/digital therapies via Big White Wall for people who are unable to attend appointments in person. 38

39 A user-led brain injury support group was set up by the Stroke Clinical Specialist and the Brain Injury Clinical Specialist within Milton Keynes. The aim of the group was to provide an opportunity to meet socially within a community setting with others who understand the challenges of living with the after effects of Stroke and Brain Injury. The meetings are held at Strudwick s Café not far from the hospital site, which has good disability access for wheelchair-using clients and supportive staff members. The group varies between 15 and 20 patients and carers and has a discussion topic for each session which have included; accessible things to do in Milton Keynes and managing fatigue. The social element of the group is also very important. There is also a Multiple System Atrophy (MSA) support group that has been set up and facilitated by the Neuro- conditions Clinical Specialist this is very well attended Communication needs are addressed Within the Community Adult Diabetes Service in Hillingdon large font Blood Glucose Chart are used for people with poor sight. In addition, talking blood glucose meters are used for patients who are blind. The Trust s addictions services are developing a range of drug and alcohol leaflets as well as patient-held care and crisis plans in Easy Read formats. These will be used to support people with learning disabilities and can also be used where people need Easy Read for many other reasons. Staff in two of the Intermediate Care Services The Hawthorn Intermediate Care Unit at Hillingdon Hospital and the Windsor Intermediate Care Unit in Milton Keynes wear name badges which are black writing on a yellow background. The colour contrast is easier to read than black and white both for patients with reduced sight and for patients with dementia. The Trust provides British Sign Language (BSL) Interpreters for service users and staff. During 2016, (01/01/ /12/16) 790 BSL sessions were booked for Deaf service users to assist in equality of opportunity for Deaf service users whose language of choice is BSL. (2015 there were 555 BSL sessions for Deaf service users). Yellow dispensing labels at the St Charles Hospital dispensary that were specifically chosen because the contrast of black type makes this the easiest combination to read by those with reduced sight. The Diabetes Service in Hillingdon routinely provides appointment letters in a large print size where patients clinical notes indicate reduced sight. This meets the requirements of the NHS Accessible Information Standard for patient information Accommodating the needs of service users with a Learning Disability Prisoners who are admitted to the Healthcare wing at HMP High Down in Surrey and who have a diagnosis of Learning Disability receive input and advice from the Learning Disability Specialist Liaison Nurse who provides support in understanding processes within the unit and advice to the clinical in-reach team on how best to communicate with those with a Learning Disability. Over the last quarter there have been a number of referrals to an outside hospital owing to the identified disability and the difficulty experienced by such individuals of managing within the prison environment. An Occupational Therapist within the Trust Learning Disability Service, based at Kingswood Centre in Brent, is teaching her colleagues to use Makaton signing, one sign at a time. Simple diagrams are stored on a shared IT system and staff are ed a Makaton Sign of the Week every week to learn and use in their conversations with their patients. Makaton is a signing system which complements speech to increase understanding and it is used extensively to aid communication for and by people with a learning disability. 39

40 Some examples are shared here: Each community mental health team has a designated Learning Disability Lead who attends the local (borough based) Learning Disability Partnership meetings where advice and support is given to extend the team s knowledge of this patient group. The healthcare team within HMP Winchester are developing an action plan for patients with learning disabilities; part of this plan is to introduce Easy Read materials into their therapeutic groups. A similar set up is in place at HMP Wormwood Scrubs where peer support workers attend groups to help clients who need support in reading and writing, meaning they are still able to participate in the therapy. The Joint Learning Disabilities Service (CTALD) within Milton Keynes are working with the local CNWL Continence Nursing Service to develop an assessment pathway for people with profound learning disabilities who can t be assessed using the established mainstream assessment process. As a result of this, people with profound learning disabilities who were previously excluded from this are now able to access the service. Community Team for Adults with a Learning Disability (CTALD) in Milton Keynes deliver Learning Disability awareness training for student nurses who are on placement within Milton Keynes General Hospital and within the local CNWL mental health services. This is to ensure nurses are aware of the needs of people with learning disabilities so appropriate measures are taken to ensure their needs are met. In January 2016, as part of their service outreach and promotion initiative, Talking Therapies Service delivered wellbeing workshops to people with learning difficulties that were organised by Mencap, a learning disability charity. The team has a specific link worker for clients with a learning disability and she has delivered training to the whole talking Therapies Team on adapting mainstream Cognitive Behaviour Therapy (CBT) for patients with a mild Learning Disability. Feedback from the Occupational Therapists across the CNWL services report modifying their practice to accommodate the needs of service users with learning disabilities including The creation of simplified handouts with easy-read and pictorial formats to reinforce what has been covered in therapy sessions Providing one to one input to individuals would be disadvantaged in a group due to concentration, processing or anxiety issues. Slowing down the pace of the intervention and providing more time at appointments for people who have difficulty in processing information The use of sensory-based activities to help settle and calm service users experiencing anxiety or agitation 40

41 4.3.5 Work to increase the disability competence within other statutory and non-statutory services The Epilepsy Specialist Nurse within Milton Keynes has developed an innovative information pack that could ensure that people with epilepsy avoid an unnecessary visit to an Accident & Emergency (A&E) department when experiencing an epileptic seizure. The pack contains details of their medical history and will be held by the patient or their carer so that ambulance crews from South Central Ambulance Service will have a better understanding of the patient when they are called to their home in the event of them suffering from a seizure. This will allow them to decide whether or not the patient needs to go to an A&E Department or whether the patient can safely recover at their home. This could not only avoid an unnecessary admission, but also potentially free up hospital beds. The epilepsy nurse approached Epilepsy Action who teamed up with health business Simplyhealth to fund 100 packs. During the year, the Older Adults and Healthy Ageing Community Mental Health Team (CMHT) developed and started the delivery of a training programme for staff within residential and care homes within the borough. The team get regularly approached by care homes for input on dealing with challenging behaviour in dementia care such as: residents resisting personal care, shouting, and physical aggression towards staff. The aims were of the work were: Prevention: Working with staff to improve confidence, skills and empathy to prevent distress from arising among residents with dementia, and therefore preventing challenging behaviour. Effective triaging and stepped-care: Helping homes prevent and manage challenging behaviour using in-house skills, to free up resources in secondary mental health for more severe and complex cases. Joint working: Evidence suggests that training is only effective if combined with ongoing support / supervision: we are working closely with the home to enable this. Outcomes guided: We are monitoring staff and patient outcomes to ensure effectiveness. The Milton Keynes Paediatric (Children s) Speech and Language Therapy Team has a range of resources in Easy Read and simplified pictorial format such as advice sheets and a pictorial explanation of the drop-in process. Feedback from the Occupational Therapists across the CNWL services report modifying their practice to accommodate individuals access needs such as: Creation or enlarged handouts to accommodate reduced eyesight and simplified handouts for clients with a learning disability Providing one to one input to individuals would be disadvantaged in a group due to concentration, processing or anxiety issues. Provided more time at appointments for people who have difficulty in processing information Provision of appropriate clinic furniture, such as chairs with higher seats and arms for the less mobile Accommodating the needs of service users with mental health issues The District Nursing Service in Hillingdon is working closely with the Community Mental Health Teams in the care of several patients who require the dual professional input. An example is a joint appointment carried out with a clinical psychologist for a patient with an extreme phobia of needles. CNWL Mental Health Services in Milton Keynes have developed a partnership with Milton Keynes Dons Football Club and secured funding from the Football Association to run training sessions for service users of the mental health services. Both inpatients from the Campbell Centre and community mental health service users have for over six months been attending practice sessions on a weekly basis with MK Dons, the emphasis is on fun, fitness and building social networks. This has led to a football team that has proved a success both on and off the pitch. Supportive friendships have been formed and health and wellbeing has improved amongst the players the next step is to expand this programme and enter more teams into national leagues. In September, Simon 41

42 Warren, Mental Health Community Services Manager, and Amy Humphries, the Fitness Lead at The Campbell Centre, as well as Service Users, were invited to the football stadium to present awards at the Annual Disability Football Awards. The event was attended by over 500 players, supporters and sponsors. Photos are shown below. 4.4 Gender A survey was held by the CAMHS services in Milton Keynes asking young people what they thought about the refurbished waiting room. Feedback was positive, however, the males thought it was too female orientated. Acting on this feedback the service changed the pictures around and increased the proportion of the magazines that were male interest focused. This was possible because equality data was collected alongside the responses which could then be analyzed for themes along protected characteristic lines. The Trust has a Gender Requests Policy in place which sets out the circumstances in which service users may request professionals of a particular gender to provide treatment and care. In addition, the Trust s Medicines Policy reminds practitioners of their duty to respect the privacy and dignity of service users and that all efforts to provide a practitioner of the same gender should be made when intimate procedures e.g. depot injections into gluteal muscle are undertaken. Chaperones are used wherever appropriate. The Forced Migration Trauma Service has gender specific therapeutic groups for their clients who have Post Traumatic Stress Disorder. This is most important as some of the issues arising in the therapy include issues arising from a warzone and rape Specific work with men who are less likely to engage with services Building on the relationship between Milton Keynes Mental Health Services and Milton Keynes Dons Football Club, training has been provided to all the football team s staff on mental health awareness and information for the supporters is provided on a an information staff by the CNWL staff about accessing local IAPT Services (Primary Care Psychological Therapies) Specific work with women who are less likely to engage with services The Milton Keynes IAPT Psychological Therapy has routinely provided peri-natal interventions for female patients. They have identified significant evidence that men experience significant rates of depression and anxiety following the birth of their child and are therefore establishing a support group for first time fathers which Harrow Talking Therapies Team have been running for some time. The Westminster-based CNWL Joint Homeless Team won further external funding from the Greater London Authority and the Rough-sleeping commissioners of Westminster to provide a third year of the Female Entrenched Rough Sleeper Project. The project was set up in recognition that homelessness affects men and women in different ways. Women become homeless much less readily, but once affected, often become more entrenched. For reasons of personal safety, they tend to bed down less frequently than men, meaning that they do not come to the attention of outreach services. There is a cohort of women who move across local authority borders, making it difficult to establish territorial responsibility within the meaning of the Care Act 42

43 2014. This project has continued to work to identify this cohort, and has advocated successfully for them to receive health, social care and housing. The Harrow Addiction Recovery Service have acted on female client feedback that they preferred some interventions with members of the same sex. They have established a set women only day, each week at one of the treatment sites in response to female services users who felt vulnerable regarding attending services with mixed gender provision. Similarly ARCH (Addictions, Recovery, Community Hillingdon) also started both a Women only Wednesday (WOW) group and a Men s Group in 2016, both are well attended. Our addiction services within every borough are involved in their local Domestic Violence Forum, which is mainly around domestic violence against women, specific work has been supporting a client in a move to a women s refuge. Female sex-workers can in particular be disadvantaged in accessing health care services. The Trust s Sexual Health Service runs an outreach service to female sex workers many of whom do not have English as a preferred language. CLASH (Central London Action on Sexual Health) runs clinic sessions three times a week on Mondays, Wednesdays and Fridays offering a mixture of walk-in and appointment based service. The service site has been refurbished to a high standard to offer the best possible clinical care maintaining the warm feel which is very precious to these hard to reach clients. During the morning clinics, only female clients can attend the service to support the clients need for a safe, female-only environment. In addition to clinical work, the Health Promotion Team within CNWL Sexual Health Service take the service out to sex workers in flats, saunas and recently they have done some street outreach sessions. They signpost patients into the clinics and also can test on outreach through our Clinic in a Box making testing available to those who cannot attend the clinics. They are working to re-establish links with XTalk who support women working in the sex industry through many things but including English lessons. They have in the past provided our premises at Soho for these lessons and are exploring space in one of our other services to re-establish this work. 4.5 Religion or Belief Supporting service users faith and religious practice Although religion or belief is part of all the assessments that are carried out by the Community Team for Adults with a Learning Disability (CTALD) religion was a key determinant in planning services for two service users in For both of them, being part of their religious communities (Christian and Muslim) was absolutely essential. They are enjoying being part of their religious communities and feel they are contributing meaningfully to these communities. Following previously successful work in 2015 in association with The Pentacostal City Mission in Harlesden the Brent Talking Therapies Service have delivered a training workshop to staff of Christ Apostolic Church (Mount Joy) on identifying signs of psychological distress and signposting parishioners to the service. The Church has a high proportion of people from an African Caribbean background within their congregations and this is a very effective way of reaching out to this community. Multi-faith Chaplaincy services are provided under a Service Level Agreement to service users at in-patient sites at South Kensington & Chelsea Mental Health Unit (provided by Chelsea and Westminster Hospital), to Charles Hospital and the Gordon Hospital (provided by Imperial Healthcare NHS Trust) and to the Campbell Centre in Milton Keynes (provided by Milton Keynes University Hospital NHS Foundation Trust) Within Harrow, the faith visiting project continues with Christian, Hindu and Muslim volunteer faith visitors visiting the mental health wards at Northwick Park Hospital fortnightly to offer one-to-one faith support in helping in-patients meet their spiritual needs, particularly those who are not allowed to leave the ward. There has been interest from the local Jewish community and training is being developed for their members in mental health awareness and the Recovery model of care in order to join the team of volunteer faith visitors. Two of the Hindu faith visitors lead a Diwali celebration on the wards of Harrow Mental Health Unit 43

44 in November 2016 which was much enjoyed and one of the Christian visitors came to the wards in December to tell the Christmas story. A multi-faith open day was held in the unit to celebrate different faiths amongst the in-patients and to promote the availability of the various Faith Visitors Making clinical services more accessible for non-christian service users The Community Children s Nursing Team in Hillingdon make sure that the family s religion is always inquired about at the initial assessment to ensure that they implement practices which respect the families beliefs for every clinical contact. The nurses offer to remove shoes or wear overshoes when entering homes if that is the family s custom. During religious celebrations, they do not visit unless necessary or if the families specifically request a visit. The CCN will also support them in ways that is acceptable to them after a child death For example, they understand the importance of burial within a time frame within particular religions, and will participate as their custom during funerals. The school nurses at the three special schools give flu vaccinations and could give advice to families who were concerned that the contents of the vaccination might compromise their dietary rules. The Outreach team at ARCH (Addiction Recovery Community Hillingdon) specifically targeted the young Muslim community in Hillingdon as this group were under represented in their service. The service taken to them by holding a stall at the Friday prayers in the busiest of the local mosques (Hayes Muslim Centre) They team have ensured that they have established a regular presence to build trust, break down stigma and establish meaningful conversations with members of this community. They met with and generated buy in from the community elders who promoted the stall and encouraged people to speak to our team. They were able to hold many, private conversations delivering harm reduction information about drug and alcohol use as well as signposting people to both CNWL and other services. They received good feedback from the mosque and had their photo taken for the Islamic Centre s website. The Adult Diabetes Service in Hillingdon provides advice both verbally and in written format for Muslims who wish to fast during Ramadan and or who are undertaking the Hajj pilgrimage. The Pharmacy Medicine Information Service is able to provide information on medicines which contain products that some service users having a particular religion or belief may wish to avoid and information to assist practitioners to make adjustments to treatment regimens when clients refrain from oral ingestion during fasting. Hillingdon Children s Community Nursing Team respect families religious beliefs. They will try not to visit on days of religious celebrations if that is the family s wishes, and will also support them in ways that is acceptable to them after a child death such as understanding the importance burial within a particular time frame, and participating in the child s funeral if requested. All of the CNWL in-patient mental health facilities in London link in with JAMI an organisation which supports Jewish mental health service users and runs a hospital visiting service. 4.6 Sexual Orientation The Trust s Club Drug Clinic (CDC) offers services to those people using so-called party drugs such ecstasy s GHB, crystal methamphetamine. Lesbian, Gay, Bisexual and Transgender (LGBT) people are disproportionately represented in the numbers of those reporting use and suffering ill effects from both drugs and alcohol. All new staff within the team receive LGBT cultural competence training provided by the service s partner agency, Antidote, who are a specialist LGBT addictions organisation. The Community Team for Adults with a Learning Disability (CTALD) have supported service users in raising awareness of and their accessing local Milton Keynes LGBT services such as Pink Punters, Q-Alliance and LGBT social groups (evening events and breakfast/brunch clubs). 44

45 The CTALD have provided Learning Disability Sexuality Awareness training to student nurses from both Northampton University and Hertfordshire University. A service user with a Learning Disability co-delivers the training session. The Milton Keynes Neurological Specialist Team hold information days for people with Multiple Sclerosis (MS) on bladder, bowel and sexual difficulties. This provides patients with MS the opportunity to address with the team issues they find difficult to talk about in an open, friendly and non-judgemental environment and this includes issues arising within same-sex relationships. Sexual Health Service Health Promotion Team offers outreach sexual health services to venues (including bars, clubs and sex on premises venues) visited by men who have sex with men (MSM). This work is provided jointly with GMI (a gay men s health charity) in Camden & Islington, providing asymptomatic screening, hepatitis B vaccinations and HIV tests. The Service regularly works in close partnership with Antidote a charity that provides support to drug using LGBT people and attends a session a week to provide advice and guidance around sexual health to this client group, safer injecting advice and slamming packs for men who engage in chemsex. 4.7 Age Working with younger service users The CAMHS services are targeted at children and young people. The team in Milton Keynes recognised that some of this group, and their carers / parents, found attendance during traditional office hours difficult, so appointments can be arranged outside of hours. The Community Children s Nursing Team in Hillingdon acknowledges that children are very different to adults and are therefore specially trained to meet the needs of children, young person and their families. They respect that children/young persons are able to give consent for their own treatment and can refer to Gillick competence when obtaining consent for treatment for them with capacity. When carrying out their initial assessment the nurses will often gain duel consent if the young person is willing and able to also sign with the parent. The Team recognise that children with chronic conditions need to go to school and have activities. For that reasons the CCN will offer visits in schools and other community locations where possible - also offering after-school and weekend visits which often suits both young person and parent who may be at work. The Diabetes Team in Hillingdon run DESMOND patient education sessions approximately three times a month. DESMOND is a one-day structured education program for newly diagnosed Type 2 Diabetes and stands for Diabetes, Education and Self-Monitoring for On-going and New Diabetes. To as to encourage participation by people who are in Monday to Friday employment, they also run weekend sessions but have also focused on delivery of this on Sundays as this meets the employment needs of a member of staff who, due to religious rules, is unable to work between sunset on Friday and sunset on Saturday. Harrow Addiction Recovery Centre staff have been targeting younger people who use substances by setting up drop in clinics at Harrow College and at the local YMCA. The Addictions Services in Hillingdon (ARCH) work with range of children under 21 years, many of whom are in looked after placements (within the care system) and there is work undertaken with schools and youth centres to engage this group. Drug and alcohol awareness training that was to students at Langley College during an all-day event this year which was well received by students and staff. The college have been in touch with the ARCH outreach team to do further education work with their students. The same team have also The two workshops with young people at P3 Navigation and there are plans to continue delivering similar events in Milton Keynes NCST MS, The Milton Keynes Branch of the MS Society hold a monthly drop-in on the last Tuesday of the month at 10am until 1pm at the local Age Concern building. The Milton Keynes Neurological Conditions Team recognised that the timing of the meeting excluded people with MS who are working. They 45

46 set up a working age group that meet on the first Thursday of the month between 6pm 8pm to allow people with MS who are working to access support from others with MS. The meeting is held in a venue that younger people would feel more comfortable in. Another neurological conditions clinical specialist from the team is working with the patient and families team at Willen Hospice and also the local branch of the Motor Neurone Disease (MND) Association to look at ways of supporting a number of young people whose parent has been recently diagnosed with motor neurone disease. The Clinical Specialist has also been actively engaging with those children s schools to ensure teachers are aware of the condition and the potential impact their parents diagnosis will have upon the children. Sexual Health Services offer a Young Peoples drop in after school Monday Thursday at the Archway Centre. This is an integrated one stop shop where young people can have their sexual health and contraception needs met in one attendance. Under 16s can drop into the service at any time without an appointment and be seen. Services with the Addictions Directorate are generally commissioned to provide a service to all persons from the age of 18 and upwards in most of its boroughs. Hillingdon Service is additionally commissioned to provide dedicated Young Persons sessions at the local YP counselling service. The Club Drugs Clinic also provides an under 18s programme, particularly assessing young people using 'legal highs' Working with older service users The CNWL Healthcare Teams within prison sites report that they are dealing with an increased number of health and care issues related to ageing prisoners. In HMP Woodhill, liaison with Milton Keynes Council provided bed sides for an older man who frequently fell out of bed. ARCH (Addiction Recovery, Community Hillingdon) have started an older person s treatment pathway and a weekly mutual help group called JEM for this older adult group, which is run by themselves. HMP Coldingly, a male prison in Surrey, has a prisoner profile that is predominantly younger men but there are a few older (over 50 years old) prisoners who are accommodated in their own wing. The CNWL Mental Health In-reach Team are involved in the assessment of individual prisoners well-being to be able to meet the criteria for this separate accommodation which is quieter than the main unit. One of the members of the Talking Therapies Team is linked into their local Falls Prevention Service in order to think about the needs of older people with anxiety and fear of falling. The Hillingdon Talking Therapies Team has made connections with a variety of third sector organisations focusing on older people s care and workshops are being planned with: Hillingdon Age UK group The Parkinson s Society The Alzheimers Society Harlington Hospice (in Hillingdon) Hillingdon Carers group 4.8 Gender Re-assignment Although CNWL does not provide a Gender Identity Service, in the course of delivering their service many of our clinical teams do see patients who are thinking about undergoing gender transition, are undergoing or have undergone gender transition. A service user within the Brent Addictions Service, in association with their Strategic Service User Group has developed a Gender Identity Mapping Model shown below. It is proposed that this tetrahedron shape takes away labels for gender identity, and instead gives an eye pleasing colour for individuals to identify themselves 46

47 which someone can point to or mark on the page. It is designed as a tool to open up an important and sometimes overlooked discussion and create a more meaningful dialogue between healthcare staff and service users. The service is currently developing clear guidelines for staff and service users for its use and hopefully this may get adopted by services trust-wid in both two-dimension and three dimensional formats. There is regular liaison with the Gender Identity Clinic (GIC) at Charing Cross Hospital (run by West London Mental Health NHS Trust) reported from several of the CNWL clinical teams including the Milton Keynes Learning Disability Team (CTALD) and ARCH (Addiction, Recovery, Community, Hillingdon) All are supporting service users through various stages of gender transition. A trans female prisoner was referred for transfer from our mental health team in HMP High Down, a men s prison in Surrey to a local Mental Health Hospital. Whilst awaiting transfer, the CNWL team were sensitive in addressing the patient by her preferred pronoun and it was arranged for the patient to be able to order makeup from a service supplied to female prisons. Following a patient s feedback, Sexual Health Services have amended their patient registration forms to give clients the opportunity to document another gender other than male or female. The CNWL Patient Experience Team met with two transgender service users along with Milton Keynes CCG and Milton Keynes Hospital following concerns from the trans community about barriers they faced accessing healthcare in the locality. One of the Sexual Health Health Promotion Specialists facilitated an LGBT group for the Single Homeless Project, as part of the National HIV Testing Week. He had been invited to talk about the work of the outreach team and to see if the group participants would like to have a HIV / SDI testing session to be arranged. During the discussion the topic of homophobia and transphobia came up. All of the group participants (2 trans women and 3 gay men) had spent time living in a hostel and all had, during that time, been physically beaten 47

48 up, 2 of them hospitalised. The group discussed the attacks and how they might as a group be able to work with hostel staff to prevent such attacks and homophobia taking place again. The Trust s LGB&T Awareness Training for frontline mental health staff specifically includes transgender issues. The training addresses the need to understand the legal requirements of working with trans* service users, appropriate use of language and the application of relevant policies and the Trust s Codes of Conduct. The session is co-delivered by a rota of LGBT network members which includes a trans woman and a trans man. The Club Drug Clinic has strong links with the third sector agency SWISH, who work with transgender sex workers Pregnancy and Maternity Consideration of pregnancy and support for new parents The Hillingdon Community Children s Nursing Team acknowledge that pregnant mothers may be tired and the team will offer visits at a time that can accommodate the mother to enable her to rest at other times if possible. Pregnant mothers who may have had a previous child disability or who have lost a child are often anxious and can be signposted to other professionals for support. It is particularly common for parents with young babies to worry about the possibility of sudden infant death. When a family has already suffered from a sudden infant death the next pregnancies and first few months of subsequent babies lives will be a time of both joy and anxiety. The Team Leader from the Community Children s Nursing Team is the co-ordinator and sets up the CONI (Care of the Next Infant) programme in conjunction with the Health Visiting teams in Hillingdon. The core elements of the programme are regular contacts with a Health Visitor, symptom diaries, weight charts and apnoea (movement) monitors. The Harrow Recovery centre have a specific Hidden Harm worker who supports parents and expectant mothers who use substances and who are being supported by local authority child services. They also have pathways in place with the Northwick Park Hospital maternity unit and midwifery services to support pregnant women who use substances to access the Addiction Recovery services. The ARCH Team report securing funding for places for their clients at a specialist mother and baby residential rehabilitation unit. And all the ARCH staff donated presents for a Santa s grotto for their clients young children. When a service user from the Milton Keynes Learning Disability Service (CTALD) became pregnant early in 2016, it wasn t a question of this shouldn t have happened. It was about how the team could support her through the pregnancy and after. The young woman has autism and is fixed in the way she sees things, Unfortunately she has had some negative experiences of witch doctors in Africa, has been the victim of Female Genital Mutilation (FGM) and has had other surgical procedures carried out as part of the families religious beliefs. The service user was understandably averse to engaging with health professionals as a result of her previous negative experiences. She would not agree for any medical investigations to be carried out and would not attend any ante natal clinics/gp appointments. CTALD worked in partnership with all key agencies, social care- children and adults, her GP, the maternity and midwifery services, with advocacy services, the police and ambulance service to plan the delivery. The multi-agency plan was taken to the Court of Protection, which authorised it. All the planning and work taking into consideration the personal circumstances of this young woman enabled the safe delivery of her baby. All of the CNWL Talking Therapies Services have established a perinatal pathway in each geographical area. In addition: Hillingdon, Harrow and Brent teams deliver a Well-being for Mums group in different venues with crèche facilities available. Training was delivered to 20 Children Centre staff from across the Borough of Hillingdon Individual therapy Counselling and Cognitive Behaviour Therapy (CBT) is now provided in three Children Centres in borough with crèche facilities provided 48

49 Harrow Talking Therapies Team work with Midwives to deliver wellbeing workshops at Northwick Park Hospital together with the Brent Talking Therapies Team Pregnant women and new mothers have always been prioritised by the service but new fathers are now also prioritised by the service with post natal fathers groups being run in by the teams in Westminster and Milton Keynes. Pregnant mothers who may already have a child with a disability or who have previously lost a child are often anxious about their pregnancy. The Hillingdon Children s Community Nursing Team offer a Care of Next Infant (CONI) Service providing emotional support for the mother with sign posting to other professionals such as genetic counselling if required. The Talking Therapy Services report that young babies regularly come into their mother s therapy sessions and breastfeeding is promoted with comfortable chairs and a private area if required. The Arch (Addiction Recovery Community Hillingdon) Service delivers training on Parental Substance Misuse to social work students, health visitors and school nurses in training at Brunel University which is situated within Hillingdon borough Marriage or Civil Partnership The Learning Disability Community Team in Milton Keynes (CTALD) has a positive history of supporting individuals with learning disabilities who wish to live together as couples. They are currently supporting two service users who live separately in their family homes but wish to get married. They have expressed the desire to live together as a couple, so the team are working with housing providers to source an appropriate property and reassessing their needs in anticipation of them living together as a couple The Homeless Although not a protected characteristic defined under the Equality Act, inequality of access to health services for the homeless is a reality within central London. The Westminster Joint Homelessness Team has continued to be part of the local Integrated Care Network, which was set up in recognition of the difficulty homeless people have in accessing health care when they have a physical or mental health need. The Integrated Care Network provides six-week intermediate care beds to ensure that treatment can be provided in a safe and secure environment. The ARCH outreach team recreated a homeless/hostel room complete with dummy and drugs paraphernalia to demonstrate the role of the outreach team in helping this client group. This was aimed at the Council s housing team, a local housing Association and the staff at the Hillingdon winter shelter. The event has led to referrals to the outreach team from these housing teams. Camden Health Visiting Service have identified that it is often difficult for families living in Homeless (hostel) accommodation to access services in the community. The service works in partnership with the Anna Freud Centre to deliver a weekly session in a local homeless families hostel which provides an opportunity for families to access health advice and also a play session which focuses on the specific attachment and developmental needs of infants living in temporary accommodation. The on-site nature of the provision makes it non-stigmatising and easily accessible to many those who would not normally access the service. In the autumn of 2016, the homeless peripatetic nurse team within the Addictions Services which covers Kensington and Chelsea and North Westminster joined in with a pop up event in the West End of London to engage with vulnerable homeless spice (synthetic cannabinoid) users. The event aimed to engage with the homeless population and guide them into treatment and start to have meaningful dialogue about their substance misuse. The feedback from the police and commissioners was that the nurse s presence was invaluable. Leaflets and sandwiches were provided and due to its success and many new clients agreeing to come into treatment, another one is being planned for early in

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51 5. Corporate Functions 5.1 Complaints Complaints are monitored for issues of discrimination or perceived discrimination. In line with the Department of Health's requirement, complaints are recorded against a set of categories, referred to as KO41 codes. These have recently been updated and the revised codes will be in use from April The code for discrimination is called Privacy, Dignity and Wellbeing, this has a sub category that lists various different types of discrimination (disability, lifestyle, religion, etc) making it easier to identify the type. Any complaints where the main issue is considered to be discrimination is recorded as such, and on an individual basis attention is always paid to whether there is any learning to be obtained from the issues raised. Consideration is given to whether there is wider learning, via the Trust s Organisational Learning Group. Complaints leaflets are printed in the most used languages in the population served by the Trust. Complaints are accepted in a complainant's mother tongue and will be translated. Responses are provided in that language also. Where needed, interpreters are provided to assist the complainant/patient concerned. In addition, where complainants considered their written English is not as good as their spoken English, complaints staff will write a draft of the information provided, which the complainant can then amend as they see fit. This helps to support them to access the complaints process and to ensure the issue that they are raising is accurately communicated. 5.2 Safeguarding The Care Act (2014) set out the local authorities responsibility for adult safeguarding for the first time in primary legislation. This included ensuring enquiries into cases of abuse and neglect, the establishment of local Safeguarding Adults Boards on a statutory footing and for information sharing amongst agencies. CNWL has reviewed local guidance, policies and procedures and updated these to ensure that work being undertaken around Safeguarding Adults is compliant with the Care Act. This specifically included updating CNWL s Safeguarding Guidance to include the increased categories that fall under the types of abuse and the approach to raising concerns and undertaking enquiries. This was also in line with new Statutory Guidance and the publication of the London Multi-agency Adult Safeguarding Policies and Procedures. The 10 types of abuse outlined in the Care Act are: Physical Sexual Psychological Neglect and Acts of Omission Discriminatory Financial Organisational Domestic Abuse Modern Slavery Self-neglect Domestic abuse, modern slavery and self-neglect were all added following the Care Act. Any adult at risk may be exposed to all types of abuse but there are certain types of abuse that individuals with protected characteristics can be particularly at risk. Financial abuse and the increased use of internet and social media in scams often target older people, younger people at risk due to their mental health problems who have property or money taken away without consent or under pressure. Men and women who have been trafficked are particularly at risk of physical and sexual abuse and modern slavery. For the reporting year there were 102,970 individuals with enquiries under Section 42 of the Care Act in England. Of these enquiries, 60 per cent were for females, 63 per cent of individuals at risk were 51

52 aged 65 or over and 84% were white. For Section 42 enquiries which concluded during the reporting year, there were 124,940 risks recorded by type of risk. Of these, the most common type was neglect and acts of omission, which accounted for 34 per cent of risks, followed by physical abuse with 26 per cent. There were 110,095 risks recorded by location of risk in concluded Section 42 enquiries. The location of risk was most frequently the home of the adult at risk (43 per cent of enquiries) or in a care home (36 per cent). (NHS Digital, 2016). There is also a wider definition of adult safeguarding to include people who may not be using or currently in need of care services but who are vulnerable. The regulations make it clear qualitative improvements; putting service users experience at the heart of safeguarding will be required. Making Safeguarding Personal is about having conversations with people about how we might respond in safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. It is about seeing people as experts in their own lives and working alongside them with the aim of enabling them to reach better resolution of their circumstances and recovery. The Care Act statutory guidance states that safeguarding should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. This approach is reflected in the mandatory training that is delivered to all staff within CNWL. The Trust has completed a Governance Review that has established three Divisional Safeguarding Boards which cover both Children and Adults. There are also 6 posts 2 per Division - leading on Adult Mental Capacity Act and Safeguarding. These posts work closely with Senior Safeguarding Adults Managers in local boroughs to provide advice, support and training locally. The Safeguarding Children structure is via Named Nurses and advisors for each area and a review this year strengthened accountabilities from all services and promoted consistency across the Trust The Trust has updated its Sexual Safety Policy and developed a leaflet on Keeping Safe Sexual Safety. This is alongside a programme of Professional Boundaries training. This has focused on our inpatient mental health services but is applicable to community physical health and mental health services. This review and update was based on the New South Wales best practice guidance. The Prevent Agenda is one of the four P s [1] that make up the UK government's counter- terrorism strategy and it aims to reduce the number of people becoming or supporting violent extremists by supporting and protecting those people that might be susceptible to radicalisation and ensuring that individuals and communities have the resilience to resist violent extremism. As part of the Prevent Strategy, Channel is a multi-agency approach to supporting people at risk of being radicalised or drawn into terrorist related activity. The Channel process aims to: identify individuals at risk of being drawn into terrorism assess the nature and extent of that risk develop the most appropriate support plans for individuals concerned CNWL are represented at each of these Panels in the local areas. CNWL has a PREVENT Lead and the Trust has a training plan to meet the agreed target of 65% of staff trained. This training takes place as part of Induction and local borough workshops. PREVENT training has been added to the Core Skills training for NHS staff and is included as part of Statutory and Mandatory training. The Board of Directors were trained in Prevent at a Board workshop in December This training also included an explanation that services have made appropriate referrals to Channel Panels. Regarding safeguarding children, there are emerging new trends identified in the annual report and since. The need to work closely with fathers is a theme from many serious case reviews and is promoted in Health Visiting practice. Breast ironing, also known as breast flattening, is the pounding and massaging of a pubescent girl's breasts, using hard or heated objects, to try to make them stop developing or disappear and this practice has come to [1] The 4 P s are: Prepare for attacks, Protect the public, Pursue the attackers and Prevent their radicalisation 52

53 light. This has been added to staff training to aid identification of this as well as FGM. Services are also learning from a recent serious case review where young children were force fed, how this can be identified and the risks to the children. 5.3 Peer Support Workers The Trust is continuing its commitment to employing peer workers with personal lived experience of overcoming mental health challenges to inspire others and promote recovery focused practice. During the past year we have continued to see an increase in the number of Peer Support Worker posts being identified especially as part of the redesign of community mental health services. The Peer Workers in post come from a variety of culturally diverse backgrounds and within CNWL are employed either as Peer Recovery Trainers based in the Recovery & Wellbeing College or as Peer Support Workers based in clinical teams across the Trust. This continues to provide employment opportunities for those with valuable lived expertise of overcoming mental health challenges, which complement the skill mix of teams, contributing to reducing stigma and discrimination. Peer Workers role model the potential for recovery increasing hope for mental health service users. They encourage principles of co-production to be at the heart of service development, delivery and review fostering a climate of shared learning. As of December 2016, we have 31 peer support workers and 18 Peer Recovery Trainers in post. A number of roles in new settings have been/are in the process of being developed including posts in the Riverside Therapies Team, the Westminster Dual Diagnosis Team; and Horton Rehab Services. A Peer Support Employment Specialist role has also been developed in Hillingdon. Peer support workers are currently employed in the following settings: Eating Disorders Service Community Recovery Mental Health Teams Horton Rehabilitation Service in Epsom, Surrey Acute mental health inpatient wards at St Charles Hospital, the Gordon Hospital, Northwick Park Hospital and Hillingdon Hospital The Westminster & Kensington & Chelsea Joint Homelessness Team The Memory Service Within Brent addiction services Within Cookham Wood and Medway Secure Training Centres The services report instances where Peer Support Workers with languages other than English have used their mother tongue to support clients, assisting them to understand their rights and have also been able to help de-escalate situations in mental health ward settings. In order to support the further development of peer support worker posts across the Trust three Senior Peer Support Worker roles have been appointed (Hillingdon, Westminster and Kensington & Chelsea). These are essential to ensure that the training, supervision and development needs of Peer Support Workers are fully met in addition to supporting role development within teams who may be unfamiliar with the peer support concept. The Trust offers a Level 4, 20 credits, accredited Developing Expertise in Peer Support module, run in partnership with London South Bank University to all newly recruited peer workers in CNWL. The course is run over 10 days and topics covered include promoting Recovery, the art of sharing lived experience, challenging stigma and discrimination, creative problem solving to overcome the challenges of the role and developing effective communication skills to overcome barriers. Peer support workers are encouraged to share work place experiences and work collectively to develop creative solutions. The peer support workers develop skills in the art of sharing lived experience, learning how to share aspects of lived experience in a purposeful, sensitive and appropriate way. 53

54 Peer Support Workers employed by JAMI, (a mental health service for the Jewish Community) joined the CNWL training again in September 2016, bringing together individuals with different cultural and religious beliefs in a climate of shared learning. As of December Peer workers have attended the training. A Day in the Life of Peer Support, a collection of narratives collected from service users, staff and the peer support workers themselves about perceptions and views about the value (and challenges) of Peer Support, was published and is available at: CNWL is participating in a randomised controlled trial - enhanced discharge from Inpatient to community mental health care (ENRICH). The few weeks after discharge from a psychiatric ward can be very difficult, and rates of readmission to hospital, suicide and self-harm are high. There is some evidence that Peer Workers help people stay out of hospital after discharge by supporting individual mental health Recovery. This is a five year 1.95M programme of applied research, which began in early 2015, funded by the UK National Institute for Health Research. The ENRICH programme is led by a joint team from South West London & St George s Mental Health NHS Trust and St George s, University of London. ENRICH will develop and test a peer support intervention that aims to improve the experience and outcomes of discharge from inpatient to community mental health care. It is anticipated that the development of two dedicated Peer workers roles within the Trust will be developed as part of this research. Due to time limited funded the posts in the Kensington, Chelsea and Westminster Memory Services ceased during However, these posts were considered key to informing posts developing elsewhere nationally and the experience of the peers was referenced in the ImROC Briefing Paper - Continuing to be me Recovering a life with a Diagnosis of Dementia, which was launched at a training event, facilitated by Dr Rachel Perkins on Central and North West London NHS Foundation Trust Older People s wards. The paper explores the parallels between person centred care and Recovery-focused practice ; and is a practical and useful guide that reframes the perception of how people with dementia can continue to live meaningful and fulfilling lives. It can be found at: CNWL Recovery & Wellbeing College The College strives to support those who use or have used CNWL services to be experts in their own recovery and to make sense and meaning out of their experiences. The College endeavours to inspire all students to live well and make the most of their skills and talents. It provides a range of educational courses/workshops and resources for people who use or have used services, their supporters (family, friends and carers) and staff. The College continues to offer an innovative and varied curriculum of 87 workshops and courses, including wellbeing courses with a focus on the principles of personal recovery for those living with the challenges of physical and/or mental health. The emphasis is upon co-production: the delivery and development of all aspects of the College through collaboration between peer trainers and mental health practitioners, hence emphasising that people are more than passive recipients of services and have assets and expertise which can help improve services and promote self-management. 54

55 Student enrolment numbers April 12 March 13 April 13 March 14 April 14 July 15 Sept 15 July 16 3 terms 3 terms 4 terms 3 terms No. of courses/workshops scheduled No. of unique students each year registering with the Recovery & Wellbeing College Service Service Service Service Carers Staff Carers Staff Carers Staff users users users users Carers Staff Total no. of student attendances Service Service Service Service Carers Staff Carers Staff Carers Staff users users users users Carers Staff The numbers of students through its doors rose slightly when compared with the figure per term last year (the table above reports a four term figure for compared with 3 terms this year). Demography of the students compared to the population of the five London boroughs where available (2011 Census). The student demographics are analysed and work undertaken in relation to the promotion and citing of the course to improve update by under-represented groups. Gender profile of students Gender of students - Year 4 (n=1067) Unspecified, 2% Male, 30% Female, 68% Age profile of students (n=1067) Unspecified 94 9% % % % % 56 5% 34 3% 55

56 Sexual orientation profile of students Student profile % Student profile % Student profile % Heterosexual Bisexual Gay or Lesbian Do not wish to disclose Ethnic profile of students Student profile % Student profile % Student Profile % 2011 Census for the Five London Boroughs % White British Mixed groups Asian Black Faith affiliation profile of students (n= 1067) Number % Agnostic 44 4 Atheist / None Buddhist 23 2 Christian - Church of England Christian- Orthodox 9 1 Christian Roman Catholic Christian - Other 82 8 Christian Other Protestant 16 1 Hindu 74 7 Jewish 22 2 Muslim 67 6 Sikh 15 1 Other religion 33 3 Not stated / do not wish to disclose

57 Disability /Learning Support Needs of students (n=1067) Number % No disability /learning support needs Blind / partially sighted Deaf / Hard of Hearing Dyslexia Learning Disability Mental health Physical / Mobility Speech / Language Impairment 0 0 Other progressive Disability Other hidden disability Yes but do not wish to disclose Some of the Recovery & Wellbeing College (RWC) developments this year include: The Recovery College model will be replicated within a General Practice setting, targeting those who attend the general practice more frequently, with the aim to effect a positive change in the health behaviours and outcomes of this group of patients, through a healthy living programme. Delivering bite-size workshops on acute, inpatient mental health wards, including Park Royal s Tasman Ward Development of a Recovery & Wellbeing College spoke at Winchester Prison. The hosting two cohorts of placements from health professionals from Hong Kong in partnership with the Arts Psychotherapies. Employment service staff continue to co-deliver the following employment workshops, reviewing the original course and developing it into a modular programme, that supports students in their journey towards employment. As well as linking physical and mental wellbeing throughout the entire curriculum, the College continues to offer 11 workshops and courses that specifically focus on physical health and treatments Ongoing recruitment of Peer Recovery Trainers with specific lived experience relevant to service user and carer groups. Ongoing development of a multi-media/digital inclusion programme, including joint partnership with the Mental Health Rehabilitation Service and the Rix Centre. The College has worked with Dr. Jeremy Anderson, Sickle Cell Team Psychologist to develop two half day workshops with peers living with sickle cell (one of the most commonly inherited conditions, but one that remains poorly understood). The RWC has also been involved in helping shape the wellbeing provision of other statutory services and were commissioned to run courses for the Re-ablement Team in Hillingdon, that help support people in independent living 57

58 5.8 Communications The Trust s public website has been developed to AA compliance for accessibility, which is the national requirement for NHS services. This means that most of the website content is accessible for people with disabilities. To achieve this compliance there are a number of priorities that must be met to support people with a disability, such as those who require screen readers. Some of the priorities include: Tagging content that provides a visual reference, such as ensuring the correct order of headlines (H1, H2, H3 ) and ensuring non-text elements, such as images, have a text equivalent. All information conveyed with colour is also available without colour. Foreground and background colours provide sufficient contrast when viewed using monochrome display. Ensure links are clearly labelled. Allow users to increase the text size. The Trust s public website has a range of easily accessible Easy Read information which includes health advice, to delivering care and the mental health act. It also has the Word Bank facility, a dictionary plugin for websites that explains the meanings of difficult words. This provides a general aid in extending accessibility, not only for people with a Learning Disability, but for people who may have limited reading capability in English. A key element of communication about Equalities and Diversity within CNWL is the Trust s internal internet (Trustnet). An image of the front page of the extensive E&D section is reproduced above. Each of the links in the Diversity strand section takes you to a page with a similar layout providing information, web links and news items specific to that particular diversity strand. The pages are regularly updated and all new pages and news items also appear on the main intranet home page for all staff to see. The LGBT Network produces a quarterly Newsletter for its full members with a separate version for the Straight Allies. This includes: role models, news on other LGBT networks, news of the Stonewall WEI and HEI awards, a social calendar, information on particular days in the LGBT calendar like bi-visibility day. Equalities and Diversity posters are on display at all sites and services. These include an anti-racism poster and Stonewall posters Some People are Gay Get Over it and Different Families, Same Care which have been branded with the CNWL logo. In addition, the Trust has a Commitment to Equality and Diversity poster (see page 3 of this report) which stresses the Trust s commitment to equality across all protected characteristics, commitment to the public sector equality duty, and zero tolerance towards racist, homophobic, transphobic and other forms of abuse. The Trust provides a language translation on all patient information to highlight the availability of Trust information in other languages and formats on request. The Trust also seeks to ensure that diverse communities are represented in the images portrayed in our communications materials and within reports and other public documents. As noted in an earlier section, the provision of interpreting is a key feature of Trust services, thereby advancing equal access to services and treatment for people whose preferred language is not English. During 2016 there were over 18,000 face-to-face interpreting episodes provided, catering for 65 different languages. In addition, telephone interpreting is now also used routinely where appropriate Freedom of Information During 2016, four Equalities-related Freedom of Information (FOI) requests have been received by the Trust. These related to: 1. Gender considerations in treating female patients 2. Legal claims for discrimination under the Equalities Act

59 3. Ethnic breakdown of Doctors referred to maintaining high professional practice 4. Cost of professional translators and interpreters used at CNWL for the past 12 months All were responded to fully with the required information provided. 6 Next Steps Having been approved by the Trust s Board of Directors, this Report will be circulated to all Service Directors, Human Resources Managers and other senior managers. It will also be distributed to all the CNWL CCG commissioners and to other external stakeholders and partners. Major areas of corporate work around Equality and Diversity for 2017 will include: Improving data collection rates for staff and service user disability, religion or belief and sexual orientation on the new electronic patient system SystmOne Strengthening the Equality and Diversity accountability within the divisional management structures which were created in December 2014 Increased analysis of patient service use by equality characteristic at Divisional and Service level and actions developed to address differentials Redevelopment of the Trust s 4-year Corporate Equality Objectives by the Equalities and Diversity Manager using the NHS Equality Delivery System (EDS2) methodology Continued Implementation of the NHS England Workforce Race Equality Standard with associated action plan in association with Staff side and the BME Staff Network Implementation of the NHS England Workforce Disability Equality Standard with associated action plan in association with staff side and staff with disabilities Development of improved support for staff members with lived experience of mental health issues, including a formal staff network Development of improved support for staff members who are also carers for family members outside of work, including a formal staff network 59

60 Appendix A. Workforce Profile and 2014 Staff Survey Results A1 Workforce Profile Within CNWL as at 31 st March 2016 the Trust employed 6,405 people this is a 2% decrease in staff numbers on the previous year (31 st March staff). The Trust uses the national NHS Electronic Staff Record (ESR) system for collecting staff data, with intermittent census held to update these records. The data is used to monitor the profile of staff to identify areas of disproportionality and for workforce planning. All new starters to the Trust routinely have this information collected as part of the national NHS Jobs application process. The following provides the overall recording rates for the Equality characteristics routinely recorded on the ESR staff data system in 2016 compared to the previous three years. % Recording rate (not Including preferred not to say ) % Preferred not to say (where option available) % Not Known Ethnicity Disability Gender Age Religion or Belief Sexual Orientation A staff census is planned for early 2017 where all employees are individually informed of the details of the personal data being held on the ESR system and asked to amend any inaccuracies and complete any gaps. This should improve the data quality for the future. The workforce profile and other key Human Resources have been analysed and the results are shown. The workforce profile is as on 31 st March Data related to a fixed period is from 1 st April 2015 to 31 st March

61 A1.1. Ethnicity Overall workforce profile The charts below show the ethnic profile of all the employees within the Trust. Nursing workforce The chart shows the nursing workforce of the Trust. This is the largest group of staff that we employ. 61

62 Nursing workforce The charts below show a year on year comparison of the ethnic profile of the nursing workforce (Bands 5 & 6 and bands 7 and above) by ethnic grouping. The numbers of staff in each grouping are shown. Medical & Dental Workforce The chart below shows the medical and dental workforce of the Trust. 62

63 Workforce Ethnicity by Gender The chart below shows the workforce ethnicity by gender for the Trust. 63

64 Starters and Leavers The chart below shows the ethnic group of all CNWL starters and leavers for the year 1 st April st March 2016 compared to the total workforce during that period. Promotions The chart below shows the percentage of internal promotions by ethnic groups compared to the total workforce. Promotion is taken as the individuals who are on a higher payband during than they had been the previous year. 64

65 A1.2. Age Overall workforce profile The chart below shows the age profile of the CNWL workforce within seven age categories. Starters and leavers The chart below shows the age profile of all CNWL starters and leavers for the year 1 st April st March 2016 compared to the age profile of the total workforce during that period. 65

66 Promotions The chart below shows the percentage of promotions by each age category. Promotion is taken as the individuals who are on a higher payband during than they had been the previous year. A1.3. Gender Overall workforce profile One quarter (24%) of CNWL staff are male and three quarters (76%) are female, similar to previous years. 66

67 Seniority The chart below shows the percentage of males and females at each payband level. Starters and leavers The gender profile of both starters and leavers is the same and is also consistent with the gender of profile of the whole workforce between 1 st April 2015 and 31 st March 2016 workforce. There has been no change to the gender profile of the workforce during the year. 67

68 Promotions The chart shows the gender profile of internal promotions compared to the total workforce. Promotion is taken as the number of individuals who are on a higher pay band during than they had been during the previous year. A1.4. Disability Charts for starters and leavers, disciplinaries and grievances are not shown by disability due to there being inadequate data to analyse. Overall workforce profile The chart below shows the disability status of staff employed on 31 st March

69 The chart below shows how the collection of data regarding the disability status of staff is steadily increasing although there is no significant increase in the proportion of staff who are declaring a disability Promotions The chart below shows the disability profile of people who received promotions compared to the disability profile of the total workforce. Promotion is taken as the individuals who are on a higher payband during than they had been the previous year. 69

70 The recruitment process, starters and leavers, disciplinaries and grievances are not shown by disability due to there being inadequate data to analyse. A1.5 Religion or Belief Overall workforce profile The chart below shows the religion profile of the CNWL workforce as a whole. The chart below shows a comparison of the religion profile of the CNWL workforce over the past three years. 70

71 Promotions The chart below shows the religion profile of people who received promotions compared to the religion profile of the total workforce. Promotion is taken as the individuals who are on a higher payband during than they had been the previous year. A1.6 Sexual Orientation The charts for starters and leavers, disciplinaries and grievances are not shown by sexual orientation due to there being inadequate data to analyse. Overall workforce profile The pie chart below shows the sexual orientation profile of the CNWL workforce as a whole. CNWL Workforce Sexual Orientation Bisexual 1% Undefined 17% Gay 1% Lesbian <1% Do not wish to disclose 19% Heterosexual 62% 71

72 The chart below shows the comparison of sexual orientation profile of the CNWL workforce over the past four years. There is a worrying significant increase in the percentage of emplyees who are not wishing to disclose their sexual orientation. Seniority The charts below show the sexual orientation profile of CNWL staff within payband groupings. 72