The action plan documents developments to support staff in care settings to deliver the recommendations of Shaping Bereavement Care.

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1 1 Equality Impact Assessment Tool: Policy, Strategy and Plans (Please follow the EQIA guidance in completing this form) 1. Name of Strategy, Policy or Plan NHS Greater Glasgow and Clyde s Shaping Bereavement Care Action Plan. Please tick box to indicate if this is: Current Policy, Strategy or Plan New Policy, Strategy or Plan 2. Brief Description Purpose of the policy; Changes and outcomes; services or activities affected In February 2011 the Scottish Government Health Directorate published guidance for the NHS in Scotland on the development of quality bereavement support to relatives and carers following a death. That guidance, entitled "Shaping Bereavement Care", was issued as a Chief Executive letter to all Health Boards (CEL 9 (2011)), and called also for improvement in the training and support of all NHS staff whose work brings them into contact with dying patients and bereaved relatives and carers. The CEL stresses that such support should be available on an equitable basis across all NHS Boards and should be offered regardless of the nature of the illness which lead to the death. The need was to produce an NHSGGC Bereavement Care Action Plan that supported all staff and mitigated against discrimination for the protected groups. The action plan documents developments to support staff in care settings to deliver the recommendations of Shaping Bereavement Care. A Bereavement Steering Group has been established to take this agenda forward. This includes membership from community health and social care partnerships; carers organisations with a point of contact through the Dixons Carer Centre, South Glasgow and the Patient Information Centres ; the 6 hospices located within Greater Glasgow and Clyde s area; hospital chaplaincy; and representatives from the Rehabilitation and Assessment Directorate; Women and Children s Directorate; Occupational Health Department. Links are being established with the Choose Life Bereavement Group (a support group for bereaved families of suicide victims). Since Bereavement is now included within Living and Dying Well Building on Progress, it will be part of each formal Palliative Care Planning Group s Agenda. This includes the recently established Acute group which has attendees from each Acute directorate. 3 Lead Reviewer Jan Whyte, Planning Manager; Rehabilitation and Assessment Directorate.

2 2 4. Please list all participants in carrying out this EQIA: Planning Manager, Rehabilitation and Assessment Directorate; Senior Nurse Manager, Older People s Mental Health; Health Improvement Officer; Assistant Senior Nurse Manager, North East Sector; Senior Nurse, North West Sector; Quality Co-ordinator; Equality and Diversity Assistant. Involvement and views were also elicited from a Carers focus group through 8-10 people at Dixons Carer Centre this subject matter makes this a very sensitive issue for involvement. 5. Impact Assessment A Does the policy explicitly promote equality of opportunity and anti-discrimination and refer to legislative and policy drivers in relation to Equality? The introduction to the policy states In carrying out our duties as an employer and service provider we will act to promote equality for all regardless of age, disability, ethnicity, religion, gender or sexual orientation. The action plan takes cognisance of the following: Better Health, Better Care (SGHD 2007); Living and Dying Well, NHS Scotland (2008); The Liverpool Care Pathway for the Dying Patient; Spiritual Care (HDL 2002); Spiritual Care (CEL2008); Spiritual Care Matters (2009); Healthcare Quality Strategy for NHS Scotland (2010). These legislative and policy drivers also take cognisance of equalities legislation. B What is known about the issues for different equalities groups in relation to the services or activities affected by the policy? General Studies undertaken in by Robert Gordon University on behalf of the then Scottish Executive Health Department (SEHD), NHS Education Scotland (NES) and NHS Quality Improvement Scotland (NHSQIS) demonstrated a need to re-shape bereavement care within NHSScotland. This work included a Systematic Literature Review and a mapping exercise entitled Bereavement and Bereavement Care in Scotland1. There were 53,856 deaths recorded in Scotland in Just over half of these occurred in NHS hospitals with a further 17.4% in other hospitals or care homes, and the remainder in the community. The average numbers of death in NHSGGC over the last few years is around The Shaping Bereavement Care report conservatively estimates that four people will be significantly affected by each death demonstrating the large number of people who experience bereavement each year. Access to Source Shaping Bereavem ent Care (CEL 2011).

3 bereavement support therefore requires to promote equality of opportunity to access the new bereavement approaches. In NHS Greater Glasgow and Clyde each year there are likely to be over 10,500 people - 3,774 people dying from cancer and 6,768 dying from other causes - who will need access to palliative care services in the last year of life. There is more statistical evidence available in relation to palliative care, which is not only available for cancer patients but for anyone who is terminally ill. There are also high numbers of unexpected deaths for example by suicide. 3 NHSGGC PallIative Care HNA 2009 There are significant inequalities in health status and outcomes across the population of Greater Glasgow and Clyde, with poorer health outcomes amongst those who live in deprived areas in particular, but also inequalities and discrimination in relation to age, sex, ethnic origin, disability, faith and sexual orientation and so it is key that the Action Plan evolves to ensure appropriate support mitigates against discrimination for the protected characteristics. The Action Plan takes cognisance of the Palliative Care health Needs Assessment. This assessment used eepidemiological, demographic and socio-economic factors to determine the extent to which they influence palliative care and so bereavement need. The findings were also informed by public and staff involvement. 212 questionnaires were completed by health and social care professionals, patients carers and members of the public. In addition to this there were 26 focus groups which involved 177 participants. Gende r The analysis of data for NHS Greater Glasgow & Clyde demonstrates that older people who are living alone are more likely to be female than male. It is anticipated that the overall percentage of lone households will continue to rise in NHS Greater Glasgow and Clyde. Men in the Greater Glasgow Health Board area have higher levels of mortality from all cancers and from lung cancer, from chronic liver disease, and from mental and behavioural disorders due to the use of drugs than in the rest of Scotland, even after adjustment for area deprivation National Registrar report for Glasgow City Council

4 4 The difference in male life expectancy between the most and least socio-economically disadvantaged local government districts in Scotland was 7.6 years in 2001 (Glasgow City had a life expectancy of 68.7 years, whereas East Renfrewshire was 76.3 years). Differences in health behaviour account for some of the health outcome inequalities between social classes. 49% of men in the most deprived areas smoke regularly compared to 26% of men in the least deprived areas. The divide is similar for women: 43% smoke in the most deprived areas, compared to 24% in the least deprived. Particular approaches to bereavement support will need to take account of taking support to where men can easily access them although the uptake by women is likely to be greater due the greater need i.e. women living longer. Glasgow Centre for Populatio n Health Glasgow Centre for Populatio n Health Ethnicit y The information and data collected will be used to further inform the NHSGGC Bereavement Action Plan. Ren CHP West Glasgow CHCP East Glas gow CHC P South West Glasg ow CHCP East Dun CHP South East Glasg ow CHCP Nort h Glas gow CHC P West Dun CHP East Ren CHP Inver clyde CHP S Lanark shire (pt) N Lanarkshire (pt) Greater Glasgow & Clyde CHCP's Scotland % Minority Ethnic origins N/A Data Source: Community Health and Wellbeing Profile Glasgow Centre for Population Health Disabil ity There may be cultural issues regarding bereavement that the Action Plan notes it will need to address as stated in the Policy Purpose paragraph There may be communication issues with the bereaved family if English is not their first language This cross referenced with NHSGGC Information on Interpreter support. The information and data collected will be used to further inform the NHSGGC Bereavement Action Plan The booklet When Someone has Died had just been updated and is available in different languages so this was used to aid promotion of bereavement awareness by the way of road shows in all major hospitals in GG&CThere may be issues with communication if the bereaved family have any communication impairments / difficulties. NHSGGC Faith and Communit ies Manual Deleted: Sexual LGBT people are estimated to make up around 5% of the population of Scotland, Civil

5 Orient ation Religi on and Belief Age (Challenging Prejudice: Changing Attitudes towards Lesbian, Gay, Bisexual and Transgender People in Scotland Scottish Government, 2008 The Action Plan will further support staff to be aware of the NHSGGC Transgender Policy. The information and data collected will be used to further inform the NHSGGC Bereavement Action Plan Challenging Prejudice: There is no statistical evidence by religion and belief in relation to death but issues for the protected groups are referenced and will be covered by information in the Faith and Communities Manual.. Significant work into age at time of death was carried out for the HNA this will inform age appropriate bereavement support is provided as required It should be noted that children are also vulnerable to complicated grief and for them evidence does support early intervention. Significant policies have been established within Woman s and Children s Services that will be appropriately referenced in the Bereavement Action Plan: NHSGG&C policies for children and young people. (NHSGG&C Policy for Dealing with the Dying Child/Young Person and their Family) (2009)). (NHSGG&C s Guideline for Neonatal Death (2010)). These two policies will be referenced in the Action Plan and will be noted for use where a young person dies in an adult setting. 5 Partnershi p Act (2004) NHSGGC Faith and Communit ies Manual NHSGGC PallIative Care HNA 2009 Shaping Bereavme nt Care Report (2011) Social and Econo mic Status The information and data collected will be used to further inform the NHSGGC Bereavement Action Plan Within Greater Glasgow, mortality from all causes and from most of the specific causes is higher in the most deprived areas. Higher levels of morbidity and unfavourable health-related lifestyle factors in Greater Glasgow relative to the rest of the country are clustered within certain subgroups of the population: individuals with no or basic qualifications; middle-aged men; women in the most deprived areas; women in low social classes; and economically inactive women. Bereavement support will require to address the needs of all people who have been bereaved. Significant Statistical information is available from the Centre for Population Health. Glasgow Centre for Populatio n Health The information and data collected will be used to further inform the NHSGGC Bereavement Action Plan

6 6 C Do you expect the policy to have any positive impact on equalities or on different equalities groups? General Gender Ethnicity Highly Likely basis through the detailed background statistics and information gathered and so plan to address any potential discrimination for people with the protected characteristics as stated in the Draft NHSGGC Bereavement Policy. All documents, leaflets and information noted in this document with be subject to approval under the Accessible Information Policy. The following resources are available to support the Shaping Bereavement Care Action Plan: What can happen when someone is dying. This leaflet explains to relatives some of the changes that can happen when a person is dying. Most wards and departments in the Acute Division have Services and facilities leaflets which are guides for relatives and carers of patients who may be nearing the end of life and require end of life care. This includes information about visiting times; parking facilities; chaplaincy services etc. The Support for relatives section makes reference to NHSGG&C s Information and Support for Friends and Relatives When Someone Has Died booklet. This contains advice on practical issues following bereavement obtaining the medical certificate (Form 11), registering the death, arranging the funeral etc as well as copying with the emotional impact of loss and grief. NHSGG&C s Palliative Care Resource Manual which includes information about: breaking bad news; spiritual and religious care; loss, grief and bereavement; and contact information for useful organisations/charities. Work is underway to develop a training programme to support Shaping Bereavement Care. The Education and Training component to be equitably provided for staff both in Acute Hospitals and also for community staff where support is likely to be delivered. The training encompasses 3 levels. The levels are targeted toward specific staff groups depending on the needs of their role. basis. basis. The action plan will incorporate the learning from The Prince and Princess of Wales Hospice Minority Ethnic Possible

7 Project (ME) which developed culturally sensitive Hospice services to help address the palliative care needs of the minority ethnic population. 7 The following resources are available to support the Shaping Bereavement Care Action Plan: NHSGG&C s Interpreting Policy and Procedures. NHSGG&C s Information and Support for Friends and Relatives When Someone Has Died booklet. This contains advice on practical issues following bereavement obtaining the medical certificate (Form 11), registering the death, arranging the funeral etc as well as copying with the emotional impact of loss and grief. This booklet is available in Urdu; Punjabi; Arabic; Mandarin; Farsi; Polish and Turkish. The What Can Happen when someone is dying leaflet is available in the following languages: Arabic; Polish; Mandarin; Urdu; Turkish; Punjabi and Farsi. Disability basis. Learning will be applied and referenced from prior work done for people with Learning Disabilities The following resources are available to support the Shaping Bereavement Care Action Plan: NHSGG&C s Information and Support for Friends and Relatives When Someone Has Died booklet. This contains advice on practical issues following bereavement obtaining the medical certificate (Form 11), registering the death, arranging the funeral etc as well as copying with the emotional impact of loss and grief. This booklet is available in an audio format; Braille and a British Sign Language DVD. The What Can Happen when someone is dying leaflet is available in the following formats: Braille and audio. Sexual Orientation basis. The Financial Advice Section of NHSGG&C s Information and Support for Friends and Relatives When Someone Has Died booklet includes benefit information for civil partners and widowers. The Plan will reference the NHSGGC Transgender Policy. Religion and Belief basis. The following resources are available to support the Shaping Bereavement Care Action Plan: NHSGG&C s Faith and Belief Communities Manual. This includes information about 12 different

8 religions and belief and includes information about death; organ donation; and attitudes towards Euthanasia and Suicide. There is also supplemented with contact information for the different religions and beliefs. NES Multi-Faith Resource for Healthcare Staff. This resource also includes information about different faith groups and death customs. NHSGG&C s Chaplaincy teams offer spiritual and pastoral care to people of all faiths and to those who have no religious beliefs. An on-call Chaplain is available 24 hours a day via the hospital switchboard. All Acute sites have a chaplaincy department that will have a designated quiet room/sanctuary. NHSGG&C s Spiritual Care Committee includes representatives from the different faith communities Most wards and departments in the Acute Division have Services and facilities leaflets which are guides for relatives and carers of patients who may be nearing the end of life and require end of life care. This includes information the about chaplaincy teams 8 Age basis. Access and physical accessibility to bereavement approaches for older people will be addressed through all facilities approaches to appropriate adjustment. The following resources are available to support the Shaping Bereavement Care Action Plan: The Yorkhill Family Bereavement Service provides a range of support to people affected by the death of a child, children who have been bereaved and support/training for staff within the Women and Children s Directorate. The Butterfly Project is funded by the Big Lottery and aims to support children and young people, aged between 2 and 18, who are facing challenging times in coping with loss and bereavement. The Service covers three hospices and their surrounding communities:- The Prince & Princess of Wales, Glasgow St Vincent s, Johnstone Ardgowan, Greenock Social and Economic Status basis. NHSGG&C s Information and Support for Friends and Relatives When Someone Has Died booklet contains information about paying for the funeral; help to pay for the funeral; information about benefits and signposts to other agencies such as Money Matters. This will be considered for roll out across NHSGGC within Carer Information funding.

9 9 D Do you expect the policy to have any negative impact on equalities or on different equalities groups? Highly Likely Possible General The action plan does not make direct reference to the protected characteristics. Although there are resources/organisations available to meet the needs of the protected characteristics. Gender See above Ethnicity See above Disability See above Sexual See above Orientation Religion See above and Belief Age See above Social and Economic Status See above

10 10 E Actions to be taken E1 Changes to policy E2 action to ensure that planned positive impact is realised E3 action to compensate for identified negative impact E3 Further monitoring The action plan needs to take cognisance of the resources currently available within NHSGG&C to support this agenda. All training provided will cover all the protected characteristics. Include an equality and diversity statement in the action plan The action plan needs to ensure that it takes into account communication difficulties that bereaved families may have. Ensure the action plan incorporates the learning from The Prince and Princess of Wales Hospice Minority Ethnic Project (ME) which developed culturally sensitive Hospice services to help address the palliative care needs of the minority ethnic population. The Action Plan needs to list all relevant policies e.g. Deaths in Hospital Policy; NHSGG&C s After Death Policy: Retention of the deceased on the ward /unit; NHSGG&C s Death of an asylum seeker in hospital (Draft). NHSGG&C s Standard Operating Procedures: Releasing Bodies Out of Hours for Clinical Co-ordinators (Draft); NHSGG&C s Guideline for Neo-natal death (2010); Standard Operating Procedures (SOP): Last Offices. The recommendations of the action plan are broad and these need to be expanded to provide more detail of how they will be implemented. The NHSGGC Bereavement Group will meet regularly to review and monitor progress on implementation when the annual workplan with timescales are agreed The Shaping Bereavement Care Policy (Recommendation 4) needs to ensure that the protected characteristics are included and reference the Equalities Act (2010). The plan does not yet indicate what monitoring will be put in place to ensure bereavement care is provided. Responsibility and Timescale

11 potential positive or negative impact E4 Further information required The membership of the Bereavement Steering Group to ensure it includes representatives from across NHS Greater Glasgow and Clyde; partnership organisations and stakeholders Review: Review date for policy / strategy / plan and any planned EQIA of services Lead Reviewer: Name: Sign Off: Job Title Signature Date: Please copy of the completed EQIA form to the Corporate Inequalities Team EQIA1@ggc.scot.nhs.uk General Information Name of Training Course/ Session Bereavement Awareness Training Level 1, 2 & 3 Name and designation of Trainer (Lead Reviewer) Susan Jackson, Education Facilitator, Accord Hospice, Paisley, PA2 7BW Please tick ( ) Please tick ( ) Is this training A new training course An existing training course Is this the course delivered Aim of the Course Locally within a directorate e.g. CHP/CHCP/ Acute Directorate? Acute Available for use across NHSGGC

12 Please list the staff groups at whom the training is aimed at? Has the course been mapped to components of KSF including Core Dimension 6 Equality and Diversity? Do you have knowledge of/or completed equality and diversity courses and know how to challenge discriminatory behaviour? To raise awareness of the needs of bereaved people as recommended within Shaping Bereavement Care (Scottish Government 2011). All health care staff should be able to access the level 1 material Targeted health care professionals (i.e. RNs) for level 2 & 3 Yes, Core 1,2,4,5, 6, G1, HWB1 and HBW4 Yes, all trainers are experienced education facilitators with teaching qualifications who recognise discriminatory behaviour and would challenge same. 12 Course Booking Good Practice Gaps identified Please describe how you capture Diversity information of staff and monitor staff attendance. Attendance at specific events will be coordinated through existing GGC channels Sign in sheets will be taken by facilitators Training being provided by external agencies who do not have direct access to present GGC learning and development systems and processes. Accessibility Good Practice Gaps identified What processes do you have in place to identify any specific needs of course attendees? Level 1 resources will be widely available on line Level 2 & 3 resources are targeted at much smaller audience so relevant information about participants needs/concerns will be gathered prior to event. Hand outs etc can be provided in different coloured paper and larger font if required. Cognisance will be taken of participants who may Difficult to ascertain specific needs of potential viewers of level 1 resource.

13 be personally affected by the training topic. Does the course venue meet A variety of venues will be used to ensure N/A accessibility requirements? maximum accessibility. On line access to materials Content Good Practice Gaps identified Using Table 1 in the guidance, how does the course promote equality and diversity issues within its content? Language used within the materials is nondiscriminatory nor does it stereotype Emphasis throughout training materials on the fact (Language, Information, Group that bereavement affects people of all ages, race, Work, Additional Content) genders, religion, disability and sexual orientation. 13 ACTIONS FROM GAPS IDENTIFED Level 1 materials focus on a very specific situation however participants will be made aware that people if different culture/belief etc may act differently. Group work in Level 2/3 resources will discuss above in more detail Training information will include a description of how the materials can be accessed and potential participants will be encouraged to contact trainers about specific concerns or needs prior to training date. Liaison between training providers and GGC learning and development team Date for completion April 2012 April 2012 Who is responsible? (initials) Susan Jackson (SJ) SJ Review Date Date.. Please send a completed copy of this EQIA to CITAdminTeam@ggc.scot.nhs.uk