Equality, Good Relations and Human Rights Screening Template. Title: Self Care Haemodialysis (HD) in the Knockbreda Health and Wellbeing Centre

Transcription

1 Equality, Good Relations and Human Rights Screening Template Title: Self Care Haemodialysis (HD) in the Knockbreda Health and Wellbeing Centre 1

2 ***Completed Screening Templates are public documents and will be posted on the Trust s website*** See Guidance Notes for further background information on the relevant legislation and for help in answering the questions on this template (follow the links). (1) Information about the Policy/Proposal (1.1) Name of the policy/proposal Self Care Haemodialysis (HD) in the Knockbreda Centre (1.2) Is this a new, existing or revised policy/proposal? This is a new proposal (1.3) What is it trying to achieve (intended aims/outcomes)? At present the only provision for in-centre HD within the BHSCT is at the BCH renal unit. The patients that attend here are provided with 3 times weekly HD (a total of 12 hours) on the following shifts: Mon, Wed, Fri or Tue, Thurs, Sat. This is known as conventional haemodialysis (CHD). Mortality remains high despite improvements in the technology for dialysis, the development of new pharmaceutical agents, and the more than 40 years of experience since renal replacement therapy became available. Moreover, while CHD sustains, it rarely improves health. Increasing the frequency of haemodialysis could improve patient outcomes. High Dose HD is defined as either short daily (SDHD) or nocturnal haemodialysis (NHD) with no consecutive days without 2

3 dialysing. For SDHD, a minimum of 5 treatment days per week is required. NHD is classified as High Dose HD when at least 6 hour per session is performed every other night. Studies have shown that High Dose HD patients may benefit from: 1. Decreased left ventricular mass (LVM) 2. Lower systolic bloods pressure 3. Improved mineral metabolism 4. Better health-related quality of life (HRQOL) 5. Reduced number of medications 6. Survival equivalent to decreased-donor transplantation. Self care HD would potentially allow patients to have improved outcomes as mentioned above. Foley et al (2011) state that the long (2-day) interdialytic interval is a time of heightened risk among patients receiving haemodialysis. In this study all-cause mortality (infection-related, cardiac causes and cardiac arrest, myocardial infection) occurred more frequently on the day after the long interdialytic interval than on other days. References: Cullerton BF, Walsh M, Klarenbach SW, et al. JAMA. 2007;298(11): Chertow GM, Levin NW, Beck GJ, et al. N Engl J Med. 2010;363(24): Foley RN, Gilbertson DT, Collins AJ. N Engl J Med. 2011;365(12): Pauly RP, Gill JS, Rose CL, et al. Nephrol Dial Transplant. 2009;24(9): A large number of patients have chosen to avail of the treatment option of Home Haemodialysis (HHD). This option allows patients to self treat in their own home having being taught by specialist nurses to undertake all aspects of their care. The benefits of HHD are many the most significant being the clinical benefits to the patient as they receive more frequent and a larger quantity of dialysis at home than compared to in-centre facility therefore increasing their life expectancy. There are patients who would greatly benefit from HHD but there are reasons beyond their control that prevents them being able to avail of this treatment option. These patients would be ideal candidates for Self Care HD. 3

4 There are also a number of patients who would benefit from the increased flexibility self care dialysis at the Knockbreda site would offer. (1.4) How will the proposal be implemented? The Self Care facility will initially be operational on the following days Mon, Tue, Thurs, Fri (8am-6pm). The goal eventually will be to open 24/7. There will be band 5 nurses from the dialysis unit moving with the service. These nurses will be working independently in a supervisory role supporting the patients who have been trained to undertake self care HD. There will be 1 band 5 nurse on duty to support up to 5 patients at a time. (1.5) Are there any Section 75 categories (see list in 2.1) which might be expected to benefit from the intended policy/proposal? It is anticipated that all affected service users, regardless of their section 75 category, will benefit from this service. (1.6) Who owns and who implements the policy/proposal? The proposal is owned and will be implemented by the Community Dialysis Team within the Nephrology and Transplant Department set within the Cancer and Specialist Services Directorate of BHSCT (1.7) Are there any factors that could contribute to/detract from the intended aim/outcome of the policy/proposal/decision? (Financial, legislative or other constraints?) 4

5 The proposal is fully supported by the directorate and meets all objectives for TYC. (1.8) Who are the internal and external stakeholders (actual or potential) that the policy/proposal/decision could impact upon? (staff, service users, other public sector organisations, trade unions, professional bodies, independent sector, voluntary and community groups etc) Internal stakeholders all staff within the nephrology and transplant service. All patients currently served by the BCH Renal Unit. External- Northern Ireland Kidney Patients Association (NIKPA). Baxter Healthcare (service provider) (1.9) Other policies/strategies/information with a bearing on this policy/proposal (for example internal or regional policies) - what are they and who owns them? Transforming Your Care strategy facilitates the provision of acute hospital based services (i.e. haemodialysis) in the community. The following information is taken from Renal Association Guidelines. They recommend the following: Haemodialysis (HD) (Guidelines ) Guideline HD: Home haemodialysis and patient choice We recommend that all patients who may be suitable for home dialysis should receive full information and 5

6 education about home haemodialysis. (1B) Rationale HD may be performed in a variety of settings, including hospital-based units, free-standing units, and in the home. Patient survival and quality of life adjusted for co-morbid risk factors has been reported to be higher on home than hospital HD (1,2). Home HD is more cost-effective than hospital HD if patients remain on dialysis for more than 14 months to offset training and setup costs (3). The choice between home and hospital HD for patients assessed as able to perform dialysis at home should be determined mainly by patient preference rather than economic grounds. Patients performing HD at home require to be motivated to perform self dialysis, have a spare room or a home cabin for conversion for home HD and have reliable vascular access and most will have a helper or carer at home (4). Audit measure 15 The proportion of dialysis patients in the main renal unit and its satellite units who are on home haemodialysis. References 1. Woods JD, Stannard D, Blagg CR et al. Comparison of mortality with home hemodialysis and centre haemodialysis: A national study. Kidney Int 1996; 49: Saner E, Nitsch D, Descourdes C et al. Outcome of home haemodialysis patients: A case-control study. Nephrol Dial Transplant 2005, 20: Mackenzie P, Mactier RA. Home haemodialysis in the 1990's. Nephrol Dial Transplant 1998; 13: National Institute of Clinical Excellence. Full guidance on home compared with hospital haemodialysis for patients with end-stage renal failure October ( Guideline HD: Daily home haemodialysis We recommend self-treatment at home as the best way to perform daily short or daily nocturnal haemodialysis. (1D) Rationale Daily short and daily nocturnal HD have been reported in small observational studies to improve patient well being and reduce recovery times after HD and have been associated with improved control of anaemia and 6

7 blood pressure, better nutritional status and regression of left ventricular hypertrophy (1-8). However the delivery of daily HD at a hospital or satellite unit is impractical for a significant proportion of HD patients. Patient travel to and from a HD unit on a daily basis makes in centre or satellite daily HD less suitable for most patients wishing to perform daily short or nocturnal HD. In centre or satellite daily HD requires increased HD facilities and also an increase in trained HD staff unless the patient was self-caring. For these reasons daily short or nocturnal HD is suited ideally to be performed by the patient at home. Audit measure 9 The proportion of hospital (main and satellite unit) and home haemodialysis patients who are prescribed more frequent than thrice weekly haemodialysis. References 1. Twardowski ZJ. Daily dialysis: is this a reasonable option for the new millennium? Nephrol Dial Transplant 2001; 16: Galland R, Traeger J, Arkouche W et al. Short daily hemodialysis and nutritional status. Am J Kidney Dis 2001; 37(Suppl 2): S Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N et al. A crossover study of short daily haemodialysis. Nephrol Dial Transplant 2005; 21: Woods JD, Port FK, Orzol S et al. Clinical and biochemical correlates of starting "daily" hemodialysis. Kidney Int 1999; 55: Fagugli RM, Reboldi G, Quintaliani G et al. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive haemodialysis patients. Am J Kidney Dis 2001; 38: Pierratos A. Nocturnal home haemodialysis: an update on a 5-year experience. Nephrol Dial Transplant 1999; 14: Mucsi I, Hercz C, Uldall R et al. Control of serum phosphate without any phosphate binder in patients treated with nocturnal hemodialysis. Kidney Int 1998; 53: Raj DS, Charra B, Pierratos A, Work J. In search of ideal hemodialysis: is prolonged frequent dialysis the answer? Am J Kidney Dis 1999; 34:

8 Section 9.3 is particularly relevant to the Self Care HD Unit. We aim to have patients dialysing more than thrice weekly therefore they should see the clinically benefits of self care HD. 8

9 (2) Available Evidence / Needs, Experiences and Priorities (2.1) Taking into account the information above what are the different needs, experiences and priorities of each of the Section 75 categories for both service users and staff. Please note there are separate tables for Service Users and staff. Service Users (The data in the following table has been extracted from a patient monitoring system called the E-Med Renal Database. The data relates to patients of Belfast health & Social care trust who currently access Belfast City Hospital Renal Unit for Haemodialysis.) Category Details of evidence/information Service users Belfast/Castlereagh population as a whole Service users affected Needs, Experiences & Priorities Gender Female Male 51% 49% *2011 census 36% female 64% male The evidence suggests that there are almost twice as many male service users as female. It could therefore be inferred that this policy could have a greater impact on men than women but there is no information available to suggest that this impact would be impact. Age % 11% 12% None 1% More than half of the patients are aged 65+ and a further 37% of patients are aged These statistics are to be 9

10 % 14% 12% 15% *2011 census 3% % % % % 65+ expected given the nature of the service provided. This policy will therefore have a differential impact on people in the older age brackets, but there is no information available to suggest that this impact would be impact. Religion Protestant Roman Catholic No Religion or No Religion Stated 42% 41% 17% *2011 census 41% Protestant 35% Roman Catholic 19% no religion/non stated Given that almost 20% of respondents did not state their religion or stated they were of no particular religion, it would be remiss to draw firm conclusions in this area. The Trust is satisfied that the introduction of the new service, as contained within this policy, would not adversely impact any person on the grounds of religion given the clinic s locality and that fact that a range of Trust services are already provided in the new premises. Political Opinion Broadly Unionist Broadly Nationalist Other Do not wish to answer/unknown 48.3% 45.4% 2.3% 4% * 2011 Assembly election Using the Assembly election data as a proxy, there is nothing to suggest that this policy will have an adverse impact on any service user as a result of his/her political opinion. 10

11 Marital Status Single Married Other/Not known 36% 47% 17% *2011 census 22% single 56% married 22% other Most service users are married but there is no evidence to suggest that this policy would adversely impact on a person as a result of their marital status. Dependent Status Caring for a child dependant older person/ person with a disability 12% of usually resident population provide unpaid care There is no evidence to suggest that this policy will have an adverse impact on any service user as a result of his/her dependant status. None Not known * 2011 census Disability Yes No Not known 21% 69% n/a *2011 census It is reasonable to assume that a significant percentage of service users may have a disability given the nature of the service concerned. As such, this proposal will have a differential impact on people with disabilities, but the impact will be a positive one as it relates to an enhanced level of service provision. If a person with a disability requires information in an alternative format, or any other form of communication support in order to fully understand information, this will be provided. 11

12 Ethnicity White non white Not known 98.21% 1.8% n/a *2011 census 90% white 2% non white 7% blank/not known The data indicates that at least 90% of the patients concerned are white, therefore this policy would have a differential impact on people who are white but there is no evidence to suggest that this impact would be adverse. If a patient s first language is not English, information, both written and oral will be provided in the appropriate language and an interpreter will be provided where necessary. Sexual Orientation Opposite sex Same sex/same and Opposite sex The general view in NI is that an estimated 6-10% identify as lesbian, gay, bisexual There is no evidence to suggest that this policy will have an adverse impact on any service user as a result of his/her sexual orientation. Do not wish to answer/not known *2012 report by Disability Action & Rainbow Project 12

13 Staff The move will affect 11 staff who are currently involved in providing the service at BCH. An equality analysis has been carried out but a detailed breakdown of the analysis under the 9 Section 75 categories has not been provided due to the small numbers involved and to ensure confidentiality. The staff are predominantly female, white and none have stated that they are disabled. (2.2) Provide details of how you have involved stakeholders, views of colleagues, service users and staff etc when screening this policy/proposal. Meetings/discussions with all Consultants Nephrologists, senior nursing staff, community dialysis nursing team, HHD service provider. All patients who have been referred for HHD assessment as well as those who would benefit from Self Care HD have been informed of this new proposal/new treatment option. The discussions with both staff and patients were favourable and did not uncover any major issues. Discussions with NIKPA who are fully supportive of the proposal. 13

14 (3) Screening Questions You now have to assess whether the impact of the policy/proposal is major, minor or none. You will need to make an informed judgement based on the information you have gathered. Staff There will be no adverse impact on staff. Service Users (3.1) What is the likely impact of equality of opportunity for those affected by this policy/proposal, for each of the Section 75 equality categories? Category Details of policy/proposal impact Level of impact? Minor/major/none (3.2) Are there opportunities to better promote equality of opportunity for people within Section 75 equality categories? If yes, provide details. If no, provide reasons. Gender None None No Age None None No Religion None None No Political Opinion None None No Marital Status None None No Dependent Status None None No Disability None None No Ethnicity None None No Sexual Orientation None None No 14

15 (3.3) To what extent is the policy/proposal likely to impact on good relations between people of different religious belief, political opinion or racial group? Minor/major/none Good relations category Details of policy/proposal impact Level of impact Minor/major/none Religious belief None Political opinion None Racial group None (3.4) Are there opportunities to better promote good relations between people of different religious belief, political opinion or racial group? Good relations category Religious belief Political opinion Racial group Please provide details Staff and managers of the service can attend Equality and Good Relations training sessions, as provided by the Trust on a regular basis. Staff will be made aware of the Trust s Multi Cultural & Belief handbook 15

16 (4) Is there an opportunity to better address the health and social inequalities of groups/areas in greatest social, economic or educational need by altering the policy/decision? Suggestions No (5) Consideration of Disability Duties How does the policy/proposal or decision currently encourage disabled people to participate in public life and promote positive attitudes towards disabled people? Consider what other measures you could take. Staff will be made aware of the Trust s provision of Disability Awareness training and will be encouraged to attend. Staff will informed of the existence of the Trust s Disability Etiquette guide and Making Communication Accessible Guide. For example, have your staff received disability equality training or training on the Trust s Patient and Client Experience Standards? (6) Consideration of Human Rights (6.1) Does the policy/proposal affect anyone s human rights in a positive, negative or neutral way? Complete for each of the articles 16

17 Article Article 2 Right to life Positive impact Negative impact = human right interfered with or restricted Neutral impact Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment Article 4 Right to freedom from slavery, servitude & forced or compulsory labour Article 5 Right to liberty & security of person Article 6 Right to a fair & public trial within a reasonable time Article 7 Right to freedom from retrospective criminal law & no punishment without law Article 8 Right to respect for private & family life, home and correspondence. Article 9 Right to freedom of thought, conscience & religion Article 10 Right to freedom of expression Article 11 Right to freedom of assembly & association Article 12 Right to marry & found a family Article 14 Prohibition of discrimination in the enjoyment of the convention rights 1 st protocol Article 1 Right to a peaceful enjoyment of 17

18 possessions & protection of property 1 st protocol Article 2 Right of access to education Please note: If you have identified potential negative impact in relation to any of the Articles in the table above, speak to your line manager and/or a representative from the Equality Team. It may also be necessary to seek legal advice. (6.2) Please outline any actions you will take to promote awareness of human rights and evidence that human rights have been taken into consideration in decision making processes. Staff will be encouraged to attend Trust Human Rights Awareness training 18

19 (7) Screening Decision (7.1) Given the answers in Section 4, how would you categorise the impacts of this policy/proposal? Major impact Minor impact No impact (7.2) Do you consider the policy/proposal needs to be subjected to ongoing screening? Yes No A full Equality Impact Assessment (EQIA) is usually confined to those policies or decisions considered to have major implications for equality of opportunity. (7.3) Do you think the policy/proposal should be subject to an Equality Impact Assessment (EQIA)? Yes No 19

20 (7.4) Please give reasons for your decision. The policy will result in an improved and enhanced level of treatment for self care dialysis patients. From the anecdotal evidence provided in this document, it appears that there will be no adverse impact on service users. Given that this is a new policy, it is prudent for the policy to be subject to Ongoing screening so that any issues that may arise as a result of the change in service can be assessed from an equality perspective. (7.5) If you have identified any impact, what mitigation have you considered to address this? Staff are aware of the proposal and have not raised any equality related issues. An expression of interest notice was made available to all band 5 staff working within the nephrology and transplant service to see if they were interested in moving to the self care unit when it opens. 7 of the staff have chosen to move as a result of this trawl. 20

21 (8) Monitoring. In line with the guidance, you will be obliged to monitor this policy every 2 years. Please detail how you will monitor the effect of the policy/proposal for equality of opportunity and good relations, disability duties and human rights? The Trust monitoring framework, developed in relation to the monitoring of service change impact regarding Section 75 groups, will be followed. Feedback and complaints will also be considered for monitoring purposes. Approved Lead Officer: Position: Date: Judith Moore Acting Pre Dialysis and Home Therapies Team Leader 7 th June 2013 Policy/proposal screened by Equality Manager: Employment Equality Manager: Louise McNicholl Miriam Gibson Please forward completed schedule to lesley.jamieson@belfasttrust.hscni.net 21