NHS Greater Glasgow and Clyde Equality Impact Assessment Tool for Frontline Patient Services

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1 NHS Greater Glasgow and Clyde Equality Impact Assessment Tool for Frontline Patient Services Equality Impact Assessment is a legal requirement and may be used as evidence for cases referred for further investigation for legislative compliance issues. Please refer to the EQIA Guidance Document while completing this form. Please note that prior to starting an EQIA all Lead Reviewers are required to attend a Lead Reviewer training session. Please contact CITAdminTeam@ggc.scot.nhs.uk for further details or call Name of Current Service/Service Development/Service Redesign: Sandyford Sexual Health Services Please tick box to indicate if this is a : Current Service Service Development Service Redesign Description of the service & rationale for selection for EQIA: (Please state if this is part of a Board-wide service or is locally determined). What does the service do? Sandyford Sexual Health provides universal sexual health services for the whole of NHS Greater Glasgow and Clyde as well as specialist services for complex procedures and specific population groups. Many of the specialist services are provided on a regional or national basis. Why was this service selected for EQIA? Where does it link to Development Plan priorities? (if no link, please provide evidence of proportionality, relevance, potential legal risk etc.) Sandyford sexual health service is currently undergoing a comprehensive service review, with implementation of the recommendations taking place throughout The current service model is open access and appointment-based, accessed mainly by telephone self-referral. Young people aged under 18 can currently access the service via walk-in if they prefer. The review will look at how the core Sandyford service is structured with particular emphasis on the delivery of genito-urinary medicine and sexual and reproductive health services currently provided. A revised, sustainable service model will be implemented that is based on localities with identified team structures. It will: - Improve the use of existing resources through service redesign which will consider team structures, skill mix, localities and patient pathways

2 - Encourage those who could be self-managing to be supported differently - Ensure that Sandyford services are accessible and target the most vulnerable groups This EQIA will act as both a guide and a checking mechanism to ensure that the review proposals are inclusive of the diverse needs of our patients and provides the highest quality of care Who is the lead reviewer and when did they attend Lead reviewer Training? (Please note the lead reviewer must be someone in a position to authorise any actions identified as a result of the EQIA) Name: Date of Lead Reviewer Training: Runima Kakati, Communication and Engagement Co-ordinator, Sandyford Please list the staff involved in carrying out this EQIA (where non-nhs staff are involved e.g. third sector reps or patients, please record their organisation or reason for inclusion): As this is a baseline EQIA for the service review, only a few staff involved at this stage: Runima Kakati, Communication and Engagement Co-ordinator, Sandyford Fiona Noble, Planning and Performance Manager, Sandyford Gareth Greenaway, Planning Manager, Glasgow City HSCP Lead Reviewer Questions 1. What equalities information is routinely collected from people using the service? Are there any barriers to collecting this data? Service Evidence Provided Sandyford has the facility to collect data on age, sex, disability, ethnicity and postcode when clients register for services. Follow up / repeat patients are asked to complete the proforma at each visit so that changes in equalities status can be noted. Additional social history information and lifetime/recent sexual histories are collected during patient consultations. These capture data on sexual orientation, alcohol use, smoking, substance use, accommodation, violence and abuse, eating disorders, sexual activity Routine collection of data has decreased following service change from walk-in to drop-in in Action 01: System to routinely collect equalities data is required.

3 status, and partner gender. 2. Can you provide evidence of how the equalities information you collect is used and give details of any changes that have taken place as a result? Maternity/pregnancy and gender reassignment data are captured where clients access these services specifically. This data is not captured routinely from all users of services. Currently there is no routine capture of data on religion and belief or marriage or civil partnership status, as this may put people off seeking non-judgemental sexual health care. Data analysis of the system of first come first served walk-in service showed a disparity in that that urgent care patient risked long waiting times while routine care patients were likely to be seen quickly. The system was therefore changed to an appointment system to differentiate between urgent care and routine care patients. Anecdotal information from staff indicates that the change to a phonein system may have negatively impacted on service users with chaotic lifestyles. Lead nurses are collating and analysing data to see whether this is the case. Service user data in Govanhill showed low uptake from the community. A pilot is underway, offering targeted assessment and services. Age related data showed a year on year decline in young people attending services. Following consultation with young people, clinic times at our Parkhead hub were extended. Action 02: Analyse service uptake data for service users with more than 1 protected characteristic as part of continuous improvement

4 3. Have you applied any learning from research about the experience of equality groups with regard to removing potential barriers? This may be work previously carried out in the service. Childhood sexual abuse affects 1 in 12 adults and is estimated to currently affect 1 in 20 children. We have carried out an exploratory study to determine if adverse childhood experiences impact risktaking behaviours and poorer health outcomes of patients attending sexual health services. Consultation with young people suggested that the service is not open at the right times and is not easily accessible in some locations. As a result extended opening times has been piloted in Parkhead We revised our strategic plan following consultation : adjusted vision statement with key aims; clarified partnership working with primary care colleagues to improve patient pathways; made service improvement actions explicit stated performance measures, highlighting key indicators. A 12-month review of the changes to urgent care provision was conducted and actions identified. Service improvement actions have been identified and some are underway e.g. providing test only clinics to MSM to further increase capacity. Action 03: Service review considers ACE research study results Action 04: Service review considers pilot results Action 05: Service review considers service improvement actions 4. Can you give details of how you have engaged with equality groups to get a better understanding of needs? A 12-month review of the changes to urgent care provision included targeted and general client satisfaction surveys. Consultation with young people identified current opening times were not meeting their needs. Opening times were therefore changed.

5 Tailored Waverley Care African Health Project s Sexual Health Care Access Questionnaire to gain a better understanding of the needs to this priority group. To inform service review Action 06: Service review considers responses 5. If your service has a specific Health Improvement role, how have you made changes to ensure services take account of experience of inequality? The Sexual Health strategic plan identifies specific actions based on the analysis that people who experience the poorest sexual health and blood borne viruses, people with multiple or complex needs, or who have been traditionally harder to reach in society are often those who are most vulnerable or at risk. These actions would be incorporated into the service review proposals. Action 07: Service review considers actions in strategic plan 6. Is your service physically accessible to everyone? Are there potential barriers that need to be addressed? The Service review has an Accessibility work stream. One of its aims is to ensure that Sandyford Services are accessible and target the most vulnerable groups. The phone in service may pose a barrier to accessibility and will be included in the Service review. Loop systems are available in some hubs and satellites. An audit tool for facilities was launched by the West of Scotland MCN and all 53 locations in the West of Scotland were audited by the MCN Manager and Sandyford Operations Manager, in 2009/10. The audit covered accessibility issues including accessible toilets, ramps, signage, parking and public transport. NHSGGC Estates department conduct DDA compliance audits, which include Sandyford premises. Action 08: Service review considers accessibility issues in its proposals. Action 09: Install loop system where needed

6 7. How does the service ensure the way it communicates with service users removes any potential barriers? We have redesigned and user tested the sexual health website which has made our information much more accessible. An action place is in place with further improvements, this includes redesigning the Information and Services sections using client pathways through the website All our publications follow the Clear to All guidance and adhere to NHSGGC Accessible Information Policy. We routinely use interpreters and provide large print and translated information when required. We have provided Working with Interpreters and Deaf Awareness training for our staff. Action 10: continue to implement actions in the action plan We have staff on hand who are sensitive to patients who may not be able to understand or complete forms. Patients are registered privately one-to-one with a receptionist. Patient-centred consultations are emphasised including checking patient understanding of diagnoses and therapies. Our website has an introductory video which illustrates the patient pathways without the need to read anything, as well as videos with information 8. Equality groups may experience barriers when trying to access services. The Equality Act 2010 places a legal duty on Public bodies NB: There is a need to separate out issues that the service needs to address and issues that the service review

7 to evidence how these barriers are removed. What specifically has happened to ensure the needs of equality groups have been taken into consideration in relation to: needs to consider. Action 11: for a j below, review how equality data is collected and used. Action 11a: Service review to include systematic staff learning and development across all protected characteristics? (a) Sex A men only clinic was established in our Johnstone hub following review of data which identified a need to connect with more men. Gender split for attendance is monitored and reported for all sites. (b) Gender Reassignment Sandyford hosts the largest service for transgendered people in Scotland, with over half of our patients coming from outside NHSGGC. We also host the national Gender Identity service for young people. We provide support to TransparentSees - a support group for parents and family members of trans peoples. We need to ensure that all Sandyford staff and services are sensitive to the needs to our transgender clients and respond to their needs appropriately. Action 12: Staff training on Gender reassignment

8 (c) Age Include attendance data by age. Sandyford provides a specific young peoples service to under 18s. We provide specialist menopause service. Our Parents@Sandyford website provides support to parents around addressing sexual health issues with their children. (d) Race We offer information in a range of languages and use interpreters in our clinics. We have provided staff training on working with interpreters. There is ongoing work required to ensure that information is accessible in a range of languages (e) Sexual Orientation The Steve Retson Project provides services specifically to men who have sex with men. Action 13: The service review process needs to ensure that data is routinely captured, analysed and reported on, with actions identified as appropriate. Sandyford is one of five teams in the HSCP working to achieve Bronze level LGBT Charter of Rights. (f) Disability NHSGGC Estates department conduct DDA compliance audits, which include Sandyford premises. Our Service review had an Accessibility work stream. One of its aims is to ensure that Sandyford Services are accessible and target the most vulnerable groups. Action 14: Operations Manager to check the latest DDA position for NHSGGC

9 The phone in service may pose a barrier to accessibility and will be included in the Service review. Loop systems are available in some hubs and satellites. We have systems on place to book BSL interpreters for our patients. We offer printed information in large print and Braille. (g) Religion and Belief We have previously conducted faith group consultation as part of the preparation for the development of the Hubs, but there has been no further focus in this area. This was a deliberate decision, and due to the nature of Sandyford services. Many people would find being asked about faith or religion a barrier to their accessing the services contraception, termination services, STI checks, LGBT services, etc, could be embarrassing and sensitive for people and may be a source of fear or guilt depending upon their religious beliefs. (h) Pregnancy and Maternity The nature of our service means that we routinely advise patients not to bring children or babies with them. Staff can access the breastfeeding policy on staff net if required. (i) Socio Economic Status Attendance data for all our services is collected by SIMD and this feeds into service planning processes There has been no recent specific staff training on living in poverty, and general issues relating to health and poverty.

10 (j) Other marginalised groups Our Inclusion team ensures access to Sandyford services by Homelessness, prisoners and exoffenders, marginalised groups; for example people who are homeless, living ex-service personnel, with disabilities including physical and learning disabilities, seeking people with addictions, asylum asylum, living with alcohol/drug addictions and mental health seekers & refugees, travellers problems; women experiencing gender based violence; people involved in prostitution; BME groups; LGBTI individuals. Action 15: Service review to include working with intermediary organisations to highlight pathways to Sexual health Services 9. Has the service had to make any cost savings or are any planned? What steps have you taken to ensure this doesn t impact disproportionately on equalities groups? 10. What investment has been made for staff to help prevent discrimination and unfair treatment? We provide monthly services in Greenock women s prison We have an action plan for GBV (gender based violence) data recording. Our G3 Priority Clinic offers confidential and discreet sexual health service for women and men involved in the commercial sex industry Archway is our sexual assault reporting centre which also provides emotional support. The service review was initially predicated on the achievement of 250,000 efficiencies for 2017/2018 and this has been achieved. Further financial pressure has resulted in the scope of the review process widening to consider an additional 15% over the next three years. The use of spend to save to develop new technology which will improve accessibility and the service user experience is vital as is the requirement for transitional funding to facilitate the workforce changes required. Sandyford has recently carried out a Cultural Improvement programme and established a number of short life working groups to address themes such as annual leave, behaviour code, management Action 16: An EQIA will be carried out in relation to any reform proposals that come forward as a consequence of the review of the overall service.

11 accessibility, Red Q System and clinical audits. All teams have participated in the imatter initiative. We are working toward the LGBT Charter of Rights Bronze award. If you believe your service is doing something that stands out as an example of good practice for instance you are routinely collecting patient data on sexual orientation, faith etc. - please use the box below to describe the activity and the benefits this has brought to the service. This information will help others consider opportunities for developments in their own services. Actions from the additional requirements boxes completed above, please summarise the actions this service will be taking forward. Cross Cutting Actions those that will bring general benefit e.g. use of plain English in written materials Date for completion Who is responsible?(initials)

12 Specific Actions those that will specifically support protected characteristics e.g. hold staff briefing sessions on the Transgender Policy Ongoing 6 Monthly Review please write your 6 monthly EQIA review date: Lead Reviewer: EQIA Sign Off: Quality Assurance Sign Off: Name Job Title Signature Date Name

13 Job Title Signature Date Please a copy of the completed EQIA form to eqia1@ggc.scot.nhs.uk, or send a copy to Corporate Inequalities Team, NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospital, 1055 Great Western Road, G12 0XH. Tel: The completed EQIA will be subject to a Quality Assurance process and the results returned to the Lead Reviewer within 3 weeks of receipt. PLEASE NOTE YOUR EQIA WILL BE RETURNED TO YOU IN 6 MONTHS TO COMPLETE THE ATTACHED REVIEW SHEET (BELOW). IF YOUR ACTIONS CAN BE COMPLETED BEFORE THIS DATE, PLEASE COMPLETE THE ATTACHED SHEET AND RETURN AT YOUR EARLIEST CONVENIENCE TO: eqia1@ggc.scot.nhs.uk

14 NHS GREATER GLASGOW AND CLYDE EQUALITY IMPACT ASSESSMENT TOOL MEETING THE NEEDS OF DIVERSE COMMUNITIES 6 MONTHLY REVIEW SHEET Name of Policy/Current Service/Service Development/Service Redesign: Please detail activity undertaken with regard to actions highlighted in the original EQIA for this Service/Policy Status: Status: Status: Status: Completed Date Initials Please detail any outstanding activity with regard to required actions highlighted in the original EQIA process for this Service/Policy and reason for non-completion To be Completed by Reason: Reason: Date Initials 14

15 Please detail any new actions required since completing the original EQIA and reasons: Reason: Reason: To be completed by Date Initials Please detail any discontinued actions that were originally planned and reasons: Reason: Reason: Please write your next 6-month review date Name of completing officer: Date submitted: Please a copy of this EQIA review sheet to eqia1@ggc.scot.nhs.uk or send to Corporate Inequalities Team, NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospitals Site, 1055 Great Western Road, G12 0XH. Tel: