EAST CHESHIRE NHS TRUST BED MANAGEMENT POLICY

Transcription

1 EAST CHESHIRE NHS TRUST BED MANAGEMENT POLICY

2 Policy Title: Executive Summary: Bed Management Policy This document provides instruction and guidance to managers and others on the protocol for Trust bed management. Supersedes: Bed Management Policy Description of Amendment(s): Bed configuration Specialty process This policy will impact on: Trust wide impact Financial implication: Possible financial impact for extra resource provision if identified during a bed crisis. Policy Area: Trust Wide Document ECT Reference: Version Number: 2 Effective Date: November 2016 Issued By: Deputy Director of Review Date: November 2018 Operations Author: AS/CG/CF Impact Assessment Date: November 2016 APPROVAL RECORD Date Consultation Urgent Care board meeting (planned) December 2016 Approved by Acute and Integrated Community Care Services Directorate Board December 2016

3 Contents 1.0 INTRODUCTION 1.1 Policy statement Purpose of the bed management policy 1.3 Context 2.0 ORGANISATIONAL RESPONSIBILITIES Hierarchy of accountability arrangements 2.2 The Trust bed management team 3.0 TRUST STATUS Scoring parameters 3.2 Capacity escalation policy 3.3 Deflection or divert requests 4.0 EMERGENCY ADMISSIONS CATCHMENT AREA Elective or planned admission The source of admission can be from the following areas 4.2 GP MEDICAL REFERRALS Ambulatory Care Admission 4.3 Surgical referrals 4.4 Gynaecology referrals Orthopaedic referrals 4.6 Psychiatric referrals 4.7 Patients requiring specialist care not provided by ECT 4.8 Generic Support worker ELECTIVE ADMISSIONS Surgery, Gynaecology and Orthopaedics 5.2 Surgical Admissions Unit (SAU) 5.3 Medical Repatriation of patients from other hospitals 6.0 SPECIALIST ADMISSIONS 6.1 Critical Care 6.2 Coronary Care Unit (CCU) Rehabilitation beds 7.0 OUTLIERS DISCHARGE LOUNGE SINGLE SEX ACCOMODATION Guidance for staff APPENDIX 1 Equality and Human Rights Policy Screening Tool 12

4 1.0 INTRODUCTION 1.1 Policy statement This Policy should be read in conjunction with the escalation policy. 1.2 Purpose of the bed management policy This policy covers all areas of guidance to effectively manage capacity and flow for emergency and elective of patients across East Cheshire Trust. The purpose of this policy aims is to ensure the following: All patients requiring emergency treatment have access to the appropriate specialty bed. A managed process that ensures patients requiring emergency or elective admission are accommodated in a timely and efficient manner to an appropriate area with the right resources and skills for their clinical needs. Elective admissions are planned and capacity is managed creatively to effectively managing anticipated bed availability. Where appropriate utilising the surgical admissions lounge (SAL). Specialty outliers receive appropriate, care and treatment and effective discharge planning. The capacity is effectively managed at all times; during increased demand the escalation policy is implemented. Patients should be accommodated in a segregated gender environment unless they are in an area exempted by the policy. Communication between trusts to enable repatriation to and from regional specialties and escalation as appropriate where a delay occurs. 1.3 Context Patient flow and capacity management is an integral part of the bed management and the night services role. The philosophy is to ensure patients receive care and treatment in a timely way, in an appropriate environment for their clinical needs in line with the trust s Equality and Human Rights policy. Effective use of beds is governed by the following standards: 95% of emergency patients spending < 4 hours from arrival to admission, transfer or discharge The 18 week referral to treatment standard The cancer access standards

5 The following areas are covered by this policy: Acute Assessment Unit and Ambulatory care management Medical Admissions Unit General Medical wards Coronary Care Unit Surgical Admissions Lounge General Surgical wards and day case beds Gynaecology beds Orthopaedic inpatient and day case beds Critical care unit - Intensive care and high dependency Intermediate care beds, ward 11 and Aston Ward, Congleton War Memorial Hospital Discharge lounge Medical Day Case Unit The following beds are excluded from the policy: Obstetric Paediatric In patient beds: Matron/ Charge nurse for Paediatrics will contact the Bed Manager when available Paediatric beds are down to two. It is then the Duty Bed Managers responsibility to establish Paediatric cover from other hospitals i.e. Stockport, Leighton, Wythenshawe, Manchester Royal Infirmary and Tameside. The treat and transfer process will then be implemented. (Refer to guidelines) General children s wards and department s standard for bedside, deliverable hands on care: Children <2 years of age 1:3 registered nurse: child, day and night. Children >2 years of age 1:4 registered nurse: child, day and night. Criteria for Admission to Children's Unit Children and Young People between the ages of birth and their 16th birthday. Children with long term conditions warranting continuing Paediatric involvement up to the age of 18 years. Children with disabilities who remain under the care of the Paediatricians up their 19th birthday. Children with Complex or Palliative Care needs under the care of a consultant paediatrician who are not expected to survive very long after their 16th birthday. Young people presenting with Diabetic Ketoacidosis (DKA) up to the age of 18 years. Please see (Admission of Children and Young People age 16 and over to the Children s Ward policy for more details.)

6 2.0 ORGANISATIONAL RESPONSIBILITIES 2.1 Hierarchy of accountability arrangements The Director of Operational Services will have executive management of all beds within the Trust, on behalf of the Chief Executive. The Manager on-call will have designated executive authority of all beds within the Trust outside of routine hours The duty bed manager and site management team will be responsible for providing accurate, timely and up to date information to inform the capacity meetings, Trust status reports, on call manager and Executive Manager The Trust Bed Management Team will be accountable for coordinating the bed management function on behalf of all service lines, to ensure that all beds within the Trust are used to the optimal effect. The Trust Bed Manager on duty will be the first point of contact for staff concerning bed management issues from , 7 days a week. The bed management team will undertake the role of site manager from 7:00-20:00 7 days a week. The site manager will support patient flow, manage issues across the Trust, escalate and communicate with the on call manager as appropriate. The Night Sisters on duty will be the first point of contact for staff concerning bed management and site issues between , 7 days a week. It is incumbent on all staff to ensure that this policy is adhered to. The Trust Bed Manager/Senior Night Sister on duty has delegated authority from the Director of Operational Services to allocate patients to beds across the Trust based on clinical need within any 24-hour period. 2.2 The Trust Bed Management team Senior bed manager, Bed Managers, Night Sisters and Site Managers The responsibilities of the Bed Management Team: To use clinical skills to ensure patient flow and accommodation of emergency planned, elective and the repatriation of patients is done in a timely way with the clinical need of the patient being the priority. To ensuring accurate and timely information is available regarding the bed status and any issues that have potential to impact on patient flow. To have an overview of the Trust wide situation and to provide timely information for capacity and escalation meetings. To support the escalation process and maintain the capacity in line with the predicted demand. To utilise skills and experience to provide solutions for capacity issues Communication of current and predicted status to the management team. Completing the Trust status report, daily text message and direct communication of any issues affecting patient flow.

7 Provision of support for the discharge coordinator simple discharges, criteria led discharges and the management of medical outliers. Site Management for Trust issues and senior support for junior staff, including resolution of issues or escalation to managers on call as appropriate. The Bed Manager/Senior Night Sister can be contacted via BLEEP 3011; Site Manager via bleep TRUST STATUS 3.1 Scoring parameters ECT defines the overall status of the Hospital into five categories: Status Green <4 Status Yellow 4-8 Status Amber 9-14 Status Red Status Black =25 + (Declared by an Executive manager) 3.2 Capacity - escalation policy The management of patient flow is an ongoing process which is incorporated into the escalation policy with the aim to maintain sufficient capacity for the predicted demand. Each status from Green to Black is covered within the Trust s escalation policy (Refer to policy) Capacity and escalation meetings will be convened and supported in the operational management office and Silver Command will be based in this area covered by the senior manager on call for that day. 3.3 Deflection or divert requests In line with the escalation policy the request for deflection or divert will be made at operational management level and agreed with NWAS for 1 hour deflections and will be based on the ability of the Trust including ED to safely manage further attendances and the capacity of neighboring Trusts to provide support for the agreed period of time. It may be necessary to accept out of area patients when neighboring Trusts have requested deflection or divert. This will be agreed by the Operational Manager will be for an agreed period of time. Deflection is the movement of ambulance borne activity to another site within the same hospital group border. Divert is a request for patients in border areas to be taken to the acute trust under less pressure. Full divert is the movement of ambulance borne activity away from a site under pressure, to the next nearest ED with prior agreement (NHS commissioning board).

8 4.0 Emergency Admissions An emergency admission is defined as an unplanned episode. A patient requiring a period of hospitalisation that cannot be managed on an ambulatory care or outpatient pathway. 4.1 Catchment area The "catchment area" is defined as the local area normally served by a receiving hospital. The East Cheshire NHS Trust catchment area covers Macclesfield, Alderley Edge, Wilmslow, Handforth, Knutsford, Poynton, Congleton and Holmes Chapel. GPs may also refer from Buxton, Leek, Whaley Bridge and Biddulph. 4.2 Elective or planned admission This applies to patients that have a date for a planned admission for treatment, investigation or surgery. It applies to all specialties and they will be given a priority status which ensures patients with the highest clinical need are unlikely to be cancelled due to capacity issues. Patients with planned admission date are subject to the 18 week referral to treatment pathway. There are three clinical categories used nationally for classifying patients for surgery. Clinicians performing triage will allocate received referrals with one of the following urgency Definitions: Cat A URGENT - Has the potential to deteriorate quickly to the point where it may become an emergency. Procedures that are clinically indicated within 30 days Cat B SEMI- URGENT - Causes pain, dysfunction or disability. Unlikely to deteriorate quickly or become an emergency. Procedures that are clinically indicated within 90 days. Cat C NON-URGENT - Causes minimal or no pain, dysfunction or disability. Unlikely to deteriorate quickly, does not have the potential to become an emergency. Procedures that are clinically indicated within 365 days. 4.3 The source of admission can be from the following areas: ED to specialty wards AAU following GP referral Outpatient clinics Repatriation from specialist Centers Repatriation from out of area or abroad

9 4.4 GP Medical referrals Emergency GP referrals are taken by the nominated Sister responsible for the Acute Assessment Unit (AAU). The AAU will function as the designated areas for assessing medical referrals and will provide a base for the on-take medical team and the Physician of the day (POD).Those patients deemed unsuitable for the AAU, i.e. clinically unstable or requiring intensive intervention, will be assessed in either the resuscitation or critical care rooms. When the AAU has reached capacity, patients will be assessed in the ED main area (AAU escalation policy) Ambulatory care The philosophy of AAU is only to admit patients that have a clinical need for an inpatient bed, where appropriate patients will be managed on an ambulatory care or outpatient pathway. These patients will be followed up by the Acute Physicians and reviewed in an ambulatory care clinic following a clinical management plan Admission It is intended that all emergency medical patients with a decision to admit should go to the Medical Assessment Unit (MAU) (Refer to MAU operational policy) in the first place with the following exceptions: Acute myocardial infarction or cardiogenic shock -direct to CCU Acute stroke - direct to hyper-acute stroke centres at Stepping Hill, Salford Royal and Royal Stoke Patients requiring non-invasive ventilation - direct to ward 4 Patients requiring intensive or high dependency care direct to ICU/HDU Patients requiring side-rooms when one is not available on MAU - direct to available side-room All patients will have an expected date of discharge (EDD) set on admission or at the posttake ward round by a senior clinician. The target length > 24 hours will be transferred, at the earliest possible opportunity, to an appropriate subspecialty ward, usually requested by the Consultant of Acute Medicine (CAM) or the POD. Ward 3 Gastroenterology, Ward 4 Respiratory, Ward 7 Cardiology, Ward 9 Elderly care intermediate care ward 11 Aston or community nursing home bed. 4.3 Surgical referrals Emergency GP referrals will be referred via the ED and assessed within the department or fast tracked to a surgical bed dependent on availability.

10 4.4 Gynaecology referral Emergency referrals via a GP, Antenatal clinic or Early Pregnancy Unit (EPAU) will be admitted to either Maternity or Ward 1a where possible. (Refer to EPAU operational policy). 4.5 Orthopaedic referrals Emergency referrals will be seen within the ED and if required admitted to the Orthopaedic Unit. Patients with fractured neck of femur will be managed on the fast track protocol and admitted to the trauma unit Ward Psychiatric referrals The psychiatric team will be informed immediately of any referrals. Unless contra- indicated by a medical condition, these patients will usually be assessed in ED interview room for observational and safety purposes. The patient will either be followed up in the community and discharged from ED or admitted to an available psychiatric bed in the area. 4.7 Patients requiring specialist care not provided by ECT Acute stroke, PPCI, complex cardiology, plastics, ENT, burns. Patients in ED who require specialist care not provided by ECT must be referred by the ED consultant/team and accepted by the on-call team at an appropriate hospital. Acute stroke patients: Patients from East Cheshire who would normally have presented to Macclesfield Hospital (exclusive of postcodes in Congleton and Holmes Chapel as these will be transferred directly to Stepping Hill Foundation Trust by NWAS as a 24/7 service), Patients needing Primary Percutaneous Coronary Intervention (PPCI) for Acute Myocardial Infarction, or other complex cardiology input ED must follow the pathway which is kept in resus, complete the primary PCI proforma, then call the PPCI Centre at University Hospital of South Manchester, the patient should then be urgently sent via ambulance, East Cheshire NHS trust then has an arrangement to repatriate the patients at the nearest opportunity or if delays in repatriation starts to compromise service provision at the PPCI center then this needs to become a priority, as a matter of urgency. Patients requiring plastic surgery: ED doctor to complete referral and transfer to Wythenshawe if appropriate. Patients with complex burns: ED doctor to complete referral, making sure patient fits criteria and guidelines kept in ED department, transfer to Wythenshawe Burns Unit if appropriate. Patient requiring specialty doctor for Ear, Nose and Throat (ENT) needs to be referred to Wythenshawe, transfer out if appropriate. 4.8 Generic Support Workers Where possible and appropriate, Generic Support Workers, or Hospital at Night Workers will facilitate the transfer of patients from ED or AAU to the requested admission area. 5.0 ELECTIVE ADMISSIONS 5.1 Surgery, Gynaecology and Orthopaedic

11 Patients listed for surgery on the day of admission are requested to report to the appropriate ward or unit on the day of their procedure. Waiting Lists should be kept up-to-date by the Inpatient Flow Co-coordinator or the Admissions Booking Clerks as appropriate, using data received from various sources. The Trust policy is that patients are listed within 2 working days from that decision to treat (1 working day for cancer listings). Detailed monitoring of the waiting list is the responsibility of the 18 Week PTL Monitoring Team. From the 1 st November 2015 the trust will be penalised for incomplete pathway over 18 weeks, 300 per patient per specialty. (Please see the patient access policy) The decision to cancel elective surgery will only ever be taken in times of prolonged bed crisis and following consideration of all possible alternatives (Refer to escalation guidelines). This decision will be reviewed on a daily basis in discussion with the Clinical Director of Surgery and Anaesthetics, Lead Clinician Gynaecology, Divisional Manager Surgery and Duty Bed Manager. Patients of category A status urgent - should always be protected as part of the policy management of overall capacity and the 18 week target taken into consideration. The decision to ring-fence a bed to accommodate a category "A" patient will be made by the General Manager for Surgery. This will only be considered in exceptional circumstances. Once agreed, this bed MUST NOT be used without discussion with either the Bed Manager or the On-Call Manager. In the event that a patient on the Day Case Unit requires an overnight stay, the Bed Manager on duty must be informed at the earliest opportunity. This also applies to patients on the Endoscopy and Treatment Unit (ETU). 5.2 Medical The consultants will list all elective medical patients as follows: 1. A preferred date of admission indicated by the Consultant. The patient will be requested to telephone to enquire for bed availability at 0800hrs on the appropriate date. 2. Urgent - patient to be admitted with 48 hrs. 3. As soon as possible - patient to be admitted within a week. If the status of these patients changes, the secretary will inform the Bed Manager. If a listed patient's condition deteriorates they will be admitted as an emergency to an appropriate bed. 5.3 Repatriation of patients from other hospitals 1.If the patient has a history of a known infection for example MRSA, VRE,CPE, CDI (with active diarrhoea) the must be admitted into a side room. If side room accommodation is not available the IC side room risk assessment document must be used to identify patients who can be moved as a lower risk into a main bay. 2. Repatriated patient who do not have a history of any known infections for example MRSA,VRE,CPE, CDI ( with active diarrhoea) Should ideally be admitted to a side room, and then screened for MRSA and CPE. If due to organisational pressures this cannot be achieved the returning organisation should be asked the result of the patient s last screen for MRSA and CPE and if they have had any recent contact with known MRSA or CPE patients.

12 If their screen was negative they can be returned into a main bay. However if they have no recent screens then the risk is deemed too great and the patient repatriation may be delayed. To prevent compromising the patient s clinical pathway further advice must be sought from the Infection Prevention and Control Team, out of hours the On Call microbiologist who may agree to the patient returning to a main bay and being screened. If that screen proves to be positive then the patient will need moving into a side room and the patients in the bay contact screened. 6.0 SPECIALIST ADMISSIONS 6.1 Critical care Admission of patients to these areas is in accordance with each individual unit's operational policy (Refer to ICU operational policy) Any elective patients requiring critical care postoperatively will only be admitted following assessment of the potential availability of critical care beds within the Trust. Consultation will take place between Bed Managers, the Critical Care Unit and the consultant(s) in charge of care. Emergency patients requiring critical care will only be transferred to an outside unit once all attempts to make a critical care bed has failed. If there are NO available critical care beds within the Trust, the Regional Bed Bureau should be contacted on short dial When the general acute bed situation inhibits the transfer of patients from the Critical Care Unit, or the repatriation of patients from other Trusts, priority will be considered before inviting in routine elective admissions. Discussion will take place with the Divisional manager, Bed Manager, Team leader and Consultant in Charge of the Unit to prioritise repatriation and elective admissions. Patients requiring transfer from the Critical Care Unit to a general ward will wherever possible be given priority. The Bed Manager will contact the Critical Care Unit on a daily basis to establish potential transfers from the unit. An I.C.U bed should be kept available at all times to facilitate an emergency admission. To accommodate this, the last H.D.U admission must have a bed ring-fenced on the ward. When the general acute bed situation inhibits the transfer of patients from the Critical Care Unit, discussion should take place between the Bed Manager and consultant in charge of the unit, to review the potential for adjusting the critical care capacity. 6.2 Coronary Care Unit (CCU) It is essential that there is bed capacity to enable the fast-tracking of emergency cardiac patients from A&E, transfer of unstable patients from the wards and return of 'treat and transfer' cardiac patients (Refer to CCU treat and return checklist). Ideally, to facilitate this, there should be one male and one female bed available on the general medical wards (preferably ward 7) to accept transfers from the CCU. When this is not possible this situation would constitute a 'trigger' for implementing the Bed Escalation procedure (Refer to policy). Patients with cardiac arrhythmias may be admitted directly onto the MAU or general medical wards to allow telemetry monitoring to take place. 7.0 OUTLIERS Patients will be placed within a specialty bed whenever possible. If the volume of

13 emergencies results in the need for patients to be transferred to beds on other wards to out lie they will be accommodated on ward 1, 1A only, Orthopaedic beds must not be used for outliers due to infection risk. The criteria for outlying patients should ideally be: a) Medically/surgically stable b) At low risk of infection c) With discharge arrangements in place (Refer to suitability of outlier checklist). Any patient with a known or suspected infection risk should be discussed with the Infection control team or on call microbiologist prior to outlying. Direct admissions may in some cases be preferable to transfers. The suitability for these admissions should be discussed with the admitting medical team. Outliers should be transferred back to the appropriate area to facilitate the admission of elective patients. The transfer of a patient due to bed shortages should only occur once during any inpatient episode. In exceptional circumstances this may happen, but must follow a risk assessment that takes account of the Trust s capacity to respond to emergency admissions. 8.0 DISCHARGE LOUNGE All patients due for discharge should be considered for transfer to the discharge lounge in accordance with the operational policy - (Refer to discharge lounge operational policy). The generic support workers and discharge lounge staff will facilitate the move to the discharge lounge once informed by the ward. 9.0 SINGLE SEX ACCOMODATION The maintenance of patients privacy and dignity is a fundamental component of patient care. All in patients will be nursed in wards or enclosed rooms/bays that are for single sex occupancy. Single sex accommodation for this policy is defined as when a room or bay is specifically for one sex with washing facilities also available solely for this one sex. Exceptions to the provision of single sex accommodation will only apply in the following areas: Intensive Care /Designated High Dependency Areas. Recovery suites Day case areas where patient are fully clothed, for example Haemodialysis Children s service In these areas, staff must make every effort to ensure that patient privacy is maintained with patients being transferred to single sex accommodation as soon as their clinical condition allows. Working in conjunction with the Delivering Same Sex Accommodation Mixed-sex occurrence policy and procedure. This is now part of the Privacy and dignity policy 9.1 Guidance for staff It is accepted that there may be extreme situations that necessitate that patients of one sex have to be admitted to an area occupied by patients of the opposite sex. It must be noted that unless there is clinical justification, the CCG will withdraw payment for that patient and all others affected. These extreme situations include: Times of major incident

14 When clinical needs takes priority over provision of single sex accommodation. For all occasions when patients are placed in mixed sex accommodation this should be explained to the patient/carer and an apology given which is documented in the patient s record.

15 Equality Analysis (Impact assessment) Please START this assessment BEFORE writing your policy, procedure, proposal, strategy or service so that you can identify any adverse impacts and include action to mitigate these in your finished policy, procedure, proposal, strategy or service. Use it to help you develop fair and equal services. Eg. If there is an impact on Deaf people, then include in the policy how Deaf people will have equal access. 1. What is being assessed? Bed Management Policy Details of person responsible for completing the assessment: Christine Gillespie Urgent Care Service manager: Patient Flow State main purpose or aim of the policy, procedure, proposal, strategy or service: (usually the first paragraph of what you are writing. Also include details of legislation, guidance, regulations etc which have shaped or informed the document) This policy covers all areas of guidance to effectively manage capacity and flow for emergency and elective of patients across East Cheshire Trust. 2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who use the service and the staff that provide it. Think about the information below how does this apply to your policy, procedure, proposal, strategy or service 2.1 Give details of RELEVANT information available that gives you an understanding of who will be affected by this document Cheshire East (CE) covers Eastern Cheshire CCG and South Cheshire CCG. Cheshire West & Chester (CWAC) covers Vale Royal CCG and Cheshire West CCG. In 2011, 370,100 people resided in CE and 329,608 people resided in CWAC. Age: East Cheshire and South Cheshire CCG s serve a predominantly older population than the national average, with 19.3% aged over 65 (71,400 people) and 2.6% aged over 85 (9,700 people). Vale Royal CCGs registered population in general has a younger age profile compared to the CWAC average, with 14% aged over 65 (14,561 people) and 2% aged over 85 (2,111 people). Since the 2001 census the number of over 65s has increased by 26% compared with 20% nationally. The number of over 85s has increased by 35% compared with 24% nationally. Race: In 2011, 93.6% of CE residents, and 94.7% of CWAC residents were White British 5.1% of CE residents, and 4.9% of CWAC residents were born outside the UK Poland and India being the most common 3% of CE households have members for whom English is not the main language (11,103 people) and 1.2% of CWAC households have no people for whom English is their main language. Gypsies & travellers estimated 18,600 in England in Gender: In 2011, c. 49% of the population in both CE and CWAC were male and 51% female. For CE, the assumption from national figures is that 20 per 100,000 are likely to be transgender and for CWAC 1,500 transgender people will be living in the CWAC area. 13

16 Disability: In 2011, 7.9% of the population in CE and 8.7% in CWAC had a long term health problem or disability In CE, there are c.4500 people aged 65+ with dementia, and c.1430 aged 65+ with dementia in CWAC. 1 in 20 people over 65 has a form of dementia Over 10 million (c. 1 in 6) people in the UK have a degree of hearing impairment or deafness. C. 2 million people in the UK have visual impairment, of these around 365,000 are registered as blind or partially sighted. In CE, it is estimated that around 7000 people have learning disabilities and 6500 people in CWAC. Mental health 1 in 4 will have mental health problems at some time in their lives. Sexual Orientation: CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) population in CE was estimated at18,700, based on assumptions that 5-7% of the population are likely to be lesbian, gay or bisexual and 20 per 100,000 are likely to be transgender (The Lesbian & Gay Foundation). CWAC - In 2011, the LGBT population in CWAC is unknown, but in 2010 there were c. 20,000 LGB people in the area and as many as 1,500 transgender people residing in CWAC. Religion/Belief: The proportion of CE people classing themselves as Christian has fallen from 80.3% in 2001 to 68.9% In 2011 and in CWAC a similar picture from 80.7% to 70.1%, the proportion saying they had no religion doubled in both areas from around 11%-22%. Christian: 68.9% of Cheshire East and 70.1% of Cheshire West & Chester Sikh: 0.07% of Cheshire East and 0.1% of Cheshire West & Chester Buddhist: 0.24% of Cheshire East and 0.2% of Cheshire West & Chester Hindu: 0.36% of Cheshire East and 0.2% of Cheshire West & Chester Jewish: 0.16% of Cheshire East and 0.1% of Cheshire West & Chester Muslim: 0.66% of Cheshire East and 0.5% of Cheshire West & Chester Other: 0.29% of Cheshire East and 0.3% of Cheshire West & Chester None: 22.69%of Cheshire East and 22.0% of Cheshire West & Chester Not stated: 6.66% of Cheshire East and 6.5% of Cheshire West & Chester Carers: In 2011, nearly 11% (40,000) of the population in CE are unpaid carers and just over 11% (37,000) of the population in CWAC. 2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or concerns raised either from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service or its effects on different groups?) No 2.3 Does the information gathered from indicate any negative impact as a result of this document? No 3. Assessment of Impact Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy or service (part 1) and looked at the data and research you have (part 2), this section asks you to assess the impact of the policy, procedure, proposal, strategy or service on each of the strands listed below. RACE: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, racial groups differently? No Explain your response: No impacts identified 14

17 GENDER (INCLUDING TRANSGENDER): From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender groups differently? No Explain your response: Same sex accommodation will be provided apart from exceptions to the guidance as detailed at point 9. Transgender patients will be located with the gender with which they identify. Please refer to trust Transgender Policy. DISABILITY From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, disabled people differently? No Explain your response: For young people with long term conditions such as learning disabilities, they will be admitted to the children s ward until their 19 th birthday and will be under the care of a paediatrician. AGE: From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have the potential to affect, age groups differently? No Explain your response: See also section on disability. For children not expected to survive long after ther 16 th birthday, they will be admitted to the Children s Ward. LESBIAN, GAY, BISEXUAL: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual groups differently No Explain your response: No impacts identified. RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief groups differently? No Explain your response: Staff will be sensitive to the needs of different faiths and ensure segregation is maintained. Staff can get further information form the Opening the Spiritual Gate website. CARERS: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers differently? No Explain your response: Carers will be kept up to date with any movements of their relatives. OTHER: EG Pregnant women, people in civil partnerships, human rights issues. From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect any other groups differently? No Explain your response: No other impacts identified. 4. Safeguarding Assessment - CHILDREN a. Is there a direct or indirect impact upon children? No b. If yes please describe the nature and level of the impact (consideration to be given to all children; children in a specific group or area, or individual children. As well as consideration of impact now or in the future; competing / conflicting impact between different groups of children and young people: c. If no please describe why there is considered to be no impact / significant impact on children Children s bed management policy is separate to this policy, but also see sections on age and disability. 15

18 5. Relevant consultation Having identified key groups, how have you consulted with them to find out their views and that the made sure that the policy, procedure, proposal, strategy or service will affect them in the way that you intend? Have you spoken to staff groups, charities, national organisations etc? Local policy management groups for review. 6. Date completed: 28/11/2016 Review Date:28/11/18 7. Any actions identified: Have you identified any work which you will need to do in the future to ensure that the document has no adverse impact? Action Lead Date to be Achieved Consider adding in a line to reflect the placement of Chris By the time of publishing the policy transgender patients as identified in the EIA. Gillespie 8. Approval At this point, you should forward the template to the Trust Equality and Diversity Lead lynbailey@nhs.net Approved by Trust Equality and Diversity Lead: Date: