Equality & Rights Action Plan

Transcription

1 Equality & Rights Action Plan This document outlines the actions we will take to work towards our Equality & Rights Outcomes. Outcomes not processes An outcome is an end result, for example having staff who are all aware of Equality and Rights issues and who can treat all people with dignity and respect. A process is how to get there, for example a training plan or revising the contents of the training course. We have tried to focus the actions in this plan on outcomes as much as possible. Sometimes it is difficult to measure outcomes, but during the life of this action plan we will develop ways of doing this. The actions we have included here are in addition to equality activities mainstreamed in other plans. This means that we have not referred to work set out elsewhere which will promote Equality and Rights. This is to ensure that the action plan is as clear and concise as possible and addresses current gaps in services, information and evidence. The Equality Act makes no specific reference to people on low incomes but all work subject to impact assessment as outlined in this action plan takes account of the impact of socio-economic position on tackling health inequalities. Unique ID: NHSL. Author (s): JG, LB Category/Level/Type: Category 1 Strategy Version: 1 Status: Final version for publication Authorised by: NHS Lothian Board Date of Authorisation: Review Date: April 2015 Date added to Intranet & website: 24 April 2013 Key Words: policy, strategy, outcomes, equality, diversity, human rights, duty, duties, age, race, disability, gender, sex, religion, faith, sexual orientation, LGBT, lesbian, gay, bisexual, transgender, marriage, civil partnership, pregnancy, impact assessment, EQIA, monitoring, action plan Comments: Outcomes action plan supporting the Equality Outcomes required by specific duties of the Equality Act 2010, and published separately. Page 1 of 22

2 International standards in equity for health care The action plan is based on the International Standards for Equity of Health Care, developed by the World Health Organization s network of Health Promoting Hospitals & Health Care Services. You can find out more about these standards here: There are 5 separate Equity Standards which are described here: Standard 1: NHS Lothian is fair and equitable in the way it develops its policies and strategies, and in the way it employs its workforce. Standard 2: Access to NHS Lothian s healthcare services is equitable. Standard 3: NHS Lothian s healthcare services deliver an equitable quality of care to all patients. Standard 4: NHS Lothian involves and consults with people in an inclusive and equitable way when developing services or policies. Standard 5: NHS Lothian promotes equality and diversity in its work with partners, in its contracts and in its procurement of goods and services. For more information about how we identified these outcomes and actions, see the NHS Lothian Equality Outcomes You can find this on the NHS Lothian website at 2

3 Equality & Rights Action Plan NHS Lothian is fair and equitable in the way it develops its policies and strategies, and in the way it employs its workforce Outcome Action Output Deliver by end of 1.1 All healthcare developments, policies and plans take account of the diversity of needs and characteristics of patients and the community Improve and review impact assessment processes, including monitoring, training, quality and the performance of NHS Lothian committees and services in completing and acting on impact assessments Various compliance performance measures, impact assessment action plan Lead EQIA Steering Group Update New Integrated Impact Assessment (IIA) developed between NHS Lothian and the four local authority areas in Lothian. This will enable a joint impact assessment in Health and Social Care Partnerships and increase opportunities to address the wider determinants of health inequalities. This new IIA approach will replace RIA for all NHS Lothian Impact Assessments. An audit of Impact Assessments is also ongoing. Assess the performance of key services using the International Equity Standards taking a risk-based approach, with stakeholder involvement Number of services subjected to assessment and follow up actions completed Equality leads New International Equity Standards have now been agreed and work is beginning to implement these within NHS Lothian such as the Acute wards at the Royal Edinburgh Hospital and the Substance Misuse Directorate with plans to roll out further in due course. 3

4 Establish a policy to ensure that senior decision makers address equality & diversity in their performance management arrangements Policy approved, objectives in place for all relevant managers 2016 Human Resources & Organisational Development NHS Lothian Equality, Diversity and Human Rights was approved by the Lothian Partnership Forum in September 2014 and is now in use within the organisation (based on NHS Scotland Embracing Diversity, Equality and Human Rights PIN policy). Develop effective processes to gather evidence and data about equality, poverty and all protected characteristics Evidence bank accessible to all staff to support impact assessment and service improvement. Implementation of Additional Support Needs and protected characteristic data collection workstream across all services. Public Health & Health Policy All Board, CMT, SMT including Integrated H and SC management meeting papers are scrutinised to ensure that RIAs have been completed (where appropriate) and corrective action is taken as required. The Additional Needs and Diversity Information Taskforce s (ANDI TF) goal is to facilitate the use of additional needs and diversity information to enable improvements in the delivery of health services and consequently enhance patient experience. It is currently working towards developing a system where additional needs data can be attached to patient details and be passed through IT systems between Primary, Secondary and Tertiary services. These data will alert service providers to patients additional needs so that these can be provided for in 4

5 a timely, efficient and appropriate manner. A subgroup of the ANDI TF also meets to oversee the remaining goal of the preceding Ethnicity Coding Task Force (ECTF) which was to promote the use of resultant ethnicity data. This group has developed an analysis plan for the first data set covering the period April This analysis will be available during 2014 and will enable NHS Lothian services to assess service usage by ethnicity; identify inequalities in care; plan the appropriate design and delivery of services; gain feedback on improved coding; and Identifying areas where further education and training are still required to improve ethnic coding. 1.2 The NHS Lothian workforce better reflects the diversity of the population it serves, and staff with protected characteristics are represented appropriately at all levels of the organisation. Develop more targeted training for members of interview panels in equal opportunities Establish a programme to improve workforce monitoring across all protected characteristics Number of staff completing equal opportunities in recruitment training by job family and pay band % disclosure of protected characteristics increases Human Resources & Organisational Development Management In Practice Module 4 (Equality and Diversity) is targeted at senior staff and managers and is an essential requirement for staff chairing recruitment and selection panels. Following implementation of eess, the new national HR System, a programme of activity to improve monitoring and encourage staff to update their 5

6 own details via the self-service part of eess can be undertaken but this relies on eess implementation going ahead later this year. This will allow better reporting on all characteristics. Develop provision of mentoring, coaching and other support for staff with protected characteristics once they are in post. Various outputs including number of staff supported by protected characteristics, by pay band, job family 2015 BME Nurses project has attracted funding from Big Lottery and is now being taken developed and implemented under Associate HR (Workforce Planning and Development) 1.3 The pay gap between staff of different genders, ethnicity and for disabled staff is reduced. Improve the knowledge and skills of Employee Relations staff so that they are better able to provide support when an employment issue concerns equality & diversity Prepare and publish an equal pay statement for NHS Lothian equal pay plan in priority pay bands and job families. Identify and review horizontal and vertical occupational segregation Improved monitoring of Employee Relations cases by protected characteristic; improved reported outcomes Statement published with demonstrable staff and Partnership involvement Narrower % pay gap and gender imbalance in key job families between male and female staff For disabled staff and BME staff Human Resources & Organisational Development All staff complete mandatory Equality and Diversity training every 2 years, additional training is available for managers and those involved in recruitment and selection panels. Details of ER cases by protected characteristics are available. NHS Lothian published an equal pay statement between men and women as at April 2013 and April Whilst this exercise can be repeated as required additional work is required to improve the level of staff reporting protected characteristics so that the information published in meaningful. 6

7 1.4 There is improved dignity at work for all staff and volunteers. Launch and publicise a revised Dignity at Work policy and clear organisational values Organisational Values programme delivered, Dignity at Work policy revised, Management Culture plan delivered, NHS Scotland annual staff survey Human Resources & Organisational Development The Preventing and Dealing with Bullying and Harassment policy replaced the Dignity at Work policy in August 2013 The revised Organisational Values Values into Action were adopted in July 2013 and a programme of engagement with local teams is under way to roll out the revised values. Facilitate the establishment of robust staff-led networks for LGBT, disabled and BME staff Staff networks in place, number of meetings and members 2015 Staff networks continue to develop. Over the last 12 months networks for Lesbian, Gay, Bisexual and Transgender staff and for BME staff have been strengthened and developed. Implement Gender-Based Violence policy and develop monitoring system for staff reporting and ensure appropriate training, support and referral pathway. Policy and procedures in place, monitoring system developed 2015 Gender based violence policy implemented. Routine Enquiry implementation is in phase 3, with training delivered to health visitors within Edinburgh CHP and scheduled for Health Visitors in East, Mid and West CHCP. Recording of routine enquiry scheduled to go live within existing IT systems. NHS Lothian has two GP practices that have completed specialist GBV Training with the national GBV Manager and Public Health Practitioner to 7

8 increase levels of awareness and selective enquiry of female patients with appropriate referral to a linked Advocacy Worker. This initiative is showing great initial results and good levels of referral and onward support and may be rolled out further. The national GBV Team and Lesley Johnston are working on an e-learning module for Managers and NHS Lothian HR Department has assisted in development of GBV Employee Policy within NHSL which is an ongoing piece of work. 8

9 2. Access to NHS Lothian s healthcare services is equitable Outcome Action Output Deliver by end of 2.1 Access to health services is more equitable for people with protected characteristics Develop data gathering on how people access primary and acute health services Establishment of baseline and robust data set to include all protected characteristics Lead Public Health & Health Policy Update Additional Needs and Diversity Taskforce, chaired by Prof Raj Bhopal developing a pilot of key additional support needs to reduce DNAs in selected acute settings ongoing see 1.1 above. Develop and implement programme of training and awareness raising with GP surgeries on registration policies, equality & diversity and communication. To include all protected characteristics. Patients report improved experience (e.g. through Better Together survey); other measures e.g. number of GPs and reception staff trained. Equality Leads, Public Involvement Coordinators, Development Managers, Public Health Practitioners Training developed for GP practice reception staff in patient/public involvement and delivered to approx 200 staff. Training has been evaluated and changes made to content and methods. Review of interpreting & communication support arrangements, implement development plan including awareness-raising and training for staff in working with interpreters, and participation in NHS 24 pilot on videoconferencing for BSL interpreters Plan will include various measures; improved level of service data will identify areas for further improvement. Number of staff trained; improved patient and interpreter experience Senior Manager, Staff Bank Interim appointments to the ITS Coordinator has enabled close working with areas to establish best practice around use of interpretation and translation services. This has been done informally in local areas rather than formal sessions. There has been a series of workshops with interpreters from CEC to identify issues for interpreters working within the NHS. All patients who need support receive this to encourage improved access to Through use of service ethnicity data; review of Ongoing Public Health & Health Over 140 complex cases were referred to a temporarily reduced 9

10 2.2 NHS Lothian has minimised architectural, environmental and geographical barriers to its services health services and anticipatory health care, through cultural bridging. Develop the way that Estates & Facilities assess and improve the accessibility of all NHS Lothian buildings, including improving links to local access panels and making better use of service data in implementation plans. referrals, attendance etc by all protected characteristics and additional needs; monitoring of patients supported by Minority Ethnic Health Inclusion Service. % of estate assessed as non-compliant. Grading of buildings identifies areas requiring improvement; capital plan addresses these. Policy, Equality Leads Facilities & Estates Minority Ethnic Health Inclusion Service (MEHIS) team (sickness, career break and delays in recruitment). Partial two-year funding from the Health Foundation has been allocated for two additional linkworker posts for Polish and emerging East European communities including Roma to bridge people in to health and community based services to improve health outcomes and to reduce the incidence of health risk behaviours. Rapid Impact Assessments are completed for all major projects and should be completed by service areas as part of business case for redevelopment projects. All new capital projects have to take cognisance of equality issues and when upgrading areas/buildings and must comply with building control requirements in terms of access. The Board s Asset Management Strategy highlights a number of properties where they are non compliant. The Capital Investment Plan identifies projects which will address a number of these issues. The Board has now closed and disposed of a number of properties which are non compliant including the former Rosslynlee, Edenhall, 10

11 Loanhead and Corstorphine Hospitals. The Board are also undertaking projects within the CHP s to address issues with GP surgeries and health centres. 2.3 Health promotion and public health interventions are inclusive, reach all intended audiences and address stigma in the community Develop and implement specific health promotion activities in a range of subjects for people with protected characteristics (e.g. sexual health, tobacco, substance misuse). Interventions delivered, service data demonstrates reach through analysis of results using equality and diversity monitoring Public Health and Health Policy Health awareness and health promotion sessions were provided to minority ethnic communities covering topics including breast screening, hepatitis, retinopathy screening, CHD, Podiatry foot care and oral health promotion. Hepatitis screening is being rolled out to South Asian and Chinese Communities as is work in partnership with CHSS to ensure that their services and information are accessible to non English speakers. 11

12 3. NHS Lothian s healthcare services deliver an equitable quality of care to all patients Outcome Action Output Deliver by end of 3.1 Patients with protected characteristics have a more personalised, individualised service where they are better able to exercise their independence, control and autonomy with an advocate if needed, and where their rights are protected. Develop a person centered approach that builds on the learning from the Compassionate Care and Delivering Better Care programmes. Patient feedback, patient experience quality indicators generate data by protected characteristic/additional need Lead Chief Nurse, Quality & Professional Standards Update Person Centered Health and Care Programme ambition is that by December 2015 people using health services will have positive experience and get the outcomes they expect. We have 2 patient experience surveys in place Tell us Ten Things (TTT) and the in-depth survey. We arte looking at ways to increase our responses which will give us a wider coverage. Results are feedback monthly to the clinical teams. The in-depth survey results are feedback to the clinical teams where staff can look at ways of making local improvements. Services use patient data to ensure that care is person-centred, making use of additional support needs and equality data. This includes provision of information. See additional needs workstream in outcome 1.1 Public Health & Health Policy The Additional Needs and Diversity Information Taskforce s (ANDI TF) goal is to facilitate the use of additional needs and diversity information to enable improvements in the delivery of health services and consequently enhance patient experience. 12

13 It is currently working towards developing a system where additional needs data can be attached to patient details and be passed through IT systems between Primary, Secondary and Tertiary services. These data will alert service providers to patients additional needs so that these can be provided for in a timely, efficient and appropriate manner. A subgroup of the ANDI TF also meets to oversee the remaining goal of the preceding Ethnicity Coding Task Force (ECTF) which was to promote the use of resultant ethnicity data. This group has developed an analysis plan for the first data set covering the period April This analysis will be available during 2014 and will enable NHS Lothian services to assess service usage by ethnicity; identify inequalities in care; plan the appropriate design and delivery of services; gain feedback on improved coding; and Identifying areas where further education and training are still required to improve ethnic coding. Carry out a strategic review of Human & Children s Rights risks Actions identified and monitored Equality Leads Children s rights have been incorporated into the Joint 13

14 and opportunities. Integrated Impact Assessment. 3.2 People in Lothian are more assured that health services will respect their dignity and identity. Communications and awarenessraising activities to encourage service users to self-identify their protected characteristics or additional support need. Patient feedback, Better Together surveys etc. Increase in recording of patient protected characteristics and additional needs see outcome 1.1 Equality Leads Health literacy training for up to 77 staff has taken place in acute and community settings. Teach-back techniques are now being used in a number of settings routinely ensuring that patients have understood the outcomes of their assessments and can be more involved in their health care. Implement Gender-Based Violence Strategy, to include further development of routine enquiry and awareness-raising of the risk of Gender-Based Violence in relation to forced marriage, Female Genital Mutilation and Human Trafficking. Service monitoring data demonstrates implementation. Annual reporting of progress to achieve measurable outcomes Nurse Director, Public Health & Health Policy Routine Enquiry implementation is in phase 3, with training delivered to health visitors within Edinburgh CHP and scheduled for Health Visitors in East, Mid and West CHCP. Recording of routine enquiry scheduled to go live within existing IT systems. NHS Lothian has three GP practices that have completed IRIS Project (specialist GBV Training with the national GBV Manager and Public Health Practitioner) to increase levels of awareness and selective enquiry of female patients with appropriate referral to a linked Advocacy Worker. Community midwifery trained in and undertaking routine inquiry and 14

15 being undertaken in acute receiving unit at the Royal Edinburgh Hospital with training being delivered to other areas of mental health nursing. Learn Pro module in Gender Based violence now live Staff are better equipped to deliver health care that takes into account patients protected characteristics, health literacy needs and dignity Review training provision to allow for more targeted provision and content, including: developing understanding about the intersections/ overlaps in people s identities e.g. disabled LGBT people understanding of the equality & diversity contexts that may inform a service user s health engagement understanding about Do Not Attempt Resuscitation policies for people with life-limiting conditions recognition of age-related transitions in service provision training in how to ask patients questions about protected characteristics or about their family, significant other or next of kin training in the implementation of a Human Rights and Children s Rights approach Training completion data shows increased takeup in specified staff groups/services. Service data and patient experience demonstrate improvement. Increased recording of patient data including protected characteristic and additional needs. MEHIS reports number of staff supported to provide culturally competent services through building their capacity. Human Resources & Organisational Development Equality Leads Fields for collecting data from primary care and secondary care on additional support needs is work in progress. One day training was held on intersectional issues with key staff and people with protected characteristics. Further work is planned in this area. Gypsy/Traveller health issues are led through the Lothian Joint Gypsy/Traveller Health Group with appropriate representation from all the relevant groups. MEHIS staff work alongside clinical staff in primary care and mental health services to build the capacity of staff and teams to work effectively with minority ethnic patients providing advice and support on cultural issues. They also provide a range of health promotion sessions with specialist staff. 15

16 Independent advocacy services are provided in mental health, learning and physical disability, older people and carer s services. Further advocacy pilots have been developed around welfare and prison services, stroke and transitions carer advocacy. Joint working and training with LGBT Health and Wellbeing around the needs of older people in the LGBT community. An SLA has been agreed with Heath and Social Care funding to improve the health and well being of the LGBT community in Lothian. 16

17 4. NHS Lothian involves and consults people in an inclusive and equitable way when developing services or policies Outcome Action Output Deliver by end of 4.1 NHS Lothian Review and develop Evaluations and data from involves with people arrangements for planning, engagement activities 2015 in a more inclusive monitoring and evaluating demonstrate improvement in and equitable way, patient and public engagement services. including people to improve inclusivity and with all protected effectiveness. characteristics and from across the socio-economic spectrum Lead Assoc Dir of Comms and Public Affairs Update NHS Lothian involves people in the context of, and in support of, local and national policies, strategies and legislation that provide guidance and duties to involve. It also aligns with current and emerging Scottish Government policies such as the integration of health and social care. The 4 Lothian Integrated Joint Boards are currently developing their Communications and Engagement Plans to outline their continued commitment to inclusive engagement. Following discussion with members (including the public), the Improving the Patient Experience, Involving People and Clinical Information for Patients group were disbanded to make way for a more interactive and practical workshop approach to review and develop engagement arrangements. The outline for this approach is contained in NHS Lothian s Involving People Framework The first workshop deliberated improvements to NHS Lothian s 17

18 outward facing public engagement including the Get Involved pages on the website. The output is currently informing a review of the entire website to ensure that information is inclusive and accessible. The second workshop started a review of the volunteering system and processes. Volunteers will be involved in the development of the NHS Lothian s volunteer framework. 4.2 NHS Lothian ensures that any individual can provide feedback or make a complaint and this is addressed equitably and transparently Establish ongoing arrangements for patient involvement in Gender Reassignment pathway Develop existing mechanisms to measure the patient experience so that they are sufficiently detailed to link data to protected characteristics or additional support needs. Transgender patient and staff group established As for outcome Gender Reassignment lead specialist in Public Health Public Health & Health Policy Transgender stakeholder group established and meets every 2-3 months including patient and their sector representation. There is also a Managed Clinical Network for gender services in Scotland which some of the group members are involved with which impacts at a national level. Developing the capability to attach additional needs and diversity information to patient details (as per the goals of the Additional Needs and Diversity Information Taskforce) will allow existing mechanisms for the measurement of patient experience to link to protected characteristics and additional support needs information. 18

19 Review arrangements for encouraging feedback and suggestions so that all patients have an opportunity to provide these. Monitoring of feedback and suggestions demonstrates improvement by protected characteristic Chief Nurse, Quality & Professional Standards Person Centred Health and Care Programme ambition is that by December 2015 people using health services will have positive experience and get the outcomes they expect. The care experience is measured using reliable application of the 5 Must Do With Me elements. Leaders of care teams will test and develop tools to facilitate person-centered education, development & reflection for their teams Develop complaints procedures so that complaints relating to discrimination are demonstrably treated seriously Monitoring of complaints demonstrates takeup and resolution by protected characteristic 2015 Human Resources & Organisational Development CRaFT advise that where complaints specifically relate to protected characteristics then this information can be recorded. It is proving difficult however to collect this information in feedback unrelated to protected characteristics unless offered. Upcoming service redesign may provide opportunities to improve take up and resolution through revised complaint investigation procedures. This will be subject to an Impact Assessment prior to implementation. 19

20 5. NHS Lothian promotes equality & diversity in its work with partners, in its contracts and in its procurement of goods and services Outcome Action Output Deliver by end of 5.1 NHS Lothian s Review and update standard Contracts and agreements partner contractual terms and revised to specify how they 2015 organisations and conditions and Service Level will take account of the suppliers operate Agreements to include needs of people with in a way that is specific requirements protected characteristics consistent with its relating to promotion of and those on low incomes. approach to the general duty. Monitoring provides baseline promotion of for ongoing development equality work with suppliers and contractors. Lead Health & Social Care Partnerships, Finance, Strategic Planning Update (as of date) The Strategic Planning has instructed all Managers within the Directorate to undertake this action when reviewing existing or developing new contracts and SLAs. There is a review of all third party contracts which the Chief Officer, Acute Services is leading. A set of principles and decision making criteria are being developed by Strategic Planning to ensure equity and transparency in the process as well as requesting that the Vice Chair of the Board sits on the review panel. Identify key partner organisations and support them to monitor protected characteristics of service users, and use the resulting data to evaluate the accessibility and effectiveness of these services and improve the extent to which they promote equity, build social capital and address poverty. Monitoring and reviewing service data demonstrates improvement in accessibility and outcomes and identifies any barriers to access Equality Leads Associate Procurement advises that terms and conditions of contract to ensure compliance are in place and there have been no breaches recorded during 2014/15. This diligence will continue through 2015/16 through application of the Equalities Procurement Policy. Service Level Agreements will be continue to be subject to broad range governance review in 2015/16 and compliance with the Equalities Act, to include emerging compliance 20

21 requirements of the Public Procurement Reform (Scotland) Act. 5.2 Individuals and communities who are vulnerable to, or victims of hate crime feel safer and more secure Improved knowledge and understanding of hate incidents and hate crimes and reporting mechanisms including the involvement of police when necessary, through greater integration of hate crime issues in mainstream staff training. Joint Hate Crime campaigns make better use of local data. Improved publicity for joint hate crime arrangements with other organisations, e.g. police. Social capital outcomes in service level agreements contribute to building community cohesiveness and community safety Issue of hate incidents/hate crime are integrated within both mainstream and equalities training, and in HR policies. Increased reporting of hate incidents and hate crimes on DATIX system. Monitoring of referrals to support organisations and police As above. As above Ongoing Human Resources & Organisational Development, Public Health & Health Policy, Equality Leads Equality Leads Equality Leads Social capital outcomes are built in to joint contracts with the third sector through Community Health Initiative and Health Improvement funding and monitored on an annual basis. Edinburgh Hate Crime Strategic Development Group is a sub group of the Edinburgh Community Safety Partnership and reports annually to that group on progress on joint objectives. Contracts with third sector organisations include the need to reduce discrimination and harassment and foster good relations through making services accessible and inclusive of all people with protected characteristics. Datix sub-categories include several forms of hate crime (e.g. racial abuse, sectarian abuse) meaning that data can be obtained as to the number of incidents which occur year on year. NHS Lothian representation on Hate Crime Strategic Development Groups and the Community Safety Partnerships Increased reporting and monitoring of hate crimes reported through multiagency groups 2016 Equality Leads A seminar was held to review the process of Third Party/Remote Reporting and a report completed. The Hate Crime SDG plans further work on reporting and support. 21

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