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 referred cases regarding 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 EQIA@ggc.scot.nhs.uk for further details or call Name of Current Service/Service Development/Service Redesign: Glasgow City CHP Rehabilitation Services. Please tick box to indicate if this is a : Current Service x 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? There are three community based Rehabilitation teams within the Glasgow City CHP based in the North West, North East, and South Sectors. The service was established in May 2011 by bringing Hospital Discharge teams (formerly IRIS, DART, MATCH), Community Older Peoples Teams and Physical Disability Teams together to establish a Glasgow City CHP Rehabilitation Service. Each Rehabilitation Team has dietitians, nurses, pharmacists, physiotherapists, occupational therapists, speech and language therapists, administration support and support workers. The teams are managed within Primary Care and Community services and aim to deliver equitable and consistent services across the three sectors.

2 The Rehabilitation service is for people over the age of 16 years who can benefit from and can consent to early supported discharge from hospital and/or have ongoing nursing and rehabilitative needs. Referrals are also taken for patients with rehabilitation needs living in the community. The service is for people who live in Glasgow City or are admitted to a Glasgow City hospital facility and require rehabilitation. The service can also be used an alternative to hospital admission for people when the person is at risk of deterioration or has an acute episode of illness/injury which requires rapid access to equipment or homecare. There is access to a rehabilitation service response in Accident and Emergency in all sectors of Glasgow to support hospital admission avoidance. The service focuses on rehabilitation. For some people this will be a short term intervention for other people who have ongoing complex needs a rehabilitation plan will be kept in place. The sector teams work out of a number of locality bases and provide a range of functions. A timed response to referrals from Accident and Emergency and Hospital Discharges. Rapid Response to GP referrals to prevent hospital admission. Rehabilitation Intervention - In addition to the availability of a wide range of specialist therapies within the Team, the unique combination of sharing skills focuses on individual need. Care Co-ordination. Symptom Management prevention of secondary complications to minimise the impact of further deterioration. It can also facilitate self-management of condition. Rehabilitation goal focussed input to enhance health status, increase levels of activity, improve level of function and enable access to opportunities for increased participation. Education and training - Intervention is targeted to achieving present patient centred goals within an agreed timeframe. Supported discharge to prevent re-admission into hospital.

3 The rehabilitation teams provide comprehensive assessment either within the hospital or within the person s home. Generally treatment interventions and reviews take place within a patient s own home, or other appropriate community workplace settings. A number of clinic based services are also offered where available. 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.) There is a need to assess the service s compliance with the forthcoming age equality legislation (Equality Act 2010) particularly with respect to equity of access to services for older people. The Rehabilitation Service wants to embed inequalities sensitive practise within the model of service delivery. Further information on Rehabilitation services can be found on the NHS GG&C website. Who is the lead reviewer and where are they based? (Please note the lead reviewer must be someone in a position to authorise any actions identified as a result of the EQIA) John Quinn Service Development Lead / North West Sector Rehabilitation Services Centre for Community Health, 547 Dumbarton Road, Partick, Glasgow G11 6HU 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): Jean Cherry: Change and Development Manager, John Quinn: Service Development Lead, Nicola McCardle: Physiotherapist: Rachel Davies: Occupational Therapist, Karen Hemple: Nurse, Isabel Horsfall:

4 Physiotherapist, Wilma Robertson: Administrative Assistant 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 (please use additional sheet where required) The routine information which is collected on the : Single Point of Access (SPOA) referral form, adapted Standardised Shareable Assessment (SSA) paperwork, and patient database includes: Age, sex, ethnicity, disability, religion, preferred language, communication issues, economic status, vocational and employment status. Revised paperwork has been agreed across the three teams. There is now a consistent method of enquiry across the city with agreed standardised documentation. Gender re-assignment and sexual orientation information is not routinely collected in the initial enquiry. The staff member will use their professional discretion when collecting data Transgender status would only be asked Additional Requirements A case recording audit cycle will be developed. There is a training need to ensure all staff understand the need to enquire and collate information consistently.

5 if pertinent to the individual patient s care and if this is the case then this information should be transferred to rehab staff by the GP following GP discussion with the patient as GP will be the approved holder of the information. Staff are aware of the NHS Transgender policy. An inequalities sensitive approach would be evident in planning the support and care for the individual. 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? The initial triaging of the referral determines the access route and responsiveness of the service. Monthly performance reports include information and analysis on gender and age in order to inform service delivery. The focus of the service has been on access to treatment targets and delayed discharge targets. Referral patterns have been consistently higher for hospital discharge referrals Need to ensure Business Objects reports can provide more analysis on equality groups.

6 over the winter periods. Data is being analysed particularly in relation to age and disability and vulnerability to focus more on anticipatory care programmes. 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. The service model for rehabilitation and enablement services has been developed in line with national strategy recommendations and Rehabilitation Standards. (Co-ordinated, integrated and fit for Purpose. A Delivery Framework for Purpose Adult Rehabilitation in Scotland ) To date Glasgow CHP rehab staff have participated in a survey monkey questionnaire to determine experiences and knowledge in relation to inequalities sensitive practice. A cross sector staff group participated in a focus group which provided qualitative experiences to augment the survey monkey data. A subsequent report is being completed by a social sciences student from Glasgow Caledonian University. This report will Service user evaluation models are being developed. Literature will be examined to identify information about the experience of equality groups with regard to removing potential barriers to accessing or benefiting from Rehab services

7 also provide a comparison between the Renfrewshire and Glasgow City CHP staff groups. Staff are aware of the NHS GG&C Equalities Website and supporting services. Gender matching of staff is supported where possible. 4. Can you give details of how you have engaged with equality groups to get a better understanding of needs? A component of the evaluation of the Out of Hours (OOH) rehabilitation service pilot included a telephone patient satisfaction survey which was independently carried out by the Clinical Governance Support Unit. Communications and Information leaflets have been modified following feedback from service users. Service user evaluation models are being developed. To date have been unable to confirm identified nominated person(s) to represent Rehab Service users within Public Partnership Forums. Requires to be a priority action to ensure link with rehabilitation services to promote service user involvement in service developments and evaluation of services.

8 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 rehabilitation goal for the patient may have a health improvement outcome. Where there is a need for more specific and prolonged health improvement interventions as part of the assessment process and care plan, onward referral to other agencies and organisations would be considered with the patient consent e.g. smoking cessation clinics. Clinic facilities have been maintained in some areas to enable service users to receive services to meet their specialist needs. The Shared Solutions Model of Public Engagement is being piloted as part of the NW Exemplar and we will actively seek participation of Rehabilitation Service users and Team members in the forthcoming Shared Solutions Event being held in the North West Sector. Collaborative working with the Health Improvement Team, Welfare Services and Housing Associations to look at developing accessible resources and support for health improvement activities.

9 The North West Sector Joint Implementation group are scoping where health clinics could take place nearer to peoples homes in housing associations 6. Is your service physically accessible to everyone? Are there potential barriers that need to be addressed? 7. How does the service ensure the way it communicates with service users removes any potential barriers? Service delivery is predominantly within patient s home. Where there are clinic based services, no issues with access to premises, the clinics comply with Disability Discrimination Act (DDA) regulations. All staff have moving and handling training. Interpreting services are available and accessed as required. Rehabilitation Services have a profile at Glasgow and Locality events to share information. Staff are aware of cultural sensitivities that need to be considered in the delivery of services. There is a need to further develop work in partnership with other services to target people who will benefit from more of an anticipatory care approach and will require additional services to keep them active and safe at home. Actions to strengthen to service user engagement will further inform Rehab services understanding and response to service user communication issues.

10 Links with Carers Forums and Public Partnership Forums. Information regarding access to services is available on the Solus Screens within health services and a small number of housing associations. Service links with CHP Information and Publicity officer to develop communications in a range of formats for service users. Expertise outwith the scope of the Rehabilitation Service is accessed when required eg. Sensory Impairment

11 8. Equality groups may experience barriers when trying to access services. The Equality Act 2010 places a legal duty on Public bodies 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: Service level agreements from the previous service model are in place for some disciplines for services for people under the age of 65 years. There are inequalities in provision of various disciplines within rehabilitation services This is a service change and redesign issue that requires to be reviewed in collaboration with adult and acute services to review the role and responsibilities of services for people over the age of 65 years. Recruitment to the Rehabilitation service will need to reflect the gaps in service provision. (a) Sex Gender is recorded within the assessment documentation. Data on gender is available and can be disaggregated as required. Gender matching can be accommodated if this is highlighted as a need by patient / Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information.

12 (b) Gender Reassignment carer or staff member during assessment / intervention Adult Support and Protection Act (ASPA) is routinely considered and used in relation to any form of abuse, e.g. Gender Based Violence (GBV) The service tackles discrimination through a number of processes including the DATIX incident reporting tool, complaints and discussion with team members Staff are aware of the NHSGGC Transgender policy and the service will meet the needs of any transgender patients where those needs have been articulated by the patient, carer or by another health professional with the express permission of the transgender patient. Gender diversity can be accommodated if this is highlighted as a need by patient / carer or staff member during assessment Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information.

13 (c) Age / intervention Staff are sensitive to gender diversity during the assessment and intervention process The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members Service is provided for adults age 16 and above. Data on age is available and can be disaggregated as required. Inequalities in provision of various disciplines within rehabilitation services. This will be addressed where possible in future recruitment and manpower planning. Sign post staff to Equalities information on NHS GG&C website for regular policy updates and on line training. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry

14 Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information. (d) Ethnicity Ethnicity is recorded within assessment documentation. Data on ethnicity is available and can be disaggregated as required. Initial documentation gathers information on cultural based information. Rehab staff have direct access to language support/interpreting/advocacy services Information leaflet can be made available in different languages as required Rehab staff have access to translated Sign post staff to Equalities information on NHS GG&C website for regular policy updates and on line training. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information.

15 information for dissemination to patients e.g. exercise programs The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members (e) Sexual Orientation Staff are sensitive to patients sexual orientation during the assessment and intervention process The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members Sign post staff to Equalities information on NHS GG&C website for regular policy updates and on line training Review of agreed assessment paperwork (Standardised Sharable Assessment) for all clients. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Performance Reporting Development of a performance/

16 Business Objects report that will analyse the client data base in relation to equalities information. (f) Disability Rehabilitation Teams provide a specialist/ expert service to people with disabilities. Data on disability is available but not currently disaggregated or analysed. This can be developed. Patient Environments are DDA compliant. Staff have access to other specialist services and resources within Glasgow. The Rehabilitation Service Training Plan and individuals Personal Development Plans capture any additional specialist requirements for the service. Service information to be updated in a range of formats and mediums. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information. Flexible appointment times can be arranged The service tackles discrimination

17 (g) Faith through a number of processes including DATIX, complaints and discussion with team members Religion/belief information collected during the assessment process. Data on religion/belief is available and can be disaggregated as required. Religious requirements are included within the assessment process. If appropriate, and with patient consent, information is shared with other service providers. This includes issues relating to dietary needs, personal hygiene and religious practices Flexible appointment times can be arranged to suit religious requirements The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members Sign post staff to Equalities information on NHS GG&C website for regular policy updates and on line training opportunities. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information.

18 (h) Socio Economic Status Staff would seek to signpost patients to money advice services when money worries have been identified. The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members Directory of Money Advice Services available in all teams. Staff awareness sessions in relation to Welfare Reform implementation programme. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information. (i) Other marginalised groups Homelessness, prisoners and exoffenders, ex-service personnel, people with addictions, asylum seekers & refugees, There is an open referral criteria. If the client is living in the community and is registered with a GP and has a rehabilitation need the individual would be assessed and have equal access to services. In many instances the marginalised groups may be being supported by other health care services Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information.

19 travellers and rehabilitation advice would be required and joint working with services. Work in collaboration with the Asylum Health Bridging Service And Refugee Local Enhanced Services to ensure referral pathways are established. 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? The service tackles discrimination through a number of processes including DATIX, complaints and discussion with team members Equipu equipment ordering system no local budget for small aids and patients are directed to where they can be purchased. This has been a strategic policy change and there is no local influence on the local implementation. Impact of change in policy is being raised at strategic level. There is currently a review of the Out of Hours Service. The outcome of this could shift the accessibility to current service

20 provision to the range of rehabilitation services over the 7 day period. This will be led by the service demand and it is envisaged that any change would be monitored to ensure no adverse impact on those with protected characteristics. 10. What does your workforce look like in terms of representation from equality groups e.g. do you have a workforce that reflects the characteristics of those who will use your service? 11. What investment has been made for staff to help prevent discrimination and unfair treatment? Within the Glasgow Rehabilitation Service the current workforce is reflected by the current characteristics 80% female and 20% male staff. Rehabilitation training plan and individual Personal Development Plans (PDP) reflect the needs of the service and to support staff to develop confidence in Inequalities Sensitive Practice. Access to a wide range of training. 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

21 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. Patients can self refer to the service. Single Point of Access will provide access to a range of rehabilitation health services for people over the age of 16 years. Collaborative working with local authority colleagues e.g. social work,re-ablement Services, CORDIA, Housing Associations, Third Sector to reduce risk and vulnerability to older people and people with disabilities. Case co-ordination and team working provides a more streamlined, responsive and seamless service to support people with complex disabilities. Development of a Rehabilitation Service Training plan which reflects the diversity of need of all patients. Flexible working - currently covering weekend / bank holiday cover within acute services to provide a responsive service for people at the right time and in the right place. See link below for language translation of printed materials e.g. exercise programs (also into Braille, large print, audiotape, CD, pod cast, BSL, DVD, web clip, easy read words and pictures). Target to respond to requests within 4 days

22 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 Literature will be examined to identify information about the experience of equality groups with regard to removing potential barriers to accessing or benefiting from Rehab services Review of agreed assessment paperwork (Standardised Sharable Assessment) for all clients. Implementation of audit cycle for monitoring the standard of data collation in relation to assessment enquiry Update of information on rehab services in accessible format for users. Development of Service User Evaluations Date for completion ongoing 6 month period 12 month period As required 12 month period Who is responsible?(initials) Service Development Leads S Ml/ Rehabilitation Manager North West Sector Lead Service Development Leads Team Leads Service Development

23 Improve links and pathways with health improvement teams Work in partnership with other agencies to deliver locality based services for patients e.g. Clinics in Housing Association bases or community facilities. Improve engagement with Public Partnership Forums, ensure nominated person(s) identified to link with rehabilitation services to promote service user involvement in service developments and evaluation of services Improve engagement with local organisations to promote service user involvement in service developments and evaluation of services. To ensure that staff use the reporting mechanisms within the service structure to report concerns and issues that service changes have impacted on service users. e.g. access to equipment Specific Actions those that will specifically support protected characteristics e.g. hold staff briefing sessions on the Transgender Policy 6 month period 6 month period 3 month period 6 month period 3 month period Leads Rehabilitation Managers Rehabilitation Managers and Team Leads. Service Development Leads Rehabilitation Managers Rehabilitation Managers

24 Performance Reporting Development of a performance/ Business Objects report that will analyse the client data base in relation to equalities information. Recruitment of staff to service should address the service gaps e.g. over 65 years age group. Staff briefing sessions required for updates on Transgender Policy, Adult Support and Protection Act, Gender Based Violence, Review of the Rehabilitation Training plan to ensure all staff have access to training and support in relation to inequality sensitive enquiry, Gender based Violence, Adult Support and Protection, Sensory Impairment, Policy updates. Sharing of information from the EQIA survey and focus group with the rehabilitation teams. 12 month period As posts become available 6 month period 6 month period 3 month period Rehabilitation Managers Adult Service Managers/ Rehabilitation Managers Service Development Leads Service Development Leads Rehab Managers Service Development Leads Signposting for staff to use staff net resource to update personal information and knowledge from the Equalities Health Website. 1 month period Service Development Leads

25 Ongoing 6 Monthly Review Please write your 6 monthly EQIA review date: 15 th July 2013 Lead Reviewer Name : John Quinn EQIA Sign Off: Job Title : Service Lead Development Signature : Date : 15 th January 2013 Quality Assurance Sign Off: Name : Kath Gallagher Job Title : Planning and Development Manager Signature : Date : 15 th January 2013 Please a copy of the completed EQIA form to EQIA@ggc.scot.nhs.uk, 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.