SCREENING TEMPLATE. Temporary closure of the Emergency Department (ED) at Belfast City Hospital (BCH) from 1 st November, 2011.

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1 SCREENING TEMPLATE For further information on screening, please refer to the Guidance Notes, which are also available in hard copy from the Health and Social InequalitiesTeam. 1

2 SCREENING TEMPLATE For further information on screening, please refer to the Guidance Notes, which are also available in hard copy from your organisation s equality contact. (1) Information about the Policy/Decision 1.1 Title of policy/decision Temporary closure of the Emergency Department (ED) at Belfast City Hospital (BCH) from 1 st November, Description of policy/decision what is it trying to achieve? (aims/objectives) how will this be achieved? (key elements) what are the key constraints? (e.g. financial, legislative) This proposal is to temporarily close the ED at BCH and consolidate Emergency Care Services at the Royal and the Mater Hospitals. The proposal is in response to the urgent need to address the inability to sustain ECS services at BCH primarily caused by the loss of senior medical staff, recruitment shortages and a report by Northern Ireland Medical & Dental Training Agency (NIMDTA) on Belfast Emergency Department services which highlighted serious concerns in relation to the safety and sustainability of services as a result of sustained medical staff shortages at all grades. The crisis situation which these difficulties have created has serious implications regarding the safety of patients. Staffing Shortfall Work Permits The problem relating to the recruitment of medical staff specifically in Emergency Medicine is due to a number of reasons including the loss of Indian sub-continent recruitment due to government policy on recruitment and visa restrictions for candidates from outside the European Union. Vigorous attempts made by the Trust over the last couple of years to recruit middle grade staff through a range of methods have failed repeatedly. Recruitment Drives have included delegations to India on two occasions and an intensive Eastern European interview process. 2

3 Locum and agency staff are used both on a short term and long term basis, which can be difficult and creates uncertainty and instability in the service. Other options aimed at filling the gap in recruitment include additional shifts undertaken by staff inside and outside the Trust as well as redeployment. The failure to recruit successfully, resulting in shortages of relevant medical staff, leaves the Trust with no options but to close one of the EDs to consolidate the resources that remain. European Working Time Directive (WTD) The working time directive means that junior doctors, and other staff, can now only work up to 56 hours a week which increases the number of doctors needed to cover hospital rotas. The aforementioned staff recruitment difficulties will mean that it is not sustainable to deliver this type of rota. NIMDTA, the Northern Ireland Medical and Dental Training Agency Following an inspection by NIMDTA, which assessed the training environment for doctors against GMC standards under categories including patient safety and support and development of trainees, a number of concerns were highlighted. Both BCH and RVH Emergency departments were graded as unsatisfactory and required immediate attention. This was due to inadequate clinical supervision of trainees at nights and weekends and the number of recruits coming forward against the number of training posts needed to support Emergency Departments. NIMDTA also highlighted issues in respect of junior doctor workload and supervision which has a direct impact on patient safety and the sustainability of the ED at BCH. In addition where numerous shifts are filled on a regular basis by locums, there is concern about the ability of the Trust to provide appropriate and adequate levels of safety to patients. These concerns further substantiated concerns of Trust Clinicians and professionals to maintain required levels of staffing. These factors coupled with the imminent loss of senior medical clinicians at BCH and the RVH demands that action is taken urgently to address the issues. GMC (General Medical Council) If urgent measures are not taken to address the health and safety issues for staff and patients, the GMC have the authority to remove trainee doctors 3

4 which would have serious implications for Trust Emergency Departments. Implications on training requirements for Emergency Department trainees from the modernisation of medical careers (MMC); A revised training programme (Modernisation of Medical Careers (MMC)) to ensure that junior doctors are appropriately skilled for modern Emergency Departments requires more direct patient care and supervision of junior trainees to be undertaken by consultants, senior trainees, staff grade and associate specialist doctors. The shortage of senior medical staff at Belfast HSC Trust ECS impacts on the ability to ensure the appropriate training of junior doctors which impacts on patient safety. Equality Assessment The Trust is committed to its legal duties and fundamental principles under Section 75 of the Northern Ireland Act In terms of equality assessment of this proposal, it is recognised that the immediate need to address a potential clinical emergency which is linked to patient safety, supersedes the need for equality in the first instance. The Trust is however, cognisant of the need to nonetheless consider and mitigate any potential adverse impact. This proposal was screened out with mitigation. Belfast Trust has committed to monitor the impact of the temporary closure on an ongoing basis to ensure that the impact is not more significant than initially anticipated. Current Service Profile The Belfast Trust currently operates three Level 1 Emergency Departments: 1 at the Royal, City and Mater Hospitals, and provides a GP Out of Hours service to the population of Belfast and Castlereagh. There is also a Children s Emergency Department at the Royal Belfast Hospital for Sick Children which sees children up to the age of thirteen. The three adult ED s within Belfast deal with a total of around 145,000 new attendances each year. As can be seen from the map, these hospitals are relatively close together. The driving distance from RVH ED to BCH ED is 1.2 miles, from RVH to MIH is 1.6 miles and from BCH to MIH is 2.1 miles. 1 A Level 1 Emergency Department is a consultant-led 24-hour service with full resuscitation facilities and designated accommodation for the reception of Accident and Emergency patients (NHS Data Dictionary, 4

5 BHSCT Emergency Department Attendances between 1/7/10 to 30/6/11 The Royal Hospitals 59,082 Belfast City Hospital 43,972 Mater Hospitals BCH Attendances at ED between 1 st July 2010 and 30 th June 2011by District Council Belfast West North South East Northern Ireland Lisburn Newtownabbey Castlereagh Carrickfergus Down Antrim Larne North Down Banbridge Ards Newry & Ballymena Craigavon Dungannon Magerafelt 5

6 Mourne Armagh Cookstown Coleraine Omagh Ballymoney Fermanagh Derry Moyle Strabane Limavady Future Proposal This proposal is to temporarily close the ED at BCH and consolidate Level 1 Emergency services at the Royal and Mater Hospitals. The Trust has been reviewing its ECS provision and intends to develop a full consultation programme on the long term plans for emergency care services in Belfast. Trust senior staff have worked closely with staff within the Trust, the Health and Social Care Board, Public Health Agency and other Trusts to put in place temporary arrangements to satisfy the requirements of NIMDTA and the GMC to ensure safe and sustainable services. A number of further measures have been proposed for the RVH, the MIH and BCH to ensure adequate physical capacity is in place to support the delivery of the preferred model. Staff changes will be undertaken in line with agreed Trust Human Resources policies. There will be no Emergency Department staffing reductions as a result of the temporary closure. Access A number of measures have been proposed to ensure access and free flow of traffic around the Emergency Department at the RVH which will include the creation of new parking spaces for Patient Care Service ambulances, removing them from the spaces in front of the Emergency Department with secondary access to the Emergency Department for ambulance traffic via the Receipt and Distribution Yard (providing direct access off the Grosvenor Road). Consideration is also being given to realignment of the road at the car park of the RBHSC to reduce congestion on the main site. Additional ambulances will be provided to accommodate the change. The Trust is working with the Health & Social Care Board and other Trusts to ensure they have appropriate capacity arrangements in place which will be subject to ongoing monitoring and review. 6

7 Partnership Planning Discussions have taken place with relevant practitioners such as GP s who are keen to work with the Trust to look at alternative approaches to relieve pressure on the Emergency Departments. Dialogue has also taken place between Local Commissioning Groups and geriatricians to put in place schemes for the prevention of admissions building on existing patterns of service in integrated care teams for intermediate and community care services. Communication & Engagement The Health & Social Care Board has established a Communication subgroup, which includes representatives from Belfast Trust and South Eastern Trust to prepare for the dissemination of information to the general public in relation to a temporary closure of Emergency Services at BCH. Key Drivers Impact on Patient Safety due to: Shortage of Senior Medical staff and lack of recruitment NIMDTA concerns regarding work load and supervision of junior doctors. The delivery of safe and sustainable services to our patients Providing safe services and ensuring patients are not at risk in the three hospitals is a top Trust priority. Having appropriately trained staff working in appropriately sized teams will assist in both improving patient safety and sustaining the continued provision of these services. Belfast HSC Trust Strategic Objectives: To provide safe, high quality and effective care To make the best use of our resources to improve performance and Productivity. 7

8 Key Benefits Patient Health and Safety The concentration of specialist medical and nursing staff at the RVH and Mater Hospitals will maximise resources, enhance the level of senior medical cover to allow a senior doctor to be present 24/7 in the RVH Emergency Department. This will enable patients to be assessed by doctors with the appropriate training and expertise, optimising patient health and safety. 1.3 Main stakeholders affected (e.g. staff, actual or potential service users, other public sector organisations, voluntary and community groups, trade unions/professional organisations or private sector organisations) Staff and service users. Trade Unions. General Practitioners. 1.4 Other policies/decisions with a bearing on this policy/decision what are they? who owns them? European Working Time Directive (WTD). New Directions (2008). The Way Ahead College of Emergency Medicine. 8

9 (2) Screening the Policy/Decision 2.1 In terms of groupings under Section 75, what is the make up of those affected by the policy/decision? Service Users BCH Gender Sex Total % F % M % (blank) % Age Ages of Attendees at BCH A&E Number Age at No % Attendance % % % % % % % % % % Not Known %

10 Religion Political Opinion This information is not currently recorded. The population profile for the Belfast Health and Social Care Trust area in the 2001 Census was 44.7% Protestant, 37.4% Catholic 17.3% not known and Other 0.06% The Belfast Health and Social Care Trust does not currently ask service users for their political opinion. Northern Ireland Local Elections May 2011, 26 district councils DUP UUP Alliance Others SDLP Sinn Fein Seats won (2011) Vote share (2011) 27.2% 15.2% 7.4% 10.4% 15.0% 24.8% Seats won (2005) Vote share (2005) 29.6% 18.0% 5.0% 6.8% 17.4% 23.2% Belfast District Council Election results May 2011 Marital Status Dependent Status DUP 15 seats Sinn Fein 16 seats Alliance 6 seats SDLP 8 seats UUP 3 seats PUP 2 seats Other 1 seat ESRC (Economic & Social Research Council) This information is not currently recorded. The population profile for the Belfast Health and Social Care Trust area in the 2001 Census was as follows: Single 38.9%, Married 39.5%, Separated 5.1%, Divorced 4.8%. This information is not currently recorded. In the 2001 Census, 30.4% of households in the Belfast Health and Social Care Trust area contained dependent children. Statistics provided by Carers Northern Ireland show that 17.6% of adults in Northern Ireland reported some caring responsibilities and that 62% of carers are female and 38% male. 10

11 Disability This information is not recorded. Statistics produced by Disability Action Northern Ireland, state that 1 in 5 of the population in NI have a disability or 20% of the population. Statistics Research Agency statistics show that 45.64% of people in the 50 plus age group have a long term limiting illness (NISRA T46 Age People, Family and Households). Census Disability statistics in 2001 based on the population profile for the Belfast HSC Trust area (based on households with one or more person with a limiting long-term illness) state there are: Disabled 43.6%. Not Disabled 56.4%. Ethnicity Patient s ethnicity is not recorded at Emergency Departments. Census statistics from the 2001 census indicate; Belfast contained 30% of the minority ethnic population of Northern Ireland, with 57% of the minority ethnic population of Belfast living in South Belfast. Ethnic Minority Groups Total numbers living in Belfast Belfast % of total numbers in Northern Ireland Total numbers living in Northern Ireland Chinese % 4145 Mixed % 3319 Indians % 1567 Pakistanis % 668 Black African % 494 Black Caribbean 62 24% 256 Bangladeshi 62 25% 251 Other Black 74 19% 381 Other Asian 92 42% 191 Other ethnic groups %

12 TOTAL POPULATION in 2001 Percentage total Ethnic Minority groups Percentage White Ethnic Origin % 0.74% 98.14% 99.26% Demographic Changes There have been demographic changes in Northern Ireland with an influx of people from Eastern European countries in recent years since the European enlargement. This would indicate a rise in those users from ethnic minority backgrounds. In line with general trends the Trust has been experiencing an increase in the use of its services by users from black and ethnic minority communities. Anecdotal evidence would suggest that a considerable proportion of these service users are not registered with a GP in Northern Ireland and often choose to access primary care through an Emergency Department. This may in part be due to Migrants from A2 countries that do not have recourse to public funds who access Emergency Care Services as the only feasible and permissible interaction with Health and Social Care services. Information from the Northern Ireland Health & Social Care Interpreting Service statistics indicates there were no requests for face to face interpreting at BCH Emergency Departments. Due to the nature of the service, interpreting requests may be accessed via telephone interpreting services. Sexual Orientation Health and Social Care Trust does not yet actively ask users for their sexual orientation and so this data is not currently available. Research by the Rainbow Project indicates that 10% of a population is Lesbian, Gay or Bisexual. 12

13 2.2 Is there any indication or evidence of higher or lower participation or uptake by different groups? Service users Group Gender Age Religion Political Opinion Marital Status Dependent Status Yes/No/ Don t Know Please provide details Gender analysis of patients that attended emergency services at BCH between April 2010 and March 2011 illustrate a slightly higher number of males 52.79% than females 47% attended the Emergency Department at BCH. Attendances at BCH Emergency Department indicate a high proportion of users aged between years (21.69%) with 55.0% aged 40 or over. The population profile for the Belfast Health and Social Care Trust area in the 2001 Census was 44.7% Protestant, 37.4% Catholic and 17.3% not known. This would indicate there may be a differential impact on users from the Protestant religion. Whilst patient political opinion is not collated, information from the Economic and Social Research Council illustrates that the Democratic Unionist Party (15 seats) and Sinn Fein (16 seats) obtained the highest number of seats in the Belfast District Council. The population profile for the Belfast Health and Social Care Trust area in the 2001 Census indicates that the majority of users may be either married or single. There is no available evidence to suggest that the proposal would have an adverse impact with regard to marital status. Available statistics show that 17.6 percent of adults may be carers. There is no available evidence to suggest that the proposal would have an adverse impact in regard to carers or dependants. 13

14 Disability Ethnicity Sexual Orientation Information on disability is not collected, however, statistics show there is a high percentage of older users that access the Emergency Department at BCH. Statistics Research Agency statistics show that 45.64% of people in the 50 plus age group have a long term limiting illness which may indicate a differential impact on this age group. Demographic changes in Northern Ireland, due in part to the accession of the European states together with anecdotal evidence, suggests a rise in the numbers of patients from ethnic minority backgrounds that attend the ED at BCH. However, when compared with the majority white population the numbers of patients from an ethnic background is low. Research by the Rainbow Project indicates that 10% of a population is Lesbian, Gay or Bisexual. There is no available evidence which would indicate an adverse impact due to sexual orientation. 2.3 Is there any indication or evidence that different groups have different needs, experiences, issues and priorities in relation to the policy/decision? Service Users Belfast City Hospital Group Gender Age Yes/No/ Don t Know No Please provide details There are a high number of patients in the age group that attended BCH Emergency Department in the last year. This may be due to the proximity of BCH to the University area. It is probable that young people in this age group access ECS to access primary care rather than go to their local GP. This is particularly relevant to students who may not be registered with a GP in Belfast. There would therefore be a differential impact on this age group. The high numbers of those over 40 years (55.07%) 14

15 that accessed ECS at BCH reflect statistics by the Statistics Research Agency (SRA) that indicate that 45.64% of people in the 50 plus age group have a long term limiting illness. It may be presumed that a high proportion of these attendances may be related to health conditions associated with age. Statistically there is a higher incidence of older people that may have a disability. (See section on disability) there is no available evidence to suggest however, that the impact will be adverse. Consideration has been given to mitigation (see section 2.4). Religion Political Opinion Marital Status Dependent Status Disability No No Census statistics indicate there may be a differential impact on users from the Protestant religion. However, progressive political developments in Northern Ireland over the last number of years have created a process of normalisation and stability with improved community relations. The Trust would maintain that these developments facilitate equality of opportunity in terms of access to any of the sites. Historically in Northern Ireland there has been some correlation between political opinion and religion. (See section on religion) Whilst information on the dependant status of patients is not recorded, it is likely that there are patients that attend the ED at BCH who may be dependents or carers. There is no available evidence to suggest that the proposal will have an adverse impact relating to dependant status. For those patients with a chronic disease that requires admission to hospital, the most common point of entry is an Emergency Department. Other patients that access E Ds may have other types of disabilities including limited mobility, sensory disability or mental illness. Consideration has been given to mitigation. (See section 2.4). 15

16 Ethnicity Sexual Orientation No Demographic and anecdotal evidence suggest a rise in people from an Ethnic Minorities that access Emergency services at BCH. Information available indicates there were no requests over the past year for face to face interpreting at ED. However, this may be related to the nature of the service which may require telephone interpreting. 2.4 Is it likely that the policy/decision will meet those needs? Group Yes/No/ Don t Know Please briefly give details Age The driving distance from RVH ED to BCH ED is 1.2 miles, from RVH to MIH is 1.6 miles and from BCH to MIH is 2.1 miles. This illustrates that whether travelling by ambulance, private or public transport from whatever direction, the difference in distance between each of the hospitals is minimal. A free shuttle bus service is also available from BCH to RVH. It is therefore not anticipated there would be an adverse impact in relation to age. The temporary closure of the emergency care services at BCH will enable the Trust to concentrate staffing resources at RVH and the Mater. This will mean that more senior doctors will be available at busy times of day and throughout the night, so that patients will obtain the best possible treatment for their condition whenever they present. More nursing staff will be available on the floor. This will bring an increase in the quality of clinical care in the Trust s EDs, resulting in better treatment and shorter waiting times for all patients. Trust senior staff have worked closely with staff within the Trust, HSC Board, Public Health Agency and other Trusts to put in place temporary arrangements to satisfy the requirements of NIMDTA and the GMC to ensure safe and sustainable services. 16

17 Disability Due to the short distance between BCH, RVH and the MIH hospitals particularly if travelling by ambulance or private car and also due to the availability of public transport, it is not anticipated that the temporary closure of emergency care services at BCH will have a significant adverse impact with regard to disability. A Shopmobility service is available at the RVH. This service offers a range of mechanised vehicles, free to users with limited mobility. Religion Whilst there is no specific religious statistics for users that access the Emergency Department at BCH, there is no available evidence that there would be an adverse impact with regard to religion. Geographical information on attendances at BCH Emergency Department between 1 st August 2010 and 30 th June 2011by District Council illustrate that the highest numbers of patients that accessed Emergency Care Services at BCH were from West and North Belfast with a lesser amount of patients from South and East Belfast. Belfast West North South East This would indicate that those that access the Emergency Department at BCH derive from all community and religious backgrounds. Information from Trust clinical activity illustrates there always has been and continues to be ongoing access to each of the hospital sites by all sections of the community. The Trust is committed to the promotion of good relations and endeavours through a range of measures to ensure a welcoming and safe environment at each of its hospitals for all patients. The Trust will continue to engage with Community Groups and public representatives in the Belfast area to ensure that all Trust services and Hospital sites are accessible to all sections of the community. 17

18 Ethnicity The Trust would continue to ensure that the language, religious, spiritual and cultural needs of ethnic patients are considered in the provision of all services. The Trust will ensure that the needs of ethnic patients would be considered when communicating changes involved with this proposal. The Trust will continue to work with users and representative groups to monitor impact and ensure that minority ethnic patients have access to all Trust services. Each of the Trust Emergency Departments has access to Translated Welcome Packs for those patients that may not speak English proficiently. The pack provides information for staff and patients relating to language, religious and spiritual needs of ethnic patients. 18

19 Belfast Health and Social Care Trust: Staff profile (2) Screening the Policy/Decision 2.1 In terms of groupings under Section 75, what is the makeup of those affected by the policy/decision? This information relates to staff in the Belfast Trust in January 2011 and staff based at Belfast City Hospital Emergency Department. It includes 40 Nursing staff, 22 Administrative, 7 Domestic, 2 Portering and 7 Medical staff. Junior Doctors who are on short term rotations have not been included in the analysis. The profile of the 78 staff is compared below with the profile of all Trust employees to identify any potential adverse impact. It should be noted that due to rounding of the figures the percentages may not always total 100 percent. Trust Staff Religion Trust Staff BCH ED Protestant % 46 59% Roman Catholic % 28 36% Unknown % 4 5% Gender Total Female % 65 83% Male % 13 17% Age Group Total Under % 59 76% % 19 24% Disabled Total No % 32 41% Yes 392 2% 3 4% Unknown % 43 55% Marital Status Total Married % 47 60% Single % 27 35% Other/Not Known % 4 5% 19

20 Caring Responsibilities Total Child % 12 15% Older Person 567 3% 1 1% Disabled Person 220 1% 0% None % 15 19% Unknown % 50 64% Political Opinion Total Unionist % 4 5% Nationalist % 2 3% Other % 6 8% Do not wish to answer/unknown % 66 85% Race Total White % 59 76% BME 896 4% 3 4% Unknown % 16 21% Sexual Orientation Total Opposite Sex % 20 26% Same Sex 192 <1% 2 3% Both Sexes 38 <1% 2 3% Do not wish to answer/unknown % 54 69% 20

21 2.2 Is there any indication or evidence of higher or lower participation or uptake by different groups? Staff Group Yes/No/ Don t Know Please provide details Gender No The BCH ED staff are predominantly Female (83%). This is reflective of the Trust position of 78% Female: 22% Male. Age Yes The overall Trust position is 59% under 45 and 41% over 45. In the area under review a higher proportion (76%) of staff are under the age of 45 years and 24% are over 45. Religion Yes The overall Trust position is 45% Protestant and 49% Roman Catholic, and 6% Other. In the area under review there is a higher proportion of Protestants (59%), and 36% are Roman Catholic. 5% of the staff are from outside NI or unknown/other. This would however be in line with the composition of the staff at Belfast City Hospital which is 58.4% Protestant and 41.6% Roman Catholic. Political Opinion No In the Trust 7% state that they are Unionist, 6% Nationalist and 7% Other. 80% provided no information or chose not to answer. Marital Status No In the area under review 85% have chosen not to declare their political opinion or provided no information, 5% are Unionist, 3% are Nationalist and 8% are Other. The Trust position is 56% married, 38% single and 6% other. In the area under review a total of 60% are married and 35% are Single and 5% Other. 21

22 Dependent Status No In the Trust 18% staff care for a child, 3% care for an adult, 1% care for a disabled person, 17% have no caring responsibilities and 61% are not known. For staff based at the ED dependent status is not known for 64% and 19% have no dependents. 15% care for a child, 1% for an older person, 0% for a person with a disability. Disability No 2% of Trust staff stated that they have a disability. In the area under review 4% have stated that they have a disability. This does relate to a very small number of staff. Reasonable adjustments will be facilitated according to the individual needs identified. Ethnicity No In the Trust 76% of staff are white; 20% not known, and 4% BME. In the area under review 76% of staff are recorded as White, 21% Unknown, and 4% Black and Minority Ethnic. Sexual Orientation No The Trust position is 64% not known/wish not to declare; <1% state their sexual orientation is towards the same sex or both sexes; and 34% state their sexual orientation is towards the opposite sex. In the area under review 69% are not known/wish not to declare; 5% state their sexual orientation is towards the same sex or both sexes; and 26% state their sexual orientation is towards the opposite sex. 2.3 Is there any indication or evidence that different groups have different needs, experiences, issues and priorities in relation to the policy/decision? Staff based at the Emergency Department at Belfast City Hospital will be required to temporarily relocate to the Royal Group of Hospitals or the Mater Hospital or be redeployed within Acute Services Directorate, depending on the role they currently undertake, with the majority of clinical staff moving to the Royal. The Table below shows the home locations of the staff who may be moving. Staff are already travelling to the City Hospital from across 22

23 Belfast and beyond. Excess mileage/fares will be payable to eligible staff who move location and a free bus service for staff is available between the City and Royal Hospitals which is a distance of less than 2 miles. Home Location Total Antrim/Ballymena 14 18% Armagh/Craigavon 3 4% Castlereagh 4 5% Co. L Derry 1 1% Co. Fermanagh 1 1% Co. Tyrone 3 4% East Belfast 4 5% Lisburn/Dunmurry 18 23% Mid Down 3 4% Newtownabbey 6 8% North Down 6 8% North Belfast 6 8% South Belfast 6 8% West Belfast 3 4% The temporary relocation of staff will be dealt with in accordance with the Framework on the Management of Staff affected by Organisational Change and the Staff Redeployment Protocol and will be applied in conjunction with Trade Unions. Any Reasonable adjustments identified will be made for staff with disabilities as appropriate in line with the Trust s Framework on the Employment of People with Disabilities. 2.4 Is there an opportunity to better promote equality of opportunity or good relations by altering the policy/decision or working with others in government or in the larger community? Group Ethnicity Religion Political Opinion Suggestions The Trust will continue to engage with Community Groups and public representatives in the Belfast area to ensure that all Trust services and Hospital sites are accessible to all sections of the community. Belfast HSC Trust will continue to engage and work with Section 75 representative groups, community organisations and political representatives to ensure that that emergency care services are accessible to all the community. 23

24 There will be a planned communication process with the community and service users in relation to the proposal. 2.5 What changes to the policy/decision if any or what additional measures would you suggest to ensure that it promotes good relations? Group Suggestions Religion See section 2.4 Political Opinion Ethnicity 2.6 Is there an opportunity to better address the health and social inequalities of groups/areas of greatest social, economic or educational need by altering the policy/decision or working with others in government or in the larger community? Group Suggestions No 2.7 Have previous consultations with relevant groups, organisations or individuals indicated that particular policies create problems that are specific to them? Also, please detail information used to answer any of the questions above (e.g. statistics; research reports; views of colleagues, service users, or other stakeholders). Service Users Whilst the Trust did not publicly consult on this proposal due to time pressures and clinical need, there will be a planned communication and engagement process with the community, service users and other relevant stakeholders. In addition, the Trust plans to fully consult on the long term future of ECS for Belfast in coming months. Staff 24

25 The proposal will impact on staff currently working in the Emergency Department at Belfast City Hospital. Initial discussions were held with staff early in July. The review of emergency care services in the Trust has already been discussed at the Trust Joint Negotiating and Consultative Forum and the Local Negotiating Committee for Medical Staff. There will be a planned consultation with staff and Trade Unions in relation to the redeployment and transfer of staff. 2.8 Please detail what data you will collect in the future in order to monitor the effect of the policy/decision on any of the groups under Section 75? The Trust monitoring framework developed in relation to the monitoring of the impact of service changes in relation to of Section 75 groups will be followed. This will include monitoring of Emergency Department attendances and complaints. (3) Should the Policy/Decision be subject to Equality Impact Assessment? Equality Impact Assessment procedures are confined to those policies/decisions considered likely to have significant/major implications for equality of opportunity. If your screening has indicated that a policy/decision is likely to have an adverse differential impact, how would you categorise it? Please tick. Significant/major impact Low impact X Do you consider that this policy/decision needs to be subjected to a full Equality Impact Assessment? Yes No X Please give reasons for your decision. The overriding concern of the Belfast HSC Trust is patient health, safety and wellbeing. This proposal is to temporarily close the Emergency Department at the BCH and consolidate Emergency Care Services at the Royal and the Mater Hospitals. 25

26 The proposal is in response to the urgent need to address the inability to sustain Trust emergency services caused by the loss of senior medical staff and recruitment shortages. Other factors directly linked to patient safety which have prompted this decision are concerns highlighted by NIMDTA in relation to the junior doctor workload related to recruitment shortages in addition to regulations under the EWTD. The safety of staff and patients is paramount to the Trust and in this situation where a service has the potential to collapse, there are serious implications regarding patient safety, therefore the Trust is left with no choice but to temporarily close the Emergency Department at BCH. Emergency Care Services will be consolidated at the RVH and Mater Hospitals where there will be a concentration of expert senior medical clinicians. Considering the urgent timescales required to deal with this situation and the overriding regard to patient safety combined with a concentration of ECS provided at the RVH and Mater Hospitals, this proposal will be screened out with mitigation. Mindful of equality responsibilities a communication process will be implemented with Section 75 groups, the Trust Patient and Public Involvement Group, the community and service users. Monitoring mechanisms will be implemented to monitor for possible unforeseen adverse impact. 26

27 (4) Disability Discrimination 4.1 Does the policy/decision in any way discourage disabled people from participating in public life or does it fail to promote positive attitudes towards disabled people? No. 4.2 Is there an opportunity to better promote positive attitudes towards disabled people or encourage their participation in public life by making changes to the policy/decision or introducing additional measures? No. The proposal promotes positive attitudes towards disabled people by considering the needs of disabled people in relation to the proposal. A Communication strategy will be conducted with service users including those with a disability. 4.3 Please detail what data you will collect in the future in order to monitor the effect of the policy/decision with reference to the disability duties? The Trust monitoring framework developed in relation to the monitoring of service change impact in relation to of Section 75 groups will be followed. 27

28 (5) Consideration of Human Rights 5.1 Does the policy/decision affect anyone s Human Rights? [PLEASE COMPLETE THE TABLE BELOW] ARTICLE POSITIVE IMPACT NEGATIVE IMPACT = human right interfered with or restricted NEUTRAL IMPACT Article 2 Right to life x Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment x Article 4 Right to freedom from slavery, servitude & forced or compulsory labour x Article 5 Right to liberty & security of person x Article 6 Right to a fair & public trial within a reasonable time x Article 7 Right to freedom from retrospective criminal law & no punishment without law. x Article 8 Right to respect for private & family life, home and correspondence. x Article 9 Right to freedom of thought, conscience & religion x Article 10 Right to freedom of expression x Article 11 Right to freedom of assembly & association x Article 12 Right to marry & found a family x 28

29 Article 14 Prohibition of discrimination in the enjoyment of the convention rights 1 st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education x x x If the effect you have identified is positive or neutral please move on to Question If you have identified a likely negative impact who is affected and how? At this stage we would recommend that you consult with your line manager to determine whether to seek legal advice and to refer to Human Rights Guidance to consider: whether there is a law which allows you to interfere with or restrict rights whether this interference or restriction is necessary and proportionate what action would be required to reduce the level of interference or restriction in order to comply with the Human Rights Act (1998)? 29

30 5.3 Outline any actions which could be taken to promote or raise awareness of human rights or to ensure compliance with the legislation in relation to the policy/decision. The Trust is committed to the safeguarding and promotion of Human Rights in all aspects of its work. The Human Rights Act 1998 gives effect in UK Law to the European Convention on Human Rights and requires legislation to be integrated so far as possible in a way that is compatible with the convention rights and makes it unlawful for a public body to act incompatibly with the convention rights. Policy/Decision Screened by: Linda Linford Veronica McEneaney Louise Beckett On behalf of Service Group On behalf of Health and Social Inequalities On behalf of Employment Equality Date: August