Inclusion matters Equality information report 2017

Transcription

1 Inclusion matters Equality information report 2017

2 Contents 1. Executive summary Our journey 4 Overview of our performance in the year Delivering our equality objectives 8 3. Our site updates 19 Performance/overview of the year Corporate recognition Our priorities for Contact us Appendices Appendix one - our workforce data 28 Appendix two - summary community engagement activity 50 Appendix three - patient data 52 2

3 Executive summary The Equality Information report provides a summary of the Trust s progress and presents a summary of its work programme extending to both employment practice and service delivery provision. This year s report sets out key achievements against each of our equalities objectives over the last year, key challenges faced and introduces the reader to key priorities for Listed below are some of the key achievements made during the reporting period: 1. Each site now having an Equality and Inclusion group established 2. CQC Well-led Review recognised progress and heralded an aspect of our work as an area of outstanding practice 3. Statutory and mandatory training compliance data on Equality and Diversity training as at 18 th December 2017 is 93.97% 4. Barts Health is one of 17 Trusts in the country to take part in the Workforce Disability Equality Standard (WDES) pilot. 5. A review of disciplinary procedures where a pause and review process is required before commencing formal disciplinary activity has seen a reduction in both the volume of cases and the likelihood of the BME staff affected. 6. The Trust was successful in being one of the 5 Trusts nationally, working with NHS England Workforce Race Equality Standard (WRES) team and Institute for Healthcare Improvement (IHI) in embedding a Quality Improvement (QI) approach to improving two of our WRES indicators as 7. Successful in being selected by NHS London Leadership Academy as an Inclusion-Lab site to support the development of our Inclusive Manager Programme 8. Dementia Friendly environment project completed at Whipps Cross Hospital and 3 separate projects presented by the team at the National Dementia Congress in Deputy CEO-led Trust Equality Data working group established, with a significant programme of work including waiting times acute and elective, cancellations and clinical outcomes 10. We launched our new children s website co-designed with our Youth Empowerment Squad. Whilst progress is welcomed, many activities continue into 2018 and we know from our WRES reporting and NHS Staff and Patient Surveys that the Trust is only at the beginning of a journey to ensure that its ambitions for safe and compassionate care permeate the experiences of everyone. 3

4 Our journey Barts Health NHS Trust is a group of five hospitals that became a single entity in This report provides the reader with a summary of activity across the group of Barts Health hospitals over the last 12 months. It also serves as a platform to report on equality information which is a statutory requirement of the Public Sector Equality Duty (PSED). Barts Health is committed to the Equality and Inclusion agenda and the following statement from the Trust Chairman is further testimony: It s not about compliance it s about improvement We serve over 2.5 million patients each year and our vision is to be a high performing group of NHS hospitals, renowned for excellence and innovation and providing safe and compassionate care to our patients in east London and beyond. In 2015, we developed an improvement plan in response to feedback from our staff, our partners and inspectors from the Care Quality Commission (CQC) and we have come a long way in our improvement journey and further testimony to our improvement has been the recent CQC report published December 2017 There is also evidence of improved engagement with staff through the national NHS staff survey and we are getting better with regards to patient s experience of care at our hospitals. It should be noted that the Trust recognises that the journey of improvement includes a journey towards inclusion and indeed is beyond minimum statutory compliance.the Public Sector Equality Duty (PSED) has two parts: General Duty and Specific Duty. The General Duty has three aims: The need to: a. Eliminate unlawful discrimination, harassment and victimisation and other conduct b. Advance equality of opportunity c. Foster good relations The Specific Duty places a requirement on the Trust to publish: a. Equality objectives, at least every four years b. Information to demonstrate compliance with the equality duty, annually This report provides a summary of PSED activity and other action designed to minimise disadvantage, improve staff and patient experience and service delivery ensuring equity for all. As one of the largest group of Hospitals in the country, located in one of the most diverse areas of the country, it is imperative that both staff and patients experience equity and inclusion. Orientation to report The report is set out using our Equality Objectives as the framework. We hope this aids readers in: understanding the focus of our Inclusion work over the last year; getting a sense of our journey towards achieving the goals we set at the beginning of 2017; 4

5 accessing some examples of a range of key achievements in relation to our staff, patients and communities we serve, and what that means for shaping our priorities for the coming year. 5

6 Overview of Our Performance in 2017 The CEO led Equality and Inclusion Board continues to provide strategic leadership for the agenda as well as providing assurance for the delivery of set equality objectives. This section of the report covers the following key aspects of performance in 2017: Progress in relation to strengthening the governance of our equality and inclusion work Promoting BartsAbility, improving the experience of our staff living with a disability Achieving Fairness, with a focus on addressing the over-representation of our BME staff in disciplinary processes Supporting Progression, taking positive action to promote equality of career progression from initial recruitment and beyond Building Psychological Safety, by effectively addressing bullying, harassment, abuse, violence and discimination Promoting Inclusive Service, by identifying and addressing in equality in access, experience and outcomes for our patients Seeking and responding to Stakeholder Views, by engaging with our feedback from patients, staff and communities we serve to drive improvements in our diversity and inclusion practices The report also includes highlight reports from our Site Inclusion Groups. Key Workforce Data and Patient Data features in appendices and is used to help us identify where improvement is required and provides trend data in relation to helping us monitor the impact of the interventions we are pursuing. Strengthening our Governance In 2017, we set out to articulate ambitious and measurable goals for each of our equality objectives. We also recognised the need for establishing site inclusion groups to strengthen engagement in taking forward the work plans of the CEO-Led Equality and Inclusion Group and the Staff Diversity Network. Key achievements in 2017 Each site now has an Equality and Inclusion group established A Trust Board development session on Inclusion facilitated by Roger Kline (Author, Snowy White Peaks of the NHS and Research Fellow at Middlesex University) and joined by the chairs of our staff diversity networks. Key outcomes included securing Occupational Health budget for Reasonable Adjustments to better support staff with disabilities and the commencement of a Diversity Charter engagement process The CQC Well-led Review recognised improvements, including a statement reading; Staff from Black, Asian and Minority Ethnic groups reported that they felt more engaged and included. The CQC also recognised the Aspiring BME / Female Leaders Career Development Programme as an area of outstanding practice. 6

7 A better established Staff Partnership Forum (SPF) with joint initiatives driving improvements An Inclusion Summit focusing on explicit equality and inclusion actions in respect of Staff Engagement; Leadership Development; Staff Led Change; and Patient Engagement. Inclusion Listening into Action (LiA) Big Conversation with over 200 staff in attendance. Key outcomes include the establishment of a Dyslexia staff support forum and the roll out of yellow badges for front-line staff Statutory and mandatory training compliance data on Equality and Diversity training as at 18 th December 2017 was 93.97%. With a workforce of approximately 16,000 permanent members of staff and having up to 150 new starters join the Trust every week, this is a significant achievement. Bespoke, departmental Equality, Diversity and Human Rights training activity undertaken by the Dental team in response to learning from grievance raised. Equality Analysis activity for the year included Probation, Substance Misuse, Flexible Working and Disclosure and Barring Services (DBS) policies. Looking forward to 2018 Continuing to strengthen governance of the Equality and Inclusion work programme with a focus on embedding delivery within sites and corporate functions, and setting aspirational and achievable annual goals 7

8 Delivering our equality objectives For each of the equality objectives, the reader s attention is drawn to the goal, key achievements during the reporting period of 2017 and looking forward to Promoting Barts Ability: Our Goal In 2017 NHS Staff Survey results, over 75% of staff reporting adequate reasonable adjustments made. In this equality objective, we set out to investigate and actively seek to address the low numbers of staff with disability status recorded on Electronic Staff Records (ESR), as well as their negative experience in the workplace compared to others as shown by staff survey results Key achievements in 2017 Barts Health is one of 17 Trusts in the country to take part in pilot Workforce Disability Equality Standard (WDES) metrics. Taking part in the pilot requires participating organisations to check pre-populated data, provide workforce and employee relations data, and provide views of the metrics proposed. Together with presence on the national workforce disability equality steering group, participation in the pilot allowed Barts Health NHS Trust the opportunity to further contribute towards the shaping of the national agenda on disability equality. BartsAbility team conversations were completed across all hospital sites with three work streams emerging. The three BartsAbility LiA Teams actions a. Staff BartsAbility passport b. Dyslexia support forum c. Improved Access actions with work programme re-commissioned to DisabledGo Roll out plan for outputs from LiA BartsAbility clarified Occupational Health to advance pre-employment good practice to better support staff and managers in agreeing reasonable adjustments and access to specialist advice Communication plan regarding achievements made to encourage better use of ESR self-service updates to disability declarations Barts Health achieving Disability Confident Employer status during the reporting period The 2017 Staff Survey results will be published in March Looking forward to 2018 Implementing Workforce Disability Equality Standard (WDES) Dedicated Occupational Health budget for reasonable adjustments Estates Improving Access work programme with DisabledGo 8

9 Ensuring Fairness: GOAL By March 2018 we achieve 50:50 in the likelihood of BME staff being disciplined compared to white staff In this equality objective we set out to investigate and address the overrepresentation of BME staff facing disciplinary action compared to non-bme staff, with key actions including the introduction of a new electronic case management system capable of supporting effective equalities monitoring data and case tracking; to pilot the introduction of a pre-disciplinary decision check list and to revise our disciplinary practice guidelines. Key achievements in 2017 Procurement of new case management system completed and initial implementation started November 2017 The Equality & inclusion Board commissioned a review of disciplinary procedures where a pause and review process is required before commencing formal disciplinary activity. The pre- disciplinary checklist was developed in January 2017 and rolled out across each of the hospital sites and was followed up with a review after eight months of use. Our Workforce Race Equality Standard (WRES) metrics as at 31 March 2016 showed that the relative likelihood of BAME employee entering disciplinary process was 2.14 compared to White staff. An evaluation of the pilot showed a reduction in number of staff entering the disciplinary process and an improved likelihood for BME staff. The Trust is treating this data with caution and plans to carry out further enquiries to establish why the numbers have reduced. Support will be enabled from an academic partner, as part of a pan-london improvement programme. January-August 2017 Ethnicity Entered Disciplinary Headcount (staff in post) % Entering disciplinary White % BME % Not Stated % TOTAL % Relative Likelihood of White employee entering disciplinary process Relative Likelihood of BAME employee entering disciplinary process Table 1: Ethnicity data from the pilot of the pre-disciplinary checklist Looking forward to Agree with SPF colleagues the permanent implementation of changes and progress the work required to review Trust wide guidelines for disciplinary processes 9

10 Embed the use of the checklist Take a leading role in the pan-london programme for improvement Supporting Progression: GOAL By March 2018 to achieve 10% improvement in percentages of BME staff at Bands 7 & 8 At the beginning of 2017 we set out to improve our appraisal system, building in greater consideration of talent management; agree the scope and focus of our career service; scope of review of our recruitment and selection policy and practice; and commission a management development programme to support inclusive management. Key achievements for 2017 The key measures for this area are the percentage of staff in each of the Agenda for Change (AfC) Bands 1 to 9 and VSM (including executive Board members) compared with the percentage of staff in the overall workforce (WRES 1) and Percentage believing that Trust provides equal opportunities for career progression or promotion (WRES 7) Good initial improvements have been seen in both areas as shown in the tables below: Headcount March ending Clinical Non-Clinical Total BME Change from Total BME AfC Total BME AfC Total BME AfC Table 2: Part WRES 1 Narrative Ethnicit y Trust in 2016 Trust in 2015 Moveme nt since 2015 Believing that the organisation provides equal opportunities for career progression or promotion BME 63% 59% +4% White 82% 80% +2% Table 3: WRES 7 The Career Development Programme for Female and BME staff has seen two hundred and ninety three (293) participants attend, with 20 cohorts completed. Each cohort consists of three half-day workshops Many delegates have gone on to achieve significant personal success; fifty nine (59) have been successful in applications to Higher Band posts and nine have been awarded places on national development programmes The Trust 10

11 was successful in being selected by the NHS London Leadership Academy as an Inclusion-Lab pilot site to support the development of our Inclusive Manager Programme. The Apprenticeship Board has been established to govern the Trust s approach to the new apprenticeship levy, which, when fully realised, will enable the Trust to achieve greater reach and development of staff from diverse backgrounds The Healthcare Works programme continues to provide local people with pathways into lower banded roles in the Trust with the following key achievements reported: i. 99 local people secured Band 2 to 3 jobs ethnicity and age profile as follows Ethnicity Number Age Number Asian or Asian British Bangladeshi Asian or Asian British Chinese Asian or Asian British Indian Asian or Asian British Pakistani Black or Black British African Black or Black British Caribbean Black or Black British Somali 7 17 Other Asian 2 Other Black Background 1 Other East European 3 Other White background 12 White British 7 White Polish 1 Other I prefer not to say 1 Other 1 Asian or Asian British Vietnamese Total 99 ii over 60 1 Total local people secured apprenticeship opportunities iii. 30 local people completed Project Search internships, of which 7 proceeded to substantive employment with Barts Health 11

12 iv. 32 local learners provided specialist internships v. Annual award ceremony held for over 130 participants of HW programme Looking forward to 2018 Progressing apprenticeship levy work and growing take-up Progressing the recruitment project to revise attraction and selection processes in partnership with staff diversity networks Progressing the inclusive manager programme; inclusion lab, in collaboration with NHS London Leadership Academy for circa 200 leaders Building Psychological Safety: GOAL 2017 NHS Staff Survey results better than average For 2017, we set out to develop our approach to targetting hot spots from our service line staff survey data; embark on a programme of senior leadership team development; continue to build our internal faculty to be able to deliver management and leadership development; commence work to better understand the high levels of violence reported; and to undertake a review of our services in place to support staff raising concerns. Key achievements in 2017 The Executive team and many others participated in psychological safety workshops Successful implementation of Super T Leadership Team Development programme with eight (8) teams and over 90 leaders currently going through Super T cohort 1 Active subgroups of the Trust s Staff Diversity Network with executive championing of each as follows: i. BartsAbility (Disability)subgroup - Executive Director of People ii. iii. BAME subgroup - Chief Finance Officer LGBTQ subgroup - Executive Director of Clinical Operations Visible leadership with CEO and site leadership attending diversity subgroup meetings Effectively dealing with violence and aggression improvement by responding to staff survey results and setting up an improvement collaborative to reduce violence and aggression. We have run three workshops (60 staff participated) using the medical mediation foundation and have run a master class with 30 participants learning from East London Foundation Trust (ELFT). Newham and RLH hospitals commenced campaigns for Respect towards staff from patients and visitors Increased channels for raising concerns with information on take up include Guardian Service and Speak-In -Confidence 12

13 For Faculty of Improvement, Leadership and Management - 6 accredited Aston Team Performance Inventory practitioners trained; 3 Healthcare Leadership Model (HLM) 360 Feedback Facilitator Train the Trainers trained; 6 accredited HLM 360 feedback facilitators trained. Health and Wellbeing analysis following completion of Health and Wellbeing questionnaire by 2,033 respondents. The report shows that there has been an improvement in stress levels, with reduced percentage having higher stress levels as shown in chart below: 25.00% How stressful do you currently find your job? On a scale from 0-10, with10 being most stressful 20.00% 15.00% 10.00% % 0.00% Looking forward to 2018 Evaluation and review of services to support staff raising concerns Taking more steps to address violence & aggression Developing a Diversity Charter Continuing to extend psychological safety development with teams Providing Inclusive Service: GOAL - Monitoring of patient data to shape Trust s approach to understanding, achieving and measuring equitable access and outcomes for patients For this equality objective the focus is on ensuring improved access and patient experience for all, irrespective of their protected characteristic group identify, using equalities monitoring data effectively to identify where we need to focus our efforts in improving both patient access, outcomes and experience. Achievements in 2017 Dementia Friendly environment project completed at Whipps Cross University Hospital 13

14 Three separate projects presented by the team at the National Dementia Congress in November 2017 Deputy CEO-led Trust Equality Data working group established The working group has established a significant programme of work looking at a basket of indicators including waiting times acute and elective, cancellations, DNAs, some clinical outcomes such as breastfeeding rates; and stage of cancer at presentation. The full list of the basket of indicators are shown in table below: INDICATOR RATIONALE NEXT STEPS OP Hospital cancellations - rebooking ED wait for assessment (4 Hour wait) ACCESS ACCESS Rebooking of hospital cancellations meeting ED wait for assessment clarity of existing dataset underway Diagnostic Waits ACCESS No further action at this stage Cancer stage at presentation SAFETY To link to Somerset cancer registry Incidents SAFETY Data by protected characteristics Screening take up rates Breast feeding rates Utilisation of stand-alone maternity units Maternity - gestation at time of booking Complaints / compliments SCREENING EFFECTIVENESS / OUTCOMES ACCESS EFFECTIVENESS / OUTCOMES PATIENT EXPERIENCE AAA screening and breast feeding For review with Clinical Board team and research lead Review of attendances by ethnicity and deprivation index Identify dataset Data by protected characteristics The group have looked at variations by ethnicity, age and deprivation and this has revealed areas where we need to do further study and plan interventions. An example of this is DNA rates by deprivation and we are putting in place a programme of work to try and understand the variations and causes of DNAs to plan interventions to reduce those. 14

15 Variations in DNAs by index of multiple deprivation score were identified and follow-up work has begun Patient experience team worked with team to explore participation in clinical trials (findings by ethnicity shown on page 48 of this report) Held our first Patient Experience and Engagement conference, in which we refreshed our Strategy for 2018 Collaborative Pairs Programme delivered in partnership with The Kings Fund. The programme tracked what it takes for a member of the public and a member of staff to collaborate and to note the areas of activity where collaborative relationships might flourish, in both informal and formal settings. Piloted the use of text/telephone in our Emergency Departments to gain patient feedback about their experiences of care. Set up patient panels and forums at the Royal London Hospital and Newham University Hospital, refreshed the delivery at St Bartholomew s and worked with our well-established patient panel at Whipps Cross Hospital to model what good looks like for the other sites. Continued the roll out of Experience Based Co-Design across clinical services engaging patients, staff and carers to capture, understand, improve and measure experiences of care across Cancer Services and Physiotherapy Services Trust wide. We're proud to be the largest provider of children's services in London and have recently launched our new children s website to represent the services we provide to over 500,000 children and young people across east London, codesigned with our Youth Empowerment Squad. Improving Access Communication, in particular, we have: o Launched a new website and intranet that can be translated into over 100 languages as well as adjusted for people with visual impairments o Produced films with subtitles to reach people with hearing loss 15

16 o Launched a new range of name badges for staff with large font in high contrast, to welcome people with visual impairments o Conducted TV interviews in Sylheti and translated press releases into a variety of languages and built relationships with ethnic media o Worked with interpreters to support patient participation in media interviews where English isn't their first language and translated our patient information leaflets into the top five languages spoken in our local boroughs o Ensured that our communications collateral represents a diverse mix of people and perspectives o Raised awareness of many our equality objectives and initiatives, including the career development programme, support for staff experiencing bullying and harassment, and a specific campaign focussing on respect at Newham Hospital o Raised awareness of public health messages during Ramadan and celebrated key religious and spiritual events o We also regularly review our accessibility score on our website. We are above the industry standard for online accessibility and regularly review our score (measured by an independent online tool) to have plans to make our site even more accessible in the coming year. Looking forward to 2018 Progressing Accessible Information standard Commencing Non-Attendance Project which will help understand the reasons for non-attendance in our outpatient appointments and co-design improvements to experience and access to help meet the needs of the population to attend appointments Collaboration in re-designing the Women and Children s Service at Whipps Cross University Hospital Refreshing our overall approach to using patient feedback and engaging patients in driving quality improvements Engaging with Stakeholder Views: GOAL - Achieve improvements to our current Equality Delivery System (EDS2) grades for patient & workforce aspects (ref Equality Annual Report 2016) and publish a consolidated community engagement annual calendar of events The focus of this equality objective is securing feedback from our stakeholders in relation to our progress with our equality and inclusion practices as an organisation. Achievements in 2017 Community Engagement EDS2 event conducted in September in Waltham Forest Borough over 100 public and community group reps participated. A key outcome following the engagement event includes establishing the existence of and raising awareness of adapted kits (e.g. bowel cancer kits) required to meet the needs of patients who are visually impaired especially when these kits or guides are required as part of their treatment or care 16

17 Initial discussions held by leadership team to progress further corporate and local Community Engagement activity to support commitment to improve patient experience and reduction of health inequality An evaluation of current performance against achieving better health outcomes for all and improving patient access and experience as shown in table below with grading of performance against each of the patient focussed EDS2 goals. The Equality Delivery System (EDS2) gradings 1 for each EDS2 goal and outcomes 2 as determined through feedback from community engagement event September 2017 is shown in tables below: Goal 1 Better Health Outcomes for All Grading as at 2015/16 Target grading 2018/19 Actual grading 2017/18 Outcome 1.1 Developing Achieving Developing Outcome 1.2 Developing Achieving Developing Outcome 1.3 Developing Achieving Developing Outcome 1.4 Developing Excelling Developing Outcome 1.5 Developing Achieving Developing Overall EDS2 Goal 1 Developing Achieving Developing Table 4: Grading EDS2 Goal 1 Goal 2- Improved Patient Access & Experience Grading as at 2015/16 Target grading 2018/19 Actual grading 2017/18 Outcome 2.1 Developing Excelling Developing Outcome 2.2 Developing Achieving Achieving Outcome 2.3 Developing Excelling Developing Outcome 2.4 Developing Achieving Developing 1 There are four possible gradings within EDS2 Undeveloped people for all protected groups fare poorly compared with people overall OR evidence is not available; Developing people from only some protected groups fare as well as people overall; Achieving people from most protected groups fare as well as people overall; Excelling - people from all protected groups fare as well as people overall Services are commissioned, procured, designed and delivered to meet the health needs of local communities; 1.2 Individual people s health needs are assessed and met in appropriate and effective ways; 1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone wellinformed; 1.4 When people use Barts Health NHS Trust services, their safety is prioritised and they are free from mistakes, mistreatment and abuse; 1.5 Screening, vaccination and other health promotion services reach and benefit all local communities; 2.1 People carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds; 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care; 2.3 People report positive experience of Barts Health NHS Trust; 2.4 People s complaints about services are handled respectfully and efficiently. 17

18 Overall EDS2 Goal 2 Developing Achieving Developing Table 5: Grading EDS2 Goal 2 Looking forward to 2018 A refreshed community engagement strategy 18

19 Our site updates Newham University Hospital Performance/overview of the year 2016/17 The equalities and inclusion working Group at Newham University Hospital started to meet in November 2017 and is led by the Managing Director of the site and supported by the site Assistant Director of People. Key achievements during the year Work Shadowing Programme that offers a programme of work shadowing, thereby giving staff valuable insight into other departments, or more senior roles. Hosted BME subgroup staff diversity network meeting with site Executive Managing Director and Trust wide Executive Director of People in attendance. Successful RESPECT campaign with the aim of addressing significant number of staff reporting the experience of harassment, bullying or abuse at work from patients, their relatives or other members of the public. Picture: What do you think of Newham Hospital? 19

20 Royal London Hospital and Mile End Hospital Performance/overview of the year 2016/17 The equalities and inclusion working Group at the Royal London Hospital meets regularly every month and is chaired and led by the Director of Nursing, supported by the site Assistant Director of People. The group reports via the people and leadership committee to the Hospital Management Board for Royal London and Mile End Hospitals. The group has an agreed Terms of Reference which includes leading and driving the development and delivery of the different work streams necessary to achieve the equality objectives as they relate to both patients and staff at RLH and MEH. The Working Group provides assurance to the Equality and Inclusion Board. The attendance at the group includes Representatives from each division (leadership), staffing representative (cross section) staff side, assistant directors, patient representative, Staff diversity networks e.g. BartsAbility, Estates and Facilities and communications and the Trust Speak Up Guardian. In addition a Staff/Patient Story is provided at each meeting with learning s from each story shared across teams. Key achievements during the year The agenda over the year has included the following: developing site based objectives; impact of BREXIT; Workforce Disability Equality Standard; consideration of breakdown of site Staff survey results by protected characteristics; Patient access report; use of pre-disciplinary checklist; Updates from Listening into Action (LiA) sub groups; Black History month site celebration planning; Workforce Race Equality Standard (WRES) actions; Career Development Workshop for BME and Female staff planning and implementing the Accessible Information Standard (AIS) Highlights during the reporting period include Improved patient access; Listening to Staff and Patient Stories Black history Month celebration On-site Career development event Taster session provided by in-house facilitator Workshop on developing site based equality objectives Pre-disciplinary Questionnaire action planning with the aim of addressing disproportionate number of BME staff accessing the disciplinary process Key Equality & Inclusion challenges during the year Improving links with other sites and sharing best practice 20

21 St Bartholomew s Hospital Performance/overview of the year 2016/17 The hospital started up an Equality and Inclusion Forum in September Attendance had been variable so a re-launch of the group took place in October 2017 and meetings are now attended by over 20 managers and front-line staff. The aim of the Forum is to become a better and more inclusive employer by making full use of the talents of its diverse staff and the communities it serves. The hospital used the Listening into Action (LiA) approach to hold an equality and inclusion conversation event in March The conversation was well attended, and staff told the senior leadership team that they would like to see a more diverse leadership profile, training on diversity and recruitment process changes to include an independent interview panel member. St Bartholomew s hospital has a challenge on workforce race equality; with demonstrable improvement in closing the gap between white and BME staff being appointed from shortlisting, greater BME representation in leadership positions and reducing the level of BME staff being bullied by colleagues are all site priorities. Other priorities include engaging and supporting staff in BREXIT implications, increasing SBH attendance to the Inclusion sub-groups including BME, Disability and LGBT, embedding DisabledGo reforming the recruitment process plus access to application and interview training for staff and giving ready feedback. Key achievements during the year Provision of Unconscious bias training to staff Introduced a pre-disciplinary checklist Improved senior representation from BME background Held a #BartsAbility Listening into Action (LiA) session Introduction of easy to read, yellow name badges Improved signage to stairs for staff use with on-going efforts to improve access for disabled staff and patients as well as improving awareness of the forum through team talk to encourage attendance of all staff. Key Equality & Inclusion challenges during the year The 2016 Staff Survey results showed whilst the majority of staff feel that the organisation does act fairly in respect of career progression/promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age. 23% of staff did not agree with this. Compared to the national average (18%), this is an outlier. In response 15 hospital staff participated in the Trust Career Development Programme for BME and Female Staff; Relative likelihood of BAME staff in the Trust entering the formal disciplinary process, compared to that of white staff entering the formal disciplinary process (as measured by entry into a formal disciplinary investigation). At St Bartholomew s this is currently 50/50 representation. A new pre-disciplinary checklist was introduced in April A reduction of formal disciplinary cases has occurred since the new checklist was introduced. 21

22 Whipps Cross University Hospital Performance/overview of the year 2016/17 The equalities and inclusion working Group at Whipps Cross University Hospital started to meet in September 2017 and is chaired and led by the Executive Managing Director for Whipps Cross, and supported by the site Assistant Director of People. Key achievements during the year Hosted BME subgroup staff diversity network meeting and the LGBTQ subgroup meeting with site Executive Managing Director in attendance. Based on feedback from LGBTQ subgroup, Whipps Cross was first to pilot LGB awareness training where the healthcare needs of people from the LGB community is explored with front line staff Increased level of staff engagement as evidenced through improved percentage staff survey completion Picture: Whipps Cross University Hospital 22

23 Corporate recognition During the reporting period, the following occasions of corporate recognition are noteworthy: Barts Health invited to sit on the NHS Employers Widening Participation Programme Board April 2017 to March 2018 Shortlisted for Inclusive Culture category Employers Network for Equality & Inclusion (ENEI) Awards 2017 The award-winning Career Development Programme for BME and Female staff case Study presented at Royal College of Nursing (RCN) International Nursing Research Conference, University of Oxford - April 2017; Global Equality and Diversity Conference University of East London November 2017 BartsAbility case study presented at Global Equality and Diversity Conference University of East London November 2017 Director of People commenced as co-chair of Pan- London Inclusion & Diversity Network Barts Health NHS Trust finished 31st in the 2017 Social Mobility Employer Index ranking, the only NHS Trust in the top 50, demonstrating that the Trust is performing well in a number of areas such as working with young people and offering routes into employment. 23

24 Our priorities for 2018 A great deal of activity has been undertaken in 2017 and the themes remain highly important to the coming year, as change is embedded and pilots progressed to full implementation. At the same time, 2018 is also likely to see new activity arise, such as work with the LGBTQ staff network and on the gender pay gap analysis due in April. The Trust Inclusion Board, with membership of the staff diversity networks and site boards is currently reviewing achievements and challenges in order to shape refreshed objectives and goals for A report to the Board will detail these in the coming months. In the meantime, the table below shows the existing priorities as we enter the new year. Strengthening Governance Continuing to strengthen governance of the Equality and Inclusion work programme, embedding delivery within sites and corporate functions, and setting aspirational and achievable annual goals for all areas. Equality Objective Specific actions for 2018/19 a. BARTSABILITY Promoting Barts Ability Our Goal: NHS Staff Survey over 75% of staff reporting adequate reasonable adjustments Lead Director of People b. FAIRNESS To investigate and seek to address the over-representation of BME staff facing disciplinary action compared to White staff in the Trust. Lead Director of People Implementing Workforce Disability Equality Standard (WDES) Dedicated Occupational Health budget for reasonable adjustments Estates Improving Access work programme with DisabledGo Agree with SPF colleagues the permanent implementation of changes and progress the work required to review Trust wide guidelines for disciplinary processes Embed the use of the checklist Take a leading role in the pan-london programme for improvement c. PROGRESSION To investigate the high rates of reported discrimination and concerns about the equality of opportunity from NHS Staff Survey results, commencing with a review of our current recruitment practices. Lead Director of People Progressing apprenticeship levy work and growing take-up Progressing the recruitment project to revise attraction and selection processes in partnership with staff diversity networks Progressing the inclusive manager programme; inclusion lab, in collaboration with NHS London Leadership Academy for circa 200 leaders d. PSYCHOLOGICAL SAFETY Evaluation and review of services to 24

25 To focus on effectively addressing bullying and harassment, violence and discrimination at work Lead Director of People support staff raising concerns Taking more steps to address violence & aggression Developing a Diversity Charter Continuing to extend psychological safety development with teams e. INCLUSIVE SERVICE To ensure improved access and patient experience for all, irrespective of their protected characteristic group identify, using equalities monitoring data effectively to identify where we need to focus our efforts in improving both patient access, outcomes and experience Our Goal: Monitoring of patient data to shape Trust s approach to understanding, achieving and measuring equitable access and outcomes for patients. Demonstrate effective use of Equalities Monitoring data and on using patient and population data to shape our Clinical Strategy Lead Chief Nursing Officer/Deputy Chief Executive Officer/ Chief Medical Officer f. STAKEHOLDER VIEWS To achieve improvements to our current Equality Delivery System (EDS2) grades for patient and workforce aspects (ref Equality Annual Report 2016) Publish a consolidated community engagement annual calendar of events Progressing Accessible Information standard Commencing Non-Attendance Project which will help understand the reasons for non-attendance in our outpatient appointments and co-design improvements to experience and access to help meet the needs of the population to attend appointments Collaboration in re-designing the Women and Children s Service at Whipps Cross University Hospital Refreshing our overall approach to using patient feedback and engaging patients in driving quality improvements A refreshed community engagement strategy Lead Chief Nursing Officer/ Director of People 25

26 Contact us We would like to hear from you and welcome your feedback, so if you have any comments or questions regarding this report or suggestions for further improvement, please write to us. You can or write to: The Inclusion Team Organisational Development Barts Health NHS Trust Ground Floor, 9 Prescot Street London, E1 8PR Or follow us on 26

27 APPENDICES Appendix one: our workforce data Appendix two: summary community engagement activity Appendix three: patient data 27

28 Appendix one - our workforce data With a diverse workforce of approximately 16,000 and being the largest single employer situated in one of the most diverse parts of London, building an inclusive workplace culture where people can perform at their best is critical. Appendix I to this report sets out the detailed workforce information, by category, as at 30 September 2017 whilst table 6 below, shows the summary workforce composition of our staff population for 2016 compared to 2017 by protected characteristic. Protected characteristic Summary workforce information as at 30 September headcount of 15,640 (Previous year figures in brackets) Age Under 25 5% (6%) % (30%) % (28%) % (23%) % (11%) 65 and over 2% (2%) 40% 35% 30% 25% 20% 15% 10% 5% 0% under and above Disability Yes 2% (2%); No 82% (80%); Not stated/undefined 16% (18%) 28

29 100% 80% 60% 40% 20% % Yes No Not stated Ethnicity White 39% (40%) We have seen a reduction in number of staff choosing not stated or undefined BME 48% (46%) Mixed 2% (2%) Other 8% (6%) Not stated/undefined 8% (6%) 60% 50% 40% 30% 20% % 0% White BME Mixed Other Not stated BME representation in the workforce profile has increased by 2% from last years figures Gender/sex Male 27% (26%); Female 73% (74%) 29

30 80% 70% 60% 50% 40% 30% % 10% 0% Male Female Male representation in workforce profile has increased by 1% from last year s figures. Religion/belief Atheism 8% (7%) Christianity 40% (39%) Hinduism 4% (4%) Islam 12% (12%) Other 5% (5%) Undefined 0% (0%) Do not wish to disclose 31% (33%) 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Number of staff choosing not to disclose their religion has reduced by 2% 30

31 Sexual orientation Bisexual 0.5% 85; 1% (75) Gay 1% 181; 1% (173) Lesbian 0.3% 40; 0% (43) Heterosexual 63%; 62% (9,530) Do not wish to disclose 35%; 36% (5,474) Undefined/other 0.2% 29; 0% (2) 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% We have started to see a slight increase in disclosure rate for sexual orientation compared to last year s figures Table 6: Summary workforce information taken from Electronic Staff Records (ESR) for Barts Health staff population by protected characteristics 31

32 The table below provides details of workforce equality information and where it can be found in the report by page number. The workforce equality information is based on substantive staff in post as at 30 September Headcount 15,640. Workforce data A. Workforce profile by: B. Workforce diversity profile by band C. Recruitment D. Starters and leavers profile E. WDES statistics F. WRES statistics Very Senior Manager (VSM) profile by ethnicity and WRES 1 G. Disciplinaries H. Training and development Page number Staff group 34 Age 34 Disability 35 Ethnicity 35 Gender 36 Religion/belief 36 Sexual orientation 37 Profile by band 37 Age profile by band 38 Ethnicity profile by band 38 Gender profile by band 39 Religion/Belief by band 42 By age 40 By disability 40 By ethnicity 41 By Religion or belief 42 Starters/leavers by age 43 Starters/leavers by ethnicity 43 Starters/leavers by gender 44 Workforce Disability Equality statistics Trust level Very Senior Manager (VSM) information by site WRES 1 statistics by band and by site 47 Total disciplinaries - By site - By category/type Number of staff accessing nonstatutory & mandatory traing - By disability - By ethnicity

33 - By sex/gender 50 33

34 A. Workforce profile Based on headcount as at 30 September 2017 Nursing continues to be the largest staff group, accounting for 33% of the workforce, followed by Administration and Clerical (A & C) which is 22% Figures indicate that all groups are represented within the workforce with 2% of the workforce aged over 65 years and the largest age group being workers aged 25 to 34 years. 34

35 Our figures indicate that a large number (2502) of staff have not declared their status while some are undefined (18). This however is an improvement on last year s figures where 2740 did not declare With a slight increase from last year s figures, 52% of the workforce are from a BAME background (this includes those categorised as 'Others' which accounts for 8%) 35

36 Male % % % Female % % % Since 2015, there has been a year on year 1% increase in male population compared to female even though female staff still account for approximately threequarters of the Trust s workforce. Figures indicate that the top three beliefs are Christianity (40%), Islam (12%) and Atheism (8%) where Atheism has shown a 1% increase from last year s figure. Percentage of staff not wishing to disclose has reduced from 33% in 2016 to 31% 36

37 Percentage staff choosing not to disclose (35%) has decreased from last year s 36%. Work done by re-established LGBTQ staff diversity network subgroup is expected to drive considerable improvements in this area. B. Workforce Diversity Profile by Band Profile by band Figures show that staff in Band 5 account for 20% of the workforce, followed closely by Band 6 (17%). The wide pool of Band 1 to 4 roles (total of 29%), also provides a pathway for apprenticeship roles which supports our Community Works Programme (pages 10 and 11) that is aimed at providing access to the local community to lower banded roles through pre-employment training, apprenticeship and internship opportunities in the Trust. 37

38 Age profile by band It is worth noting that the largest number of those in age group 65 and over are in band 2 roles. Without knowing length of service, it may be difficult to determine whether this is reflective of lack of career progression. Ethnicity profile by band The ethnicity profile by band shows an above Trust baseline average of BME staff on bands 5 and 6 and a lower than Trust baseline average on bands 7 upwards, with numbers decreasing the higher you go up the bands. This is made clearer in the following table: 38

39 Gender profile by band The gender profile by band shows an above Trust baseline average of female staff on bands 5 and 6. This is most likely due to the higher numbers of Nurses and Midwives in the workforce, and they are mostly female Religion/Belief by band Although percentage number not disclosed has dropped from 33% in 2016 to 31% in 2017, its worthy to note that over 56% of our consultants do not wish to disclose religion or belief. 39

40 C. Recruitment (Based on information from July 2017 to December 2017) The information on recruitment is information based only on candidates recruited through Trac. Trac is a new system introduced at Barts Health in July 2017 and both medical as well as international recruitment is not fully reflected here. i. By Age Not stated Under 20 0 All applications (%) Shortlisting:All (%) Interview:All (%) Outcome:Recruited (%) The highest proportion of applicants appointed by age group are those aged between 25 to 39 ii. By Disability All applications (%) Shortlisting:All (%) Interview:All (%) Outcome:Recruited (%) Not stated Yes No I do not wish to disclose whether or not I have a disability Percentage of candidates stating they have a disability continues to remain low however numbers stating they do not wish to disclose is decreasing which is a positive sign. A further breakdown of type of disability is also shown in chart below: 40

41 All applications (%) Shortlisting:All (%) Interview:All (%) Outcome:Recruited (%) Physical impairment Sensory impairment Mental health condition Long-standing illness Other Learning disability/difficulty Not stated None / Not Applicable The Trust is committed to supporting staff Mental Health wellbeing and has had over 50 staff undergo Mental Health First Aider training. iii. By Ethnicity All applications (%) Shortlisting:All (%) Interview:All (%) Outcome:Recruited (%) I do not wish to disclose my ethnic origin MIXED - White & Asian OTHER ETHNIC GROUP - Chinese WHITE - Irish MIXED - White & Black African MIXED - White & Black Caribbean MIXED - any other mixed background BLACK or BLACK BRITISH - Any other black background OTHER ETHNIC GROUP - Any other ethnic group Not stated As part of efforts to improve our performance against WRES metric 2 i.e. Relative likelihood of BME staff being recruited from shortlisting compared to that of white staff being recruited from shortlisting across all posts, plans for improving the fairness and equality of recruitment procedures and processes, acknowledging and putting strategies in place to address unconscious bias, are underway. 41

42 iv. By Religion or Belief All applications (%) Shortlisting:All (%) Interview:All (%) Outcome:Recruited (%) Jainism Judaism Sikhism Buddhism Not stated Other Atheism Hinduism I do not wish to disclose my religion/belief Islam Christianity The information shows that the likelihood of being appointed is a recognisably higher for candidates with religion or belief not stated when compared to information for others with a religion or belief 42

43 D. Starters and leavers profile The number of leavers exceeds the number of starters for the 55 to 64 and 65 and over age groups. Excluding Other, the average starter: leaver ratio for BAME staff is 100:68 which is close to the ration for White staff which is 100:67 - i.e. for every hundred that start with the Trust, 68 or 67 leave the Trust respectively. 43

44 The starter: leaver ratio for female and male staff is similar i.e. (100:62) and (100:60) respectively. 44

45 E. Workforce Disability Equality statistics by group of bands Information based on data from 1 st April 2016 to 31 March Band Yes - Disability No - Disability Unknown /Not Declared Bands % 23.77% 5.82% Bands % 39.31% 7.07% Bands 8, 9 & VSM 0.11% 4.67% 1.55% Other 0.16% 13.64% 2.40% TOTAL 1.76% 81.39% 16.84% 45

46 F. Workforce Race Equality statistics of Very Senior Manager by ethnicity VSM Diversity Information by Site Source: ESR Staff in post as at 30th September 2017, based on substantive staff, band 8-9, Trust paid staff and Consultants. Site Clinical Support Services Newham University Hospital St Bartholome w's Hospital Royal London Hospital Whipps Cross University Hospital Corporate and Others Non- Medic al White BME Other Medic al Non- Medic al Medic al Non- Medic al Medic al Not Stated/Undefin ed Non- Medic al Medic al 72.2% 27.8% 65.2% 34.8% 40.0% 60.0% 36.7% 63.3% 43.4% 56.6% 28.2% 71.8% 40.0% 60.0% 60.0% 40.0% 40.0% 60.0% 30.0% 70.0% 50.0% 50.0% 6.7% 93.3% 41.8% 58.2% 24.0% 76.0% 15.4% 84.6% 22.0% 78.0% 44.9% 55.1% 24.4% 75.6% 33.3% 66.7% 14.3% 85.7% 97.1% 2.9% 96.4% 3.6% Non- Medic al % White BME Other Medic al Non- Medic al Medic al Non- Medic al 0.0% 96.6% 3.4% Medic al Not Stated/Undefin ed Non- Medic al Medic al Trust Level- VSM 57.2% 42.8% 43.1% 56.9% 40.0% 60.0% 36.9% 63.1% 46

47 Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a & above 120.0% Ethnicity by Band and by Hospital Site BME White 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Clinical Support Services Corporate and Others Newham University Hospital Royal London Hospital St Bartholomew's Hospital Whipps Cross Hospital 47

48 G. Disciplinaries 2016/2017 Ethnicity Entered Disciplinary Headcount % Enter disciplinary White % BME % Not Stated % TOTAL % Relative Likelihood of White employee entering disciplinary process 0.52 Relative Likelihood of BME employee entering disciplinary process /2016 Ethnicity Entered Disciplinary Headcount % Enter disciplinary White % BME % Not Stated % TOTAL % Relative Likelihood of White employee entering disciplinary process 0.47 Relative Likelihood of BME employee entering disciplinary process

49 H. Training and Development i. Attendance of Core NHS Leadership Academy Programmes by Gender and Ethnicity 2017 Programme Barts Health Total Female Male BME Ethnicity White Do not wish to disclose Edward Jenner Mary Seacole (Leading Care I) Elizabeth Garrett Anderson (Leading Care II) Ready Now Stepping Up TOTAL

50 Barts Health Leadership Programme Second Cohort Programme Total Female Male Leadership Transitions programme 2 nd Cohort 2016 Leadership Transitions programme 3 rd Cohort 2017 BME Ethnicity White

51 ii. Equality, Diversity and Inclusion Training Programmes The following list below provides an outline summary of stand-alone and bespoke equality and diversity training sessions provided with representation from across each of the hospital sites. i. Equality, Diversity, Human Rights and Inclusion ii. iii. iv. Unconscious Bias Disability Awareness Preventing Bullying and Harassment v. Diversity Awareness session Meeting Health needs of the LBG community Name of workshop Numbers attended Prevention and Awareness of Bullying & Harassment Unconscious Bias - Awareness of 60 Disability Equality Awareness 19 Equality, Diversity, Human Rights & Inclusion 112 Pilot Diversity Awareness session Meeting Health needs of the LBG community

52 Appendix two summary community engagement activity Outlined below is a summary of key community engagement activity that took place during the reporting period Date 4 April July 2016 Name of organisation Woolf Institute (WI) & Compassion in Dying Org. Roma Refugee & Migrant Forum Purpose Attended Information gathering and also participated in focus group to share intelligence. Outcome of focus group will be a public document that will influence services around End of Life Care. Roma migration forum (an east London Organisation) arranged a meeting to discuss concerns following BREXIT outcome of referendum; members concerns regarding immigration and the use of public services including NHS. Key message WI seek to involve with local Muslim community to promote Compassion in Dying services. Through focus groups they are trying to gather information about the community and their current practice and opportunities. Provided assurance to the Forum and members that Barts Health NHS Trust is committed to equity, values diversity and inclusion; and that as a healthcare provider and a major local employer in the area, recognises it s role to the wider community in reducing health inequality and is committed to ensuring that our services and employment practices are a true reflection of our values. 2 Dec 2016 APASEN and Tower Hamlets Council International Day of the Disabled Person Partnership Working with local council and voluntary sector organisation Showcasing Barts Health initiatives in improve the experience of patient and staff with a disability, e.g. BartsAbility. Staff recognition Award ceremony 52

53 20 Sept 2017 Sept 2017 Sept 2017 Oct 2017 Organisations across Barts Health catchment area Kidney Research UK CVS TH Council for voluntary Services in Tower Hamlets Asian Parents Association of Special Educational Needs Apasen 11 Oct 2017 Tower Hamlets together Seeking feedback from local community about services provided with a focus on Equity of Patient Access and Patient Experience Supporting this project to encourage more donors from the Bengali / Muslim community. Building partnership with the voluntary sector. Observe international day of Person with a disability over the year through 3 major programmes. Building partnership and gathering feedback on services Recent CQC reports; Key developments of Whipps Cross services, e.g. Children services; sharing Patient experience feedback; overall performance of Trust General advice on how to engage with the local community, connecting with events to promote this issue and encourage organ donation from this community. Promoting Trust vision and values and using voluntary sector platform to promote Barts Health activities. Awareness of Barts Health BartsAbility campaign; Corporate recognition; and improving Barts Health s image as a disability confident organisation. Awareness of Barts Health activities and community engagement 16 Oct 2017 London Muslim Centre Refreshing and rebuilding Barts Health partnership work with the local Mosque Opportunities in involving LMC to improve Royal London Hospital maternity services; opportunities for apprenticeship, volunteering and Health sessions 53

54 DNA % Appointmetns DNA's Appendix three - patient data Out Patients DNA Rate (December 2016 November 2017) Asian Bangladeshi Indian Pakistani Black African Caribbean Mixed White British Irish Chinese Other Not Stated Unknown Royal London 2,335 13,961 2,273 2,594 2,035 5,065 2,462 1,914 5,833 17, ,819 2, Whipps Cross 2,396 1,394 2,120 5,074 1,000 2,857 2,997 1,339 5,326 13, ,505 2, Newham 1,996 4,116 2,715 2,978 1,103 3,705 1, ,773 5, ,827 2,800 2,515 St barts 616 1, , ,846 8, , Others 673 1, , , ,983 2, , Mile End , Grand Total 8,157 23,641 8,759 12,428 5,012 14,012 8,153 4,708 20,034 49,624 1,627 1,085 40,894 9,651 3,494 Asian Bangladeshi Indian Pakistani Black African Caribbean Mixed White British Irish Chinese Other Not Stated Unknown Royal London 19, ,310 22,110 19,778 13,057 31,749 16,806 11,706 46, ,118 4,727 4,917 95,232 19,782 1,026 Whipps Cross 18,669 10,181 19,589 36,875 6,316 17,623 21,571 9,117 39, ,507 4,380 2,049 73,300 18, Newham 14,241 29,239 20,881 19,267 6,046 21,675 7,256 3,304 32,051 37,554 1,086 1,807 55,809 17,474 9,645 St barts 5,983 14,398 7,356 5,394 3,430 7,764 9,068 3,073 17,004 94,352 3,161 1,521 46,458 9, Others 6,867 18,524 9,911 9,983 2,454 8,858 3,854 2,564 20,148 28, ,453 30,422 7,974 4,396 Mile End 1,085 5,748 1, ,502 1, ,933 7, , Grand Total 66, ,400 81,373 92,294 31,823 89,171 59,566 30, , ,816 14,390 11, ,316 73,935 15,814 Asian Bangladeshi Indian Pakistani Black African Caribbean Mixed White British Irish Chinese Other Not Stated Unknown Royal London 11.7% 11.9% 10.3% 13.1% 15.6% 16.0% 14.6% 16.4% 12.5% 11.7% 12.8% 8.7% 14.5% 13.6% 44.8% Whipps Cross 12.8% 13.7% 10.8% 13.8% 15.8% 16.2% 13.9% 14.7% 13.4% 9.9% 10.0% 8.1% 13.0% 12.2% 47.5% Newham 14.0% 14.1% 13.0% 15.5% 18.2% 17.1% 16.0% 17.6% 14.9% 14.7% 12.7% 13.7% 15.8% 16.0% 26.1% St barts 10.3% 12.2% 8.5% 10.3% 14.0% 13.2% 10.1% 14.2% 10.9% 9.4% 10.7% 7.5% 10.6% 10.2% 22.0% Others 9.8% 8.4% 8.4% 10.8% 13.2% 12.2% 12.3% 13.9% 9.8% 9.8% 9.2% 7.8% 10.8% 10.1% 5.5% Mile End 13.0% 14.8% 12.8% 14.5% 13.5% 18.6% 13.8% 18.6% 14.1% 14.1% 15.6% 7.6% 16.7% 19.7% 35.1% Grand Total 12.2% 12.1% 10.8% 13.5% 15.7% 15.7% 13.7% 15.6% 12.7% 10.8% 11.3% 9.1% 13.4% 13.1% 22.1% 54

55 Out Patients DNA Rate by Age Group DNA Volume DNA % Mile End Newham Others Royal London St barts Whipps CrossGrand Total Mile End Newham Others Royal London St barts Whipps CrossGrand Total ,222 2,467 7, ,311 16, % 17.9% 16.8% 13.2% 20.0% 15.6% 14.9% , , ,214 17, % 19.5% 16.5% 13.1% 18.2% 16.0% 14.7% ,312 3,717 12,934 2,680 7,777 36, % 14.8% 9.2% 15.5% 17.3% 16.3% 14.7% ,382 3,579 13,781 3,741 9,076 41, % 14.0% 7.9% 13.2% 14.2% 12.9% 12.7% ,174 1,590 9,406 3,842 6,751 27, % 16.3% 13.2% 13.0% 12.0% 13.4% 13.5% ,266 1,333 8,443 4,131 6,635 25, % 15.7% 11.9% 12.0% 9.2% 11.6% 11.8% , ,796 3,593 4,742 18, % 13.4% 8.1% 10.4% 7.4% 8.9% 9.4% , ,881 2,968 4,319 14, % 14.0% 7.5% 10.4% 7.6% 8.5% 9.3% , ,270 1,651 3,335 9, % 15.8% 8.7% 12.6% 9.8% 9.7% 11.0% , % 22.3% 12.7% 14.9% 15.0% 12.1% 14.3% % 18.2% 25.0% 31.0% 57.1% 14.1% 21.2% % 9.4% 25.0% 16.0% unk 2 2, , % 26.0% 5.0% 14.6% 11.8% 12.2% 19.4% 55

56 Maternity 56

57 Deliveries at Barts Health by Ethnic Origin 57

58 Patient engagement in Renal Department by Ethnicity Overall Asian Black Mixed Race/Other White I feel like taking part in a clinical trial should be offered as part of routine clinical care 0 Overall Asian Black Mixed Race/Other White I worry about the risks of taking part in clinical trials Overall Asian Black Mixed Race/Other White I think taking part in a clinical trial will improve my health 0 Overall Asian Black Mixed Race/Other White I feel there should be more clinical trials for people with kidney disease 58

59 Find out more: