Scottish Ambulance Service Equality Impact Assessment for the Proposed Budget 2016/17 March 2016 Version 0.1 Note: This version supersedes all previous versions
Equality Impact Assessment Draft Budget 2016/2017 Equality Impact Assessment is concerned with anticipating and identifying the equality consequences of particular policy / service initiative and ensuring that as far as possible any negative consequences for a particular group or sector of the community are eliminated, minimised or counterbalanced by other measures. This document constitutes the Equality Impact Assessment for The proposed Budget 2016/17. 1. Introduction The Scottish Ambulance Service annual budget is designed in line with the resourcing limits defined by Scottish Government Health Directorate with a small amount of additional income from external sources. The budget must align with the Strategic Direction Towards 2020: Taking Care to the Patient, Corporate Plan, Local Delivery Plan and Workforce plan. It seeks to best use the resources at its disposal and in doing so does not seek to adversely impact protected groups. Its primary aim is to ensure there is clarity on how the financial resources of the organisation are deployed across the organisation. In terms of governance the budget is presented to the SAS Board in draft in January 2016 and the final version in March 2016. The EQIA process commenced in October 2015. 2. Progress SAS will continue to engage with stakeholders, both internally and externally and encouraged the ongoing identification and assessment of possible positive or negative impacts on protected groups. This will be through a series of divisional meetings involving Managers / Staff / The Strategy and Quality directorate / Workforce planning / Finance staff. Discussions were also held with Scottish Government Health Directorate around the Local Delivery Plan. Engagement is routinely sought from our Health Board partners at all levels. A series of meetings have taken place between November 2015 and March 2016 with budget holders. The Equality Impact Assessment Team included; Gerry O Brien, Director of Finance and Logistics Lead Maria McFeat, Head of Financial Planning and Reporting Ann Tobin, Equalities Manager
The completed Equality Impact Assessment Report can be seen at Annex 1 of this summary report. 3. Key Findings Pay Budget The budget for 2016/17 allows for the impact of the Scottish Living Wage increase to 8.25, increasing pay for those on pay point 2 should be moved to pay point 3 resulting in an increase of 418 per person. This discontinues Band 1on the pay scale. From 1 April 2016, national salary scales will increase in line with Scotland s Public Sector Pay Policy. This will mean that all pay points currently over 22,000 will receive a 1% uplift, and all pay points currently below 22,000 will receive a flat rate increase of 400, except those staff covered by the provisions of the Scottish Living Wage already noted. 2016/17 Projection for Start of Year Prior to 2016/17 the award was 300 per person for low paid staff below 21,000. 2015/16 Information There is also provision in the budget for additional investment up to the value of 0.6m set aside for to allow employees who have nominated caring responsibility for a child under age 14 (18 in the case of adopted or disabled children) to take up to 4 weeks paid leave whilst caring for their offspring.
Strategy Investment Continued investment from 2015/16: Low Acuity The Service has introduced a model for safely managing patients who have been assessed by other health care professionals (e.g. GPs, District Nurses etc) as being of low clinical acuity but who require an unscheduled attendance or admission to an acute facility. This should:- 1. Improve experience for patients. 2. Improve response from the SAS for patients who present to the NHS via 999. 3. Improve patient safety. 4. Improve inter professional working between SAS, GPs and other community based health care professional. National Ambulance Control Centre Investment in Clinicians within the control room environments is required in order to achieve the 30% Hear & Treat, assist with deployment of appropriate resources to increase See & Treat potential and reduced hospital admissions as well as deliver the quality ambitions of the service. Investment in the call handling function within control is key to improving how quickly patients can access care and to allow sufficient time for staff audit, training and development, ensuring that they are appropriately trained to deliver effective patient centred care through the initial triage process, resulting in an alternative care pathway or ambulance response that meets their needs. New Investment 2016/17: Peterhead, Northern & Western Isles Additional investment in ambulance staff will allow the Scottish Ambulance Service to provide a 24/7 integrated service delivery model across a range of localities which takes care to the patient by: Improving access to healthcare. This is achieved by ensuring patients are treated in the right place first time and in doing so reduce the number of patients conveyed to hospital. By increasing the level of see, treat and refer following face to face assessment by an appropriately trained paramedic with access to enhanced decision support and alternative referral pathways. Peterhead has been identified through the OPTIMA model as the highest priority in Scotland for investment in an additional 24/7 accident and emergency ambulance resource given the demand profile and exciting
resource levels. Additional investment in Peterhead will allow the Scottish Ambulance Service in the Buchan Corridor to develop an integrated service delivery model which takes care to the patient by: Improving access to healthcare. This is achieved by ensuring patients are treated in the right place first time and in doing so reduce the number of patients conveyed to hospital. This links into Decision Support, alternative pathways of care, Health and Care Teams and the Community Hospital Network in Grampian. By increasing the level of see, treat and refer following face to face assessment by an appropriately trained paramedic with access to enhanced decision support and alternative referral pathways. This would include developing Paramedic Practitioner skills in addition to a double crew ambulance resource. Whilst: Delivering care that ensures quality outcomes for patients. Develops a workforce that is trained and enabled to deliver the service model evidences a shift in the balance of care by taking more care to the patient improves outcomes for patients through the development of clinical skills builds and strengthens community resilience working in partnership to achieve a service model that is integrated with communities and with the wider health and care service. enhances our clinical skills as a key and integral partner working with primary and secondary care National Ambulance Control Centre Investment for National Ambulance Control Centre Staff, improving care for our patients, increasing business continuity and providing career and development opportunities for staff. Investment in the dispatch function is required in order to bring Scottish Ambulance Service in line with the average incidents by dispatcher in the UK, ensuring that there is enough shrinkage in the system to appropriately train and develop staff which would improve decision making and patient outcome. Out of Hospital Cardiac Arrest Scotland s Strategy for Out of Hospital Cardiac Arrest highlighted the inequalities in survival from OHCA. People in deprived communities are more likely to suffer from OHCA and less likely to survive than those from more affluent areas. In addition to socio-economic inequalities, significant numbers of the Scottish population live in areas where geography presents a significant
challenge in terms of ambulance response times therefore requiring the development and delivery of rural and remote pathways. There is scope for all supporting partners of the strategy to explore opportunities to engage with disadvantaged communities to strengthen their awareness of and response to cardiac arrest and its causes. A survey of public attitudes to Cardiopulmonary Resuscitation (CPR) published in January 2016 showed that most affluent groups were more likely to be CPR trained and more confident to administer CPR than more disadvantaged groups and suggested social marketing activity needs to be targeted on the elderly, the unemployed and the working class (social class C2DE). The key objectives of the Services s Out of Hospital Cardiac Arrest Strategy is to oversee the delivery of the Scottish Ambulance Service s agreements laid out in the OHCA Strategy for Scotland. We aim to increase survival rates after OHCA by 10% across the country within five years. Reaching this level of performance would mean around 300 more lives being saved every year compared to recent years. Starting an improvement programme now could result in a total of 1,000 additional lives saved by 2020. Delivering Frontline Leaders and Managers Investment of for continued development of frontline staff and First line leaders and Managers, which will allow career enhancement for staff and also provide a more patient centred, higher clinically focused workforce for the public in Scotland as a whole, irrespective of background. This benefits all staff who have not previously had exposure to non clinical personal development. Training This investment is required to deliver the predicted workforce education needs for the next 5 years (2016-2021). It encompasses initial education leading to qualifications for Ambulance Care Assistant, Technician, Paramedic, Specialist and Advanced Paramedic staff. The workforce numbers not only incorporate the predicted change in workforce profile, but also vacancies created by staff leaving the service, and also advancing their career into higher grade positions e.g. technician to paramedic. A positive impact on protected groups who currently need to attend Glasgow Caledonian University for long periods of time as part of their training. They will be able to complete technician training more locally and without significant time away from family. This will be more flexible for those with family who have traditionally struggled with attendance in Glasgow for 13 weeks. This cuts across a number of protected characteristics including (but not exclusively) marriage/age/religion and advances the equality of opportunity. Disability support locally delivered programmes with smaller student numbers will allow there to be more focus on individual students and
supporting their learning needs. This includes the access to support for conditions such as dyslexia. Widening access the Vocational Qualification programme allows access to technician education that may not have been possible on the Cert HE which had different (and more academic) entry requirements. The Vocational Qualification programme allows a career pathway for entrants that traditionally would not have been able to access higher education. This will support groups such as those that left education to raise a family or those who struggled with traditional education due to disability or other protected characteristic. It should also be noted that this offers opportunities to staff in the service who wish to pursue and develop a career in Education but reside outside of the central belt to become involved in face to face delivery of clinical programmes without relocating to Glasgow. This means those with a protected characteristic that may limit their ability to relocate will be afforded opportunities that were not available before. Health and Care Professions Council (HCPC) approval that requires (through their Standards of Education and Training) for programmes to have equality and diversity policies and for there to be equitable access for students across protected groups. Vocational Qualification centre approval that requires equity of delivery of the programme over multiple sites and for there to be appropriate education and development and access processes in place. A full Equality Impact assessment will be completed in readiness for Health and Care Professions Council (HCPC) re-approval and commencement of delivery of programmes. This will also fully capture the positive impacts and allow the service to build upon these to further support protected groups. Ambulance Telehealth Programme The Ambulance Telehealth Programme aims to upgrade and improve the current emergency ambulance technology (hardware in Phase 1 and associated software in Phase 2) to provide a better user and patient experience and a faster, more reliable communications infrastructure. When this programme is completed patients will be treated in the most appropriate environment and where possible this will be at, or near, their home or in a homely setting. Efficiency and Productivity Savings Scheduled Care Service: Positive Impacts: Scheduled care service will continue to provide a more patient centred service delivering enhanced services to patients with clinical requirement for support en route to hospital.
Negative Impacts: The Scheduled care programme has Equality Impact Assess, its service provision and any possible negative impacts have been accounted for through their public consultation. This will require to be monitored through implementation of the programme. There has been the possibility to adversely impact on females in the workforce due to the reorganisation of the scheduled care service however this was taken into account by HR policy re management of change and all staff have been able to be accommodated successfully. The current unidentified savings ( 1.550m) due to their unknown nature could have an impact on specific groups. However as these savings are identified during financial year 2016/2017 consideration will be given on any impact. Conclusion The draft budget has been assessed generally for any impact it might have on the public from disadvantaged groups in line with the Equalities Act October 2010. Any potential negative impacts have been addressed by the Development Boards taking forward work streams (e.g. Scheduled Care)