Statutory Equality and Diversity Report: Service Equality Compliance Report January 2016

Statutory Equality and Diversity Report: Service Equality Compliance Report January 2016 Page 1 of 39

Contents Page 1. Introduction 3 1.1 Use of the Public Sector Equality Duty 3 1.2 About The Hillingdon Hospitals NHS Foundation Trust 4 1.3 Trust Membership 4 2. Understanding Hillingdon 5 2.1 Population Growth London Borough of Hillingdon population 6 2.2 Ethnic breakdown 7 2.3 Joint Strategic Needs Assessment (JSNA) 7 3. Patient Access to Services provided by the Trust 8 3.1 Patient Activity April 2013 to November 2016 8 4. Patient Feedback 10 4.1 National Patient Surveys 10 4.2 Friends and Family Test 11 4.3 4.4 4.5 Local Patient Surveys NHS Choices Complaints/Patient Advice and Liaison Service (PALS) 5. Interpreting and Translation Services 13 6. Engaging with patients, carers and service users 14 6.1 People with dementia 14 6.2 People with a learning disability 14 6.3 People with a sensory disability 15 6.4 Older People 15 6.5 Maternity Services 15 6.6 Children and People 16 6.7 Patients living with Cancer 16 6.8 Other Patient Groups 17 7. Pastoral and Spiritual Care 17 8. Equality Impact Analysis/Assessment 18 9. Examples of service provision/improvement 18 10. Policies and Programmes to address Equality 21 12 12 12 Appendix A Foundation Trust Membership Demographic information 22 Appendix B Patient Population Demographic information 25 Appendix C National Patient Surveys 2013/2014 Demographic information 31 Appendix D Family and Friends Test Demographic information 26 Page 2 of 39

1. INTRODUCTION Service Equality Compliance Report January 2016 This annual compliance reports seeks to demonstrate compliance with the Public Sector Equality Duty (PSED) as required by the Equality Act 2010 (Specific Duties) Regulations 2011. NHS organisations have a statutory requirement to publish information to demonstrate compliance with the general and specific duties of the PSED. 1.1 Use of the Public Sector Equality Duty The Public Sector Equality Duty (PSED) was created under the Equality Act 2010 and came into force on 5 th April 2011. The Public Sector Equality Duty (PSED) was created under the Equality Act 2010 and came into force on 5 th April 2011. Eliminate unlawful discrimination, harassment and victimisation and any other conduct prohibited by the Act Advance equality of opportunity between people who share a protected characteristic and those that do not Foster good relations between people that have protected characteristics and those that do not share them There are nine protected characteristics and include Age - Refers to a person having a particular age (for example, 32 year olds) or being within an age group (for example, 18-30 year olds). This includes all ages, including children and your people. Disability - Includes significant and lengthy conditions that are physical as well as not seen, such as those relating to sight, hearing speech, learning and mental health. Also includes HIV and cancer and other types of diseases. Gender reassignment - This is the process of transitioning from one gender to another, whether proposing to undergo, undergoing or having already undergone a process (or part of a process) to reassign biological sex. Marriage and civil partnership - Marriage being a union between a man and a woman and civil partnership being legal recognition of a same-sex couple s relationship. Civil partners must be treated the same as married couples. Pregnancy and maternity - Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth. Race - Refers to a group of people defined by their colour, nationality (including citizenship), ethnic or national origins. Religion or belief - Religion means any religion, including a reference to a lack of religion. Belief includes religious and philosophical beliefs including lack of belief (for example Atheism). Sex - Someone being a male or a female. Assigned at birth. Page 3 of 39

Sexual orientation - This is whether a person s sexual attraction is towards their own or opposite sex or to both. Includes people that are gay (men who are attracted to men), lesbian (women who are attracted to women) and bisexual (people attracted to both sexes. To make sure the Trust meets the Duty, the following specific duties regulations are required to be met: Sharing information on how everyone is being treated fairly by 31 January each year. Setting and publishing equality objectives that address the most pressing issues facing protected groups by the 6 th April 2012 and reviewing each one set every four years. This information aligns to the specific duty to share information on how everyone is being treated fairly. 1.2 About The Hillingdon Hospitals NHS Foundation Trust The Hillingdon Hospitals NHS Foundation Trust provides a wide range of specialist and acute services from both Hillingdon Hospital and Mount Vernon Hospital. In 2013/2014 the Trust had a turnover of 190 million and we employ over 2,500 staff. We deliver high quality healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving us a total catchment population of over 350,000 people. There have been some exciting developments to Hillingdon Hospital, details of which can be found on our public website: www.thh.nhs.uk. This include the redevelopment of Emergency Care services, the refurbishment of Beaconsfield East ward to be a dementia friendly ward, the refurbishment of our labour ward, development of a new Endoscopy Unit. Our culture and values Our Trust Vision is to put compassionate care, safety and quality at the heart of everything we do. Both our staff and patients have been involved in developing our values. We believe that Putting People First is the right thing to do; we will achieve this through our CARES values which are: Communication Attitude Responsibility Equity Safety We recognise the importance of listening and communicating clearly We strive to understand others needs, responding with care, compassion and professionalism We take responsibility for consistently delivering excellence and being open in all that we do We recognise people are different and value everybody equally We view patient, staff and visitor safety as a priority 1.3 Trust Membership Foundation Trust (FT) public membership stands at 7000 members. Membership recruitment is on-going via a membership application form which is distributed at Trust public events both within the hospital and in the community. We have a dedicated FT section of the Trust s website, including an online application form. Page 4 of 39

The Trust s membership application form includes age, gender, ethnicity, religion, disability and sexual orientation with the option to opt out if required. Representation is monitored by our Council of Governors on a quarterly basis. We have email addresses for approximately 25% of our membership and this is used whenever appropriate and possible to communicate with our FT members in order to keep such costs to a minimum. Key Findings The current membership data suggests that the following have been achieved: A good even geographical distribution of membership across the North, Central and South Constituencies; There is an overrepresentation of members aged 49 plus; There is a need to recruit a greater number of younger members; There are more female members to male members; White British are over represented; There is an over-representation in social class AB, under representative in C1 and largely representative in C2, D and E; The Trust ensures that all of our membership activities are inclusive of all protected characteristics. All opportunities are taken to increase membership from all local ethnic communities. The current FT membership profile of the Trust is set out in Appendix A and shows representation broadly reflective of the local population. 2. UNDERSTANDING HILLINGDON Hillingdon has the second largest area (116 km2) of London s 32 boroughs + City of London with the 12 th largest population. The overall size of the population for the London Borough of Hillingdon is shown in the following table: Table 1: Hillingdon population 2015 National Statistics, 2012-based subnational population projections (SNPP) Greater London Authority (GLA) 2014 round short-term projection Hillingdon Clinical Commissioning Group (CCG) GP registered population Hillingdon CCG GP registered population that actually resides in Hillingdon 2016 300,000 2016 301,000 2015 301,000 2015 283,000 The population pyramid below (table 2) shows the population of Hillingdon by age band and gender and contrasts it with the population of London and the population of England as a whole. The populations for England and London are scaled so the proportion of the population in each age band can be compared with Hillingdon. The age structure in Hillingdon is intermediate between that for London and that for England, with, for the most part, a distribution that is slightly older than London as a whole but younger Page 5 of 39

than England. Among children and young adults however there is a larger proportion resident in Hillingdon than for both London and England. Table 2 Population for Hillingdon compared to London and England 2.1 Population Growth London Borough of Hillingdon Population The population increase in Hillingdon over the next 5 years is expected to be 7.1% (around 1.4% year on year). The main driving force behind the increase in the population between 2016 and 2021 is natural change i.e. 14,800 more births than deaths. The figure below shows the trend in the population size of each age-band. Table 3: Hillingdon Population Growth 2012 2022 by age Page 6 of 39

The population size of all broad age-bands either remains the same or increases; none of the age-bands decrease in size. Age bands that are expected to increase by more than 100 per year on average are: 85-89 by an extra 110 per year 75-84 by an extra 220 per year 0-4 by an extra 280 per year 65-74 by an extra 360 per year 25-39 by an extra 890 per year 40-64 by an extra 1,380 per year 2.2 Ethnic Breakdown The ethnic population projections for 2016 and 2022 are shown in the pie charts below. The Black, Asian and Minority Ethnic groups (BAME) are all projected to rise in number and proportion between 2016 and 2022. Given that prevalence of long terms conditions like diabetes, cardiovascular disease, dementia and cancers varies across different ethnicities, this may have implications for future demands on health care. Table 4: Hillingdon Population Growth 2012 2022 by ethnicity Hillingdon 2015 White Black Caribbean Black African Black Other Indian Pakistani Bangladeshi Chinese Other Asian Other 163,800 5,300 14,300 10,950 43,300 11,400 3,000 3,500 27,700 13,900 Hillingdon 2020 White Black Caribbean Black African Black Other Indian Pakistani Bangladeshi Chinese Other Asian Other 159,000 5,900 16,800 13,500 49,500 13,500 3,500 4,000 33,700 16,500 2.3 Joint Strategic Needs Assessment (JSNA) The Joint Strategic Needs Assessment (JSNA) analyses the health needs of the local population to inform and guide commissioners and providers to deliver health and well being within local authority areas. The main goal of a JSNA is to bring partners together to jointly assess and Page 7 of 39

describe the health needs of a local population in order to inform improvements in the physical and mental well being of communities and reduce health inequalities. The above information has been made available by the Performance and Intelligence Team at the London Borough of Hillingdon. For further information please refer to the Joint Strategic Needs Assessment (JSNA) http://www.hillingdon.gov.uk/article/29581/population-statistics 3. PATIENT ACCESS TO SERVICES PROVIDED BY THE TRUST 3.1 Patient Activity April 2013 to November 2016 The Hillingdon Hospitals NHS Foundation Trust collects and analyses a variety of quantitative, numerical data on patients by protected characteristic as a way of making sure any trends that potentially indicate lack of access or the receiving of a lesser service due to belonging to a particular group are identified for further investigation and if necessary rectification. The Trust uses the following measures to identify the extent at which the Trust is performing, which are local and national indicators: Referral to Treatment Patients treated within 18 weeks of being referred Accident and Emergency Breaches Patients not treated within a 4 hour target Outpatient DNAs (Do Not Attends) Outpatients who do not attend hospital appointments Readmissions Patient that have been admitted as an inpatient within a specified time period following discharge from a continuous inpatient stay The performance measures above are set against patient activity to provide further context, including first outpatient attendance, elective (non-emergency hospital appointment arranged in advance) and non-elective admissions and accident and emergency attendance. As a result, the information is presented under the following headings: Outpatient Inpatient Accident and Emergency Maternity In respect of the protected characteristics referred to, they include the following based on the information available through the Patient Administration System (PAS): Age Race Religion and belief Sex Disability has not been routinely collected but is added to a patient s PAS record as and when known. If a patient with a learning disability is admitted and is clinically coded with a learning disability this will be added the patient s registration details. Page 8 of 39

The Trust s Patient Administration System does not currently allow for the following protected characteristics to be recorded: Sexual orientation Pregnancy Gender reassignment A full statistical and graphical breakdown of the population that have used our Accident and Emergency, Outpatient and Inpatient services by Age, Ethnicity and Gender from April 2013 to November 2016 can be found in Appendix 2. For the purposes of this report the services have been grouped as Outpatients, Inpatients (including day care), Accident & Emergency (excluding Urgent Care Centre) and Maternity. 3.1.1 OUTPATIENTS Protected Characteristic Key Findings 2015/16 Age Greater outpatient activity with age with potential issue of access for the 20-39 age bands regarding not attending outpatient appointments. Gender As seen in previous years, more females attended outpatient departments compared to males. More males fail to attend their appointments. Ethnicity Outpatient activity was also greater amongst the white British population followed by the Asian Indian reflecting the local population. 3.1.2 INPATIENTS (excluding Maternity) Protected Characteristic Key Findings 2015/16 Age As in previous years, the percentage of admission increases with age. Gender Similar to inpatients, more females attended outpatients compared to males. Ethnicity The percentage of inpatient admissions was higher for the White British population followed by the Asian Indian reflecting the local population. 3.1.3 ACCIDENT & EMERGENCY Protected Characteristic Key Findings 2015/16 Age Greater use of A&E services by those between 0-9 years and 20-29 years Gender Very little difference between male and female patients using A&E services Ethnicity Greater A&E activity by White British followed by Asian with Asian Indian reflecting the local population. Page 9 of 39

3.1.4 Maternity Protected Characteristic Key Findings 2015/16 Age A slight reduction in the 20-29 year age band and a slight increase in the 30-39 and 40-49 age groups. Ethnicity Reduction in the White British group and an increase in the BME population using maternity services. Largest BME groups are Asian Indian, Asian any other and other ethnic groups. 4. PATIENT FEEDBACK The Hillingdon Hospitals NHS Foundation Trust collects and analyses a range of qualitative data to compliment and provide further depth to the quantitative data it also captures and analyses outlined in 3.1. The Trust achieves this through completing a number of national survey programmes on a rolling basis through commissioning the assistance of various organisations. 4.1 National Patient Surveys The Trust participated in the following national patient surveys 2015: Inpatient 2014 Maternity 2015 Children and Young People 2014 For each of the above The Picker Institute sent a survey to patients who had used our services at a specific time. An attached letter from the Trust s Chief Executive was included which offered patients the opportunity to access interpreting services to enable completion of the survey. Appendix C provides a breakdown of response rates by demography for the above surveys. The data in each report shows how a trust scored for each question in the survey however due to the small sample size it is not possible to draw any conclusions about how patients with different protected characteristics feel about their care and treatment. There are also issues about using written surveys and the difficulty in getting broad high quality feedback due to communication difficulties (with those with some disabilities) and those unable to read written English. The Trust also participated in the annual National Cancer Patient Experience Survey in 2015 using the services of Quality Health to distribute and report the findings. The following chart provides background demographic information about the respondents for each of the surveys. National Survey of Adult Inpatients 2014 850 patients who were admitted in July 2014 were invited to provide feedback on their experience. 313 patients completed a survey, giving a response rate of 38% which was lower than the national average. The largest ethnic group after White British was the Asian Indian group (9%) which reflects the local population. With regard to religion, there was a higher response from Hindu, Muslim and Sikh patients compared to other Trusts. The percentage of patients living with a long term condition was similar to those of other Trusts. Page 10 of 39

A survey of Women s Experiences of Maternity 2015 305 mothers who delivered in February 2015 at Hillingdon Hospital were sent a questionnaire. 113 surveys were returned, giving a response rate of (39%) compared to 41% nationally. 40.2% were aged 20-29 years, 54.5 were aged 30-39 years. The response rate from Asian Indian women was higher than the national average while the response rate from White women was worse than the national average. In terms of religion there was a higher than average response rate from Hindu, Muslim and Sikh women. National Children s Inpatient and Day Case Survey 2014 300 young inpatients and day case patients were sent a questionnaire; 87 surveys were returned giving a response rate of 28% which is 1% higher than the national average. 42.9 of responses were from parents of children aged 0-2 years which is higher than other Trusts. The response rate for all other ages was similar to those of other Trusts. The largest ethnic group after White British (42.6%) was Asian Indian (16.2) followed by 11.8% who were Other White background and 13.2% African. 34.7% of children had a disability / long standing condition which is slightly higher than that of other Trusts. Religion was not included in this survey. National Cancer Patient Experience Survey 2014 There was one other major survey conducted during 2014, this being the National Cancer Patient Experience Survey, undertaken by Quality Health on behalf of NHS England. This survey reported on gender, age, ethnicity, disability and sexual orientation of respondents however it is not possible to link the results of each question to a specific protected characteristic. 4.2 Friends and Family Test The NHS Friends and Family Test (FFT) implemented across The Hillingdon Hospitals NHS Foundation Trust is an important opportunity for patients to provide feedback on the care and treatment they receive and to improve services. Since April 2013, patients have been asked whether they would recommend hospital wards and Accident and Emergency departments to their friends and family if they needed similar care or treatment. This means every patient in these wards and departments is able to give feedback on the quality of the care they receive, giving hospitals a better understanding of the needs of their patients and enabling improvements. Data is currently available on: Accident and Emergency Inpatients Women s Services Outpatients In respect of the protected characteristics referred to, they include the following: Age Race Sex Disability data is collected but not reported. The disability section as it currently stands is broken down into a number of different impairments permitting patients to declare more than one and therefore it is not possible to analyse feedback by individual disability. The Trust is currently procuring a new system for reporting FFT and other patient feedback which will address this issue going forward. Page 11 of 39

The Trust received feedback from 13094 patients who had either attended the Accident and Emergency Department or had been an inpatient or maternity patient during 2015. Appendix D provides a graphical presentation of patient demographics by Age, Gender, Ethnicity and Disability for the FFT. In respect of the actual experiences reported in the A&E and Inpatient by protected group between April and December 2015 Age - 25-34 year olds report a less positive experience and are less likely to recommend the ward or A&E department to friends and family (91.14% would recommend). Patients aged 55-64 are the most likely to recommend (97.12%). Ethnicity - all BME groups, with the exception of the Asian group, report a slightly less positive experience than the White group. The Other group scored 2.44% lower than the average of 95.10%. The Asian group were the most likely to report a positive experience with 95.29% stating they would recommend the Ward or A&E department. Gender - Males were more likely to score Extremely Likely (74.36%) compared with Females (68.63%). However when looking at the overall recommend score there is just over 1% difference between the two groups (95.88% of males and 94.55% of females would recommend the Trust) Gender reassignment - No data captured at present Religion or belief - No data captured at present Sexual orientation No data captured at present With regard to the percentage of patients recommending The Hillingdon Hospitals NHS Foundation Trust to Friends and Family between April and December 2015 95.5% of patients would recommend the ward 91.8% of patients would recommend the Accident and Emergency Department 90.6% of patients would recommend the Maternity Department. 4.3 Local Patient Surveys Quarterly surveys were conducted for inpatients, outpatients, maternity and children during 2015. All surveys can be analysed by some protected characteristics; for example a breakdown of the respondent s ethnicity, disability, age, gender and religion is provided. However, as this information does not provide the protected characteristic breakdown per survey question, it is not possible to provide more detailed analysis on the patient experience by a protected characteristic. 4.4 NHS Choices / Patient Opinion Websites Data is provided from NHS Choices and Patient Opinion websites (this does not collect any demographic information when an entry is added). The majority of comments are anonymised. All comments, both positive and negative are reported to the respective division and a response posted on the website. 4.5 Complaints / Patient Advice and Liaison Service (PALS) The Trust revised and updated its policy for the management of Complaints in March 2014. A patient or their representative can make a complaint or raise a concern either verbally (in person or by telephone) by email or letter. Page 12 of 39

The Complaints Department deal with all formal complaints that come into the Trust and ensure that all matters raised are investigated thoroughly and responded to in a timely manner in line with the Trust procedure. The PALS team continues to offer an on the spot open door service for patients, relatives and carers. PALS is a first contact point for questions, concerns and suggestions about our services. PALS aim to be as accessible as possible to all users of the Trust s services and can be contacted by attending the office, making a phone call or by written communication, using fax, email or letter. If an inpatient is unable to visit the office in person PALS are more than happy to visit a ward. The service is available from 9am to 5pm, Monday to Friday with an answerphone facility when the office is closed. A member of the PALS team has the ability to speak Punjabi to a patient, relative or carer wishing to speak to PALS. For other languages, the PALS team will arrange for an interpreter. A PALS on line form is also easily accessible on the Hillingdon Hospital website inviting feedback from patients and relatives. PALS have become more proactive in visiting wards on a weekly basis, talking to carers of dementia patients to capture their feedback within the carers survey and ensuring that patients have had the opportunity to complete the inpatient survey during their stay and assisting those patients that have required help in doing so. Posters and leaflets are available around the whole of the Trust to promote the PALS and ensure that patients and relatives are aware of the support and advice that is available to them should they wish to discuss any worries or concerns. The PALS leaflet is available in other languages, large print or audio if required. Although PALS and the Complaints Management Unit are two separate departments, there is the opportunity for dialogue between the two areas to ensure easy flow of information between the two functions and we work closely to offer a seamless service. The Trust investigated 398 formal complaints and actioned 1052 PALS contacts during 2014/15. Currently equality monitoring information is not routinely collected and therefore it is not possible to analyse complaints and PALS activity by different protected characteristics. There were 2 complaints and 4 PALS concerns that related to issues associated with one or more of the protected characteristics between April 2014 and March 2015. This feedback provides the Trust with a vital source of insight about people s experiences of healthcare at The Hillingdon Hospitals NHS Foundation Trust and how our services can be improved. 5. INTERPRETING AND TRANSLATION SERVICES The Trust recognises and welcomes its legal duties under the Equality Act 2010 and as a Trust ensures its interpreting and translation services comply with any legislative requirements. The Trust s Interpreting Service, provided by One Stop Language Services continues to provide face-to-face and telephone interpretation and translation to include British Sign Language for patients and carers across all services in the Trust. The Trust s Interpretation and Translation Policy ensures that patients, relatives and carers have access to the communication tools required to allow complete understanding of their diagnosis and proposed treatment, and to ensure that each patient s communication needs are met. This may include people from minority ethnic communities, new migrants, refugees, asylum seekers, and those whose first language is not English or those who may have a sensory impairment, Page 13 of 39

mental health illness, learning disability or people who are non-verbal without a learning disability. During 2014/15, the Trust requested an interpreter on 2692 occasions supporting patients with 54 different languages. This is an increase of 331 requests from 2013/14. The following table provides a breakdown of the top five language requests. Table 5: Hillingdon Top Five Languages 2011/12 2012/13 2013/14 2014/15 1 Punjabi Punjabi Punjabi Punjabi 2 Somali Somali Tamil Somali 3 Polish Tamil Polish Polish 4 Arabic Polish Somali Arabic 5 Tamil Arabic Arabic Tamil Since 2011 the top 5 languages have remained the same reflecting the composition of our local population as outlined in section 2.2 of this report. 6. ENGAGEMENT WITH PATIENTS, CARERS AND SERVICE USERS The Trust prides itself in the fact that it does engage and will continue to engage with patients, carers and service users to deepen its understanding of the equality themes. Engaging with our local communities that we serve and providing opportunities for service users to feed back on their experience is an important feature of our work. The following is some of the involvement activity that has taken place during the last twelve months. 6.1 People with Dementia Improvements in dementia care have continued throughout 2014/15. Ensuring all relevant patients are screened for potential signs of dementia, and referred for follow up as indicated, has remained a priority, with over 1950 patients over 75 years admitted as an emergency having been assessed within 72 hours of admission. Staff education has similarly remained a priority, with all staff receiving dementia awareness training on joining the Trust. This is delivered by the Dementia Clinical Nurse Specialist and is presented from the eyes of a patient, using the critically acclaimed Barbara s Story DVD; this has now been seen by 3569 staff. Doctors, nurse and therapists receive more detailed bespoke clinical training and several go on to undertake the Alzheimers certificate or, for specific staff, a specialist module at university. As well as welcoming carers to support their loved ones outside of visiting hours, experience for inpatients with dementia has been improved by the provision of more activities such as reminiscence rummage boxes, fidget blankets, singing and music sessions and provision of books, puzzles and board games. We continue to advocate an inclusive approach for patients with dementia, and aim to incorporate dementia-friendly design and facilities across all the Trust. Future work is being driven by patient and carer feedback. All carers are offered the opportunity to complete a short survey about their experience while at the Trust. We will be participating in the National Dementia Audit early in 2016/17, the results of which will provide more guidance about which service developments we should prioritise. 6.2 People with a Learning Disability In order to provide assurance that the Trust is listening and responding to the needs of patients with a Learning Disability, staff from the Trust have attended a variety of forums where there are Page 14 of 39

carers and service users. This is an excellent opportunity to hear the views of people to respond to their questions, and improve outcomes. The Trust ensures staff awareness with regard to the need to listen and make reasonable adjustments for those with learning disability. Clinical and non-clinical staff receive awareness training as part of their mandatory safeguarding training making them more aware of the needs of learning disability patients and their carers. The Good Practice Guidelines for staff working with people with learning disabilities remain in place. There are also care pathways for patients with learning disabilities in A&E, outpatients and the radiology department which continue to be used for patients with learning disabilities. Patients with a learning disability can provide feedback to the Trust on their experience through completing an easy-read survey. 6.3 People with a Sensory Disability The Trust has engaged with service users with a sensory disability to capture their feedback on their experiences of accessing our services and receiving care. These included both positive and negative viewpoints. This has been invaluable in terms of ensuring our services are responsive to the needs of this group of service users. Some of these service users have expressed an interest to be involved in the design of new services. This will be taken forward by a task and finish group in 2016/17. In 2015/16 the Trust has installed additional hearing induction loops based on feedback from patients. The introduction of the hearing loop system not only improves communication for these patients but also ensures their privacy, dignity and well-being. Signage has been improved across both sites to ensure easier way-finding for patients and visitors. In addition the Trust has a contract with One Stop Language Services for the provision of BSL for patients using our services. 6.4 Older People Age UK Hillingdon meal time visits Since 2011, Age UK Hillingdon has conducted unannounced visits to ward areas to provide an informed view of the standards of care, specifically related to nutrition, dignity and compassion towards the elderly. The visits are currently planned quarterly and the outcomes are reported both to the Trust Board and to the area visited. 6.5 Maternity To improve the experience of the women and their families who choose to have their baby at The Hillingdon Hospitals NHS Foundation Trust our Maternity team have undertaken several projects over the last year. Engaging with BME As part of our commitment to engage with, and better understand the needs of our BME population, members of staff have identified communities that we would like to engage and meet with. These include the growing Polish community, as well as groups that we would like to strengthen our connections with, such as the local Afghan Women s group. Building ties with these communities and groups will enable us to discuss their experiences and expectations of our services. The aim would be to forge closer links with particular groups enabling mothers to share their recent experience of having a baby at Hillingdon hospital to: Page 15 of 39

Capture and understand their experiences Manage expectations Improve their experience for the future Measure improvements over time Midwifery Led Unit The new midwifery led unit (MLU) opened in July 2015, this consists of 4 en-suite rooms located on Katherine ward and is staffed by midwives keen to support and promote active birth. The purpose of this unit is to offer ladies the opportunity to give birth in an informal intimate space with the support of a midwife, using natural methods and minimal intervention. At present approximately 46 ladies each month are giving birth here, but we are hoping to increase the number of births to 70 each month. Maternity Volunteers Over the last year and following engagement with user representatives we have had an increase in volunteer applications from minority communities. This covers many roles including: Breastfeeding peer support workers Community administration Receptionists Maternity mates User representation on maternity forums This highlights our commitment to involve users which in turn adds value to our service and provides an opportunity for individuals to gain valuable work place skills prior to pursuing a career in health and social care. 6.6 Children and Young People A small group of patients (14-18 year olds), who had personal knowledge of the care provided at the hospital attended a focus group in October 2015. In some cases, the care was provided over a long period of time and involved several episodes through the Emergency Department, Outpatient Clinics and also time spent as in-patients in both emergency and elective settings. On the whole the feedback was positive particularly around the care provided in the elective ward setting; the young people however made a number of recommendations for improvement in relation to care and facilities in A&E and these findings are now informing the design of a new paediatric A&E service at Hillingdon Hospital. The Paediatric Diabetes Service at The Hillingdon Hospital strives to engage our patients and families for optimum health and well-being and therefore have introduced School Multidisciplineary team clinics and school therapy. The team take the hospital clinic into some schools which has reduced our Do Not Attend (DNA) rates, reduced time missed from school (and work time for parents). This has also reduced the stigma of having a chronic condition. Our psychologist has also run therapy groups providing emotional and peer support. 6.7 Patients living with Cancer People involved in Cancer Services (PICS) was launched in January 2006 and over the last nine years members have been committed to effecting practical changes in the way all aspects of cancer services are delivered. The group s membership is made up of a diverse group of patients, survivors, carers and health professionals. Cancer affects people representing all the protected characteristics and therefore it is important that the Trust continues to work with a variety of service users to bring about positive change. Page 16 of 39

A Cancer Information Centre is available on the first floor of the Outpatients Department at Hillingdon Hospital to provide advice and information to patients, carers and families. The Centre is managed by a specialist nurse with support from volunteers, many of whom have had cancer. Information is available on line and in different formats / languages for those who request it. 6.8 Other Patient Groups The Trust has a number of regular patient support groups providing information and improving awareness on: Age related macular degeneration Glaucoma Psoriasis Cardiac care The sessions are delivered by clinicians and are organised both in the hospital and in the community. In 2007, the Trust set up the Fighting Infection Together (FIT) group to provide an essential link between patients/public and staff. The members are all volunteers with a keen interest in the prevention and control of infection. Since coming together, the Fighting Infection Together group has proved invaluable in contributing to a number of initiatives: Supporting hand hygiene campaign and events Manning the infection control stand at the annual general meeting since 2008 Auditing hand hygiene practice Reading and approving patient information leaflets Examining our hospital laundry arrangements Producing a patient friendly infection control annual report Supporting food safety awareness events Auditing signage for hand washing Working with the Trust on the new cleaning and catering contract Supporting the upgrades of the Trust public toilets Producing infection control information for visitors 7. PASTORAL AND SPIRITUAL CARE The Hillingdon Hospitals NHS Foundation Trust is committed to providing a fair, equitable and professional Spiritual and Pastoral Care Service; a service which meets the individual spiritual, religious and pastoral care needs of all service users in innovative and creative ways. The Chaplaincy service consists of 1 full time and 1 part-time chaplain supported by a group of volunteers. There is a multi-faith chapel and an Islamic prayer room available for patients and staff at both Hillingdon and Mount Vernon Hospitals. Over the last 12 months, the Chaplaincy team has: Continued to recruit Chaplaincy volunteers of diverse religious and ethnic backgrounds to work with patients and the public of any / no faith background Contributed to the Trust s procedures for End of Life Care Engaged on an on-going basis with Multi-disciplinary Palliative Care Team Page 17 of 39

Been implementing a programme to make scriptures of 3 world religions available on wards for patients and staff Contributed to the Trust s End of Life Committee and Maternity Bereavement Committee. Provided religiously sensitive funeral care for families who have experienced loss of pregnancy (pre and post viable) Offered expertise on religion and faith issues as they arise in the organisation Conducted faith and religious services for patient, carer, staff and the public. 8. EQUALITY IMPACT ANALYSIS/ASSESSMENT To ensure the Trust adopts a positive, proactive and pragmatic approach to equality, making sure access and quality at all times for all people, an equality impact assessment toolkit has been developed and accessible on the Trust s intranet. Due to policies being instrumental in the running of the Trust, essentially being the basis from which decisions are made, the Trust requires all policies to have undergone an equality impact assessment which involves anticipating the consequences of the policy on different communities or groups staff, service users and carers making sure that any negative impact is eliminated or minimised. All Trust Board reports include an Equality Impact Assessment statement outlining whether there is any negative impact on equality. 9. EXAMPLES OF SERVICE PROVISION IMPROVEMENT The following are examples of Equality action undertaken showing due regard for the Equality Act 2010: Protected Characteristic Age this can be for older people or younger persons/children Disability Improvements made between 2012 and 2015 All patients to be asked how they would like to be addressed and this is written on a board behind the patient s bed head Use of the red tray system at meal times to ensure any patient who needs assistance with their meals are identified and assistance provided Nutritional assessments are completed on all patients over the age of 60 years. All patients are screened on admission Introduction of large clocks, showing date as well as time to support patients with dementia Dementia strategy and CQUIN agreed to improve care and experience for those with dementia and their carers. Paediatric menus are available for children who are admitted. BSL interpreting service available Picture cards for patients with brain injury, stroke, learning disabilities and for those who do not understand English The use of the hospital passport to ensure that individual information about a person with learning disabilities is shared with healthcare professional The use of This is me booklet within Future Plans New paediatric A&E department is being built ensuring that quality services and facilities are available to children and young people. Eye Clinic Liaison Officer will be provided by The Royal National Institute for Blind people to support people with sight disability Page 18 of 39

ward areas for carers or relatives of patients to share with healthcare professionals providing information about the patient and their life Best practice guidance, a dedicated internet and intranet pages with information on the Patient Passport and Easy Read information The Trust has signed up to the Getting it right charter for learning disability led by MENCAP Training provided to a range of staff regarding dementia care and safeguarding E-learning module for vulnerable adults training in in place to support staff conduct mandatory training Patient Administration System (PAS) disability and special needs fields used to identify a patient with a learning or sensory disability All refurbished areas are being made more suitable for people with disabilities Beaconsfield East has been designed as a dementia friendly ward Higher tables in the restaurant are provided to allow better access for wheelchair users Improved signage Hearing loops available in patient areas. Race Religion and Belief Culturally appropriate menus available on wards. Dual handsets available in Accident & Emergency and Outpatients Department (children and adult) to support telephone interpreting. Patient Administration System (PAS) field advising that an interpreter may be needed. The Chaplaincy team offers spiritual, religious or pastoral support to people of all faiths, beliefs, and no faith background Muslim and Sikh chaplains have joined the Chaplaincy team as volunteers. Community faith leaders representing the major world religions can be called to support a patient A religious guide was updated and is available on wards and via the intranet Islamic prayer room available for staff and patients to use Chaplaincy volunteer numbers have increased Chaplains and volunteers work with patients and the public of any/no faith Efforts continue to record inpatient and outpatient religious and belief data in order to be part of care Trust policies will be written with religion and belief as core requirements. Page 19 of 39

background Chaplain has contributed to the Trust s procedures for End of Life Care Chaplain engages on an on-going basis with MDT-Palliative Care Currently implementing programme to make scriptures of 3 world religions available on wards for patients and staff Chaplain contributes to Trust End of Life Committee and Maternity Bereavement Committee. Gender Gender reassignment Sexual Orientation Pregnancy and maternity Marriage and civil partnership All groups All wards have dedicated male and female bays with designated male and female facilities. Staff have attended Equality and Diversity training. Patients will be treated according to the gender they appear as. Staff have attended Equality and Diversity training. Breastfeeding rooms available for women attending the hospital. Improved maternity facilities for new mums and their babies. Labour rooms are being fully modernised to enhance the experience of mothers, their partners and their babies Improved bereavement care for families with improved information and closer working relation with the Spiritual and Pastoral Care team. Recording of status recognising marital and civil partnership. CARES logo appears on all trust literature (E = Equity) Equality and Diversity training is part of Trust induction and is available via e- learning Our website conforms to World Wide Web Consortium (W3C) accessibility guidelines. We strive to meet the Web Content Accessibility Guidelines 2.0 at AA level. Working towards implementing the NHS England Accessible Information Standard Page 20 of 39

10. POLICIES AND PROGRAMMES TO ADDRESS EQUALITY The following have been put into place over the last four years: Policy or Programme Date Religious Guide 2011 CARES Culture and Values 2013 Patient and Public Engagement toolkit 2012 Equality and Diversity toolkit 2014 Equality and Human Rights Policy 2014 Safeguarding Vulnerable Adults Policy 2014 Spiritual and Pastoral Care Policy 2015 Policy on the use of translators and interpreters 2015 Safeguarding children and young people Policy 2016 Page 21 of 39

Foundation Trust Membership Demographic Information Appendix A Page 22 of 39

White - English, Welsh, Scottish, Northern Irish, British White - Irish White - Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Mixed Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Asian or Asian British - Other Asian Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Black Other Ethnic Group - Arab Other Ethnic Group - Any Other Ethnic Group Not stated % of Members Foundation Trust Membership Ethnicity (as at 27.1.15) 60 50 40 30 20 10 0 % of Membership % of Area Ethnicities Source: 2011 Census, Office of National Statistics Page 23 of 39

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2013/2014 2014/2015 2015/2016 2013/2014 2014/2015 2015/2016 2013/2014 2014/2015 2015/2016 Patient Population Demographic Information Appendix B 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Hospital Activity by Gender Excludes Maternity F M A&E Inpatient Outpatient Page 25 of 39

Proportion of all Inpatient Activity 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Inpatient Activity by Age Band Excludes Maternity 2013/2014 2014/2015 2015/2016 Age Band - Years Page 26 of 39

Proportion of all Outpatient Activity 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Outpatient Activity by Age Band 2013/2014 2014/2015 2015/2016 Age Band - Years Page 27 of 39

Proportion of all Maternity Activity Maternity Activity by Age Band 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 2013/2014 2014/2015 2015/2016 0.0% 10-19 20-29 30-39 40-49 50-59 60-69 Age Band - Years Page 28 of 39

2.00% 1.80% 1.60% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% DNAs by Age 0-09 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 Age Band - Years 2013/2014 2014/2015 2015/2016 Page 29 of 39

6.00% DNAs by Gender 5.00% 4.00% 3.00% 2.00% F M 1.00% 0.00% 2013/2014 2014/2015 2015/2016 Page 30 of 39

Appendix C National Patient Surveys 2014/2015 Demographic information The Hillingdon Hospitals NHS Foundation Trust National Survey of adult inpatients 2014 Background information The Hillingdon Hospitals All Trusts NHS Foundation Trust Number of respondents 313 Response rate (%) 38.2% 44.2% Demographics characteristics Gender (percentage) Male 37.7 46.4 Female 62.3 53.6 Age Group percentage percentage Under 20 1.3 1.1 20-29 4.6 3.2 30-39 4.6 4.8 40-49 10.9 8.5 50-59 12.5 14.1 60-69 17.8 22.2 70-79 26.3 25.2 80-89 17.8 17.5 90+ 4.3 3.5 Ethnic Group percentage percentage English/Welsh/Scottish/Northern Irish/ 76.4 90.2 British Irish 2.4 1.2 Gypsy or Irish Traveller 0 0 Any other white background 2.8 2.1 White and Black Caribbean 0.3 0.2 White and Black African 0.3 0.1 White and Asian 0 0.2 Any other mixed / multiple ethnic 0 0.1 background Indian 9.7 1.6 Pakistani 1.4 0.9 Bangladeshi 0.7 0.3 Chinese 0.3 0.3 Any other Asian background 1.4 0.4 African 1.7 1.0 Caribbean 1.0 1.0 Another other Black / African / 0 0.1 Caribbean background Arab 0.7 0.2 Any other ethnic group 0.7 0.1 Page 31 of 39

Disability percentage percentage Deafness or severe hearing impairment 12.0 13.8 Blindness or partially sighted 4.9 4.5 A long-standing physical condition 30.7 27.8 A learning disability 2.1 1.6 A mental health condition 7.4 5.6 A long standing illness such as cancer, 28.3 31.6 HIV, diabetes, chronic heart disease or epilepsy Do not have a long-standing condition 42.0 39.9 Religion percentage percentage No religion 6.5 15.8 Buddhist 0.7 0.4 Christian 72.1 76.3 Hindu 4.8 1.0 Jewish 0.7 0.7 Muslim 6.8 2.3 Sikh 4.4 0.6 Other religion 1.7 1.1 Prefer not to say/unknown 2.4 1.8 Sexual Orientation percentage percentage Heterosexual/straight 91.0 93.9 Gay/lesbian 0 0.9 Bisexual 0.4 0.4 Other 1.1 0.6 Prefer not to say 7.5 4.1 Page 32 of 39

The Hillingdon Hospitals NHS Foundation Trust National Children s Inpatient and Day Case Survey 2014 Background information The Hillingdon Hospitals All Trusts NHS Foundation Trust Number of respondents 83 Response rate (%) 27.9% 27.4% Demographics characteristics Gender (percentage) Male 43.9 56.4 Female 56.1 43.6% Age Group percentage percentage 0-2 years 42.9 32.5 3-5 years 14.3 22.7 6-7 years 11.7 11.9 8-9 years 6.5 7.6 10-11 years 7.8 7.9 12-13 years 9.1 7.3 14-15 years 7.8 10.0 Ethnic Group percentage percentage English/Welsh/Scottish/Northern Irish/ 42.6 73.7 British Irish 0 0.3 Gypsy or Irish Traveller 0 0.1 Any other white background 11.8 5.4 White and Black Caribbean 2.9 1.3 White and Black African 2.9 1.0 White and Asian 1.5 1.8 Any other mixed / multiple ethnic 1.5 1.1 background Indian 16.2 3.5 Pakistani 1.5 3.2 Bangladeshi 0 1.2 Chinese 0 0.7 Any other Asian background 4.4 1.4 African 13.2 3.7 Caribbean 0 0.6 Another other Black / African / 0 0.3 Caribbean background Arab 0 0 Any other ethnic group 1.5 0.3 Disability percentage percentage Deafness or severe hearing impairment 4.2 2.9 Blindness or partially sighted 2.8 2.4 A long-standing physical condition 12.5 7.7 A learning disability 4.2 7.5 A mental health condition 4.2 1.9 A long standing illness such as cancer, 18.1 17.7 HIV, diabetes, chronic heart disease or epilepsy Do not have a long-standing condition 465.3 70.3 Page 33 of 39

The Hillingdon Hospitals NHS Foundation Trust National Maternity Survey 2015 Background information The Hillingdon Hospitals All Trusts NHS Foundation Trust Number of respondents 113 Response rate (%) 39% 41% Demographics characteristics Age Group percentage percentage Under 20 0.9 1.5 20-29 40.2 34.7 30-39 54.5 58.8 40-49 4.5 5.0 50 years old or more 0 0 Ethnic Group percentage percentage English/Welsh/Scottish/Northern Irish/ 36.2 71.0 British Irish 0 0.5 Gypsy or Irish Traveller 0 0.1 Any other white background 10.5 11.4 White and Black Caribbean 2.9 0.5 White and Black African 0 0.3 White and Asian 2.9 0.6 Any other mixed / multiple ethnic 0 0.5 background Indian 20.0 4.1 Pakistani 7.6 2.5 Bangladeshi 1.0 1.1 Chinese 2.9 1.2 Any other Asian background 6.7 1.4 African 6.7 3.3 Caribbean 1.0 0.7 Another other Black / African / 1.0 0.1 Caribbean background Arab 1.0 0.5 Any other ethnic group 0 0.3 Disability percentage percentage Deafness or severe hearing impairment 2.7 0.6 Blindness or partially sighted 0 0.3 A long-standing physical condition 5.5 2.3 A learning disability 0 0.6 A mental health condition 1.8 3.1 A long standing illness such as cancer, 0.9 2.3 HIV, diabetes, chronic heart disease or epilepsy Do not have a long-standing condition 89.1 91.6 Religion percentage percentage No religion 15.9 35.0 Buddhist 0.9 0.6 Christian 43.4 50.2 Hindu 15.9 2.3 Jewish 0.9 0.9 Page 34 of 39

Muslim 15.0 7.2 Sikh 7.1 1.1 Other religion 0.9 0.9 Prefer not to say/unknown 0 1.8 Sexual Orientation percentage percentage Heterosexual/straight 92.9 95.7 Gay/lesbian 0 0.3 Bisexual 0.9 0.6 Other 1.8 0.7 Prefer not to say 4.5 2.8 Page 35 of 39

Appendix D Family and Friends Test Demographic Information Total responses by Month - 01 January 2015 31 st December 2015 Month Reviews Jan 2015 1008 February 2015 1231 March 2015 1067 April 2015 925 May 2015 878 June 2015 801 July 2015 1079 August 2015 1202 September 2015 1220 October 2015 1110 November 2015 1295 December 2015 1278 Grand Total 13094 Page 36 of 39

Total responses by Age - 01 January 2015 31 st December 2015 Page 37 of 39

Total responses by Gender - 01 January 2015 31 st December 2015 Page 38 of 39

Total responses by Ethnicity - 01 January 2015 31 st December 2015 Total responses by Disability - 01 December 2015 31 st December 2015 Page 39 of 39