Equality & Action Plan 2013-17 This document outlines the actions we will take to work towards our Equality & Outcomes. Outcomes not processes An outcome is an end result, for example having staff who are all aware of Equality and issues and who can treat all people with dignity and respect. A process is how to get there, for example a training plan or revising the contents of the training course. We have tried to focus the actions in this plan on outcomes as much as possible. Sometimes it is difficult to measure outcomes, but during the life of this action plan we will develop ways of doing this. The actions we have included here are in addition to equality activities mainstreamed in other plans. This means that we have not referred to work set out elsewhere which will promote Equality and. This is to ensure that the action plan is as clear and concise as possible and addresses current gaps in services, information and evidence. The Equality Act makes no specific to people on low incomes but all work subject to impact assessment as outlined in this action plan takes account of the impact of socio-economic position on tackling health inequalities. Unique ID: NHSL. Author (s): JG, LB Category/Level/Type: Category 1 Strategy Version: 1 Status: Final version for publication Authorised by: NHS Lothian Board Date of Authorisation:27 2013 Review Date: Annually Date added to Intranet & website: 24 April 2013 Key Words: policy, strategy, outcomes, equality, diversity, human rights, duty, duties, age, race, disability, gender, sex, religion, faith, sexual orientation, LGBT, lesbian, gay, bisexual, transgender, marriage, civil partnership, pregnancy, impact assessment, EQIA, monitoring, action plan Comments: Outcomes action plan supporting the Equality Outcomes required by specific duties of the Equality Act 2010, and published separately. Page 1 of 13
International standards in equity for health care The action plan is based on the International Standards for Equity of Health Care, developed by the World Health Organization s network of Health Promoting Hospitals & Health Care Services. You can find out more about these standards here: http://hphnet.org/index.php?option=com_content&view=article&id=291%3atask-force-om-migrant-friendly-a-culturallycompetent-health-care&catid=20&itemid=95 There are 5 separate Equity Standards which are described here: Standard 1: NHS Lothian is fair and equitable in the way it develops its policies and strategies, and in the way it employs its workforce. Standard 2: Access to NHS Lothian s healthcare services is equitable. Standard 3: NHS Lothian s healthcare services deliver an equitable quality of care to all patients. Standard 4: NHS Lothian involves and consults with people in an inclusive and equitable way when developing services or policies. Standard 5: NHS Lothian promotes equality and diversity in its work with partners, in its contracts and in its procurement of goods and services. For more information about how we identified these outcomes and actions, see the NHS Lothian Equality Outcomes 2013-17. You can find this on the NHS Lothian website at http://www.nhslothian.scot.nhs.uk/your/equalitydiversity/keydocuments/pages/default.aspx 2
Equality & Action Plan 2013-17 Standard 1. NHS Lothian is fair and equitable in the way it develops its policies and strategies, and in the way it employs its workforce Outcome Action Output Deliver by end of 1.1 All healthcare s, policies and plans take account of the diversity of needs and of patients and the community Improve and review impact assessment processes, including monitoring, training, quality and the performance of NHS Lothian committees and services in completing and acting on impact assessments Assess the performance of key services using the International Equity Standards taking a riskbased approach, with stakeholder involvement Various compliance performance measures, impact assessment action plan. Number of services subjected to assessment and follow up actions completed Lead EQIA Steering Group Equality leads General Duty Advancing opportunity & of a and based approach Establish a policy to ensure that senior decision makers address equality & diversity in their performance management arrangements Policy approved, objectives in place for all relevant managers 2016 Develop effective processes to gather evidence and data about equality, poverty and all protected Evidence bank accessible to all staff to support impact assessment and service improvement. Implementation of Public Health & Health Policy 3
1.2 The NHS Lothian workforce better reflects the diversity of the population it serves, and staff with protected are represented appropriately at all levels of the organisation. Develop more targeted training for members of interview panels in equal opportunities Establish a programme to improve workforce monitoring across all protected Develop provision of mentoring, coaching and other support for staff with protected once they are in post. Improve the knowledge and skills of Employee Relations staff so that they are better able to provide support when an employment issue concerns equality & diversity Additional Support Needs and protected characteristic data collection workstream across all services. Number of staff completing equal opportunities in recruitment training by job family and pay band % disclosure of protected increases Various outputs including number of staff supported by protected, by pay band, job family Improved monitoring of Employee Relations cases by protected characteristic; improved reported outcomes Advancing opportunity, eliminating discrimination, groups Article 3: No torture or humiliating or degrading treatment. Article 4: No slavery or forced labour. Article 8: Right to a private and family life. Article 9: Freedom of religious belief. 1.3 The pay gap staff of different genders, ethnicity and for disabled staff is reduced. Prepare and publish an equal pay statement for NHS Lothian Deliver equal pay plan in priority pay bands and job families. Identify and review horizontal and vertical occupational segregation Statement published with demonstrable staff and Partnership involvement Narrower % pay gap and gender imbalance in key job families male and female staff 2014 discrimination of a and based approach 4
For disabled staff and BME staff 1.4 There is improved dignity at work for all staff and volunteers. Launch and publicise a revised Dignity at Work policy and clear organisational values Facilitate the establishment of robust staff-led networks for LGBT, disabled and BME staff Implement Gender-Based Violence policy and develop monitoring system for staff reporting and ensure appropriate training, support and referral pathway. Values programme delivered, Dignity at Work policy revised, Management Culture plan delivered, NHS Scotland annual staff survey Staff networks in place, number of meetings and members Policy and procedures in place, monitoring system developed discrimination, groups Article 3: No torture or humiliating or degrading treatment. Article 8: Right to a private and family life. Article 9: Freedom of religious belief. 5
2. Access to NHS Lothian s healthcare services is equitable Outcome Action Output Deliver by end of 2.1 Access to health services is more equitable for people with protected Develop data gathering on how people access primary and acute health services Develop and implement programme of training and awareness raising with GP surgeries on registration policies, equality & diversity and communication. To include all protected. Establishment of baseline and robust data set to include all protected Patients report improved experience (e.g. through Better Together survey); other measures e.g. number of GPs and reception staff trained. Lead Public Health & Health Policy Equality Leads, Public Involvement Coordinators, Managers, Public Health Practitioners General Duty Advancing opportunity of a and based approach. Review of interpreting & communication support arrangements, implement plan including awareness-raising and training for staff in working with interpreters, and participation in NHS 24 pilot on videoconferencing for BSL interpreters Plan will include various measures; improved level of service data will identify areas for further improvement. Number of staff trained; improved patient and interpreter experience. 2016 Senior Manager, Staff Bank All patients who need support receive this to encourage improved access to health services and anticipatory health care, through cultural bridging. Through use of service ethnicity data; review of referrals, attendance etc by all protected and additional needs; Ongoing Public Health & Health Policy, Equality Leads 6
2.2 NHS Lothian has minimised architectural, environmental and geographical barriers to its services Develop the way that Estates & Facilities assess and improve the accessibility of all NHS Lothian buildings, including links to local access panels and making better use of service data in implementation plans. monitoring of patients supported by Minority Ethnic Health Inclusion Service. % of estate assessed as non-compliant. Grading of buildings identifies areas requiring improvement; capital plan addresses these. Facilities & Estates discrimination None. 2.3 Health promotion and public health interventions are inclusive, reach all intended audiences and address stigma in the community Develop and implement specific health promotion activities in a range of subjects for people with protected (e.g. sexual health, tobacco, substance misuse). Interventions delivered, service data demonstrates reach through analysis of results using equality and diversity monitoring. Public Health and Health Policy Advancing opportunity Article 8: Right to a private and family life. Articles 24: Right to health and 28: Right to education 7
3. NHS Lothian s healthcare services deliver an equitable quality of care to all patients Outcome Action Output Deliver by end of 3.1 Patients with protected have a more personalised, individualised service where they are better able to exercise their independence, control and autonomy with an advocate if needed, and where their rights are protected. Develop the Compassionate Care and Delivering Better Care programmes to improve the way services involve patients, family and carers in decisions about the care of patients with protected. Services use patient data to ensure that care is personcentred, making use of additional support needs and equality data. This includes provision of information. Carry out a strategic review of & risks and opportunities. Patient feedback, patient experience quality indicators generate data by protected characteristic/additional need See additional needs workstream in outcome 1.1 Review complete, report published, actions identified and monitored. 2014 Lead Chief Nurse, Quality & Professional Standards Public Health & Health Policy Equality Leads General Duty Advancing opportunity. of a broad and based approach. 3.2 People in Lothian are more assured that health services will respect their dignity and identity. Communications and awareness-raising activities to encourage service users to selfidentify their protected or additional support need. Implement Gender-Based Violence Strategy, to include further of routine enquiry and awareness-raising Patient feedback, Better Together surveys etc. Increase in recording of patient protected and additional needs see outcome 1.1 Service monitoring data demonstrates implementation. Annual reporting of Equality Leads Nurse Director, Public Health & Health Policy discrimination, groups. Article 2: Right to life. Article 3: No torture or humiliating or degrading treatment. Article 8: Right to a private and 8
3.3 Staff are better equipped to deliver health care that takes into account patients protected, health literacy needs and dignity of the risk of Gender-Based Violence in relation to forced marriage, Female Genital Mutilation and Trafficking. Review training provision to allow for more targeted provision and content, including: developing understanding about the intersections/ overlaps in people s identities e.g. disabled LGBT people understanding of the equality & diversity contexts that may inform a service user s health engagement understanding about Do Not Attempt Resuscitation policies for people with lifelimiting conditions recognition of age-related transitions in service provision training in how to ask patients questions about protected or about their family, significant other or next of kin training in the implementation of a and approach progress to achieve measurable outcomes Training completion data shows increased takeup in specified staff groups/services. Service data and patient experience demonstrate improvement. Increased recording of patient data including protected characteristic and additional needs. MEHIS reports number of staff supported to provide culturally competent services through building their capacity. Equality Leads discrimination, advancing opportunity, groups. family life. Article 19: protection from violence and abuse of a broad and based approach. 9
4. NHS Lothian involves and consults people in an inclusive and equitable way when developing services or policies Outcome Action Output Deliver by end of 4.1 NHS Lothian involves with people in a more inclusive and equitable way, including people with all protected and from across the socioeconomic spectrum Review and develop arrangements for planning, monitoring and evaluating patient and public engagement to improve inclusivity and effectiveness. Establish ongoing arrangements for patient involvement in Gender Reassignment pathway Evaluations and data from engagement activities demonstrate improvement in services. Transgender patient and staff group established 2014 Lead Associate Communications Gender Reassignment lead specialist in Public Health General Duty Advancing opportunity, groups. of a broad and -based approach. 4.2 NHS Lothian ensures that any individual can provide feedback or make a complaint and this is addressed equitably and transparently Develop existing mechanisms to measure the patient experience so that they are sufficiently detailed to link data to protected or additional support needs. Review arrangements for encouraging feedback and suggestions so that all patients have an opportunity to provide these. As for outcome 3.1 Monitoring of feedback and suggestions demonstrates improvement by protected characteristic. Public Health & Health Policy Chief Nurse, Quality & Professional Standards discrimination. Article 6: Right to a fair hearing. Article 10: Freedom of expression. Article 12: Respect for the views of children Develop complaints procedures so that Monitoring of complaints demonstrates takeup and 10
complaints relating to discrimination are demonstrably treated seriously resolution by protected characteristic 11
5. NHS Lothian promotes equality & diversity in its work with partners, in its contracts and in its procurement of goods and services Outcome Action Output Deliver by end of 5.1 NHS Lothian s partner organisations and suppliers operate in a way that is consistent with its approach to the promotion of equality Review and update standard contractual terms and conditions and Service Level Agreements to include specific requirements relating to promotion of general duty. Contracts and agreements revised to specify how they will take account of the needs of people with protected and those on low incomes. Monitoring provides baseline for ongoing work with suppliers and contractors. Lead Health & Social Care Partnerships, Finance, Strategic Planning General Duty discrimination, advancing opportunity, groups. of a broad and -based approach. Identify key partner organisations and support them to monitor protected of service users, and use the resulting data to evaluate the accessibility and effectiveness of these services and improve the extent to which they promote equity, build social capital and address poverty. Monitoring and reviewing service data demonstrates improvement in accessibility and outcomes and identifies any barriers to access. Social capital outcomes in service level agreements contribute to building community cohesiveness and community safety 2016 Equality Leads 5.2 Individuals and communities who are vulnerable to, or victims of hate Improved knowledge and understanding of hate incidents and hate crimes and reporting mechanisms including the involvement of Issue of hate incidents/hate crime are integrated within both mainstream and equalities training, and in HR policies. 2014, discrimination, Article 2: Right to life. Article 3: No 12
crime feel safer and more secure police when necessary, through greater integration of hate crime issues in mainstream staff training. Joint Hate Crime campaigns make better use of local data. Improved publicity for joint hate crime arrangements with other organisations, e.g. police. NHS Lothian representation on Hate Crime Strategic Groups and the Community Safety Partnerships Increased reporting of hate incidents and hate crimes on DATIX system. Monitoring of referrals to support organisations and police As above. As above Increased reporting and monitoring of hate crimes reported through multiagency groups 2016 Ongoing 2016 Public Health & Health Policy, Equality Leads Equality Leads Equality Leads Equality Leads groups. torture or humiliating or degrading treatment. Article 8: Right to a private and family life. Article 9: Freedom of religious belief. Article 19: Protection from violence and abuse 13