Equality, Good Relations and Human Rights SCREENING TEMPLATE

Equality, Good Relations and Human Rights SCREENING TEMPLATE (1) INFORMATION ABOUT THE POLICY OR DECISION 1.1 SE/AC-011/15/16 Substance Misuse Liaison Services: Acute in-patient settings 1.2 Description of policy or decision Commissioning Plan Directions (2014/15) identify the further development of alcohol/substance misuse liaison services within acute Trust settings: By March 2015, services should be commissioned and in place that provide seven day integrated and co-ordinated substance misuse liaison services within all appropriate HSC acute hospital settings undertaking regionally agreed Structured Brief Advice Intervention Programmes. During 2014/15 the HSCB and PHA will work with Trusts to establish effective substance misuse liaison services within appropriate acute hospital settings. Up to 30% of all hospital admissions (adult population) potentially demonstrate some degree of alcohol/substance misuse (definition: exceed weekly DoH/CMO safe thresholds ). This, however, is often not detected: local hospital admission statistics bear out a detection level of around 3%. Most at risk individuals within the acute in-patient setting are not addicted or dependent but rather are hazardous/harmful and/or binge-pattern users (ie. social drinkers and/or recreational substance misusers). Failure to identify even modest alcohol/drug misuse has direct consequences in terms of higher morbidity/mortality, longer inpatient stay and poorer outcomes. This translates to higher costs & increased likelihood of re-admission. With 4200 acute PoC in-patient beds in N.Ireland, extrapolating the 30% statistic implies there are hundreds of beds across various medical, surgical, 1

other acute settings occupied each day by people with some degree of alcohol/substance misuse (which frequently goes undetected). NICE (PHG-24) state that the required intervention is not specialist substance misuse or mental health but structured advice and guidance delivered by alcohol/substance misuse liaison teams. Such teams, delivering Screening-Brief Interventions, can prevent admissions, reduce length of stay, improve clinical outcomes and generate cost savings. Best practice guidance indicates (a) liaison services should operate on a 7 day per week basis, and (b) services should encompass both acute in-patient settings (in particular, admission wards) and the Emergency Dept (ED). Existing liaison services operate on a 5 day Mon Fri basis and, given their relatively small scale (1-3wte per Trust), focus mainly upon the Emergency Dept setting. To enable a 7 day liaison service encompassing both ED and in-patient settings would require a team resource of circa 5-7wte per Trust. Building upon the existing liaison teams in place, a 2 year service development approach is proposed (see schemata: In Phase 1 (15 month period: 1 st Jan 2015 to 31 st March 2016), the aim is to improve alcohol/substance misuse liaison input to acute admission wards and move from a 5 day to a 7 day per week provision. Building upon existing substance misuse resources already in place, ie. 2 wte, an additional 2.0 wte posts should be created increasing the overall team resource to 4.0 wte. Phase 1 continuing over the 2015/16 period, would be enabled by an allocation of 89,778 FYE. This amount will also be available in year as the CYE figure. This builds on previous funding allocated in 2014/15 of 19,444. Note as referenced above, the main focus is harmful/hazardous substance misuse among acute hospital admissions: the majority (>95%) who screen positive exhibit harmful but non-dependent misuse, ie. do not require access to addiction-specific interventions. The liaison service should therefore be considered as integral within the acute care process and not addiction/mental health specific (<5% of those screening positive fall within this category). Liaison team members, while primarily nursing, can therefore encompass a range of backgrounds including medical, emergency department, primary/community care, mental health/addiction. Aims: working within a 7 day model, the main aims of the service are: 1. Screening - case finding Implement a formal screening programme - by end of phase 2 (ie. March 2017), screen 90% of all (adult) non elective acute admissions per year 2

and 25% (ie. specific higher risk cases dictated by clinical risk) of ED attenders per year. Screening based upon the AUDIT / AUDIT-C (alcohol) and DUDIT (drug) tools over time these should be incorporated within in-patient and E.Dept assessment/admission procedures. Liaison practitioners will initially take the lead role in terms of undertaking screening. However, over time, as admission staff are trained/become more experienced, it is anticipated that these latter staff will assume greater responsibility for such duties with the former assigning a greater proportion of their time to provision of Structured Advice/Intervention and referral to appropriate services as required. 2. Structured Brief advice and structured interventions - to those screening positive : Best practice guidance emphasises the importance of intervening promptly at the treatable moment, ie. promptly after the assessing practitioner detects an individual with hazardous/harmful substance misuse (or within 24rs); the individual is more likely to reflect upon the impact of their substance misuse and are open to change future behaviour. Where longer term follow-up and more specialist interventions are required, subsequent consultation and referral if required to a specialist service/agency should be within 24-48hours (otherwise dis-engagement & non-attendance are more likely and the opportunity to intervene is lost). 3. Direct care of more complex patients: advising on care/management, for example, medical detoxification of in-patient 4. Aftercare/follow-up: Where moderate-to-severely dependent individuals are identified they will require referral to specialist substance misuse services. In this respect, the liaison practitioner has a key role in terms of motivational work, preparation and overseeing transition/referral to specialist addiction services (or specialist comm/vol sector partners) Handling other concerns and key issues when identified, eg. mental health, self-harm, child/family care or social care issues, ensure appropriate links and liaison with other relevant services. Repeat attenders/admissions for example, working with frequent attenders (more intensively) to moderate drinking/develop contingency plans 7 day service model - existing liaison services are largely Monday to Friday / 9am to 5pm based. The aim is to establish a 7 day service model in each Trust. 3

Taking account of national guidance / published reports and direct advice from other Trusts (in England), the priority focus should be to cover the 8am-to-4pm period daily Beyond the core 8am-to-4pm period, service models need to ensure linkage with other appropriate services, in particular, mental health/self-harm/crisis response, child/adolescent and social care services. In parallel to this specific work, Trusts should therefore consider their wider 24/7 service model for this wider range of liaison service Where possible, agreed regional approaches will be identified, including: Screening Tools Structured Brief Advice - content of the circa 5-10 mins (duration) advice and Interventions, (30-60mins) - to be delivered by specialist liaison practitioners, Take away resources following discharge (eg. Advice and drinking diary packs), Pathways for potential follow-up interventions (post detoxification and/or higher risk and/or vulnerable clients), including telephone follow up (undertake re- AUDIT / provide additional advice) Failure to secure recurrent funding Given the current financial pressures, without appropriate recurrent funding, the Trust would not be able to provide / develop the service as outlined. Existing staff would not be able to provide 7 day working and ultimately extend the service to be inclusive of inpatient / admission wards. Failure to develop the service could result in increased admissions, increased length of stay and poor clinical outcomes for patients. Failure to recruit staff The Trust will endeavour to advertise the posts within a timely manner. Increased awareness of the new posts will be highlighted in key areas including Addictions Teams, Mental Health teams, Emergency Departments and Medical Admission Wards. Successful candidates will he held on a waiting list pending subsequent release of additional posts. Failure to secure appropriate hospital base for staff due to accommodation pressures Existing staff are based on the Ards Hospital Site and within the Ulster Hospital. This arrangement will remain until further expansion of the team, with the plan to provide office based accommodation at the Ulster site. 4

1.3 Main stakeholders affected (internal and external) Service users, PHA, HSCB staff, hospital staff, specialist comm/vol sector partners. 1.4 Other policies or decisions with a bearing on this policy or decision Commissioning Plan Directions (2014/15) Public Health Agency Consultants Best Practice Guidelines NICE guidelines(phg-24 5

(2) CONSIDERATION OF EQUALITY AND GOOD RELATIONS ISSUES AND EVIDENCE USED 2.1 Data Gathering What information did you use to inform this equality screening? For example previous consultations, statistics, research, Equality Impact Assessments (EQIAs), complaints. Provide details of how you involved stakeholders, views of colleagues, service users, staff side or other stakeholders. Commissioning Plan Directions (2014/15) Public Health Agency Consultants Best Practice Guidelines NICE guidelines(phg-24 2.2 Quantitative Data Who is affected by the policy or decision? Please provide a statistical profile. Note if policy affects both staff and service users, please provide profile for both. Category Gender Age Religion Needs and Experiences Census 2011 details that 47.8% of the SE population were male 51.25% were female. This service is specifically for the adult population of South Eastern area which as per NISRA Census Information and mid-year estimate for 2011 is 279,407 people. This service is specifically for the adult population of South Eastern area which as per NISRA Census Information and midyear estimate for 2011 is 279,407 people Population across the specific age groups is as follow 0-16: 20.55%, 16-39 -30.32%, 40-64: 33.32%, 65-84: 13.82%, and 85+ - 1.92% The census for 2011 details that South Eastern Health and Social Care Trust, considering the resident population: 31.13% belong to or were brought up in the Catholic religion and 6

Political Opinion Marital Status Dependent Status Disability Ethnicity 59.79% belong to or were brought up in a 'Protestant and Other Christian (including Christian related)' religion; and 60.08% indicated that they had a British national identity, 18.78% had an Irish national identity and 31.46% had a Northern Irish. The 2011 Census data for South eastern area is not available. The 2011 census on marital status states that 51% of the South Eastern population are married or in a civil partnership. 27% single and 22% other. The 2011 Census question on provision of unpaid care showed that 3.17 of population provided 50+ hours of unpaid care in comparison to 3.1% Northern Ireland average. 12.82% of people in South eastern area stated that they provided unpaid care to family, friends, neighbours and others. Results of a UK wide survey of 3,400 carers across the UK found: 83% of carers stated that caring had a negative impact on their physical health (NI=81%) 39% of carers have put off medical treatment because of their caring responsibilities (NI=31%) 36% suffered injuries such as back pain (e.g. due to lifting/moving those they care for) and 22% suffered from high blood pressure 26% stated that an existing condition had deteriorated as a result of caring responsibilities 34% of carers exercised less as a result of caring 87% of carers stated that caring had a negative impact on their mental health (NI=88%) 91% of carers were affected by anxiety or stress and 53% suffered from depression Thirty-seven percent of those with caring responsibilities stated that their health was fair or bad/very bad, compared to 27% of those who do not have caring responsibilities. The 2011 Census states that 19.82% of people had a long term health provision or disability that limited their day to day activities. 12.82% of the SELCG population provide unpaid care to family, friends, neighbours or others. 1.46% were from an ethnic minority population and the remaining 98.54% were white (including Irish Traveller). The 2011 Census estimated that there were around 200,000 people living in Northern Ireland who were not born in Northern Ireland. Between 2001 and 2011, the proportion of the population who were born outside NI, GB and RoI increased from 7

Sexual Orientation 1.6% to 4.5%. The 2011 Census data for South eastern area is not available. 2.3 Qualitative Data What are the different needs, experiences and priorities of each of the categories in relation to this policy or decision and what equality issues emerge from this? Note if policy affects both staff and service users, please discuss issues for both. Category Gender What is the makeup of the affected group? ( %) Are there any issue or problems? For example, a lower uptake that needs to be addressed or greater involvement of a particular group? Higher % of men drink over the weekly limit in comparison to women, (28% vs 13%) According to the CDC men are over two times more likely to binge drink than women Age Religion Political Opinion Marital Status Dependent Status Disability Ethnicity There are a range of reasons for men being recorded as taking more drugs than women, and treatment between men and women can differ. This service will be based with adult ED services and therefore there will be positive benefits for the adult population. There is no evidence of a differential impact based on religion There is no evidence of a differential impact based on political opinion There is no evidence of a differential impact based on marital status There is no evidence of a differential impact based on dependent status The service users may have conditions/disabilities however as with existing Trust protocol services should be tailored and proposals have been drafted to meet the specific needs of these service users. The service users involved are experiencing problems with psychosis and eating disorders therefore care provided will be tailored to accommodate these specific needs. Prevalence of mental health problems varies by ethnicity. The 2007 Adult Psychiatric Morbidity Survey 1 highlights that those 1 Adult Psychiatric Morbidity Survey (England) 2007 (published 2009) (aged 16+), National Centre for Social Research and Health and Social Information Centre http://www.hscic.gov.uk/pubs/psychiatricmorbidity07 8

whose ethnic group is Black, experience the highest rates of suicide attempt, psychotic disorder, any drug use and drug dependence, while those whose ethnic group is White experience highest rates for suicidal thoughts, self-harm and alcohol dependence. Women from the South Asian ethnic group experience highest rates for any common mental disorder (anxiety and depression). Sexual Orientation A recent report published by The Rainbow Project: All Partied Out, identified that LGB (and T) people are more likely to abuse alcohol and certain substances than their heterosexual counterparts. 2.4 Multiple Identities N/A Are there any potential impacts of the policy or decision on people with multiple identities? For example; disabled minority ethnic people; disabled women; young Protestant men; and young lesbians, gay and bisexual people. 2.5 Based on the equality issues you identified in 2.2 and 2.3, what changes did you make or do you intend to make in relation to the policy or decision in order to promote equality of opportunity? In developing the policy or decision what did you do or change to address the equality issues you identified? The service will be accessible to all adults that qualify for access when attending ED, including through the provision of, where appropriate: What do you intend to do in future to address the equality issues you identified? N/A Information provided in alternative formats people 9

with sensory impairments or learning disabilities Participants will have access to the HSC interpreting service if required Staff will have a general awareness of the complexities of substance abuse across Section 75 characteristics 2.6 Good Relations What changes to the policy or decision if any or what additional measures would you suggest to ensure that it promotes good relations? (refer to guidance notes for guidance on impact) Group Impact Suggestions Religion Political Opinion Ethnicity NE NE NE (3) SHOULD THE POLICY OR DECISION BE SUBJECT TO A FULL EQUALITY IMPACT ASSESSMENT? A full equality impact assessment (EQIA) is usually confined to those policies or decisions considered to have major implications for equality of opportunity. 10

How would you categorise the impacts of this decision or policy? (refer to guidance notes for guidance on impact) Please tick: Major impact Minor impact x Do you consider that this policy or decision needs to be subjected to a full equality impact assessment? Please tick: Yes No x No further impact Please give reasons for your decisions. This is a proposal for additional funding for an enhanced service in ED. It will have a positive impact for those using the service. Any impacts identified were mitigated within the policy 11

(4) CONSIDERATION OF DISABILITY DUTIES 4.1 In what ways does the policy or decision encourage disabled people to participate in public life and what else could you do to do so? How does the policy or decision currently encourage disabled people to participate in public life? What else could you do to encourage disabled people to participate in public life? 4.2 In what ways does the policy or decision promote positive attitudes towards disabled people and what else could you do to do so? How does the policy or decision currently promote positive attitudes towards disabled people? What else could you do to promote positive attitudes towards disabled people? It promotes the recovery model and early brief interventions reducing admission to acute hospitals. 12

(5) CONSIDERATION OF HUMAN RIGHTS 5.1 Are Human Rights relevant? Complete for each of the articles ARTICLE Article 2 Right to life Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment Article 4 Right to freedom from slavery, servitude & forced or compulsory labour Article 5 Right to liberty & security of person Article 6 Right to a fair & public trial within a reasonable time Article 7 Right to freedom from retrospective criminal law & no punishment without law Article 8 Right to respect for private & family life, home and correspondence. Article 9 Right to freedom of thought, conscience & religion Article 10 Right to freedom of expression Article 11 Right to freedom of assembly & association Article 12 Right to marry & found a family Yes/No Article 14 Prohibition of discrimination in the enjoyment of the convention rights 1 st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education If you have answered no to all of the above please move onto to move on to Question 6 on monitoring 13

5.2 If you have answered yes to any of the Articles in 5.1, does the policy or decision have a potential positive impact or does it potentially interfere with anyone s Human Rights? List the Article Number Positive impact or potential interference? How? Does this raise any legal issues?* Yes/No * It is important to speak to your line manager on this and if necessary seek legal opinion to clarify this 5.3 Outline any actions which could be taken to promote or raise awareness of human rights or to ensure compliance with the legislation in relation to the policy or decision. 14

(6) MONITORING 6.1 What data will you collect in the future in order to monitor the effect of the policy or decision on any of the categories (for equality of opportunity and good relations, disability duties and human rights? Equality & Good Relations Disability Duties Human Rights Public Health Agency will monitor the outcomes of this service, including where appropriate, section 75 data. Approved Lead Officer: Position: Paul Turley AD Commissioning Bernie Mooty Policy/Decision Screened by: Signed: Date: April 2015 Template produced November 2011 If you require this document in an alternative format (such as large print, Braille, disk, audio file, audio cassette, Easy Read or in minority languages to meet the needs of those not fluent in English) please contact the Equality Unit: 2 Franklin Street; Belfast; BT2 8DQ; email: Equality.Unit@hscni.net; phone: 028 95363961 (for Text Relay prefix with 18001); fax: 028 9023 2304 15