Patient Experience Strategy October 2017 October 2020

Patient Experience Strategy October 2017 October 2020

Policy Title: Patient Experience Strategy 2014-2017 Executive Summary: The aim of this strategy is to ensure that all patients, their families, carers and visitors have a positive experience in our care, ensuring their physical and emotional needs and expectations are met or exceeded and that they receive a fair and equal service. This document sets out our strategy for the next three years. It identifies how the trust will continue to work towards improving the patient experience, ensuring consistency and involving service users in developing, and celebrating our services. The action plan will be reviewed annually. Supersedes: Patient Experience Strategy 2014-2017 Description of Updates to staff titles due to trust reorganization. Amendment(s): New action plan. This policy will impact on: This is a trust wide strategy and impacts on all areas. Financial Implications: May need more resource if tenders contain requirement for extensive patient experience work, but this should be built into the bid. Policy Area: Governance Document ECT002896 Reference: Version Number: V2 Effective Date: December 2017 Issued By: Author: (Full Job title ) Director of Corporate Affairs & Governance Lyn Bailey Equality & Patient Experience Manager Review Date: December 2020 Impact Assessment Date: APPROVAL RECORD July 2017 Consultation: Associate Directors Matrons Senior sisters Corporate Affairs & Governance Managers Patient Reference Group July 2017 Approved by Deputy Director: Director Corporate Affairs December 2017 and Governance Approved by Director: Director Corporate Affairs December 2017 and Governance Received for information: All staff December 2017 Page 2

Table of Contents 1. Introduction Page 4 2. Why Improve Patient Experience Page 4 3. Roles and Responsibilities Page 5 4. The trust s approach to patient experience Page 5 5. Aims Page 6 6. Strategic Context Page 6 7. Current patient Experience Activities Page 7 8. Overview of Patient Experience Objectives Page 8 9. Monitoring ( see Appendix 3) Page 8-9 Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Activities Underway Under the Patients First Approach Different Methodologies for Patient Experience Monitoring List of key policies and other documents informing the strategy Equality Analysis Template

1. Introduction The Department of Health defines patient experience as, Getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way; having information to make choices, to feel confident and feel in control; being talked to and listened to as an equal and being treated with honesty, respect and dignity (DoH, 2009) Improving patients experience is central to High Quality Care for All: NHS next stage review (Department of Health 2008a), and the reason it is important is referred to in the preface to the draft NHS constitution, which sets out certain NHS values including respect and dignity, compassion, and working together for patients: [The NHS] touches our lives at times of most basic human need, when care and compassion are what matter most. (Department of Health 2008b) In 2012, NICE (National Institute for Clinical Excellence) released patient experience guidance and a standard, enabling trusts to self- assess and work towards improving against a range of patient experience measures. Follow this link to view the standard: http://www.nice.org.uk/guidance/qs15 The aim of this strategy is to ensure that all patients, their families, carers and visitors have a positive experience in our care, ensuring their physical and emotional needs and expectations are met or exceeded. This approach will be achieved by working in partnership to shape and develop our services with a fundamental goal of delivering a consistently positive experience. This document sets out our strategy for the next three years. It identifies how the trust will continue to work towards improving the patient experience and involving service users in developing, improving and celebrating our services. 2. Why Improve Patient Experience Goodrich and Cornwall (2008) set out the case for why it is necessary to have a clear strategy for improving patient experience, both in terms of clinical outcomes and the success of the organisation: Improving patient experience makes good sense for patients because: The reduction of anxiety and fear can speed the healing process and shorten patient s length of stay The provision of information reduces post-operative complications Good communication/information enables people to (self) manage their illnesses more effectively Effective communication improves treatment and medications compliance. Improving patient experience makes good business sense because: Patients are increasingly using the internet to rate their experience, affecting organisational reputations

The NHS choice programme empowers patients to choose services perceived to provide the best care and treatment. More recently it has become apparent that readily available patient experience evidence can support the tendering process leading to increased market share. In addition, the Care Quality Commission has a clear focus on the experience of patients who have used or are currently using our services. 3. Roles and Responsibilities The Chief Executive has overall accountability for ensuring that patient experience within East Cheshire NHS Trust is managed effectively and has delegated this responsibility to the Director of Nursing, Performance and Quality. The Director of Nursing, Performance and Quality has delegated accountability for quality and the development and implementation of the Quality Strategy which includes patient experience as a key area. They will ensure action is taken from feedback via a range of data sources. Director of Corporate Affairs and Governance will ensure that there are systems in place to gather and analyse patient experience feedback, including a governance framework for sharing learning. This includes, directorate data packs, learning into practice newsletters, complaints and patient stories and formal reports to committees and the Board. All Executive Directors will support the implementation of the patient experience strategy and ensure their staff abide by best practice through listening, responding and learning from patient experience feedback and issues raised from this. The Deputy Director of Corporate Affairs and Governance has responsibility for overseeing the patient experience function and will work with the Deputy Director of Nursing and Quality to implement the strategy. The Deputy Director will provide reports on the performance indicators relating to this strategy, and complaints/ PALS, to the trust Safety Quality and Standards Committee and working in collaboration with relevant directors will ensure any improvement plans are developed and implemented. Deputy Director of Nursing and Quality is responsible for delivery of the Quality Strategy and development of the Quality Account. As chair of the Quality Forum, ensures members actively participate in the delivery of improvement plans aimed at improving patient experience. Associate Directors are responsible for ensuring the delivery of the Quality Strategy within their services areas and for ensuring action plans are developed in response to patient experience feedback. Heads of Nursing and Matrons are professionally responsible for ensuring the trust s values and behaviours are embedded and that there is continuous improvement in relation to patient experience, which will support good clinical outcomes for patients and their families/ carers.

Head of Communications, Engagement and Marketing is responsible for ensuring that the strategy is fit for purpose and for the monitoring and implementation of action plans associated with the policy. The Equality and Patient Experience Manager and Customer Care Manager will provide expertise and support to service areas in respect of patient experience. This includes: managing the trust s complaints function and PALS outreach with real time action to support a positive patient experience providing expertise to trust staff to support patient experience improvement, such as advice and training on patient experience methodology across the organisation development of procedures to ensure that their teams and staff across the trust involved in patient experience work are clear regarding their roles and responsibilities. escalating concerns identified via patient experience work. It is the responsibility of all Staff to be receptive to all forms of patient experience feedback, and recognise that such information is an essential element of clinical governance and service improvement 4. The trust s approach to patient experience The four components of the trust s patient experience approach are: Treating patients with dignity, respect, care and compassion Listening to and involving patients and their families/ carers Keeping patients informed Caring for patients and carers. The Patient Experience Strategy will be used to support staff in thinking about the many and varied elements which patients tell us make a good patient experience. Good practice and lessons learned will be shared across the trust to spread good practice and learning. See Appendix 1 to view areas that the trust is already focussing on under these four headings. 5. Aims The aims of the patient experience strategy are as follows: To be the healthcare provider of choice by ensuring that all patients, carers and visitors consistently receive a service that meets what we would accept for ourselves, our family and friends. To make the trust values and behaviours integral to the working life of all staff, to help us to inspire, develop and support every staff member to live the values for every patient, every colleague, every day. To embed patient experience as a key focus of the culture of the organisation by making sure we use this rich information to feed into service planning and development

To have up to date patient experience evidence always available in service areas To raise the profile of patient experience both internally and externally. The trust is committed to ensuring that our services are developed and improved as a direct result of patients and carers experience and involvement, and that the patient is always our priority. Excellent patient experience is supported by the trust s strategic objectives. 6. Strategic Context The trust s Quality Strategy 2015-2019 supports quality improvements in patient care and experience and describes giving equal importance to the whole experience of care provided by the trust. It also states that an attitude and culture should be developed within our entire organisation whereby everyone is constantly striving for excellence and continual quality improvement in all that they do. Follow this link to view the quality strategy: Quality Strategy The trust s Clinical Strategy 2015-2019 refers to giving the best care in the right place for the healthcare needs of patients and that any changes will support improvements in both patient care and experience. The trust has a comprehensive volunteer strategy. Having over 350 committed volunteers across community and acute areas enhances the patient experience in so many ways - from helping someone to eat their meal, to holding a patient s hand in theatre to sitting and spending time with someone. The volunteer strategy aims to increase the numbers of volunteers with a key aim of enhancing the patient experience. 7. Current Patient Experience Activities The trust has already established several mechanisms to capture patient feedback and improve the patient experience including: Use of patient stories These will continue to be delivered to the monthly trust board and Safety, Quality and Standards Committee Board assurance walkabouts using the principles of the 15 steps This enables board members to seek patient, staff and carer feedback for themselves Implementation of the Friends and Family Test across the organisation Participation in the national patient survey programme Local patient feedback plan, incorporating peer review, accreditations, and a range of methodologies including interviews, focus groups and real time surveys. See Appendix 2 for information about different methodologies Review of the complaints / concerns process to ensure that a more proactive approach is taken to facilitate early resolution of concerns Implementation of the Patient Advice and Liaison Service outreach programme Dedicated engagement with local groups and organisations, to work across equality protected characteristics Patient reference groups in a number of areas Experience based design initiatives Engagement with Healthwatch

Quarterly patient experience key performance indicators on dignity and respect and involvement in care Quarterly patient experience reports. See Appendix 1 to view the range of current patient experience in the trust. 8. Overview of patient Experience Objectives The main areas of focus are in creating an organisation wide commitment to patient experience from trust board down through all levels of the organisation. This means that patient experience will continue to feature in all key committees and will also become a standing item at team level meetings. The focus will be on what service improvements occur as a result of the feedback, how patients and carers rate these changes and how they can be sustained. Any training programmes introduced into the trust must evidence patient experience throughout. Organisational culture change will be achieved by embedding the values and behaviours developed with staff and patients and which form part of the staff appraisal process. The NICE patient experience standard will also be promoted across the trust and used as part of the staff appraisal process. There is already a wide range of patient feedback mechanisms in the trust. This will be further developed to include more real time feedback, more use of social media, listening days where patients and carers will be able to informally chat with senior leaders in the trust about their experiences, roll out of Friends and Family Test and identification of trust wide themes to enable service improvement. Data analysis will be developed to enable triangulation of data across a number of areas to identify key hot spots for action. All proposals to the board will have a quality and an equality impact assessment (EIA) and evidence that findings are considered. Proposals will be rejected if these are not in place. Improvements will be made in the cascading of patient experience performance across the trust down through wards and departments, to include good practise information. A key requirement of this strategy is that all staff commit to carrying out required actions by agreed deadlines, e.g. action plan submissions and that they are held to account by Associate Directors. Action plans based on patient feedback must have actions that: are SMART (Specific, Measurable, Achievable, Realistic and Time bound) focus on improving the way services are delivered in order to improve patient experience for the greatest number of patients. It is important that teams check patient experience following interventions to ensure that improvements are sustained. Performance monitoring of directorates will include performance monitoring on patient experience which will form a key part of any presentation to The Board or the Safety, Quality and Standards Committee or Sub-committee.

9. Monitoring Key areas included in the action plan at Appendix 3 are: Triangulating themes across patient experience measures, patient safety, Friends and Family Test and complaints data. Promoting the NICE patient experience standard Supporting directorates in ensuring that patient experience is a standing item on their SQs agendas Developing feedback forms in key languages Including the patient stories guidance as part of induction. The action plan will be reviewed and reported via the trust patient experience report which is submitted on a quarterly basis to the Quality Forum. The Trust Board will ensure there is a culture of learning from patient feedback throughout the organisation. The Safety Quality and Standards Committee has delegated authority from the Board for receiving information on patient experience, including assurance in relation to key performance indicators 9. Roles and Responsibilities.

APPENDIX 1 Patient Experience activities in the trust. Dignity, respect, care and compassion Excellent customer care Values based recruitment and appraisal Focus on privacy and continue to implement single sex accommodation guidance Reasonable adjustments for all patients who need them use of patient passports and reasonable adjustment symbols on white boards and bed spaces Work towards the National Autistic Society Hospital Accreditation (anticipated completion date Dec 2018) Staff training: mental capacity act training mental health simulation Additional needs refresher training Listening and involving Working to ensure patients feel involved in decisions about their care and treatment Monitoring themes from Friends and Family Test and implementing service improvements as a result Using the experience based design approach in service planning Full programme of national and local surveys Real time surveys in acute and community settings Triangulation of patient feedback to identify themes Engagement with local groups across the range of equality protected characteristics Keeping patients informed Using the patient information toolkit to support staff to produce patient information Accreditation under the national Patient Information Standard Communications training for all clinical staff Recording complaints meetings and giving copies to complainants Keeping trust website updated Talking to patients and carers at visiting times and implementing Welcome Policy including Visitors Charter Caring Maintain excellent scores in PLACE assessment (Patient Led Assessments of the Care Environment) Making improvements to food on hospital wards Raising the profile of the importance of spiritual care for patients Continue to implement the end of life strategy Audits of care on wards Maintain/improve scores in national patient surveys

APPENDIX 2 Different Methodologies for Patient Experience Different methodologies for patient experience feedback exercises Method Advantages Disadvantages Paper based survey Suited to quantitative 'tick box' questions May not get as many responses as you need Gives you quantitative data to analyse - good for benchmarking Can be time consuming if sending in post Can take less time for respondents to complete Questions could be misinterpreted Respondents familiar with filling in paper based questionnaires May leave you with unanswered questions i.e. the reasons behind the results Web, on-line surveys Suited to quantitative 'tick box' Not all respondents may have questions Gives you quantitative data to analyse - good for benchmarking Can take less time for respondents to complete Less time consuming than postal surveys Touchscreen surveys Can give instant feedback Quick and easy for respondents to fill in Suited to quantitative 'tick box' questions Suggestion boxes Easy to set up Anyone can complete a feedback card Focus groups Enables you to gather information from numerous respondents simultaneously Allows in depth questioning Can unearth issues you may not previously have thought of Depth telephone interviews Allows in depth questioning Can give you the full story Patient quotes can be powerful in analysis Face to face interviews Allows in-depth questioning Can give you the full story Patient quotes can be powerful in analysis Can see body language Internet access Respondents may not be familiar with completing online questionnaires May not get as many responses as you need May leave you with unanswered questions i.e. the reasons behind the results Lack of devices on which to carry out surveys Some people can find it hard to read screens Screens can get dirty - infection control issues Low response rate May not get specific feedback Can be difficult to set up Can be time consuming to arrange Can be difficult to compare and analyse information Group can be dominated by one or two members Can be time consuming Can be difficult to arrange interview time Can be difficult to compare and analyse information Cannot see body language Can be time consuming Can be difficult to arrange interview time Can be difficult to compare and analyse information

Method Advantages Disadvantages Observational research Allows you to see things through the patients' eyes Allows you to get a feel for things at a grass roots level People may feel uneasy being observed Can be easy to misinterpret what is seen Patient stories Can be powerful and moving Patients may not want to be filmed Can be time consuming Compliments Positive Assurance Complaints Learning from mistakes

APPENDIX 3 Monitoring Objective Action Lead Deadline Senior leaders have a significant focus on patients and their Patient Stories to be regularly shared at Trust Board, Safety, Quality and Standards Committee and Quality Forum. Director of Nursing, Performance & Quality March 2018 experience of care Patient Stories to be included at induction Organisational Development Manager March 2018. The organisational culture is patientfocussed and values behaviours which enhance the experience of patients There are multiple routes for patients to provide feedback, including those with diverse needs Improve the number of patients who feel Trust values and behaviours tested out via appraisal Provide evidence against NICE patient experience standard and publicise in the trust Patient Stories to be cascaded to directorates and shared Plan for real time patient experience monitoring in community/acute settings Use of audit tool to collect views of patients with information/communication support 1 needs Develop new easy read patient survey Review themes from Friends and Family Test learning disabilities patient comments Re-publicise dementia carers survey and make available online Run social media survey for feedback from patients with autism Continue with LGBT survey Through PALS and PALS outreach Via Complaints through the Customer Care Team Via Compliments sent to the trust departments NHS Choices reviews Identify the reasons for patients with physical disabilities scoring this indicator lower in Clinical Directors & Associate Directors/HR Equality & Patient Experience Manager Equality & Patient Experience Manager/Associate Directors Equality & Patient Experience Manager and Customer Care Manager March 2018 March 2018 March 2018 March 2018 Equality & Patient Experience Manager December 2017 1 In line with the Accessible Information Standard 2016

Objective Action Lead Deadline involved in decisions reasonable adjustment surveys Equality & Patient Experience Manager re care and treatment Monitor improvement is responses from Ward 9 re involvement in decisions re care and treatment (patients with dementia) and highlight any deviation in SQS data packs. January 2018 Objective Action Lead Deadline There is a systematic and consistent approach to analysing patient feedback including triangulation Contribute to monthly SQS data packs and SQS quarterly report. Equality & Patient Experience Manager Patient Experience Officer Quarterly Up to date patient experience data is available for people to access Website updated re patient survey summaries and resulting service improvements All survey leads to produce action plans and follow up reports involving staff in their area by agreed deadlines. Results posters to be developed and displayed in areas where surveys have taken place to inform patients and carers. Equality & Patient Experience Officer Survey leads/ Patient Experience Officer Survey leads/ Patient Experience Officer Quarterly Quarterly review March 2018

APPENDIX 4 List of key policies and other documents informing the strategy How the CQC regulates provider information NHS Five year Forward View (October 2014) Institute for Innovation and Improvement - The Patient Experience Book (2013) Equity and excellence: Liberating the NHS (2010) NICE Clinical Guideline 138 Patient Experience in Adult NHS Services (February 2012) High quality care for all (Darzi; DoH2008) The Kings Fund Point of Care Programme reports: Seeing the Person in the patient (Kings Fund 2009) Making shared decision-making a reality: No decision about me without me. (Kings Fund 2011) Patient Choice: How patients choose and providers respond (Kings Fund 2010) Patient Preferences Matter: Stop the silent misdiagnosis (Kings Fund 2012) Continuity of Care for Older Hospital patients (Kings Fund 2012) What Matters to Patients (King s Fund 2010) https://www.kingsfund.org.uk/projects/time-think-differently/trends-public-attitudesexpectations-services NHS Equality Delivery System 2 https://www.england.nhs.uk/wp-content/uploads/2013/11/eds-nov131.pdf DoH Framework for Patient Experience (2012) Friends and Family Test. DOH (2012) NHS Mandate (2012) NHS constitution NHS England: The Accessible Information Standard 2016

APPENDIX 5 Equality Analysis Equality Analysis (Impact assessment) 1. What is being assessed? Patient Experience Strategy 2017-20 Details of person responsible for completing the assessment: Name: Lyn Bailey Position: Equality & Patient Experience Manager Team/service: Patient Experience State main purpose or aim of the policy, procedure, proposal, strategy or service: (usually the first paragraph of what you are writing. Also include details of legislation, guidance, regulations etc which have shaped or informed the document) To ensure that the trust has a strategic direction for patient experience that all staff are aware of and strive to promote. To ensure best practice is shared. To ensure year on year improvements in ratings of patient experience across the trust. To ensure a fair and equal experience for all whatever their diverse needs and that patients are enabled to give feedback including those from hard to reach groups. 2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who use the service and the staff that provide it. Think about the information below how does this apply to your policy, procedure, proposal, strategy or service 2.1 Give details of RELEVANT information available that gives you an understanding of who will be affected by this document Cheshire East (CE) covers Eastern Cheshire CCG and South Cheshire CCG. Cheshire West & Chester (CWAC) covers Vale Royal CCG and Cheshire West CCG. In 2011, 370,100 people resided in CE and 329,608 people resided in CWAC. Age: East Cheshire and South Cheshire CCG s serve a predominantly older population than the national average, with 19.3% aged over 65 (71,400 people) and 2.6% aged over 85 (9,700 people). Vale Royal CCGs registered population in general has a younger age profile compared to the CWAC average, with 14% aged over 65 (14,561 people) and 2% aged over 85 (2,111 people). Since the 2001 census the number of over 65s has increased by 26% compared with 20% nationally. The number of over 85s has increased by 35% compared with 24% nationally.

Race: In 2011, 93.6% of CE residents, and 94.7% of CWAC residents were White British 5.1% of CE residents, and 4.9% of CWAC residents were born outside the UK Poland and India being the most common 3% of CE households have members for whom English is not the main language (11,103 people) and 1.2% of CWAC households have no people for whom English is their main language. Gypsies & travellers estimated 18,600 in England in 2011. Gender: In 2011, c. 49% of the population in both CE and CWAC were male and 51% female. For CE, the assumption from national figures is that 20 per 100,000 are likely to be transgender and for CWAC 1,500 transgender people will be living in the CWAC area. Disability: In 2011, 7.9% of the population in CE and 8.7% in CWAC had a long term health problem or disability In CE, there are c.4500 people aged 65+ with dementia, and c.1430 aged 65+ with dementia in CWAC. 1 in 20 people over 65 has a form of dementia Over 10 million (c. 1 in 6) people in the UK have a degree of hearing impairment or deafness. C. 2 million people in the UK have visual impairment, of these around 365,000 are registered as blind or partially sighted. In CE, it is estimated that around 7000 people have learning disabilities and 6500 people in CWAC. Mental health 1 in 4 will have mental health problems at some time in their lives. Sexual Orientation: CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) population in CE was estimated at18,700, based on assumptions that 5-7% of the population are likely to be lesbian, gay or bisexual and 20 per 100,000 are likely to be transgender (The Lesbian & Gay Foundation). CWAC - In 2011, the LGBT population in CWAC is unknown, but in 2010 there were c. 20,000 LGB people in the area and as many as 1,500 transgender people residing in CWAC. Religion/Belief: The proportion of CE people classing themselves as Christian has fallen from 80.3% in 2001 to 68.9% In 2011 and in CWAC a similar picture from 80.7% to 70.1%, the proportion saying they had no religion doubled in both areas from around 11%-22%. Christian: 68.9% of Cheshire East and 70.1% of Cheshire West & Chester Sikh: 0.07% of Cheshire East and 0.1% of Cheshire West & Chester Buddhist: 0.24% of Cheshire East and 0.2% of Cheshire West & Chester Hindu: 0.36% of Cheshire East and 0.2% of Cheshire West & Chester Jewish: 0.16% of Cheshire East and 0.1% of Cheshire West & Chester Muslim: 0.66% of Cheshire East and 0.5% of Cheshire West & Chester Other: 0.29% of Cheshire East and 0.3% of Cheshire West & Chester None: 22.69%of Cheshire East and 22.0% of Cheshire West & Chester

Not stated: 6.66% of Cheshire East and 6.5% of Cheshire West & Chester Carers: In 2011, nearly 11% (40,000) of the population in CE are unpaid carers and just over 11% (37,000) of the population in CWAC. No 2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or concerns raised either from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service or its effects on different groups?) 2.3 Does the information gathered from 2.1 2.3 indicate any negative impact as a result of this document? No 3. Assessment of Impact Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy or service (part 1) and looked at the data and research you have (part 2), this section asks you to assess the impact of the policy, procedure, proposal, strategy or service on each of the strands listed below. RACE: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, racial groups differently? Yes x No Explain your response: BME groups are traditionally hard to reach for patient feedback in this area, therefore it is harder to understand their experience and if we are getting it right. National patient surveys are restricted from the centre into English only format, therefore local work must be undertaken. Working in partnership with key local organisations such as Pathways and advertising opportunities for feedback in other languages is essential. We should seek to encourage staff to use telephone interpretation more widely in order to have ongoing dialogue with patients, not just at times of ward rounds and consent. Therefore this strategy represents a positive impact. GENDER (INCLUDING TRANSGENDER): From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender groups differently? Yes x No Explain your response: There is a small but increasing number of trans people accessing trust services and therefore it is difficult to understand their experience. The terminology in data collection in patient surveys could be extended to give trans people the opportunity to identify if they are of a different gender that that assigned at birth. The trust has a trans user and staff support policy. Traditionally it is older women who report difficulties with mixed sex accommodation, but the trust scores well in this area in national and local surveys and no issues have recently been raised via complaints. Therefore this strategy represents a positive impact.

DISABILITY From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, disabled people differently? Yes x No Explain your response: The trust now has a specific survey aimed at people who require reasonable adjustments due to sensory loss or disability in line with the requirements of the Accesible Information Standard 2016. The feedback from Deaf and blind patients is extremely positive. However, when compared against the general patient population, the feedback from physically disabled patients re involvement in decisions re care and treatment scores less well. Investigation into this forms part of the action plan. In the EDS 2017 stakeholder assessment information was presented which showed that older patients were less likely to feel involved in decisions re care and treatment. Further investigation shows that this relates to patients on Ward 9, which has a high number of patients with dementia. This issue is being monitored via the quarterly patient surveys and has shown improvement, but further monitoring will take place throughout the year. Therefore this strategy represents a positive impact for people with a disability. AGE: From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have the potential to affect, age groups differently? Yes x No Explain your response: There is an older population in Cheshire East we need to ensure we review feedback to make sure we have representation from over 85s. Reported poorer patient experience for teens in children s ward this has now resulted in the creation of a section of the play room for older children. Anecdotal information on poorer patient experience for people with learning disabilities who are transitioning (and their carers) further work around transition is ongoing via the Learning Disabilities and Autism Group. There is a need to ensure we get the discharge process right for all people, but particularly older people who may need additional support and who may live alone. Therefore this strategy represents a positive impact. LESBIAN, GAY, BISEXUAL: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual groups differently?yes x No Explain your response: Nationally reported poorer health outcomes and patient experience for people from these groups. The trust has a specific survey for LGBT developed with Age UK Cheshire East. A new webpage on the trust website has been developed and reviewed by Body Positive. The trust receives good ratings from patients who are LGB in patient surveys. Therefore this strategy represents a positive impact. RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief groups differently? Yes x No

Explain your response: If people are not able to practice their religion or belief and pray when they wish to, this will have a detrimental effect on their patient experience. Question as to whether all staff would see this as an integral part of patient experience. The chaplaincy lead is undertaking review of the services on offer and carrying out an EIA. The trust now has a multi-faith prayer facility which patients/carers can be accompanied to. The strategy represents a positive impact. CARERS: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers differently? Yes x No Explain your response: Informing and involving carers is often the deciding factor in what is thought of as a good patient experience, particularly for those with additional needs whose carers are closely involved in supporting them. Therefore this strategy represents a positive impact. OTHER: EG Pregnant women, people in civil partnerships, human rights issues. From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect any other groups differently? Yes x No Explain your response: The strategy recognizes that same sex partners should be accorded the same treatment as heterosexual partners and involved and informed in the same way. - 4. Safeguarding Assessment - CHILDREN a. Is there a direct or indirect impact upon children? Yes x No b. If yes please describe the nature and level of the impact (consideration to be given to all children; children in a specific group or area, or individual children. As well as consideration of impact now or in the future; competing / conflicting impact between different groups of children and young people: The trust must be aware that for some patient involvement and feedback exercises, parental consent will be required. c. If no please describe why there is considered to be no impact / significant impact on children 5. Relevant consultation Patient Reference Group, Body Positive North West, Trust LGBT network, Age UK Cheshire East, Trust staff as outlined in strategy document. 6. Date completed: 20.7.17 Review Date: July 2020 7. Any actions identified: Have you identified any work which you will need to do in the future to ensure that the document has no adverse impact?

Action Lead Date to be Achieved 8. Approval At this point, you should forward the template to the Trust Equality and Diversity Lead lynbailey@nhs.net Approved by Trust Equality and Diversity Lead: Date: July 2017 and reviewed after final amends to policy 23.10.17