Deciding Together: Equalities analysis for the in patient scenarios NHS Newcastle Gateshead CCG
Project title: Authors: Owner: Customer: Equalities analysis for the in patient scenarios Deciding Together Helen Fox Caroline Latta Wendy Kaiser Chris Piercy NHS Newcastle Gateshead CCG NB: This is, by nature, an iterative document. It will be important to note the change record of this document as it moves through its various iterations. Key milestones for publication of this document will link to the phases of consultation: Change Record Date Author Version Summary of Changes 11/11/15 Helen Fox Version 1 4/05/16 Wendy Kaiser Version 2 Contributors Name Helen Fox Caroline Latta Wendy Kaiser Position Senior Communications Manager, NECS Senior Communications and Engagement Locality Manager, NECS Transformation & Delivery Manager, NECs Page 2 of 23
1. Executive summary... 4 2. Introduction... 4 2.1 Public sector equality duties 5 2.2 The nine protected characteristics of the equality act 2010... 5 2.3 What is equalities analysis... 6 2.4 When should equality analysis be done?... 7 3. Newcastle Gateshead CCG's vision for mental health 3.1 Summary of why change is needed... 7 3.2 Scenarios for change for in patient services... 9 4. Impact on equality characteristics... 10 4.1 Equality characteristics relevance test... 11 5. Equality analysis update schedule... 222 6. What have we learnt through the process... 22 Page 3 of 23
1. Executive summary This document sets out why Newcastle Gateshead CCG is required to assess its proposals for mental health in patient services redesign in terms of the impact on the special characteristics set out in the Equality Act 2010. It describes the 9 protected characteristics and assesses how they will be addressed in each of 5 scenarios for in patient services reprovision. The key characteristic which requires mitigation is support for carers, specifically to travel to visit service users. It requests feedback from the public, service users and carers around the equality assessment and sets out a range of mechanisms to do so. 2. Introduction Newcastle Gateshead CCG is fully committed to ensuring that it commissions a fair and equal service to all. No one should have a lesser service because of their difference. Equality Analysis part of this process and it is an instrument that helps to analyse a policy/service/function or project in relation to its impact on various groups of people living within the demographic regions of the Newcastle and Gateshead. The process of completing Equality Analysis is meant to be a positive process, getting an Equality Analysis right means high quality fairer services for all. Equality is about creating a fairer society where everyone has the opportunity to participate and fulfil their potential. It is mostly backed by legislation designed to address unfair discrimination based on membership of a particular group. Diversity is all about differences in people and how we should recognise and value them. In relation to the CCG, diversity is about creating a culture that promotes positive practices that recognise, respect and value our diversity for the benefit of staff and members of the public. Prejudice and Discrimination focuses on how to understand equality, diversity and fairness it is important to have a good understanding of the term prejudice, discrimination and values. Prejudice (the thoughts) is the pre-judgemental thoughts of an individual or group based on little or no fact and have negative assumptions about others who differ from us. Discrimination is prejudice in action and occurs when a person is treated less favourably than another Institutional Discrimination occurs when the culture, policies, systems and procedures in an organisation inherently discriminate against a group or groups of people. This happens because the systems and processes were designed without taking into account the diverse needs of groups within the community in relation to e.g. their race, disability, gender, gender identity/reassignment, sexual orientation, religion or belief, age, pregnancy and maternity and marriage and civil partnership status. Page 4 of 23
This Equality Analysis supports the assessment of how a decision or any policy, strategy, function or service will affect different groups of people by identifying any adverse impacts and by identifying alternative approaches which might lessen any negative impacts and more effectively promote equality of opportunity for all. 2.1 Public sector equality duties The general and specific duties are set out in Appendix 1 section 149 of the Equality Act. A public authority must, in the exercise of its functions, have due regard (take seriously) to the need to eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act Advance equality of opportunity between people who share a protected characteristic and those who do not. Foster good relations between people who share a protected characteristic and those who do not The public sector equality duties are unique pieces of equality legislation. They give public bodies, including further and higher education institutions legal responsibilities to demonstrate that they are taking action on equality in policymaking, the delivery of services and public sector employment. The duties require public bodies to take steps not just to eliminate unlawful discrimination and harassment, but also to actively promote equality. The Equality Act and duties can be found at http://www.legislation.gov.uk/ukpga/2010/15/contents 2.2 The Nine Protected Characteristics of the Equality Act 2010 The Equality Act 2010 applies to all organisations that provide a service to the public or a section of the public (service providers). It also applies to anyone who sells goods or provides facilities. It applies to all our services, whether or not a charge is made for them. The Act protects people from discrimination on the basis of a protected characteristic. The relevant characteristics for services and public functions are: Disability Gender reassignment Pregnancy and maternity Race Religion or belief Sex Sexual orientation Marriage and Civil Partnership (named purposely in the equality act 2010. This protected characteristic was linked to the now retired sex discrimination act where people were protected on their marital status). Page 5 of 23
Age (under the Equality Act from April 2012 until then The Employment Equality (Age) Regulations 2006 still applied) 2.3 What is equalities analysis Public authorities are responsible for making a wide range of decisions, from the contents of overarching policies and budget setting to day-to-day decisions which affect specific individuals. Equality analysis is a way of considering the effect on different groups protected from discrimination by the Equality Act 2010, such as people of different ages. There are two reasons for this: To consider if there are any unintended consequences for some groups To consider if the policy will be fully effective for all target groups It involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of your functions, policies or decisions. It can help you to identify practical steps to tackle any negative effects or discrimination, to advance equality and to foster good relations. Not all policies can be expected to benefit all groups equally, particularly if they are targeted at addressing particular problems affecting one protected group. An example would be a policy to improve the access of learning disabled women to cancer screening services. Policies like this, that are specifically designed to advance equality, will, however, also need to be analysed for their effect on equality across all the protected groups. This is because any one group is likely to have several protected characteristics within it. For example, a policy on tackling gender based violence will need to analyse its potential effect on ethnic minority communities as well as gay and disabled people. An effective equality analysis will help to make sure that you are aware of any particular needs and the likely wider effects of implementing the policy. The Equality Analysis process focuses on seven stages of activity: Stage one: Define the proposal for change and the rationale behind it. Consider the expected outcomes, who will be impacted and how will it be delivered Stage two: Screen for relevancy to the Equality Act. Will the proposal impact upon different groups either positively or negatively? Stage three: Collect evidence to identify potential impacts and any options for mitigation Stage four: Consult/engage with the public Stage five: Review evidence collected from stages three and four and determine whether the proposal should: continue unchanged; continue with modifications; or not proceed Stage six: Publish the equality analysis Stage seven: Monitor and review the service change Page 6 of 23
2.4 When should equality analysis be done? Equality analysis starts prior to policy development or at the early stages of a review. It is not a one-off exercise; it is an on-going and live document and enables equality considerations to be taken into account before a decision is made. This Equality Impact Assessment supports the decision in principle around the reprovision of acute in patient facilities. Further Equalities Impact assessment will be required when the proposals for community services are developed. Equality analysis of proposed policies will involve considering their likely or possible effects in advance of implementation. It will also involve monitoring what actually happens in practice. Waiting for information on the actual effects will risk leaving it too late for your equality analysis to be able to inform decision-making. 3. Newcastle Gateshead CCG s vision for mental health A Mental Health Programme Board has been created to help the CCG transform the way people in Newcastle and Gateshead are supported when they, or people close to them, experience mental health issues. The board seeks to make improvements through developing and better coordinating the commissioning and delivery of all services, from preventative through to highly specialist services. The principles of the mental health programme board include: Being bold, brave and creative Ensuring service users see the right person, at the right time, and the right place Improving service quality and patient experience, safety and effectiveness Ensuring carer and user focused outcomes Ensuring there is engagement and involvement Recognising diversity and the need to ensure equality Hope, meaningful choice and control, and recovery orientated The membership of the board includes the clinical commissioning groups, Newcastle and Gateshead local authorities, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, South Tyneside NHS Foundation Trust and Gateshead NHS Foundation Trust. There are also key groups representing service users and carers, such as voluntary sector advisory group (mental health) known as VOLSAG, Launchpad, Advocacy Centre North, Gateshead Mental Health User Voice, Gateshead Crossroads and Newcastle Carers Centre. 3.1 Summary of why change is needed 3.1.1 National The most recent and key strategic document for the NHS published in October 2014 is the NHS Five Year Forward View. It describes how the NHS needs to: Page 7 of 23
NHS Newcastle Gateshead CCG: equalities analysis for Deciding Together Become a social movement Be a better partner to local communities Develop new partnerships with communities, local authorities and employers Find new solutions through new models of care as the NHS is too diverse for one size fits all Break down barriers in how care is provided It also emphasises the focus on parity of esteem to ensure mental health is valued equally to physical health and to achieve this by 2020. The key over-arching strategic direction for mental health is described in No health without mental health (H.M. Government 2011) It identified four main ways of increasing value for money in mental health services: 3.1.2 Local Improving the quality and efficiency of current services Radically changing the way that current services are delivered so as to improve quality and reduce costs Shifting the focus of services towards promotion of mental health, prevention of mental illness and early identification and intervention as soon as mental illness arises Broadening the approach taken to tackle the wider social determinants and consequences of mental health problems Nationally, the NHS is facing growing demands and increased costs, with funding unlikely to increase. The CCG s strategic plan includes objectives, which apply equally to mental health and physical health, to: Increase the number of people with mental and physical health conditions having a positive experience of care outside of hospital, in general practice and in the community Reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital The CCG s vision for the model of health service provision in 2018/19 is that it will be as equally focussed on improving mental health as it is on physical health and that patients, young or old with mental health problems, do not suffer inequalities. In order to ensure parity of esteem for mental health we will address the 25 areas identified in Closing the Gap: priorities for essential change in mental health, DoH, January 2014. The CCG s mental health commissioning agenda is focused on: Health outcomes ensuring patients move to recovery quickly and are supported to manage their condition, Quality of life, enabling more people to live their lives to their full potential Page 8 of 23
NHS Newcastle Gateshead CCG: equalities analysis for Deciding Together Early intervention, improving health and wellbeing through prevention and early intervention The CCG expect these overarching work programmes to support the reduction in the 20 year gap in life expectancy for people with serious mental illness. They will consider how they can adopt the following models and strategies to help achieve the reduction: A fully integrated model of mental healthcare Robust whole population emotional health and wellbeing strategies Comprehensive primary care services Redesigned specialist services Re-provision of inpatient services Implementation of the national dementia strategy Financially, in-line with national requirements the CCG are expecting Northumberland, Tyne and Wear NHS Foundation Trust to deliver services for the population of Newcastle and Gateshead within a reduction in funding of around 20% over five years (4% each year). 3.2 Scenarios for change Further information about the different scenarios for change can be found in the CCG website, www.newcastlegatesheadccg.nhs.uk. At this phase of the consultation and business case development, the Equalities Impact Assessment is focused on the 5 scenarios for acute in patient mental health service provision. Further Equalities Impact Assessment will take place for the proposed community services developments following the decision in principle on 24 th May 2016 around the in patient facilities. Page 9 of 23
3.2.1 The different ways inpatient services could be arranged NTW trust wide based scenario T: The adult acute assessment and treatment service for Newcastle and Gateshead residents being provided from NTW s hospital at St George s Park, Morpeth (two additional wards to be provided there) and from NTW s hospital at Hopewood Park, Sunderland (one additional ward to be provided there) The rehabilitation service currently at St Nicholas Hospital, Newcastle being provided from St George s Park; Elm House in Gateshead would be retained as a moving on rehabilitation unit Newcastle based scenario N: The adult acute assessment and treatment service (three wards) for Newcastle and Gateshead residents being provided from St Nicholas Hospital, Newcastle The rehabilitation ward at St Nicholas Hospital, Newcastle would provide complex care and Elm House in Gateshead would be retained as a moving on rehabilitation unit Gateshead based scenario G: The adult acute assessment and treatment service (three wards) for Newcastle and Gateshead residents being provided from a location to be identified in Gateshead A complex care rehabilitation ward would also be provided at the same location as above. Elm House in Gateshead would be retained as a moving on rehabilitation unit. 3.2.2 Older people s mental health services, for Newcastle residents Newcastle scenario 1: The older people's service being provided from St Nicolas Hospital, Newcastle Morpeth scenario 2: The older people's service being provided from St George's Park, Morpeth 4. Impact on equality characteristics As part of the consultation process for Deciding Together in Newcastle and Gateshead, the CCG IS reviewing how the proposed changes could affect each of the protected characteristics. Each of the proposed scenarios will be reviewed in turn within this section. The consultation process which took place from 13 November 2015 to 12 February 2016 provides an ongoing opportunity for the CCG to review this assessment in the light of feedback from the public and stakeholders. For each protected characteristic, a decision based on the best evidence gathered will be made based on the following information: Page 10 of 23
NHS Newcastle Gateshead CCG: equalities analysis for Deciding Together Positive impact Neutral impact Negative impact This analysis will also be updated on a frequent basis and published on the CCG website. 4.1 Equality characteristics relevance test This document invites the public to challenge, comment or express any views about any of the protected characteristics as part of the relevancy testing in the Deciding Together Consultation process. The protected characteristics are outlined in each of the following tables in this section. The CCG are keen to learn whether any person or groups of people defined as one of the equalities characteristics, feels that any of the proposals being discussed in the consultation would have a greater impact on them, whether positive or negative, than other sections of the population. If you believe this to be the case please advise us by providing us with information of what you think the increased impact will be, why and/or how you have reached this conclusion, and if negative, how such impact or impacts could be reduced or eliminated. If it is decided there is no impact on a particular protected characteristic, then we will explain why there will be no further direct investigation. However, if any evidence based submission contradicts the relevancy testing evidence, the CCG will investigate further. Throughout the ongoing processes, actions to mitigate/opportunities to promote will be updated. Page 11 of 23
4.1.1 The different ways in-patient services could be arranged 4.1.1.1 NTW trust wide based scenario T NTW trust wide based scenario T Please detail any positive, negative or impacts that this policy/ service/ project may have for people from the below groups. Protected Characteristics Potential issues identified For example: Positive- e.g. Improves access to services Neutral- e.g. It is an additional service. Negative- e.g. The service is only open between certain hours Evidence Age Patients are treated in environments appropriate to their needs rather than according to their age. Some patients using adults services will be over 65 years and some people using older peoples services will be under 65 years of age. Disability positive Ward refurbishments & new builds will be Equality Act compliant. SGP & HWP are purpose built modern facilities which lend themselves to best practice in environmental design. Gender Reassignment Positive Neutral Elm House has a lift & accessible showers on each floor. Ward reburbishments & new builds have en suite facilities. Elm House has separate floors for men & women. Any patient Actions to Mitigate/ Opportunities to Promote Page 12 of 23
Marriage and Civil Partnership Pregnancy And Maternity Race Religion and belief Sex Sexual Orientation positive Positive Positive presenting as undergoing gender reassignment would be placed on the floor for the gender they were presenting in. Specialist regional mother & child mental health services are already on site at SGP. Prayer facilities are already on site at SGP & HWP. Menu choices for religious & belief requirements are already available on these two sites. Chaplaincy for all faiths is available when required. Specific guidance for caring for Sikhs & Muslims is available for staff. Ward reburbishments & new builds have en suite facilities. Elm House has separate floors for men & women. Ward reburbishments & new builds have en suite facilities. Elm House has separate floors for men & women. Any patient presenting as undergoing gender reassignment would be placed on the floor for the gender they were presenting in. Carers negative Travel times & travel costs are the highest of all the options for carers Socio-economic Support to travel plans Monitoring of service users & carers experiences & views. Page 13 of 23
4.1.1.2 NTW trust wide based scenario N NTW trust wide based scenario N Please detail any positive, negative or impacts that this policy/ service/ project may have for people from the below groups. Protected Characteristics Potential issues identified For example: Positive- e.g. Improves access to services Neutral- e.g. It is an additional service. Negative- e.g. The service is only open between certain hours Evidence Age Patients are treated in environments appropriate to their needs rather than according to their age. Some patients using adults services will be over 65 years and some people using older peoples services will be under 65 years of age. Disability Gender Reassignment Marriage and Civil Partnership Pregnancy And Maternity Race Positive Positive Ward refurbishments & new builds will be Equality Act compliant. Elm House has a lift & accessible showers on each floor. Ward reburbishments will have en suite facilities. Elm House has separate floors for men & women. Any patient presenting as undergoing gender reassignment would be placed on the floor for the gender they were presenting in. Religion and Prayer facilities are already on site Actions to Mitigate/ Opportunities to Promote Page 14 of 23
belief at SNH. Menu choices for religious & belief requirements are already available on site. Chaplaincy for all faiths is available when required. Specific guidance for caring for Sikhs & Muslims is available for staff. Sex Ward reburbishments have en suite facilities. Sexual Orientation Elm House has separate floors for men & women. Ward reburbishments have en suite facilities. Elm House has separate floors for men & women. Carers negative Travel assessment shows increased travel time for all carers & increased costs for Gateshead carers. Socio-economic Travel plans Care plans Page 15 of 23
4.1.1.3 Gateshead based scenario G Gateshead based scenario G Please detail any positive, negative or impacts that this policy/ service/ project may have for people from the below groups. Protected Characteristics Potential issues identified For example: Positive- e.g. Improves access to services Neutral- e.g. It is an additional service. Negative- e.g. The service is only open between certain hours Evidence Age Patients are treated in environments appropriate to their needs rather than according to their age. Some patients using adults services will be over 65 years and some people using older peoples services will be under 65 years of age. Disability positive Ward refurbishments & new builds will be Equality Act compliant. Gender Reassignment Marriage and Civil Partnership Pregnancy And Maternity Race Positive Elm House has a lift & accessible showers on each floor. New builds & ward reburbishments will have en suite facilities. Elm House has separate floors for men & women. Any patient presenting as undergoing gender reassignment would be placed on the floor for the gender they were presenting in. Religion and Prayer facilities would be incorporated into the new build Page 16 of 23 Actions to Mitigate/ Opportunities to Promote
belief facility. Menu choices for religious & belief requirements are already available as NTW services. Chaplaincy for all faiths is available when required. Specific guidance for caring for Sikhs & Muslims is available for staff. Sex New builds & ward reburbishments will have en suite facilities. Sexual Orientation Elm House has separate floors for men & women. New builds & Ward reburbishments have en suite facilities. Elm House has separate floors for men & women. Carers negative Travel assessment shows increased travel time for Newcastle carers & slightly increased costs for all carers. Socio-economic Travel plan Page 17 of 23
4.1.2 Older people s mental health services, for Newcastle residents 4.1.2.1 Newcastle based scenario 1 Newcastle based scenario 1 Please detail any positive, negative or impacts that this policy/ service/ project may have for people from the below groups. Protected Characteristics Potential issues identified For example: Positive- e.g. Improves access to services Neutral- e.g. It is an additional service. Negative- e.g. The service is only open between certain hours Evidence Age Patients are treated in environments appropriate to their needs rather than according to their age. Some patients using adults services will be over 65 years and some people using older peoples services will be under 65 years of age. Disability positive Ward refurbishments & new builds will be Equality Act compliant. Actions to Mitigate/ Opportunities to Promote Gender Reassignment Marriage and Civil Partnership Pregnancy And Maternity Race Religion and belief New builds & ward reburbishments will have en suite facilities Prayer facilities would be incorporated into the refurbished facility. Menu choices for religious & belief requirements are already available as NTW services. Page 18 of 23
Chaplaincy for all faiths is available when required. Specific guidance for caring for Sikhs & Muslims is available for staff. Sex positive Ward reburbishments will have en suite facilities Sexual Orientation positive Ward reburbishments will have en suite facilities Carers Travel will be to SNH rather than to NGH Socio-economic Page 19 of 23
4.1.2.2 Morpeth scenario 2 Morpeth scenario 2 Please detail any positive, negative or impacts that this policy/ service/ project may have for people from the below groups. Protected Characteristics Potential issues identified For example: Positive- e.g. Improves access to services Neutral- e.g. It is an additional service. Negative- e.g. The service is only open between certain hours Evidence Age Patients are treated in environments appropriate to their needs rather than according to their age. Some patients using adults services will be over 65 years and some people using older peoples services will be under 65 years of age. Referral pathways between older peoples mental health services & acute services are already in place at SGP. Disability positive New builds & ward refurbishments will be Equality Act compliant. Actions to Mitigate/ Opportunities to Promote Gender Reassignment Marriage and Civil Partnership Pregnancy And Maternity Race Religion and belief positive New builds & ward reburbishments will have en suite facilities Prayer facilities are already available on site at SGP. Menu choices for religious & belief requirements are already available Page 20 of 23
as NTW services. Chaplaincy for all faiths is available when required. Specific guidance for caring for Sikhs & Muslims is available for staff. Sex positive Ward reburbishments will have en suite facilities Sexual Orientation positive Ward reburbishments will have en suite facilities Carers negative Travel costs & times are higher for all carers. Socio-economic Travel plans Care plans The general public, service users and carers are invited to comment on the equality impact assessment set out above. If you believe the assessment is not complete or accurate please advise us by providing us with information of what you think the increased impact will be, why and/or how you have reached this conclusion, and if negative, how such impact or impacts could be reduced or eliminated by using any of the following methods. Should there be any issue which causes concerns as to potential negative impacts of the in patient mental health services redesign in regard to any of the protected equality characteristics above, the CCG will develop an action plan to remove or mitigate this impact. This will be made publicly available. Ways you can get in touch: Method How Answer a survey Available online at www.newcastlegatesheadccg.nhs.uk Email us ngccg.enquiries@nhs.net Twitter @NHSngccg #decidingtogether Facebook page www.facebook.com/decidingtogether Write to us at Deciding Together public consultation NHS Newcastle Gateshead Clinical Commissioning Group Goldcrest Way Newburn Riverside (Business Park) Newcastle upon Tyne NE15 8NY Call us on 0191 217 2670 Page 21 of 23
5. Equality Analysis update schedule The equality analysis process is iterative and has been updated throughout the consultation process. The key dates that were scheduled for the consultation were as follows: Consultation period February 16 to May 16 12 th February 2016 Consultation period ends (13 weeks) 15 th February 2016 Analysis of feedback starts by an independent organisation - not the NHS. 21 March 2016 to 11 th April 2016 Publication of the feedback report from the consultation to public on the website www.newcastlegatesheadccg.nhs.uk Two public feedback sessions to be arranged and promoted to the public 26 th April 2016 CCG governing body consider preferred scenarios for acute and rehabilitation services and older people s services 9 th May 2016 Complete full business case document 24 th May 2016 CCG Governing Body Meeting held in public decision in principle around preferred acute in patient services provision made Post 24 th May 2016 Decision in principle communicated to stakeholders and the public. Options for redesigned community services developed. Timeframe to be specified. Further Equalities Impact Assessment. Further events will be published on the CCG website. Also any updates to the equality analysis will be published on the website. 6. What have we learnt through the process The Equality Impact Assessment for the in patient facilities has revealed that the key equality issue for the decision in principle is travel time and costs for carers. Therefore the mitigating actions required need to be developed alongside the plans for delivery of the selected scenario. Further consultation and equality impact assessment will be required on the proposals for redesigned community services when they develop in the next phase. Page 22 of 23
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