Equality, Good Relations and Human Rights SCREENING TEMPLATE

Equality, Good Relations and Human Rights SCREENING TEMPLATE Note: 1) Proposals cannot be implemented until an Equality Screening or EQIA has been completed 2) This template should be completed in conjunction with the accompanying Guidance Notes 3) Completed Screening Templates are public documents and will be posted on the Trust s website Section 1: INFORMATION ABOUT THE POLICY/PROPOSAL (1.1) Name of the policy/proposal Winter planning safety initiative to ensure Safe and Effective Care in Older Peoples Acute Services (1.2) Status of policy/proposal (please underline) New Existing Revised (1.3) Department/Service Group: (please underline) (1.4) Description of the policy including intended aims/outcomes Corporate Services Group (Please specify) Nursing and User Experience Unscheduled and Acute Care Surgery & Specialist Services Specialist Hospitals & Women s Health Children s Community Services Adult Social & Primary Care This proposal involves the temporary down-turning of Ward 1 Meadowlands, which provides acute services for older people and accordingly the redeployment of staff to older people's acute wards. The Trust will instead provide appropriate services in the community and fund a multi-disciplinary team to ensure the full needs of service users are met. This temporary initiative is a contingency measure to last 6 months. It is the intention of the service to re-open Ward 1 Meadowlands after 6 months assuming nursing vacancies have been filled. Context Older people s acute care wards have experienced challenging levels of nurse vacancies and turnover of staff for a number of years. These wards are located in the BCH, 3 wards (75 beds), Stroke Unit (34 beds), Mater Ward C (18 beds) and Meadowlands (68 beds). This risk remains on the service risk register and mitigation measures are continuously being worked on. Despite significant efforts, Older People s Wards and the Stroke Unit have been unable to recruit and retain nurse vacancies. In addition, it is recognised that Stroke and Older People s

Wards are often a minority choice for new nurses given the extent of choice for career opportunities in nursing generally. This is also a factor in the level of turnover experienced by the service area which is sitting at 5.9%. However, one ward has seen over 34% turnover. Absence levels within the Older People s Wards are frequently above the DHSSPS target of 5% which can be a contributory factor. The cumulative impact of vacancies and absence levels has resulted in the temporary downturn of 3 beds in the Stroke Unit. This is being kept under review. The current closure of these acute medical beds is having a negative impact on the total patient care and patient flow system across the hospital system and this is particularly evident during the winter period. A Meadowlands consultant-led survey in summer 2016 highlighted that 18% of patients did not need to be admitted to Meadowlands 39% of patients primary need was rehabilitation. 21.5% of patients required subacute medical and rehabilitation. 21.5% required subacute medical care only. It is evident that at least 50% of the patient population in Meadowlands could receive their care safety and effectively outside a hospital environment. This proposal involves the following: Temporary down-turning Ward 1 Meadowlands and reproviding the appropriate service in the community. Providing opportunities for all grades of nursing across all three wards to transfer to BCH OP wards and Stroke Unit. Opportunities for APH/SW staff to work in community setting. Reprovision of a community based service for patients requiring multi-disciplinary rehabilitation or interim assessment beds. The service area would commission on a fixed term basis 15 community intermediate care beds in a nursing home setting with a

Trust multi-disciplinary team providing rehabilitation and discharge planning. The advantages of this proposal are: Critical vacancies and gaps could be filled on the acute wards allowing the service to open the 12 beds and provide a full capacity service to frail older people. This returns 4380 bed days (annualised) and 398 patients (ALOS 11 days) and 33 patients per month to the acute system. This in turn would facilitate more urgent direct admissions and transfers from the RVH restoring essential resilience to the wider acute system. A community based intermediate care unit in the community supported by a Trust multidisciplinary team could provide evidence based effective rehabilitation in a homely environment closer to home. The unit would provide 15 beds in single rooms 8 with en-suite and areas suitable for rehabilitation activity situated in south Belfast. The Trust would commission 15 beds providing 5,475 beds per annum (with an ALOS of 22 days) for 248 patients at a rate of 20 patients per month. (1.5) How will the policy/proposal be implemented? The reduction of beds of Meadowlands will also encourage hospital teams in RVH and BCH discharge patients directly to a community setting whether the community intermediate beds of with home based rehabilitation rather than an inappropriate diversion to another hospital bed. Furthermore up to 50% of discharges from Meadowlands utilize the community rehabilitation services. 2 briefing sessions were held on 15 and 16 November with all Meadowlands staff and the Director of Nursing and Assistant Director of Nursing for Older People s services, the Nursing Workforce Manager, all AHPs and Social Work Attendants. Meetings with trade Unions were held. Previous to these meetings, a separate meeting with Trade Unions had taken place to discuss the proposals.

The Trust s Organisational Management of Change Framework was employed in the consultation and implementation of this policy. All staff personal circumstances, existing working arrangements, annual leave etc. were honoured. It was agreed by all parties that this would be a temporary measure. (1.6) Who are the internal and external stakeholders (actual or potential) that the policy/proposal could impact upon? (E.g. service users/staff/ other public sector organisations/trade unions/ professional bodies/independent, voluntary or community sector) Older people current and future patients Families and carers Belfast Trust staff Trade unions External nursing care providers Section 2: CLASSIFICATION OF POLICY The purpose of this Section is to identify those policies/proposals which have no impact on equality e.g. policies of a purely clinical or technical nature. It should be noted however that the majority of policies /proposals will have some equality impact on staff and/or service users and will require the completion of the entire template.

PART A: (2A.1) Is there an impact on equality of opportunity for those affected by this policy, for each of the S75 equality categories? (2A.2) Are there better opportunities to promote equality of opportunity for people within the S75 categories? (2A.3) Does the policy impact upon good relations between people of a different religious belief, political opinion or racial group? (2A.4) Are there opportunities to better promote good relations between people of a different religious belief, political opinion or racial group? (2A.5) Are there opportunities to encourage disabled people to participate in public life and promote positive attitudes toward disabled people? (2A.6) Does the policy/proposal impact on Human Rights? Yes No (2A.7) If you have answered Yes to any of the above questions proceed to Section 2B overleaf. If you have answered No to all of the above questions the policy may be screened out at this stage. Please give reasons supporting this decision below then sign and date below then forward to the Health & Social Inequalities Team for consideration Lesley.Jamieson@belfasttrust.hscni.net Approved Lead Officer: Position: Date: Countersigned by: Health Inequalities Manager: Employment Equality Manager: S75 Equality Categories: Age Dependants Disability Gender Marital - Civil Partnership Status Political Opinion Race Religion Sexual Orientation

PART B (2B.1) Are there any factors that could contribute to/detract from the intended aim/outcome of the policy/ proposal? Financial, legislative or other constraints? The planned re-opening of Ward 1 Meadowlands is dependent on filling nursing vacancies on the Belfast City Hospital and Royal Victoria Hospital sites. (2B.2) Other policies/strategies/information with a bearing on this policy/proposal (for example internal or regional policies) - What are they and who owns them? Winter Escalation Plan BHSCT Framework on the Management of Staff affected by Organisational Change and Staff Re-deployment Protocol - Checklist for managing a change project - Staffing structure mapping tool - Reform and modernisation programme pro-forma

(2B.3) Provide details of how you have or how you intend to involve stakeholders (refer 1.6 above) when screening this policy/proposal On-going consultation with HR, to include: - Workforce model Workforce Modernisation Team - Health and Social Inequalities Team - Employment Equality Team - Staff engagement will take place through briefing sessions and one to one meetings. - Provide consultation paper to Trade Unions to request union representation. - Trade Union Representatives invited to the communication briefing sessions with staff in November 2017 - Monthly communication briefing sessions with Trade Union Representaives regarding recruitment progress and The following processes are underway or in planning. Preliminary discussions at senior clinical and management level. Meeting with key stakeholders Preparation of briefing paper for submission to Director and Executive Team Meetings with Meadowlands Teams Meetings with medical team Details of priority vacancies immediately. One to One discussions with staff where required or requested Staff Consultation This consultation was carried out in accordance with the BHSCT Framework on the Management of Staff affected by Organisational Change and Staff Re-deployment Protocol and will encompass: Circulation of a consultation paper to affected staff Open staff briefing meetings held November 2016 Senior managers will be available to speak to staff in smaller groups or individually as required Circulation of written updates to staff Staff encouraged to speak to their line manager, their TU representative or member of

Human Resources about the change Staff will have the opportunity to submit written responses/comments during the consultation period via their line manager or trade union representative. Section 3: AVAILABLE EVIDENCE, CONSIDERATION OF IMPACTS AND MITIGATION Additional engagement took place with the fractures Clinic and Unscheduled Care colleagues. An operational policy and referral pathway was devised and shared with all internal stakeholders. One to one meetings were held with staff. All personal preferences were discussed and agreed at these meetings. Older peoples representative organisations and other groups were also informed of this proposal. These included Patient Client Council, the Commissioner for Older People for NI, Healthy Ageing Strategic Partnership, Local Commissioning Group. You will need to collect quantitative and qualitative equality data for those service users and staff affected using the templates provided in Tables 1 & 2 at the end of this document. Taking into account this data and the information gathered in Sections 1&2 you should now identify, for each of the nine Section 75 categories, the level of impact, mitigation measures and opportunities to better promote equality of opportunity. NB: Where both staff and service users are impacted, a separate table for each is required. 3A) SERVICE USERS Equality Category Level of Impact Mitigation Measures and consideration of alternative policies or actions that might lessen the severity of the equality impact (where Major or Minor Impact Major Minor None identified) Age All service users in Meadowlands are aged 65+. Many will be aged 80+. The Trust believes that the provision of high quality community beds for patients who require them, and the provision of a highly-skilled multi-disciplinary team of healthcare professionals (see 7.2 below) will ensure that there will be no adverse impact on service users. In addition, as this is a temporary initiative, any patient who requires acute care will receive it in Meadowlands Ward 1 after the 6-month period of this

initiative is complete, subject to sufficient nursing levels. Dependant Status Disability As above. Gender Marital Status Race (Ethnicity) Religion Political Opinion Sexual Orientation Multiple Identity e.g. disabled minority ethnic people or young Protestant men. 3B) STAFF Equality Category Level of Impact Mitigation Measures and consideration of alternative policies or actions that might lessen the severity of the equality impact (where Major or Minor Impact Major Minor None identified) Age The service will constructively engage with those affected and ensure that it adheres to the Organisations Management of Change Framework. Dependant Status In line with this process staff will be offered the opportunity to discuss in Disability one to one meetings any adverse impact on equality grounds. Gender

Marital Status Race Ethnicity Religion Nationality Community Background Religious Belief Political Opinion Sexual Orientation Multiple Identity e.g. female staff with caring responsibilities With a higher female workforce there may be a greater potential for female staff with caring responsibilities requesting flexible working options. All flexible working options and applications should be discussed and seriously considered whether or not for female/male staff. Section 4: GOOD RELATIONS To what extent is the policy/proposal likely to impact on good relations between people of different religious belief, political opinion or racial group? Good relations category Level of impact Mitigation Measures and consideration of alternative policies or actions that might lessen the severity of the equality impact (where Major or Minor Impact Major Minor None identified) Religious belief Political opinion No impact on Good Relations has been identified.

Racial group Section 5: DISABILITY DUTIES How does the policy/proposal or decision currently encourage disabled people to participate in public life and promote positive attitudes towards disabled people? Consider what other measures you could take. For example, have staff received disability equality training or training on the Trust s Patient and Client Experience Standards? Staff of Belfast Trust can avail of Disability Awareness training which is provided on a regular basis by the Health & Social Inequalities team. Staff will be made aware of the Trust s Making Communication Accessible Guide to assist communication with persons with a disability. Section 6: HUMAN RIGHTS Does the policy/proposal affect human rights in a positive or negative way? NB: If you identify potential negative impact in relation to any of the Articles seek advice from your line manager and/or a representative from the Equality Team. It may also be necessary to seek legal advice. Article Positive impact Negative impact A2: Right to life A3: Right to freedom from torture, inhuman or degrading treatment or punishment A4: Right to freedom from slavery, servitude & forced or compulsory labour A5: Right to liberty & security of person A6: Right to a fair & public trial within a reasonable time A7: Right to freedom from retrospective criminal law & no punishment without law A8: Right to respect for private & family life, home and correspondence. A9: Right to freedom of thought, conscience & religion A10: Right to freedom of expression Neutral impact

A11: Right to freedom of assembly & association A12: Right to marry & found a family A14: Prohibition of discrimination in the enjoyment of the convention rights 1st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education Please outline any actions you will take to promote awareness of human rights and evidence that human rights have been taken into consideration in decision making processes. The Human Rights Act 1998 extends to all nursing homes insofar as they provide care to people who are partly or wholly funded by a HSC Trust. As such, patients of Belfast Health & Social Care Trust who will be treated in a community setting as a result of this temporary down-turning of Ward 1 Meadowlands will have full protections under the Human Rights Act 1998. A negative impact is where human rights have been interfered with or restricted Section 7: SCREENING DECISION Major Minor None (7.1) How would you categorise the impacts of this policy/proposal? (7.2) If you have identified any impact, what mitigation have you considered to address this? This move is temporary in nature and will enable the closed beds in ward 7north BCH to fully open to meet the demands of Winter Pressures. It is planned that Ward 1 Meadowlands will reopen after 6 months. With the beds temporarily downturned in Meadowlands the service area would commission on a fixed term basis 15 community intermediate care beds in a nursing home setting with a Trust multi-disciplinary team providing rehabilitation and discharge planning (7.3) Do you consider the policy/proposal needs to be subjected to on-going screening? Yes No Reasons This is a temporary proposal. The screening will be reviewed in 6 months time. (7.4) Do you think the policy/proposal should be subject to Yes No Reasons

an Equality Impact Assessment (EQIA)? NB: A full Equality Impact Assessment (EQIA) is usually confined to those policies or proposals considered to have major implications for equality of opportunity. (7.5) Monitoring- Please detail how you will monitor the effect of the policy/proposal for equality of opportunity and good relations, disability duties and human rights? As this is an ongoing screening, Trust Equality representatives will be in regular contact with service area managers to assess any impact on equality, human rights or good relations for either staff or service users. Please sign and date below and forward to the Health & Social Inequalities Team Lesley.Jamieson@belfasttrust.hscni.net Catherine Collins Approved Lead Countersigned by: Officer Service Manager ASPC L Neeson Position Health Inequalities Manager 23 rd March 2017 Martin McGrath Date Employment Equality Manager Tables 1 and 2: Qualitative and Quantitative Data required to assess level of impact, mitigation and opportunities to better promote equality of opportunity (As referred to in Section 3) Table 1: SERVICE USERS 2011 Census Data unless otherwise stated Equality Category Service users Quantitative Data Qualitative Data Belfast / Castlereagh population Service users affected (Needs, Experiences, Priorities)

1. Age 0-16 16-24 25-34 35-44 45-54 55-64 65+ 22% 11% 12% 14% 14% 12% 15% 100% All service users will be aged 65+ given the nature of the service provided. 2. Dependent Status Caring for a child dependant older person/ person with a disability None Not known 12% of usually resident population provide unpaid care It is unlikely that any service user affected would have caring responsibilities. However, there is nothing to suggest from the assessment of this proposal that there would be any adverse impact on a service user as a result of their dependent status. 3. Disability Yes No Not known 21% 69% n/a Given the nature of the service provided, it can be assumed that all service users would be classed as having a disability. 4. Gender Female Male 51% 49% Most service users are female; women tend to live longer than men. There is nothing to suggest that this proposal would adversely affect a person on account of their gender. 5. Marital Status Married/Civil P ship Single Other/Not known 47% 36% 17%

6. Race Ethnicity White Black/Minority Ethnic Not known 98% 2% n/a Most service users of this age are white. There is nothing to suggest that this proposal would adversely affect a person on account of their gender. If a person s first or competent second language is not English, an interpreter will be provided when required. 7. Religion Roman Catholic 41% Presbyterian Church of Ireland Methodist Other Christian 42% 8. Political Opinion 2011 Assembly election Buddhist Hindu Jewish Muslim Sikh Other None Broadly Nationalist Broadly Unionist Other Do not wish to answer/ Unknown 17% 45% 48% 2% 5%

9. Sexual Orientation 2012 report by Disability Action & Rainbow Project Opposite sex Same sex Same and Opposite sex Do not wish to answer /Not known Estimated 6-10% of persons identify as lesbian, gay, bisexual There is nothing to suggest that this proposal would adversely affect a person on account of their sexual orientation. A total of 44 staff are currently employed with the area that would be affected by this proposal. These staff are comprised within Nursing, Support Services, Social Services and Professional and Technical Personnel Area. Due to small numbers of staff within certain equality categories a detailed breakdown of equality data will not be provided. Table 2: STAFF @January 2016 Equality Category 1. Age <25 25-34 35-44 45-54 55-64 65+ Groups Quantitative Data Qualitative Data Trust Staff affected workforce 4% 24% 26% 28% 16% 2% 4.55% 15.91% 40.91% 27.27% 11.36% A higher proportion of staff are aged between 45+ (80%) compared to that of the workforce profile (46%) 2. Dependant Status Dependants No Dependants Not known 23% 20% 57% 20.45% 11.36% 68.18% Higher proportion of staff has not declared any caring responsibility.

3. Disability Yes No Not known 2% 69% 29% 70.45% Broadly in line with overall workforce profile 4. Gender Female Male 78% 22% 88.64% 11.36% There is a higher proportion of female staff compared to that of the overall workforce profile. 5. Marital Status Married/ Civil P ship Single Other/Not known 57% 36% 7% 61.36% 25.00% 13.64% Higher proportion of staff have been classified as married/civil partnership 6. Race a) Ethnicity BME White Not Known 4% 79% 17% 79.55% Higher proportion of BME Race known compared to the overall workforce profile b) Nationality GB Irish Northern Irish Other Not known 18% 9% 2% 1% 70% 15.91% 81.82% Higher proportion of Not Known compared to the overall workforce profile

7. Religion a) Community Background Protestant Roman Catholic Neither 44% 50% 6% 52.27% 43.18% 4.55% There is a higher proportion of staff from the protestant community background compared to that of the overall workforce profile. b) Religious Belief Christian Other No religious belief Not known 28% 1% 8% 63% 22.73% 77.27% Higher proportion of Not Known Religious belief compared to that of the overall workforce profile 8. Political Opinion 2011 Assembly election Broadly Nationalist Broadly Unionist Other Do not wish to answer/ Unknown 6% 7% 8% 79% 77.28% Lower proportion of staff state they are Broadly Nationalist and Broadly Unionist or with a higher proportion stating Other compared the overall workforce profile. 9. Sexual Orientation Opposite sex Same sex or both sexes Do not wish to answer /Not known 42% 1% 57% 25.00% 75.00% Higher proportion of Not Known Sexual Orientation compared to that of the overall workforce profile

Ongoing Screening - Update as of 18 December 2017 This proposal was originally subject to ongoing screening. In December 2017 it was revisited and assessed, along with the Service Manager. To date, Ward 1 in Meadowlands remains closed. To date the ward remains closed. The majority of staff have returned to Meadowlands working on the other two wards where there were vacancies. The service is finding it very difficult to recruit nurses to this area. The service that was delivered in Meadowlands Ward 1, which was temporarily closed, is being delivered by Windsor Intermediate Care (Belfast Dedicated Centre) in Osborne Park, Lisburn Road, who are contracted on a 6 monthly basis to do this. Outcomes have been positive for service users. This independent service care option now provides 25 rehabilitation beds and is a modern facility. Recently there has been an RQIA inspection of Meadowlands. The report was favourable. The Trust is preparing an options paper regarding the Strategic Review of Rehabilitation Services for Older People, which will provide options on the future of how Rehabilitation Services will be delivered for older people. This review has involved reviewing the services provided in Meadowlands. This is expected to be finalised by February 2018 and will involve thorough engagement and consultation with staff and service users. Depending on the outcome of this, a full Equality Impact Assessment (EQIA) may be required. It is anticipated that Meadowlands Ward 1 will remain temporarily closed until the options paper is drafted and consulted on, whereupon a decision regarding the future of Meadowlands can be made. To that end, this will remain an ongoing screening and the Equality Manager will remain in close contact with the service lead, to ensure that when a decision is made, the appropriate equality process is undertaken. Please sign and date below and forward to the Health & Social Inequalities Team Catherine Collins Approved Lead Countersigned by: Officer Position Acute & Transitional Service Manager (Interim) Health Inequalities Manager 22/01/2018 Date Employment Equality Manager Louise Neeson