Statutory Equality and Diversity Report: Service Equality Compliance Report January 2014 Page 1 of 29
Contents Foreword Page 1. Introduction 5 1.1 The Aims of the Equality Duty 5 1.2 Equality Delivery System (EDS) 5 2. Equality and Diversity Governance Structure within the Trust 6 2.1 Reporting to the Board of Directors 6 2.2 Equality Leads 6 2.3 Experience and Engagement Group 6 3. Hillingdon: Key Facts about Health and Wellbeing 6 4. Characteristics of the local population 6 4.1 Age and Gender 7 4.2 Ethnic Groups 8 5. Demographic patient data April 2011 to November 2013 9 5.1 Patient Population by Age, Ethnicity and Gender 9 6. Patient Advice and Liaison Service (PALS) and Complaints 9 6.1 Subjects of PALS Cases and Complaints about Discrimination 10 7. Language interpreting and translation 10 8. 8.1 8.1.1 8.1.2 8.1.3 8.2 8.3 8.4 Engagement with Service Users Major Public Surveys undertaken by the Trust National Survey of Adult Inpatients 2012 A survey of Women s Experiences of Maternity Services Chemotherapy Patient Experience survey and the National Cancer Patient Experience Survey Local Patient Surveys Family and Friends Test Other patient feedback 11 11 11 11 11 12 12 12 Page 2 of 29
8.5 8.5.1 8.5.2 8.5.3 8.5.4 8.5.5 8.5.6 8.5.7 8.5.8 On-going Service User Engagement Maternity Services Safeguarding of Vulnerable Adults and Children People with Learning Disabilities Carers and Families Older People Caring for Patients with Dementia Improving Services for Patients with Cancer Patient Groups 12 12 14 15 16 16 16 17 17 9. Engaging with Foundation Trust Members 18 10. Equality Delivery System - consultation with members and local community organisations 18 11. Examples of Service Provision Improvements 19 11.1 Equality Actions undertaken showing due regard for the Equality Act 2010 19 11.2 Equality Impact Assessment and Equality Analysis 21 12. Policies and programmes put into place to address equality concerns 21 Appendix 1 Patient Population by Age, Ethnicity and Gender 22 Appendix 2 National Patient Surveys 2012/2013 Demographic information 26 Appendix 3 Foundation Trust Membership by Age, Gender, Ethnicity and ONS Monitor Classifications 28 Page 3 of 29
Foreword As Director of Nursing and Patient Experience I am delighted to present the 2014 Service Equality and Diversity report for our patients. The Hillingdon Hospitals NHS Foundation Trust has a longstanding commitment to ensuring that its services and employment practices are fair, accessible and appropriate for all patients, visitors and carers, as well as its talented and diverse workforce. The Trust is a service provider to a diverse group of patients living in and close to the London Borough of Hillingdon. Being sensitive and responsive to the needs of individuals from diverse groups is an essential part of our work. The Trust prides itself in the fact that it does engage and will continue to engage with service users to deepen its understanding of equality themes. Engaging with our local communities that we serve and providing opportunities for service users to feedback on their experiences is an important feature of our work. We look forward to meeting the challenge that all individuals who use our services have a positive experience. Professor Theresa Murphy Director of Nursing and Patient Experience Claire Gore Director of People and Executive Director for Equality & Diversity Page 4 of 29
Service Equality Compliance Report January 2014 1. Introduction This annual compliance reports seeks to demonstrate compliance with the Public Sector Equality Duty (PSED) as required by the Equality Act 2010 (Specific Duties) Regulations 2011. NHS organisations have a statutory requirement to publish information to demonstrate compliance with the general and specific duties of the PSED. 1.1 The Aims of the Equality Duty The aims of the Equality Act 2010 in relation to the general duty are as follows: Eliminate discrimination, harassment and victimization and other conduct prohibited under the Act; Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; Foster good relations between persons who share a relevant protected characteristic and persons who do not share it. Protected characteristics in terms of the Public Sector Equality Duty are defined as: Age Disability Gender re-assignment Marriage and civil partnership Pregnancy and maternity Race including colour, nationality and ethnic or national origins Religion or belief, including a lack of religion or belief Sex Sexual orientation 1.2 Equality Delivery System The Equality Delivery System (EDS) for the NHS was made available to the NHS in June 2011 and launched on 11 November 2011. Following an evaluation of the implementation of the EDS in 2012 and consultation with a number of NHS organisations, a refreshed EDS is now available. It is known as EDS2. EDS2 is a more streamlined generic tool for both NHS commissioners and NHS providers and should be adapted to reflect specific roles and responsibilities. It is a voluntary performance management system which Trusts can use as a framework to guide their actions and reporting of Equality initiatives. EDS2 consists of 18 outcomes, grouped under four goals that relate to issues that matter to people who use, and work in the NHS. These are: Goal 1 Better health outcomes Goal 2 Improved patient access and experience Goal 3 A representative and supported workforce Goal 4 Inclusive leadership When using EDS2, organisations are advised to select a choice of services which they wish to review or where there is a strong local need to do so, involving local stakeholders in the Page 5 of 29
selection. Choice of services should not just focus on challenges, problems and concerns but also on situations where progress is being made and good practice can be share and spread. The Hillingdon Hospitals NHS Foundation Trust is committed to ensuring that its services are fair, accessible and appropriate for the diverse patient community to which it serves. The Trust believes that its patients, carers and visitors deserve the very best the Trust can give them in an environment in which all feel respected, valued and empowered. In March 2014, the Trust will engage with local stakeholders to review equality progress during 2013/14 and to select priorities for 2014/15. 2. Equality and Diversity Governance Structure within the Trust 2.1 Reporting to the Board of Directors The Director of People is the Executive Director responsible for presenting the annual Equality Report covering employment and service issues. The reporting year is April 2013 to March 2014. 2.2 Equality Leads During 2013/14, Equality and Diversity has been delivered by the Head of Patient and Public Engagement and Deputy Director of People and Development. 2.3 Experience and Engagement Group The Experience and Engagement Group is currently being reviewed both in terms of membership and remit and will in future include a regular review of equality and diversity progress and reporting. 3. Hillingdon: Key Facts about Health and Wellbeing Understanding the needs of Hillingdon is important in order to improve health and social care and reduce inequality. Information about the needs of Hillingdon s people can be found in Hillingdon s Joint Strategic Needs Assessment (JSNA) and Hillingdon s Health and Well-Being Strategy 2013-2016, available at: http://modgov.hillingdon.gov.uk/mgconvert2pdf.aspx?id=16064 The JSNA describes in detail the health, care and wellbeing needs of the local population, identifying those groups where health and care needs are not being met and those which are experiencing comparatively different outcomes. Understanding Hillingdon and the characteristics of its population is critical for identifying current and future needs, eg for specific services such as maternity and the demand for the treatment of certain conditions which are more prevalent in specific population groups. 4. Characteristics of the local population Population estimates are the starting point to inform decisions regarding the provision of public services such as health and social care. Any overarching appraisal of need and subsequent commissioning of services by the local Clinical Commissioning Group and Councils will consider the size of the population living locally, together with the gender and age breakdown. Population statistics are also available at ward level and these inform targeting of services dependent on the local population and assessment of need. Page 6 of 29
There are a number of sources of population numbers and estimates. The most widely used population estimates are sourced from National Statistics and are known as sub-national population projections (SNPP). These estimates include 2011 Census data and are available by single year of age and gender for Local Authorities from mid-2011 to mid-2021. The Greater London Authority (GLA) also produces population projections for London Boroughs and wards, including analysis of households and ethnic groups, also incorporating 2011 Census data. SNPP and GLA estimates are used in this document. Hillingdon population Year Population estimate National Statistics, Census-based sub-national population projections (SNPP) Greater London Authority (GLA) 2012 round projections (SHLAA incorporating DCLG) 2013 285,000 2013 281,000 4.1 Age and Gender The table below shows selected age categories in numbers, broken down by gender. These figures are based on ONS Mid-Year population estimates 2012. Age Category Males Females Total Children and Young People 0-5 years 12,900 12,000 24,900 5-15 years 19,500 18,500 38,000 6-19 years 25,400 23,900 49,300 0-19 years 38,900 35,900 74,800 Young adults and working age 19-24 years 14,100 12,900 27,000 25-49 years 51,800 52,600 104,400 16-60F/64M - working age 93,200 87,800 181,000 40+ years 57,900 62,200 120,100 Older adults - Mid life 50+ years 38,300 42,200 80,500 50-65 years 23,100 23,400 46,500 60-69 years 11,200 11,800 23,000 50-70 years 27,800 29,300 57,100 Elderly 65+ years 16,500 20,200 36,700 85+ years 1,700 3,200 4,900 Total 140,000 141,600 281,800 Source ONS Mid-Year population estimates 2012 Page 7 of 29
4.2 Ethnic Groups In Hillingdon, 52% of the population are White British and 48% are from BME groups including 25% of the population that are Asian. In London over half (55%) of the population are from BME groups and in England 20% are from BME groups. The ethnic groups of the Hillingdon population are shown in the pie-chart below (Census 2011). Hillingdon population by ethnicity: 2013 Bangladeshi 1% Chinese 1% Pakistani 4% Other 4% Other Asian 9% Indian 14% White 58% Black Other 3% Black African 4% Black Caribbean 2% Hillingdon 2013 White Black Caribbean Black African Black Other Indian Pakistani Bangladeshi Chinese Other Asian Other 161,650 4,860 12,460 9,450 39,430 10,120 2,810 3,060 24,080 12,040 Source: GLA 2012 EGPP final Population estimates for Hillingdon suggest that black and ethnic minority groups are increasing as a proportion of the population, with the corresponding reduction in the white ethnic groups. For further information on Ethnicity trends please refer to the Joint Strategic Needs Assessment (JSNA) produced by the Performance and Intelligence Team at the London Borough of Hillingdon. Page 8 of 29
5. Demographic patient data - April 2011 to November 2013 The purpose of reviewing service equality data is to understand the uptake/access of inpatient, outpatient and emergency services by protected groups. This enables the Trust to identify if it is at risk of discriminating, as well as identifying opportunities for advancing equality for particular groups or for fostering good relations. The Trust currently collects data on the following fields for patients for the purposes of clinical need and also for monitoring: Age Gender Religion Ethnicity Marriage and civil partnership Learning and sensory disability Language needs The Trust s Patient Administration System does not currently allow for the following protected characteristics to be recorded: Sexual orientation Pregnancy Gender reassignment. 5.1 Patient Population by Age, Ethnicity and Gender A full statistical and graphical breakdown of the population that have used our Accident and Emergency, Outpatient and Inpatient services by Age, Ethnicity and Gender from April 2011 to November 2013 can be found in Appendix 1. For the purposes of this report the services have been grouped as Outpatients, Inpatients (including day care) and Accident & Emergency (excluding Urgent Care Centre). The data demonstrates greater use of A&E by those in the 0-29 year age group and greater A&E activity amongst white men (over 55%); the next ethnic group were Asian at 10%. Women had greater inpatient and outpatient activity this increased with age (for both sexes). Inpatient and outpatient activity were also greater amongst the white British population averaging at 55% and then Asian Indian averaging at 10%. 6. Patient Advice and Liaison Service (PALS) and Complaints Feedback from patients, relatives and carers provides the Trust with a vital source of insight about people s experiences of healthcare at The Hillingdon Hospitals NHS Foundation Trust and how our services can be improved. The Patient Advice and Liaison Service (PALS) is a first contact point for questions, concerns and suggestions about our services. Our PALS team offer help and support and try to answer questions and resolve concerns quickly and informally. The service is staffed by two full time officers and a manager from 9am to 5pm, Monday to Friday. The Complaints Department deal with all formal complaints that come into the Trust and ensure that all matters raised are investigated thoroughly and responded to in a timely manner in line with the Trust procedure. Page 9 of 29
The ultimate aim of both the PALS and Complaints team is to listen and respond to the issues being raised and use the information received to improve Trust services and the patient experience. 6.1 Subjects of PALS Cases and Complaints about Discrimination There were 4 PALS cases and 2 formal complaints regarding discrimination received between April 2012 and March 2013. The PALS cases were about: Attitude and behaviour of a staff member who assumed the patient was a heterosexual person causing embarrassment throughout the consultation. An apology was given to the patient and additional training to the staff member. Communication and respect - A patient's wife was very upset that her husband, who was an elderly war veteran had not been referred to as "Mr" during the consultation. Staff were reminded of the need to ask patients how they wish to be addressed. A lack of cultural awareness a Muslim patient and her partner felt that a staff member had not respected their religious views by allowing a male trainee sonographer into the room. The trainee understood entirely and was extremely apologetic on leaving the room. The manager of the department contacted the couple having spoken to the staff member and offered them an alternative female sonographer at their next scan. A lack of deaf awareness - The wife of a patient tried to explain to the doctor that she needed him to look at her and to be spoken to clearly as she was deaf and her husband had been diagnosed with dementia. The issue was addressed with the doctor and feedback of action was provided to the patient and his wife. The complaints cases were about: A parent of a child who wanted a circumcision to be carried out when the doctor had explained that the Trust does not carry out circumcision for religious, cultural or social reasons and that there was no clinical need for the child to have this procedure. The complaint was not upheld. A decision not to operate on a child with a disability. The complaint was partially upheld as the doctor did not mean to imply that treatment would not be given because of a disability, just that it would be wrong to operate on the 'squint' as it would not improve visual function. 7. Language interpretation and translation The Trust recognises and welcomes its legal duties under the Equality Act 2010 and as a Trust ensures its interpreting and translation services comply with any legislative requirements. The Trust s Interpretation and Translation Policy ensures that patients, relatives and carers have access to the communication tools required to allow complete understanding of their diagnosis, and proposed treatment, and to ensure that each patient s communication needs are met. This may include people from minority ethnic communities, new migrants, refugees, asylum seekers, and those whose first language is not English or those who may have a sensory impairment, mental health illness, learning disability or people who are non-verbal without a learning disability. Page 10 of 29
The Trust has a contract with One Stop Interpreting Services for language interpretation and translation to include British Sign Language. During 2012, the Trust requested an interpreter on 2423 occasions supporting patients with 34 different languages. The chart below provides a breakdown of the top five language requests. Hillingdon Top Five Languages 2010 2011 2012 1 Tamil Punjabi Punjabi 2 Punjabi Somali Somali 3 Somali Polish Tamil 4 Urdu Arabic Polish 5 Polish Tamil Arabic Since 2010 the top 5 languages have remained the same reflecting the composition of our local catchment as outlined in section 4.2 of this report. 8. Engagement with Service Users 8.1 Major Public Surveys undertaken by the Trust The largest surveys undertaken within the Trust were those by Picker Institute Europe for the Care Quality Commission (CQC). During 2012/2013, the CQC commissioned a survey of adult inpatients 2012 and a survey of women s experiences of maternity services 2013. The data in each report shows how a trust scored for each question in the survey and therefore it is not possible to draw any conclusions about how patients with different protected characteristics feel about their care and treatment. There are also issues about using written surveys and the difficulty in getting broad high quality feedback due to communication difficulties (with those with some disabilities) and those unable to read written English. Appendix 2 provides background demographic information about the respondents for each of the surveys. 8.1.1 National Survey of Adult Inpatients 2012 Data from the surveys suggests the average response rate from patients is lower than the national average. However there is a significantly good response rate from the Asian Indian group and a worse rate of response from White groups. The response rate to religious identification was significantly higher from the Sikh, Hindu and Muslim groups. 8.1.2 A survey of Women s Experiences of Maternity The response rate in general was worse than the national average (37% to 46% respectively). By Age there was a significantly better response rate by women in the 25-29 age group and particularly from Asian Indian women although the response rate from White women was worse than the national average. In terms of religion there is a significantly higher response rate from Hindu and Sikh women. 8.1.3 Chemotherapy Patient Experience Survey and the National Cancer Patient Experience Survey There were two other major surveys during 2013, this being the Chemotherapy Patient Experience Survey and the National Cancer Patient Experience Survey, both of which were Page 11 of 29
undertaken by Quality Health on behalf of the Department of Health. Both surveys only reported on gender and age of respondents and so it is not possible to link patient experience to protected characteristics. 8.2 Local Patient Surveys Monthly surveys were conducted for inpatients, outpatients, maternity and children during 2012/13. The surveys can be found by clicking on the link below: http://www.thh.nhs.uk/patientsurveys/index.php All surveys can be analysed by some protected characteristics; for example a breakdown of the respondent s ethnicity, disability, age, gender and religion is provided. However, as this information does not provide the protected characteristic breakdown per survey question, it is difficult to provide more detailed analysis on the patient experience by a protected characteristic. 8.3 Family and Friends Test The Trust has commissioned iwnatgreatcare to analyse and report on our Family and Friends test which was introduced in December 2012. All adult patients who have stayed at least one night in hospital or who have attended A&E and left without being admitted are asked: How likely are you to recommend our ward/a&e department to friends and family if they needed similar care or treatment? In October 2013 the Family and Friends test was introduced into antenatal and postnatal maternity services whereby service users are asked: How likely are you to recommend our antenatal services to friends and family if they needed similar care or treatment or How likely are you to recommend our birthing unit to friends and family if they needed similar care and treatment? The results of our Family and Friends test can be analysed by age, gender, ethnicity and disability. 8.4 Other patient feedback Data is provided from the following sources: NHS Choices and Patient Opinion websites (this does not collect any demographic information when an entry is added) 8.5 On-going Service User Engagement The Trust has extensive user involvement which is reported to the Experience and Engagement Group bi-monthly. The following is some of the involvement activity that has taken place during the last twelve months: 8.5.1 Maternity Services To improve the experience of the women and their families who choose to have their baby at The Hillingdon Hospitals NHS Foundation Trust our Maternity team have undertaken several projects over the last year. Page 12 of 29
Afghan Women s Engagement Meeting As part of our commitment to engage with, and better understand the needs of our BME population, members of staff met with a local Afghan Women s group to discuss their experiences and expectations of our services. The aim of the focus group was to bring together the views of a group of Afghan mothers who have had a recent experience of having a baby at Hillingdon Hospital to: Capture and understand their experiences Manage expectations Improve their experience for the future Measure improvements over time Approximately 15 Afghan women attended and shared their experiences of using Hillingdon Hospital Maternity Services and/or to convey the experiences of family or community members. It was also an opportunity for members of staff to provide information about maternity services provided by The Hillingdon Hospitals NHS Foundation Trust. Labour Ward Refurbishment The Trust has received a 741k grant from the Department of Health to refurbish the maternity unit facilities at Hillingdon Hospital. The funding will be used to help modernise our maternity service and so improve the care that we offer to new mums and their babies. The labour rooms are being fully modernised to provide individual en-suite shower and toilet facilities, new windows, upgraded air conditioning, adaptable soft lighting and comfortable furnishings and environment. Over 4000 babies were delivered at Hillingdon Hospital during 2012 and this number is set to rise in future years. Maternity Volunteers Over the last year and following engagement with user representatives we have had an increase in volunteer applications from minority communities. This covers many roles including: Breastfeeding peer support workers Community administration Receptionists Maternity mates User representation on maternity forums This highlights our commitment to involve users which in turn adds value to our service and provides an opportunity for individuals to gain valuable work place skills prior to pursuing a career in health and social care. Patient Feedback To enable our service to better meet the needs of our diverse population we collect data through varying means. Based on the feedback received we look for ways to develop and improve our service, no matter how small. This information is collected from: Maternity Friends and Family test Quarterly Patient survey NHS Choices website Users walk the patch Care Quality Commission survey of women s experience. Page 13 of 29
Homebirth Team We plan to increase the homebirth rate to over 2% per annum in 2014/15 (current rate 0.5%). This goal arises from our commitment to offer choice for women, and a service they can feel confident in, underpinned by a woman-centred approach to care in line with national recommendations. To achieve this aim we have reshaped our community midwifery service to create a dedicated homebirth team. This team of midwives will focus on providing evidencebased midwifery led care to low risk multigravida women living in the Borough of Hillingdon who choose to have a homebirth. Moving forward into 2014 we hope to further develop our services to encourage all women to continue to choose us as their preferred care givers. 8.5.2 Safeguarding of Vulnerable Adults and Children Safeguarding Adults arrangements at the Hospitals have continued to strengthen during 2013. The Executive Director for Nursing and the Patient Experience, who is also the Executive Director for Safeguarding, sits on the Trust board and oversees the annual work and audit programmes for safeguarding people (adults and children), and progress against these is now reported to the Trust s Safeguarding Committee on a quarterly basis. An annual report on safeguarding activity was presented to the Trust Board in September 2013. The Executive Director for Nursing and Patient Experience also is a member of the Safeguarding Adults partnership Board (SAPB) and the Local Safeguarding Children Partnership Board (LSCB). The Lead Nurse for Learning Disabilities at the London Borough of Hillingdon (LBH) is a member of the Safeguarding Committee. The Self Assessment Assurance Framework (SAAF) is a tool devised by NHS London (NHSL) for organisations to assess themselves in terms of Safeguarding assurance. The SAAF is now cross-referenced with the Care Quality Commission (CQC) Outcome 7 (regulation 11): Safeguarding people who use services from abuse. These tools give the Trust assurance in terms of safeguarding and are reviewed by the Safeguarding Committee twice a year. The Trust was referenced in March 2013 in the NHSL (now NHS England, London Branch) Pan- London Thematic review of the SAAF as an example of good practice, in relation to listening to and acting on user views. The Head of Safeguarding is a member of the Learning Disability Partnership Board and also meets regularly with the Safeguarding Lead on the Hillingdon Clinical Commissioning Group. There is also regular attendance by the Head of Safeguarding at the Hillingdon PREVENT Partnership Group. Mandatory awareness training (Level 1) for vulnerable adults is delivered monthly. In addition, monthly training is delivered to all new employees of the Trust. An e-learning module for vulnerable adults training is scheduled for 2014. Bespoke sessions are also arranged. In February 2012, there was a re-audit of staff knowledge and awareness of the Medical Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The results indicated that more awareness sessions were needed for staff and to reiterate who to contact for advice and support. There was also an audit on learning disability awareness and how Trust staff look after these patients in hospital. The results were positive demonstrating that staff knew who to contact if there were concerns. There needs however, to be increased awareness and use of the patient passport. The Psychiatric Liaison Consultants based at Riverside, Central and North West London NHS Foundation Trust (CNWL) have delivered four training sessions on MCA and DOLS during 2013. Page 14 of 29
It is planned that an e-learning module for MCA and DoLS will be made available for staff on the trust intranet. There is a Trust Safeguarding Matters newsletter, which is sent to all staff on a regular basis, covering adults, children and learning disability. 8.5.3 People with Learning Disabilities Learning Disability (LD) Awareness and Arrangements Over 300 clinical and non-clinical staff were trained to raise their awareness on learning disabilities. The training is delivered monthly by one of the Learning Disability Nursing Team based at the LBH. Most of the LD awareness sessions were delivered in conjunction with the Safeguarding Adults Level 1 training, with some delivered as bespoke sessions to different teams/departments in the hospital. The total number of staff trained includes nurses, allied health professionals doctors, and non-clinical staff. The awareness training, which is 30 minutes in duration, is not included within the induction training for new staff; there is however reference made to the services and resources available, with contact details given. The risk assessment tool for vulnerable adults was developed and will be used with nursing documentation when admitting patients. There is an additional risk assessment for adults with learning disabilities that will ensure the implementation of reasonable adjustments when required. This is to be incorporated into the revised nursing documentation. The Trust hosted the third Benchmark of Best Practice workshop in April 2013, attended by nearly 100 people. The event allowed Trust staff to engage with service users and carers and with colleagues from local health, social care and voluntary sector organisations in order to benchmark our services for patients with a learning disability and for people who are vulnerable against the NHSL Benchmark of Best Practice tool. The event focused primarily on the experiences of patients and service users accessing services at the Trust, including a multiagency case study on the care of a person with severe learning disability with very complex health needs and two people with autism talking about their condition. There was very positive feedback from all who attended. The Trust s Good Practice Guidelines for staff working with people with learning disabilities remains in place. There are alerts on the Trust s patient administration system for patients with learning disabilities which continue to be used. There are also care pathways for patients with learning disabilities in A&E, outpatients and the radiology department which continue to be used for patients with learning disabilities. The Patient Passport, primarily for people / patients with a Learning Disability, is a joint document with The Hillingdon Hospitals NHS Foundation Trust, Hillingdon Community Health (HCH) and Central and North West London NHS Foundation Trust and remains in use. There are easy-read appointment letters for patients who are identified as having a learning disability and information leaflets. There is a dedicated Learning Disability internet and intranet pages on the Trust website, which includes easy read information sheets for patients. Trust staff have access to the Learning Disability Team at the London Borough of Hillingdon if they require additional advice and support with individual patients. The Trust was involved in the validation of the Learning Disability SAAF. The Trust section of the SAAF was validated by NHSL, attended by the Head of Safeguarding. This provides the Trust with substantial assurance in terms of Safeguarding governance for learning disability patients. The Safeguarding Committee in March 2013 approved the yearly review of the Learning Disability Key Performance Indicator (KPI) which is provided as evidence to Monitor. Page 15 of 29
8.5.4 Carers and Families The Trust greatly values the very important work and support of family and friends caring for people who use our services. A carer is someone of any age who provides unpaid help to someone who is ill, frail, elderly or has a disability, mental health or substance misuse problem. They might be a family member, friend or neighbour. The Trust is committed to working in partnership with all carers and carer organisations by listening, learning and responding to feedback. The Trust strives to improve a carer s experience by: Providing appropriate and timely information to support the carer and the person they support. Actively involving carers where patient consent has been granted in decisions about the care and treatment of the person they care for. Involving carers in the planning or developing of services and in monitoring patient and carer experience. Providing support for carers who are caring for people with multiple and complex needs e.g. learning disabilities, physical disabilities and dementia. Improving staff awareness of the role of a carer in care delivery. Ensuring carers are provided with sufficient information to enable safe planning of return to caring responsibilities. During February 2014, The Hillingdon Hospitals NHS Foundation Trust will be conducting a survey of carers to find about the Carer s experience whilst the person they care for is in hospital and also about the quality of support that a Carer receives from their GP and social services. The results will be used by the hospital to identify any improvements required. 8.5.5 Older People Age UK Hillingdon meal time visits Since 2011, Age UK Hillingdon has conducted unannounced visits to ward areas to provide an informed view of the standards of care, specifically related to nutrition, dignity and compassion towards the elderly. The visits are currently planned quarterly and the outcomes are reported both to the Trust Board and to the area visited. 8.5.6 Caring for Patients with Dementia The Trust has developed a Dementia Strategy in consultation with internal and external stakeholders including user representation. The Strategy s aim is to improve care and experience for those with dementia and their carers, across four domains: Raising awareness, changing attitudes Care and support for patients and their carers Environment of care Pathways for treatment and care A Dementia CQUIN aims to increase identification of those with dementia, to prompt referral and follow up post discharge and to ensure hospitals deliver high quality care and support for carers. The Trust has secured 845,000 to create a dementia friendly environment on Beaconsfield East ward. The hospital will be able to enhance the experience of patients and their carers through the provision of both quiet and stimulating inside and outdoor areas. Improvement works will include an upgrade to ward décor including lighting, flooring and signage, the creation of a patient day-room including dining area and the creation of a Sensory Room and Sensory Garden. Page 16 of 29
8.5.7 Improving Services for Patients with Cancer People involved in Cancer Services (PICS) PICS was launched in January 2006 and over the last seven years members have been committed to effecting practical changes in the way all aspects of cancer services are delivered. The group s membership is made up of a diverse group of patients, survivors, carers and health professionals. Cancer affects people representing all the protected characteristics and therefore it is important that the Trust continues to work with a variety of service users to bring about positive change. Cancer Information Centre A Cancer Information Centre is opening on 24 th February 2013 to provide advice and information to patients, carers and families. The Centre will be managed by a specialist nurse with support from volunteers, many of whom have had cancer. Information will be available on line and in different formats / languages for those who request it. 8.5.8 Patient Groups The Trust has a number of regular patient support groups providing information and improving awareness on: Age related macular degeneration Glaucoma Care of the colon (semicolon group) Psoriasis Cardiac care The sessions are delivered by clinicians and are organised both in the hospital and in the community. The Trust organised a visit to the local Hindu/Jain community to speak about diabetes and treatment to a section of the community who have a high rate of diabetes. Over 100 members appreciated the opportunity to listen and ask questions about diabetes and the importance of diet and exercise as a means of controlling a person s blood sugar levels. In 2007, the Trust set up the Fighting Infection Together (FIT) group to provide an essential link between patients/public and staff. The members are all volunteers with a keen interest in the prevention and control of infection. Since coming together, the Fighting Infection Together group has proved invaluable in contributing to a number of initiatives: Supporting hand hygiene campaign and events Manning the infection control stand at the annual general meeting since 2008 Auditing hand hygiene practice Reading and approving patient information leaflets Examining our hospital laundry arrangements Producing a patient friendly infection control annual report Supporting food safety awareness events Auditing signage for hand washing and undertook a Trust walk around Working with the Trust on the new cleaning and catering contract Supporting the upgrades of the Trust public toilets Producing infection control information for visitors Page 17 of 29
9. Engagement with Foundation Trust Members The Trust sets membership targets every year to ensure it builds and maintains a representative membership. It needs to be noted that Monitor expects that membership should attempt to match the catchment population and not that of service users. The current membership data suggests that the following have been achieved: A good even geographical distribution of membership across the North, Central and South Constituencies; There is an overrepresentation of members aged 49 plus; There is a need to recruit a greater number of younger members; There are slightly more female members to male members; White British, White Irish and Any other Mixed Background are over represented; There is an over-representation in social class AB and membership is largely representative in C1, C2, D and E; The Trust ensures that all of our membership activities are inclusive of all protected characteristics. All opportunities are taken to increase membership from all local ethnic communities. The Trust s membership leaflet, developed in 2012, includes age, gender, ethnicity, religion, disability and sexual orientation with the option to opt out if required. A graphical breakdown of membership by age, gender, ethnicity and social class can be found in Appendix 3. 10. Equality Delivery System - Consultation with Members and Local Community Organisations The Trust adopted the Equality Delivery System tool, designed to help NHS organisations focus their work on equality, to measure how well they are doing and to identify where improvements can be made. In January 2013 the Trust invited public and staff members and local community organisations to evaluate progress on equality by compiling a survey providing evidence of some of the work it has been doing and asked respondents to score based on the following categories. Excelling Achieving Developing Undeveloped Delivering outcomes across all protected characteristics Delivering outcomes across several protected characteristics Developing actions highlighted but no outcomes Undeveloped (no actions highlighted, no outcomes Following consultation the Trust scored Achieving in all four goals Goal Description Score Goal 1 Better health outcomes for all Achieving Goal 2 Improved patient access and experience Achieving Goal 3 Empowered, engaged, well supported staff Achieving Goal 4 Inclusive leadership at all levels Achieving Page 18 of 29
11. Examples of Service Provision Improvement 11.1 Equality Actions undertaken showing due regard for the Equality Act 2010 The following are examples of Equality action undertaken: Protected Characteristic Age this can be for older people or younger persons/children Disability Improvements made during 2012 and 2013 All patients to be asked how they would like to be addressed and this is written on the board behind the patient s bed head. Use of the red tray system at meal times to ensure any patient who needs assistance with their meals are identified and assistance provided. Nutritional assessments are completed on all patients over the age of 60 years. All patients are screened on admission. Introduction of large clocks, showing date as well as time to support patients with dementia. Dementia strategy and CQUIN agreed to improve care and experience for those with dementia and their carers. BSL interpreting service available. Picture cards for patients with brain injury, stroke, learning disabilities and for those who do not understand English. The use of the hospital passport to ensure that individual information about a person with learning disabilities is shared with healthcare professional. The use of This is me booklet within ward areas for carers or relatives of patients to share with healthcare professionals providing information about the patient and their life. The Trust has signed up to the Getting it right charter for learning disability led by MENCAP. Training provided to a range of staff regarding dementia care. Best practice guidance, a dedicated internet and intranet pages with information on the Patient Passport and Easy Read information. All staff have access to learning disability awareness sessions. Patient Administration System (PAS) disability and special needs fields used to identify a patient with a learning or sensory disability. All refurbished areas are being made more suitable for people with disabilities. Future Plans New paediatric menus are being launched in 2014. Completion of the Beaconsfield East dementia friendly ward 2014 An e-learning module for vulnerable adults training is scheduled for 2014. Page 19 of 29
Race Religion and Belief Gender Gender reassignment Sexual Orientation Pregnancy and maternity Marriage and civil partnership All groups Culturally appropriate menus now available on wards. Dual handsets available in Accident & Emergency and Outpatients Department (children and adult) to support telephone interpreting. Cultural awareness sessions for maternity staff following feedback from the Somali and Afghan Women s Groups. Patient Administration System (PAS) field advising that an interpreter may be needed. The Chaplaincy team offers spiritual, religious or pastoral support to people of all faiths, beliefs, and no faith background. Muslim and Sikh chaplains have joined the Chaplaincy team as volunteers. Community faith leaders representing the major world religions can be called to support a patient. A religious guide was updated and is available on wards and via the intranet. Islamic prayer room available for staff and patients to use. All wards have dedicated male and female bays with designated male and female facilities. Staff have attended Equality and Diversity training. Patients will be treated according to the gender they appear as. Staff have attended Equality and Diversity training. Breastfeeding rooms available for women attending the hospital. Improved maternity facilities for new mums and their babies. Labour rooms are being fully modernised to enhance the experience of mothers, their partners and their babies. Recording of status recognising marital and civil partnership. CARES logo appears on all trust literature (E = Equity). Equality and Diversity training is part of Trust induction and is available via e-learning Our website conforms to World Wide Web Consortium (W3C) accessibility guidelines. We strive to meet the Web Content Accessibility Guidelines 2.0 at AA level. Introduce badges for staff who speak a second language to support patients who do not understand English. Efforts continue to record inpatient and outpatient religious and belief data in order to be part of care. Trust policies will be written with religion and belief as core requirements. Population data will be recorded Improved bereavement care for families Provide advice on naming life partner as next-of-kin Page 20 of 29
11.2 Equality Impact Assessment and Equality Analysis All Trust Board reports include an Equality Impact Assessment statement outlining whether there is any negative impact on equality. All Trust policies include an Equality Impact Assessment which involves anticipating the consequences of the policy on different communities or groups staff, service users and carers making sure that any negative impact is eliminated or minimised. 12. Policies and programmes put into place to address equality concerns The following have been put into place over the last two years: Policy or Programme Date Religious Guide 2011 Cultural menus for inpatients 2012 Policy on the use of translators and interpreters 2012 CARES Culture and Values 2013 Patient and Public Engagement toolkit 2012 Page 21 of 29
Patient Population by Age, Ethnicity and Gender Appendix 1 Page 22 of 29
Page 23 of 29
Page 24 of 29
Page 25 of 29
Appendix 2 National Patient Surveys 2012/2013 Demographic information National Survey of adult inpatients 2012 at The Hillingdon Hospitals NHS Foundation Trust Background information The Hillingdon Hospitals All Trusts NHS Foundation Trust Number of respondents 354 64505 Response rate (%) 43 51 Demographics characteristics Gender (percentage) Male 45 46 Female 55 54 Age Group (percentage) 16-35 10 7 36-50 13 13 51-65 23 25 66 and older 54 55 Ethnic Group (percentage) White (incl. Irish and white other) 74 90 Multiple ethnic group 1 1 Asian or Asian British 14 3 Black or Black British 4 1 Arab or other ethnic group 0 0 Not known 6 5 Religion (percentage) No religion 10 14 Buddhist 1 0 Christian 71 79 Hindu 6 1 Jewish 0 1 Muslim 5 2 Sikh 4 1 Other religion 2 1 Prefer not to say/unknown 1 2 Sexual Orientation (percentage) Heterosexual/straight 95 94 Gay/lesbian 1 1 Bisexual 1 0 Other 0 1 Prefer not to say 4 4 Page 26 of 29
A survey of women s experiences of maternity services at The Hillingdon Hospitals NHS Foundation Trust Background information The Hillingdon Hospitals All Trusts NHS Foundation Trust Number of respondents 108 23077 Response rate (%) 37 46 Demographics characteristics Age Group (percentage) 16-18 0 1 19-24 9 10 25-29 32 23 30-34 29 35 35 and over 30 31 Ethnic Group (percentage) White 53 83 Multiple ethnic group 3 2 Asian or Asian British 28 8 Black or Black British 7 4 Arab or other ethnic group 1 1 Not known 7 3 Religion (percentage) No religion 20 33 Buddhist 1 1 Christian 47 55 Hindu 10 2 Jewish 0 1 Muslim 9 6 Sikh 8 1 Other religion 2 1 Prefer not to say/unknown 2 1 Sexual Orientation (percentage) Heterosexual/straight 93 96 Gay/lesbian 0 0 Bisexual 0 1 Other 1 0 Prefer not to say 6 3 Page 27 of 29
Appendix 3 Foundation Trust Membership Age (as at 23.1.14) 30 25 20 % of Members 15 % of Membership % of Area 10 5 0 22 29 30 39 40 49 50 59 60 74 75+ Age 22+ Source: 2012 Population Projections, CACI Ltd Foundation Trust Membership Gender (as at 23.1.14) 70 60 50 % of Members 40 30 % of Membership % of Area 20 10 0 Unspecified Male Female Transgender Genders Source: 2012 Population Projections, CACI Ltd Page 28 of 29
Foundation Trust Membership Ethnicity (as at 23.1.14) 70 60 50 % of Members 40 30 20 10 % of Membership 0 % of Area White British White Irish White Any other White background Mixed White and Black Caribbean Mixed White and Black African Mixed White and Asian Mixed Any other mixed background Asian or Asian British Indian Asian or Asian British Pakistani Asian or Asian British Bangladeshi Asian or Asian British Any other Asian background Black or Black British Caribbean Black or Black British African Black or Black British Any other Black background Other Ethnic Groups Chinese Other Ethnic Groups Any other ethnic group Not stated Ethnicities Source: 2001 Census, Office of National Statistics Foundation Trust Membership ONS/Monitor Classifications 35 30 25 % of Members 20 15 % of Membership % of Area 10 5 0 AB C1 C2 DE ONS/Monitor Classifications Source: 2012 Population Projections, CACI Ltd Page 29 of 29