From: "Saved by Windows Internet Explorer 8" Subject: Frontline Service EQIA Date: Tue, 30 Aug 2016 11:12:32 +0100 MIME-Version: 1.0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.staffnet.ggc.scot.nhs.uk/EQIA/Pages/FrontlineService.aspx?eqiaID=64 X-MimeOLE: Produced By Microsoft MimeOLE V6.1.7601.17609 =EF=BB=BF
Equality Impact Assessment = Tool for=20 Frontline Patient Services
Equality Impact Assessment is a legal requirement and = may be=20 used as evidence for cases referred for further investigation for = legislative=20 compliance issues. Please refer to the EQIA Guidance Document while = completing=20 this form. Please note that prior to starting an EQIA all Lead Reviewers = are=20 required to attend a Lead Reviewer training session. Please contact CITAdminTeam@ggc.scot.nhs.uk= for=20 further details or call 0141 2014560.
1. Name of Current Service/Service = Development/Service=20 Redesign:
Geriatic =
Orthopaedic=20
Rehabilitation Unit (GORU) |
2. Description of the service & rationale for = selection for=20 EQIA: (Please state if this is part of a Board-wide service or is = locally=20 determined).
A. What does the service do? = |
The Geriatric =
Orthopaedic=20
Rehabilitation Unit is for the care of inpatients generally =
sixty-five=20
years and over who require treatment as a result of an orthopaedic =
injury=20
or as part of orthopaedic scheduled care and need rehabilitation. =
This is=20
a Unit consisting of 3 wards and 86 beds in total. The Service =
will have a=20
mixture of 4 bedded bays and individual rooms with en-suite =
facilities.=20
There will be rehabilitation facilities on-site with a team of =
dedicated=20
Allied Health Professionals including Physiotherapists and =
Occupational=20
Therapists. Patients admitted to GORU's are managed by both =
geriatricians=20
and orthopaedic surgeons but one consultant, usually the =
geriatrician, is=20
recognised as being formally responsible for the patient. Hip =
fracture is=20
a common serious injury that occurs mainly in older people and can =
be the=20
dominant reason for admission. The Unit can also deal with many =
other=20
orthopaedic conditions. For many patients it means loss of full =
mobility=20
and function and following a period of assessment and =
rehabilitation, a=20
decision would be made regarding the patient=E2=80=99s long term =
care planning.=20
The Service will be centralised at Gartnavel General Hospital as =
part of=20
the On the Move programme. |
B. Why was this service selected for EQIA? = Where=20 does it link to Development Plan priorities? (if no link, please = provide=20 evidence of proportionality, relevance, potential legal risk etc.) = |
This EQIA was =
selected as=20
part of the On the Move Programme as services will be centralised =
at=20
Gartnavel General Hospital with a view to developing a centre of=20
excellence. |
3. Who is the lead reviewer and when did they attend = Lead=20 reviewer Training? (Please note the lead reviewer must be someone in a = position=20 to authorise any actions identified as a result of the EQIA)
Name: |
Date of Lead Reviewer Training: = |
Britton, =
Jackie=20
|
05/02/2015=20
|
4. Please list the staff involved in carrying out = this EQIA=20 (Where non-NHS staff are involved e.g. third sector reps or patients, = please=20 record their organisation or reason for inclusion):
|
Lead Reviewer Questions = |
Example of Evidence = Required=20 |
Service Evidence Provided = |
Additional Requirements = | |
1. |
What equalities information is routinely = collected=20 from people using the service? Are there any barriers to = collecting this=20 data? |
Age, Sex, Race, Sexual Orientation, = Disability,=20 Gender Reassignment, Faith, Socio-economic status data collected = on=20 service users to. Can be used to analyse DNAs, access issues etc.=20 |
=E2=80=A2The =
service collects=20
information on age, gender, faith and ethnicity via TrakCare. =
=E2=80=A2TrakCare=20
can also record requirements for interpreter and preferred =
language=20
|
There is a need=20
to develop plans for an annual review of data to know more about =
the=20
patient group utilising the service from an equalities =
perspective, e.g.=20
ages, ethnicity, postcode areas, additional disabilities =
etc.=20
|
2. |
Can you provide evidence of how the = equalities=20 information you collect is used and give details of any changes = that have=20 taken place as a result? |
A Smoke Free service reviewed service = user data=20 and realised that there was limited participation of men. Further=20 engagement was undertaken and a gender-focused promotion designed. = |
Not =
applicable=20
|
|
3. |
Have you applied any learning from = research about=20 the experience of equality groups with regard to removing = potential=20 barriers? This may be work previously carried out in the service. = |
Cancer services used information from = patient=20 experience research and a cancer literature review to improve = access and=20 remove potential barriers from the patient pathway. |
The Service =
adheres to the=20
Prevention and Management of Hip Fracture on Older People - SIGN =
Guideline=20
56. Patients over 65 are screened for cognitive impairment and =
delirium=20
using appropriate screening tools e.g. AMT4 |
|
4. |
Can you give details of how you have = engaged with=20 equality groups to get a better understanding of needs? |
Patient satisfaction surveys with = equality and=20 diversity monitoring forms have been used to make changes to = service=20 provision. |
Previously, the =
Directorate=20
would have undertaken the monthly Senior Charge Nurse =
questionnaires.=20
However, the Unit will utilise the =E2=80=98Universal Feedback' =
tool whereby=20
patients will be asked to comment on their hospital =
experience=20
|
As =
part of the=20
wider On the Move programme, there needs to be an engagement plan =
to alert=20
communities of the service changes. |
5. |
If your service has a specific Health = Improvement=20 role, how have you made changes to ensure services take account of = experience of inequality? |
A parenting service includes referral = options to=20 smoking cessation clinics. The service provides cr=C3=A8che = facilities and=20 advice on employability and income maximisation. |
Not =
applicable.=20
|
|
6. |
Is your service physically accessible to = everyone?=20 Are there potential barriers that need to be addressed? |
An outpatient clinic has installed loop = systems=20 and trained staff on their use. In addition, a review of signage = has been=20 undertaken with clearer directional information now provided. = |
=E2=80=A2There are =
a number of buses=20
that stop within the Gartnavel site. =E2=80=A2Hyndland train =
station is nearby=20
(the station has a lift and a footbridge which links to the =
Gartnavel=20
site). =E2=80=A2The patient and visitor car park is opposite the =
main entrance=20
=E2=80=A2Disabled parking and drop off point outside the hospital =
entrance. =E2=80=A2There=20
are automatic doors at the main entrance. =E2=80=A2There are lifts =
available.=20
=E2=80=A2Lifts have an audio voice announcing floors and Braille =
buttons.=20
|
|
7. |
How does the service ensure the way it = communicates=20 with service users removes any potential barriers? |
A podiatry service has reviewed all = written=20 information and included prompts for receiving information in = other=20 languages or formats. The service has reviewed its process for = booking=20 interpreters and has briefed all staff on NHSGGC=E2=80=99s = Interpreting Protocol.=20 |
The Service is =
aware of=20
NHSGGC=E2=80=99s Clear to All Policy (previously known as the =
Accessible=20
Information Policy). The Service are aware of how to organise =
interpreters=20
and other forms of communication support. They are also aware that =
the=20
Interpreting Policy is available on NHSGGC Intranet. =
|
There is a need=20
for the development of an information leaflet to alert patients =
and=20
visitors about the transfer of service to Gartnavel General =
Hospital. This=20
information will need to include information about support =
services e.g.=20
transport links. |
8. |
Equality groups may experience barriers = when trying=20 to access services. The Equality Act 2010 places a legal duty on = Public=20 bodies to evidence how these barriers are removed. What = specifically has=20 happened to ensure the needs of equality groups have been taken = into=20 consideration in relation to: |
|||
(a) |
Sex |
A sexual health hub reviewed sex = disaggregated=20 data and realised very few young men were attending clinics. They = have=20 launched a local promotion targeting young men and will be = analysing data=20 to test if successful. |
Staff are aware =
of the NHSGGC=20
Gender Based Violence Policy. Staff will try to accommodate =
requests for=20
same sex health professionals. If this wasn=E2=80=99t possible, =
chaperoning would=20
be offered. Same sex interpreters would be booked, as required for =
individual patient need. |
|
(b) |
Gender Reassignment |
An inpatient receiving ward has held = briefing=20 sessions with staff using the NHSGGC Transgender Policy. Staff are = now=20 aware of legal protection and appropriate approaches to delivering = inpatient care including use of language and technical aspects of=20 recording patient information. |
Staff are aware =
of NHSGGC=E2=80=99s=20
Transgender Policy. Staff ensure that patients are treated as =
their chosen=20
gender. If this situation arose, they would ask patients how they =
wish to=20
be addressed. |
|
(c) |
Age |
A urology clinic analysed their sex = specific data=20 and realised that young men represented a significant number of = DNAs. Text=20 message reminders were used to prompt attendance and appointment = letters=20 highlighted potential clinical complications of non-attendance.=20 |
The Service is =
predominantly=20
for patients aged 65 and over, however, this can be flexible =
depending on=20
the patient=E2=80=99s need. Patients over 65 are screened for =
cognitive impairment=20
and delirium using appropriate screening tools e.g. AMT4. Nursing =
staff=20
have completed LearnPro module in Dementia Awareness. The Service =
will=20
have Dementia champions. Staff have undertaken adult protection =
training.=20
Service users can be accompanied by carers if preferred. =
|
|
(d) |
Race |
An outpatient clinic reviewed its = ethnicity data=20 capture and realised that it was not providing information in = other=20 languages. It provided a prompt on all information for patients to = request=20 copies in other languages. The clinic also realised that it was = dependant=20 on friends and family interpreting and reviewed use of = interpreting=20 services to ensure this was provided for all appropriate = appointments.=20 |
Interpreting =
services are=20
available and staff are aware of how to arrange interpreters for =
patients.=20
If an interpreter is used, this is documented in the case notes. =
Should a=20
racist incident occur, staff would challenge the behaviour and =
document=20
this via Datix. Information can be provided in other formats upon =
request.=20
|
|
(e) |
Sexual Orientation |
A community service reviewed its = information=20 forms and realised that it asked whether someone was single or = =E2=80=98married=E2=80=99.=20 This was amended to take civil partnerships into account. Staff = were=20 briefed on appropriate language and the risk of making assumptions = about=20 sexual orientation in service provision. Training was also = provided on=20 dealing with homophobic incidents. |
Staff are aware =
of the Civil=20
Partnership Act. Should a homophobic incident occur, staff would =
challenge=20
the behaviour and document this via Datix |
|
(f) |
Disability |
A receptionist reported he = wasn=E2=80=99t confident when=20 dealing with deaf people coming into the service. A review was = undertaken=20 and a loop system put in place. At the same time a review of = interpreting=20 arrangements was made using NHSGGC=E2=80=99s Interpreting Protocol = to ensure staff=20 understood how to book BSL interpreters. |
On initial =
assessment=20
patient=E2=80=99s physical and mental abilities are discussed, and =
care plans=20
adapted/designed to suit requirements of individuals. Staff are =
aware of=20
how to arrange British Sign Language interpreters and other forms =
of=20
communication support. The Service will ensure any information =
requests=20
for materials in alternative language or other formats will be met =
in line=20
with NHSGGC=E2=80=99s Clear to All Policy (previously known as the =
Accessible=20
Information Policy). The Service will have a mixture of 4 bedded =
bays and=20
single rooms which have en-suite facilities. All toilets and =
showers are=20
suitable for disabled access. Moving and handling equipment is =
available=20
to facilitate safe transfer of those with mobility difficulties. =
There are=20
some height adjustable chairs available and chairs that provide =
additional=20
postural support (stroke chair) if required. As part of the =
patient=E2=80=99s=20
rehabilitation there will be input from all members of the multi=20
disciplinary team as indicated by assessment and care needs. =
Patients=20
receive an Occupational Therapy (OT) assessment followed by =
interventions=20
to improve or maximise skills and abilities. Home assessment =
Visits and=20
environmental visits are carried out by OT staff accompanied by =
other=20
members of the Multidisciplinary Team (MDT) where appropriate. =
Where=20
applicable the Occupational Therapist will provide equipment to =
maximise=20
the patient=E2=80=99s independence while on the ward. Where =
applicable the=20
Occupational Therapy Department will prescribe equipment to =
facilitate=20
discharge. Communication boards are available for patients with =
verbal=20
communication difficulties. Where appropriate, patients can be =
assisted by=20
their carers. To assist patients with learning disabilities there =
is=20
access to a learning Disability Consultant Nurse for advice if =
required.=20
Staff would also involve carers as appropriate. To assist patients =
with=20
mental health needs, staff would liaise with the appropriate =
Community=20
Psychiatric Nurse (CPN) if required. Also, the Service would =
liaise with=20
Old Age Psychiatry Service. Where applicable, equipment can be =
provided=20
for patients who are at risk of falls. Staff can signpost patients =
to=20
support agencies/charities such as Alzheimer=E2=80=99s Scotland, =
Age UK. Staff are=20
aware of The Adults with Incapacity Act. Staff can access a Nurse =
or=20
Allied Health Professional Consultant for Dementia for advice on =
the=20
management of patients diagnosed with dementia / cognitive =
impairment.=20
|
Ensure a=20
portable loop systems will be available for patients who are hard =
of=20
hearing or deaf. Consider with Jane Beresford, Health Improvement =
if=20
sensory impairment face to face training is a priority area for=20
2015/16 |
(g) |
Religion and Belief |
An inpatient ward was briefed on = NHSGGC's=20 Spiritual Care Manual and was able to provide more sensitive care = for=20 patients with regard to storage of faith-based items (Qurans etc.) = and=20 provision for bathing. A quiet room was made available for = prayer.=20 |
There is a quiet =
room on the=20
ground floor of the hospital. Staff can advise patients about how =
to=20
contact the Chaplaincy Service. Staff can refer to =
NHSGGC=E2=80=99s Faith and=20
Belief Communities Manual if they have any queries about =
religions/faith=20
groups. Halal, Kosher and vegetarian meals are available for =
inpatients as=20
and when required. Pharmacy can suggest alternative medication if =
there=20
are specific religious restrictions on certain medications.=20
|
|
(h) |
Pregnancy and Maternity |
A reception area had made a room = available to=20 breast feeding mothers and had directed any mothers to this = facility.=20 Breast feeding is now actively promoted in the waiting area, = though=20 mothers can opt to use the separate room if preferred. = |
Not =
applicable.=20
|
|
(i) |
Socio - Economic Status |
A staff development day identified = negative=20 stereotyping of working class patients by some practitioners=20 characterising them as taking up too much time. Training was = organised for=20 all staff on social class discrimination and understanding how the = impact=20 this can have on health. |
Staff can refer =
patients to=20
Social Work if required as well as other support agencies such as =
Age UK.=20
Staff can signpost patients/carers for a carer=E2=80=99s =
assessment and carer=E2=80=99s=20
support groups. |
The Service=20
will advertise the free Evening Visitor=E2=80=99s Bus Service. =
Consider with Jane=20
Beresford, the role of social work vs money advice referrals in =
Acute as=20
Age UK evidence many older people have unclaimed welfare =
benefits=20
|
(j) |
Other marginalised groups - Homelessness, = prisoners=20 and ex-offenders, ex-service personnel, people with addictions, = asylum=20 seekers & refugees, travellers |
A health visiting service adopted a = hand-held=20 patient record for travellers to allow continuation of services = across=20 various Health Board Areas. |
For patients who =
are=20
homeless, the service would liaise with the Acute Homeless Liaison =
Service=20
(AHLS). For patients with addictions =E2=80=93 the Service would =
liaise with the=20
Addiction Service. For patients in the Criminal Justice System the =
Service=20
would work with the relevant authorities. |
|
9. |
Has the service had to make any cost = savings or are=20 any planned? What steps have you taken to ensure this = doesn=E2=80=99t impact=20 disproportionately on equalities groups? |
Proposed budget savings were analysed = using the=20 Equality and Human Rights Budget Fairness Tool. The analysis was = recorded=20 and kept on file and potential risk areas raised with senior = managers for=20 action. |
As with all =
departments and=20
services, cost savings will be taken into account going forward. =
However=20
it is anticipated that this will not impact on equality groups.=20
|
|
10. |
What investment has been made for staff to = help=20 prevent discrimination and unfair treatment? |
A review of staff KSFs and PDPs showed = a small=20 take up of E-learning modules. Staff were given dedicated time to = complete=20 on line learning. |
All staff have =
undertaken the=20
Acute Services Statutory and Mandatory Training which includes a =
session=20
on equality and diversity. All staff have KSF=E2=80=99s and =
PDP=E2=80=99s. There will be=20
an induction programme for all staff regarding the new Service.=20
|
|
As part of the =
centralisation of the Services, it is anticipated that this will =
create a=20
Centre of Excellence. Specialist training programmes have been =
created for=20
Nursing staff and Allied Health Professional Staff. There will be =
a=20
dedicated rehabilitation service. The centralisation will bring =
together=20
all staff groups to provide a unified service.=20
|