Frontline Service EQIA

Equality Impact Assessment Tool for Frontline Patient Services

Equality Impact Assessment is a legal requirement and may be used as evidence for cases referred for further investigation for legislative compliance issues. Please refer to the EQIA Guidance Document while completing this form. Please note that prior to starting an EQIA all Lead Reviewers are required to attend a Lead Reviewer training session. Please contact CITAdminTeam@ggc.scot.nhs.uk for further details or call 0141 2014560.

1. Name of Current Service/Service Development/Service Redesign:

Therapies Department - QEUH

2. Description of the service & rationale for selection for EQIA: (Please state if this is part of a Board-wide service or is locally determined).

A. What does the service do?

The Therapies Department provides outpatient treatments for patients requiring Physiotherapy, Occupational Therapy and Speech and Language Therapy. Visiting services also use this environment – these include Pulmonary Rehab, The Physiotherapy Continence Service, Occupational Health, Vestibular Rehab, Ortho (Hip group) and Rheumatology research services. Previously these services were located in various areas within the South and the proposal in developing this area was to create a facility that was purpose built and provided a modern environment from which to provide good quality patient care and effective rehabilitation. This department provides care for patients in the South West of Glasgow and the Occupational Health Service for staff within the South site. This EQIA focuses on the redesign element of the department i.e. • The development of a Therapy department which encompassed – o 6 Individual treatment rooms o A separate splinting room o Group/education room for patients o 2 gym areas o 10 Physiotherapy treatment cubicles o Hand Therapy Room This Therapies department strengthens the focus on rehabilitation and enhances the patient’s experience and supports earlier discharge either completely from the service or to community/third sector. Patients receive more extensive input from specialists in rehabilitation from across the full range of Allied Health Professionals using specialist facilities. Working in this way enables more effective and efficient links with specialist outpatient services and the allied health professions.

B. Why was this service selected for EQIA? Where does it link to Development Plan priorities? (if no link, please provide evidence of proportionality, relevance, potential legal risk etc.)

As part of the ASR implementation to develop the Queen Elizabeth University Hospital, the Therapies Department was a new build area which had not been EQIA at time of transfer. An EQIA is now being undertaken as this department has been operational for one year.

3. Who is the lead reviewer and when did they attend Lead reviewer Training? (Please note the lead reviewer must be someone in a position to authorise any actions identified as a result of the EQIA)

Name:	Date of Lead Reviewer Training:
Catherine Nivison	31/01/2017

4. Please list the staff involved in carrying out this EQIA (Where non-NHS staff are involved e.g. third sector reps or patients, please record their organisation or reason for inclusion):

Catherine Nivison (Chief AHP); Lynsey Warner (O/T); Alison Leiper (AHP Team Lead); Jan Stanier (SLT Team Lead)

	Lead Reviewer Questions	Example of Evidence Required	Service Evidence Provided	Additional Requirements
1.	What equalities information is routinely collected from people using the service? Are there any barriers to collecting this data?	Age, Sex, Race, Sexual Orientation, Disability, Gender Reassignment, Faith, Socio-economic status data collected on service users to. Can be used to analyse DNAs, access issues etc.	The TrakCare patient information system allows the recording of age, gender, ethnicity; religion; any interpreting requirements; preferred language etc. Disability is recorded in the Patient’s Notes for O/T and SLT but MSK Physiotherapy will be recorded in their own records. Rheumatology Physiotherapy and O/T record in SELMA. Barriers to capturing data might be the patient’s condition e.g. communication impairment. There may be further barriers if the relative has a learning disability or English is not the first language. For those patients with a learning disability, staff in these circumstances would ensure they involve other relative/carers. For all other areas staff are aware of the various interpreting tools/services and utilise these as appropriate.
2.	Can you provide evidence of how the equalities information you collect is used and give details of any changes that have taken place as a result?	A Smoke Free service reviewed service user data and realised that there was limited participation of men. Further engagement was undertaken and a gender-focused promotion designed.	In planning for the proposed department, the numbers of service users and their requirements were considered to ensure that the most appropriate clinical environment was provided. This took into consideration patient, numbers, gender of patients and those requiring specialist assistance and assistance with transport.
3.	Have you applied any learning from research about the experience of equality groups with regard to removing potential barriers? This may be work previously carried out in the service.	Cancer services used information from patient experience research and a cancer literature review to improve access and remove potential barriers from the patient pathway.	When developing the QEUH site, extensive work within the local community was undertaken by the Community Engagement Teams and a number of both patient and staff surveys were undertaken to look at access and services. This includes private cubicle space for confidentiality. Plans are now in place to undertake an audit of patient experience within the department. Use of CARE measure as PREM for MSK Physiotherapy. Act on feedback from Hip Education Group.
4.	Can you give details of how you have engaged with equality groups to get a better understanding of needs?	Patient satisfaction surveys with equality and diversity monitoring forms have been used to make changes to service provision.	When developing the Clinical Services Strategy wide scale engagement, including specific engagement on AHPs. All areas of NHS Greater Glasgow and Clyde were represented in this engagement activity including organisations based and/or working within the South of Greater Glasgow. Specific audits have been undertaken by the Therapies which have helped inform the design/layout of the department e.g. the O/T service sought patient feedback on service provision which highlighted the need for more privacy at point of treatment – this supported the design of the cubicle and individual rooms.
5.	Question 5 has been removed from the Frontline Service Form.
6.	Is your service physically accessible to everyone? Are there potential barriers that need to be addressed?	An outpatient clinic has installed loop systems and trained staff on their use. In addition, a review of signage has been undertaken with clearer directional information now provided.	Through the Community Engagement Teams a system wide review of patient transport was undertaken to ensure ease of access to the QEUH site. The buses drop off directly outside the front door. The ambulance drop off is to the side of the building. Patient Transport drop off is directly outside the front door of QEUH. There are disabled parking spaces available on the ground floor of the car park with ramp access into the hospital. Access to the Therapies department was a key consideration in placing this on the ground floor near to the front door to allow ease of access for less ambulant patients. Within the department all doors are wide enough to allow both wheelchair, walking aid and trolley access. As well as the main reception there is a reception within the department and this has both a high and low counter. All toilets and showers are wheelchair accessible. Lack of signage has been complained about as an issue for some patients – informal feedback no written complaint.	Doors are a barrier as are problematic (not automatic). Patients do complain about distance to walk from car park
7.	How does the service ensure the way it communicates with service users removes any potential barriers?	A podiatry service has reviewed all written information and included prompts for receiving information in other languages or formats. The service has reviewed its process for booking interpreters and has briefed all staff on NHSGGC’s Interpreting Protocol.	Staff are aware of NHSGG&C’s Clear to all and Interpreting Policy. LearnPro used. Staff explore the best method of communicating with patients as there can be those with communication difficulties. Staff training provided – LearnPro, events, condition specific training e.g. dementia/stroke. Staff arrange for interpreters as and when required. Mobile phone available for laryngectomy patients to access. Patients can use text to communicate. Portable loop systems are available. Key members of staff are also trained in BSL. Use of BSL interpreters. Quenda system for patients to automatically check in (available in different languages).
8.	Equality groups may experience barriers when trying to access services. The Equality Act 2010 places a legal duty on Public bodies to evidence how these barriers are removed. What specifically has happened to ensure the needs of equality groups have been taken into consideration in relation to:
(a)	Sex	A sexual health hub reviewed sex disaggregated data and realised very few young men were attending clinics. They have launched a local promotion targeting young men and will be analysing data to test if successful.	It is expected that staff will accommodate requests for same sex health professionals as requested or provide appropriate chaperoning. Individual treatment spaces have curtains and all windows have blinds to maintain patient’s privacy. Individual treatment rooms are available for patients who require privacy to disclose sensitive information. Staff are aware of NHSGG&C’s Gender Based Violence Policy.
(b)	Gender Reassignment	An inpatient receiving ward has held briefing sessions with staff using the NHSGGC Transgender Policy. Staff are now aware of legal protection and appropriate approaches to delivering inpatient care including use of language and technical aspects of recording patient information.	Staff are aware of NHSGGC’s Transgender Policy. Staff ensure that patients are treated as their chosen gender and ask patients how they wish to be addressed.
(c)	Age	A urology clinic analysed their sex specific data and realised that young men represented a significant number of DNAs. Text message reminders were used to prompt attendance and appointment letters highlighted potential clinical complications of non-attendance.	The services are for adults > 16 years old across all age ranges. Staff have undertaken adult protection training, including the on-line training modules. They have also undertaken Child protection training as some children may require to accompany an adult for their treatment. Equality and Diversity Training is undertaken. Condition specific training available as required.
(d)	Race	An outpatient clinic reviewed its ethnicity data capture and realised that it was not providing information in other languages. It provided a prompt on all information for patients to request copies in other languages. The clinic also realised that it was dependant on friends and family interpreting and reviewed use of interpreting services to ensure this was provided for all appropriate appointments.	Interpreting services are available and staff are aware of how to arrange interpreters for patients. Information is provided in other formats upon request e.g. patient leaflets that have gone through quality assessment. Quenda self check in available.
(e)	Sexual Orientation	A community service reviewed its information forms and realised that it asked whether someone was single or ‘married’. This was amended to take civil partnerships into account. Staff were briefed on appropriate language and the risk of making assumptions about sexual orientation in service provision. Training was also provided on dealing with homophobic incidents.	Staff are aware of the Civil Partnership Act. Staff do not make assumptions about relationships and use appropriate terminology. Sexual orientation data is not captured routinely as patients are not treated any differently regardless of sexual orientation. In some patient’s records this may be recorded for specific clinical reasons. Staff are aware of how to signpost patients to relevant services should they disclose any information that therapies are unable to deal with e.g. victim support, counselling.
(f)	Disability	A receptionist reported he wasn’t confident when dealing with deaf people coming into the service. A review was undertaken and a loop system put in place. At the same time a review of interpreting arrangements was made using NHSGGC’s Interpreting Protocol to ensure staff understood how to book BSL interpreters.	As outlined above the therapies department is designed for access by wheelchair, trolley and walking aids. Clear signage on entrance to main hospital. Lower reception desks for wheelchair users. Staff are aware of how to arrange British Sign Language interpreters and other forms of communication support. The Service ensures any information requests for materials in alternative language or other formats are met in line with NHSGGC’s Clear to All Policy. The Service has a mixture of cubicles, single rooms, male and female changing areas. All toilets and showers are suitable for disabled access. Moving and handling equipment is available to facilitate safe transfer of those with mobility difficulties. To assist patients with mental health needs, staff liaise with the appropriate Community Psychiatric Nurse (CPN) if required. Also, the Service liaises with Old Age Psychiatry Service as required. Where applicable, equipment can be provided for patients who are at risk of falls. Staff will signpost patients to support agencies/charities. Staff are aware of The Adults with Incapacity Act. Acquired & Augmentative communication aids are available including iPads with appropriate apps for service users with communication difficulties e.g. loss of voice.
(g)	Religion and Belief	An inpatient ward was briefed on NHSGGC's Spiritual Care Manual and was able to provide more sensitive care for patients with regard to storage of faith-based items (Qurans etc.) and provision for bathing. A quiet room was made available for prayer.	The QEUH has access to multi-faith chaplaincy service and patients attending therapies department can utilise these services, through self referral or referral via Therapies staff. Posters about the Chaplaincy service are available within the main atrium.
(h)	Pregnancy and Maternity	A reception area had made a room available to breast feeding mothers and had directed any mothers to this facility. Breast feeding is now actively promoted in the waiting area, though mothers can opt to use the separate room if preferred.	Breast feeding facilities are available for patients and relatives within the building.
(i)	Socio - Economic Status	A staff development day identified negative stereotyping of working class patients by some practitioners characterising them as taking up too much time. Training was organised for all staff on social class discrimination and understanding how the impact this can have on health.	Staff will signpost patients/relatives to advocacy services who in turn will signpost them accordingly for financial advice, e.g. Social Work Services, Money Matters. The Information Centre based within the ground floor of QEUH provides information and advice to patients/relatives and staff will signpost to this facility. Staff will liaise with Social Work regarding financial issues if this is disclosed.
(j)	Other marginalised groups - Homelessness, prisoners and ex-offenders, ex-service personnel, people with addictions, asylum seekers & refugees, travellers	A health visiting service adopted a hand-held patient record for travellers to allow continuation of services across various Health Board Areas.	It is not anticipated that this proposal discriminates against any of these equality groups. For these vulnerable groups there are policies and protocols in place e.g. signpost to Addiction Services, Homelessness Team, and the Asylum Seeker Services. Staff are aware of NHS polices governing access of care.
9.	Has the service had to make any cost savings or are any planned? What steps have you taken to ensure this doesn’t impact disproportionately on equalities groups?	Proposed budget savings were analysed using the Equality and Human Rights Budget Fairness Tool. The analysis was recorded and kept on file and potential risk areas raised with senior managers for action.	Not applicable.
10.	What investment has been made for staff to help prevent discrimination and unfair treatment?	A review of staff KSFs and PDPs showed a small take up of E-learning modules. Staff were given dedicated time to complete on line learning.	All staff have KSF’s and PDP’s. All staff undertake the Acute Services Statutory and Mandatory Training which includes a session on equality and diversity. All staff undertake adult protection training, child protection training and gender based violence training.

11. In addition to understanding and responding to our legal responsibilities under the Equality Act (2010), services have a duty to ensure a person's human rights are protected in all aspects of health and social care provision. This may be more obvious in some areas than others. For instance, mental health inpatient care (including dementia care) may be considered higher risk in terms of potential human rights breach due to removal of liberty, seclusion or application of restraint. However risk may also involve fundamental gaps like not providing access to communication support, not involving patients/service users in decisions relating to their care, making decisions that infringe the rights of carers to participate in society or not respecting someone's right to dignity or privacy.

Please give evidence of how you support each article, explaining relevance and any mitigating evidence if there's a perceived risk of breach. If articles are not relevant please return as not applicable and give a brief explanation why this is the case.

Right to Life

Not applicable.

Everyone has the right to be free from torture, inhumane or degrading treatment or punishment