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:

Dermatology (Glasgow Royal Infirmary)

This is a : Current Service

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?

Dermatology service is delivered primarily on out patient basis with service available on all sites in NHSGG&C. The focus of this EQIA is Dermatology OPD, GRI. It functions exclusively on an out patient basis. The main pathway is referral via Primary Care or within Acute Specialties

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.)

Service at Glasgow Royal Infirmary is delivered in Walton Building and has some notable restrictions / difficulties from access perspective for certain patients

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:

Con Gillespie
12/03/2010

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):

Con Gillespie (Lead Nurse)

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.

OP service primarily collects core clinical and demographic information via Trakcare, additional information is secured via primary care which includes relevant practical info regarding equality and diversity data. Trakcare has limitations in the amount of characteristics information it can gather. This centres on age, disability and gender. Out patient documentation identifies communication / language information via referral process although there is an awareness of the need to address any concerns when a patient attends for appointment.
Consider developing availability of relevant information with Health Records this further

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.

The evidence is more anecdotal The system of including relevant equalities information in planning and supporting patients attendance at the service has matured and is robust for 'return' patients who attend who have know disabilities etc. This will be flagged on clinic notes so that staff are aware of any protected characteristics that need to be addressed. There are limitations within the service to carry out any detailed analysis of attenders with regard to planning and making future adjustments to the service and would require a robust corporate approach to address this. Although an anecdotal observation, it has been noted that a higher number of Polish patients attend the service at GRI.

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.

Higher number of Polish patients attend the service. There is considered to be a higher level of residency in North East Glasgow and since the service serves this geographical area, proportionately there appears to be higher attendance numbers of Polish nationals at Dermatology OPD GRI.
Review information for patients - consider providing additional written material

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.

Use of Patient of local Patient Experience Questionnaires, contact information regarding generic systems are available on display in the department.

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.

The department is located in an old building with access restrictions. While the majority of patients can access the department through 2 entrances - both have some restrictions, one due to proximity to outside the hospital and the other since there are stairs before entering the department. There is disability parking - though no ramp to access to Dermatology. The main restrictive issue revolves around patients who require to attend while on a trolley or bariatric chair, as there is no practical way to do this. These patients are still seen though it requires staff reviewing them in wards / departments / locations outwith dermatology. Given the limitations of access to the building, the service engages annually with hospital management to consider relocation of the department to a more accessible area - no solution to date.
Review current access problems

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.

All staff are aware and consistently use the Interpreting Policy appropriately. A Patient Experience Questionnaire is used to gauge service feedback. It is currently under review. Any additional communication needs are captured on patient referral letters and available via patient notes. This allows the team to arrange interpreting support via application of NHSGGC's interpreting policy.
Reviewed document to included protected characteristics to assess any difficulties experienced by vulnerable, protected groups of patients.

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.

No gender issues identified Unisex toilets Through the assessment no differential negative impact was found for men or women. The staff group has a balanced gender mix allowing choice of gender where specified by patient. Staff are aware of the NHSGGC Gender Based Violence Policy and can respond to any disclosures from patients.

(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.

Transgender policy available to staff - able to outline guiding principles when caring for individual undergoing / completed gender reassignment
Since staff are not completely aware of policy - some awareness raising required, arrange awareness training

(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.

Wide range of patients age cared for in the service - non discriminatory approach - staff sensitive to looking after patients with age related deficits and focus on person centred individual care evident

(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.

No race issues evident. Staff are aware of the interpreting policy and will book appropriate languages when required. Non discriminatory approach at all times - Department includes mix of races amongst staff group - no datix / HR issues raised

(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.

No issues identified. Non discriminatory policy, recognition of patient's sexuality as fundamental principle. Department includes mix of heterosexual and homosexual staff - no datix / HR issues raised

(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.


The department is located in an old building with access restrictions. While the majority of patients can access the department through 2 entrances - both have some restrictions, one due to proximity to outside the hospital and the other since there are stairs before entering the department. There is disability parking - though no ramp to access to Dermatology. The main restrictive issue revolves around patients who require to attend while on a trolley or bariatric chair, as there is no practical way to do this. These patients are still seen though it requires staff reviewing them in wards / departments / locations outwith dermatology. Given the limitations of access to the building, the service engages annually with hospital management to consider relocation of the department to a more accessible area - no solution to date.
Review access to building

(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.

No issues identified. Non discriminatory policy, respect and recognition of patient's religious beliefs and customs and accounted for if any impact on clinical care. GRI has a full Hospital Chaplaincy service available for patients if required

(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.

The department is positive about breast feeding. If a breast feeding mother requests a private space for this one would be made available. As previously referred to pregnancy is clinically contra indicated for a specific dermatology treatment and referral to pregnancy services are addressed on occasions that this occurs in a supportive sensitive way. The therapy is stopped if patient is pregnant.

(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 not extensively trained in financial support but are able to offer basic advice and support and are able to advise on expenses and onward referral if a financial concern is raised when attending the Department.

(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.

The Department caters for all patients in a non discriminatory way including marginalised groups and seek to recognise individual difficulties in a sensitive manner - an example of this includes taking prisoners etc into consulting rooms without use of public waiting areas

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.

Cost saving plans have been channelled to ensure service is efficient and meets set access targets - there is no issue regarding discrimination. Current pilot projects designed to use technology to improve patient access are currently being trialled but are closely monitored to ensure that more vulnerable groups (such as older people who are not engaged with IT systems) are not penalised

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.

Equality training available on line and core part of eksf system for staff. Revised Statutory/Mandatory Equality and Diversity training module will be going live 2018. Staff compliment will be supported to complete this.
Promote increased uptake in on line/ module 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

The service is largely OP therefore unusual to have significant life saving issues, although informed consent is practiced with all patients who have capacity.

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

No significant issues regarding this - Unit practices a person centred approach to care ensuring patient dignity and respect is maintained at all times

Prohibition of slavery and forced labour

No issues regarding slavery or forced labour in the Unit

Everyone has the right to liberty and security

No issues regarding this in the Unit.

Right to a fair trial

No issues regarding this in the Unit.

Right to respect for private and family life, home and correspondence

No issues regarding this in the Unit.

Right to respect for freedom of thought, conscience and religion

All beliefs of patients, carers and staff upheld and recognised. Faith and Belief manuals reference or any unfamiliar areas for staff

Non-discrimination

The Unit practices the ethos of non discrimination throughout the service.

12. If you believe your service is doing something that ‘stands out’ as an example of good practice - for instance you are routinely collecting patient data on sexual orientation, faith etc. - please use the box below to describe the activity and the benefits this has brought to the service. This information will help others consider opportunities for developments in their own services.

Dermatology is engaged with developing dynamic alternative methods to facilitate patient review. Attend Anywhere is currently being piloted in parts on NHSGG&C service and anticipated that it will have a significant role to play in helping patients to be seen without having to encounter some of the access difficulties highlighted earlier in this EQIA