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:
Plastic Surgery
Pre-Assessment |
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? |
We are a nurse led pre
operative plastic surgery clinic with 4 Nurse practitioners and 2 Health
care support nurses. We cover Monday to Friday 9-5pm. Our role is to
anaesthetically assess patients prior to their elective plastic surgery
procedure. This could include adjusting medications, organising echos and
chest x rays to optimise the patients prior to their operation. We liaise
with surgeons and anaesthetists and GPs again to discuss patient health
history for best management.We see roughly 200 patient a month with
varying health requirements. We also assess patients coming in for dental
treatment that cannot be dealt with in the community due to various health
conditions. Again we work closely with the anaesthetist with this cohort
of patients. Patients are asked to attend our clinic weeks before their
procedure. Each individual is assessed and depending on their health we
take blood, routine observations, height and weight and an ECG. The nurse
practitioner will also obtain an in-depth health and socio economic
history. |
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.) |
This service was selected due
to the various patients we see to ensure the needs of the individuals are
captured. This is an opportunity to identify, if any, areas of improvement
within our service. |
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: |
Lorraine Carr
|
15/12/2017
|
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):
Jackie Dunlop (Lead
Nurse); Lynne Danskin (Nurse Practitioner)
|
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. |
During our health history we
routinely obtain sex,age, gender , any disabilities (INCL bbv), pregnancy
and maternity status, socio- economic, religion and belief. These details
help with planning the patients admission and any special needs and
requirements are highlighted to the ward staff. |
We currently do
not collect sexual orientation and marriage and civil partnership status
as this is does not affect the patient journey and is not required to
assess the patients health requirements. |
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. |
We pass on information eg
disability to wards to make transition to inpatient care easier. Eg
Hoisting requirements, the need/requirement to bring own equipment in eg
zimmer frames, wheelchairs. The patients and ward then are more prepared
to deal with the patients individual needs. Another example of equality
information is our bariatric patients requirements. We currently are
seeing an increase of bariatric patients. We communicate to the wards and
Theatres details such as the requirement for bariatric beds. The wards now
keep larger gowns also for patients as previously communicated from a
service user that this stopped them coming into hospital due to the
embarrassment. |
|
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. |
We have undertaken a lot of
work around dementia care, staff have all attended study days and one NP
is undertaking the Dementia Champion course to educate us in the potential
of Delirium when the patient comes into hospital. We have started using a
Delirium screening tool 4AMT and TIME in the pre op assessment to assess
the possibility of an increased chance of this happening during their
hospital stay. This is then communicated to the ward staff and used as a
bench mark score.We also give advice on how to minimise delirium
'triggers'eg ensure mobility aids, glasses etc are brought to hospital and
advice on hydration pre operatively. |
This is
currently a trial. After 3 months we will review its effectiveness.
|
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. |
Not done |
For service
improvement a patient satisfaction survey should be undertaken.
|
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. |
Our building currently has a
ramp for wheelchair access at the back. This is currently accessable
however this is a steep ramp. Patients are unable to be dropped at the
back door due to building works. We are a ground floor building with
wheelchair accessible toilets. All doors have to be accessed with a swipe
card therefore all patients are escorted with a nurse. |
Ramp access
will require a review March 2018 once building works are completed.
|
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. |
We endeavour to meet the
requirements of the NHSGGC Interpreting Services for patients.
Interpreters booked regularly for the service incl. BSL for the pre op
assessment and for admission. |
|
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. |
Staff trained in disclosure
of GBV, study days and learn pro modules are undertaken. We can at times
work with survivors of FGM and patients who have been victims of physical
trauma and torture. We have Clinical psychologists on site and have a good
working relationship and excellent referral system. 3 NPs have complete
the in house psychology course. |
|
(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. |
Our clinic work with gender
reassignment patients. We are referred patients at various stages of
reassignment. Staff are aware of the NHSGGC reassignment policy. Our
patients are all treated equally and we have not experienced any
challenges with this cohort of patients. |
Further
awareness/update to all clinic staff regarding NHSGGC reassignment
policy. |
(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. |
We operate a service from
aged 17 to no limit of age. Due to the aging population we see a high
percentage of elderly. All patients despite age are treated equally and
each requirement / needs are dealt with accordingly. We have many posters
giving information regarding carer needs/help, usually focusing on the
elderly. |
Look into
posters that incorporate all age groups. |
(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. |
We use the interpreting
service for all patients that have difficulty with the English language.
We make provisions for interpreters and at times female interpreters are
requested due to their culture, also due to the sensitivity of some of the
procedures we will request gender matching of interpreters with patients
where appropriate. Staff are made aware again attending equality study
days and learn pro modules related to race related crimes. We rarely have
patients that have experienced this, or that choose to tell us these
details as it may not be relevant to their impending operation.
|
|
(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. |
We do not capture this
information as part of our assessment. This information may be volunteered
as part of the 'next of kin' question. Staff do not make assumptions about
relationship status across all age groups. Staff use the appropriate
language eg partner rather than husband/wife/boyfriend/girlfriend. Staff
again treat each person as an individual irrelevant of sexual
orientation. |
|
(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. |
We consider all disabling
factors for patients incl. BSL provision. We generally are aware of
patients requirements prior to their visit, eg interpreting. The physical
environment is suitable for all wheelchair users. We also accommodate
assistance dogs. All details captured at the assessment is communicated to
the ward to aid the patient on admission. Loop system is available if
required |
No loop system
in place - investigate |
(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. |
We capture patients religion
and beliefs at the assessment. We communicate eg HALAL meals required.
Jehovah witness patients information regarding transfusion beliefs are
particularly important while undergoing a surgical procedure. A legal
document is 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. |
This information is captured
during the assessment. We routinely do not operate on pregnant ladies
unless it is a emergency. Patients that are breast feeding do require
consideration due to the anaesthetic drugs therefore the anaesthetist is
always included in those patients. We do not have crèche facilities,
however patients that require to bring children in are welcomed.
|
|
(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. |
As we are a regional service
we do find patient's are far travelled and can struggle with finances to
fund the visit. We have a Cashiers office on site - clients advised what
to bring and escort to cashiers office for reclaim. We have some
flexibility in working with patients in their locality, completing a
telephone assessment and asking them to get blood tests are their local
GP, however this is only possible for certain patients as it is critical
we see the majority of our patients at our clinic. |
|
(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. |
We see patients from our
local prison at the pre op assessment clinic. Due to poor appointment
systems this was not done previously. We now have a robust system that the
prisoners are not disadvantaged and can attend our clinic. We treat all
patients on an individual basis and look at their needs, eg addictions -
we liaise with local pharmacy regarding methadone dispensing prior to
surgery. |
|
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. |
no cost savings in
effect. |
|
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 are given the
chance to attend all relevant study days related to diversity &
equality. modules are undertaken on learnpro. |
|
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 relevant - all information
provided to allow patients to self-determine treatment options.
|
Everyone has the right to be free from torture, inhumane or degrading treatment or punishment
Not relevant
|
Prohibition of slavery and forced labour
Not relevant
|
Everyone has the right to liberty and security
Not relevant
|
Right to a fair trial
Not relevant
|
Right to respect for private and family life, home and correspondence
As part of our service we discuss
the discharge process and work with the ward to help with adequate
discharge planning. We highlight care packages that are in place, also if
the patient lives alone. This impacts on our decision for overnight stay
etc. The ultimate decision for discharge is with the ward, they ensure a
pack in place to support return to community once the patients needs are
assessed. |
Right to respect for freedom of thought, conscience and religion
All religious beliefs are treated
with respect and dignity and provisions are made, where appropriate for eg
prayer time. We have a Chaplaincy service within the hospital that
patients can use and also a chapel and a Sunday service.
|
Non-discrimination
All patients are treated as equal
and individuals and are assessed on their individual needs and
requirements. |
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.
We have completed a lot of
work around the elderly/dementia/carers and delirium. We use a 'getting to
know you' form that asks patients/carers to fill in prior to admission.
This gives the ward staff a good insight into the 'person' they are
treating taking into account eg favourite foods, what they prefer to be
called, fears and anxieties. We highlight and ask if the patients
themselves are carers and help with the use of organisations to organise
respite/further care for their relative while they are in hospital and the
recovery period. We now screen patients at the pre op clinic for the
possibility of delirium while in hospital, highlighting at an early stage
to the ward staff if their are any triggers, aiming to reduce the chance
of a delirium episode. |