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:

Dermatology - Redesign of 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?

NHSGG&C Dermatology service is primarily delivered on an ambulatory care model. It serves the board area and beyond. Currently there are 12 in patient beds which are used for patients who have acute inflammatory skin disease not able to be cared for on an out patient basis.

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 the service is developed it has been concluded that the service will be enhanced by transferring some current in patient activity into out patient services. In essence this will result in the transfer of resources from 6 inpatient beds to out patient services. EQIA to ensure this does not have a detrimental affect on patient pathway.

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	01/03/2012

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):

Suzanne Hartness (SCN)

	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.	Although there is potential to have some analysis of equality and diversity issues, any data collection is generally limited to demographic considerations whereby service are tailored towards demands of local population	Consider developing analysis based on other equality & diversity characteristics
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 use of inpatient beds based on numbers and demographic factors have been monitored for the past few years to ensure equity of access for all patients requiring dermatology in patient care throughout the board area. This has also been used to assess the need for number of beds required to deliver a safe and effective model of in patient care within the specialty
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.	Although no extensive evidence exists, access to all parts of the service appear to be open, inclusive with no obvious barriers based on diversity of patients who require either in or out patient dermatology care
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.	The in-patient ward carries out patient feedback mechanisms by issuing Universal Feedback at discharge which has ability to highlight any pertinent equality & diversity issues requiring to be addressed. Further information on patient experience is gained by out-patient questionnaires, patient experience systems (eg Care Opinion)and formal, informal complaints. Recent poor experience highlighted at one of out patient sites regarding care of vulnerable person with dementia	Assess current systems, staff education base and aim to improve care for vulnerable adults using service
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.	All in patient and out patient sites have been fully assessed for core access - GRI service at Walton Building has some limitations in access which requires regular review as less than ideal - the site is accessible though there are some restrictions. All areas have full services regarding disabled toilets, appropriate doors, disabled parking at entrance etc	Highlight limitations for GRI site to Estates and review suitability for service
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.	Service currently involved in short life working group to ensure Clear to All policy is used optimally. Interpreting Service promoted and all staff clear of accessing mechanisms etc.	Telephone lines unsuitable in certain areas to support telephone interpreting - currently being addressed.
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.	Staffing for the service allows for full equity and sensitivity for looking after gender of all patients - chaperone service well established when required. Particular sensitivity delivered for patients with vulva skin disease.
(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.	All staff are familiar and have access to Gender Reassignment Policy. Facilities are conducive both for in patients and out patients who attend at any stage of reassignment	Ensure all staff familiar with Gender 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.	The service delivers care to patients from 12 upwards. Age sensitivity is promoted with staff to ensure all persons receive person centred care with dignity and respect regardless of age and that facilities are consistent in providing full support for all.
(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.	The services cares for persons from a wide variety of racess and ethnicity reflected local demographics in Glasgow and Clyde population. Staffing profile also reflects a variety of races within its profile across all staff groups. use of interpreting services is recognised as vital in service deliver , particularly when considering the short focussed time allocated for most out patient appointments and the need for informed consent for minor surgical procedures frequently carried out.	Review Information availability for different languages in all sites.
(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 discriminatory practice evident or tolerated throughout the service. Sexual orientation is not routinely asked on clinical basis but there is a strong sense that care should be delivered on an individual , dignified and respectful basis to all at all times. This extends to all members of staff regardless 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.	All areas are compliant with providing suitable adaptations to look after all patients regardless of disability, as stated one site is less accessible but has adequate provision. Person centred approach and staff awareness to ensure that any additional adaptations and actions are taken to make sure all persons with a disability are looked after optimally.	see action Question 6.
(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.	Faith manual is accessible via PC access. Staff have good awareness of popular religious and faith beliefs and know to access when unfamiliar with any specific belief that requires to be accounted for during patient visit or in patient stay.
(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.	Although not custom built, the service can provide suitable facilities for both pregnant and mothers with maternity needs (eg breast feeding. One of the treatment offered requires a pregnancy test to be carried out before treatment is commenced since the medication can potentially harm an unborn child. Staff are very aware of the need to deliver sensitive care for women who may be found to be pregnant during this process.
(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.	The service cares for a wide range of socio of people from across the socio economic divide. All patients are care for in accordance with their needs - staff signpost social work, hospital cashiers when appropriate for patients with financial challenges relating to visit or stay in hospital.
(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.	Given the breadth of skin disease - the service looks after perons form most marginalised groups. Staff are aware of recognising vulnerability in such patient groups that might require further support form other services. This is particularly evident with in patients - often persons with alcohol and drug dependency are admitted and addiction support services are accessed - it is less of a prominent issue for short out patient visits but staff are cited on supporting when required
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.	The redesign of the service has some cost benefits identified with resource transfer but this will not be detrimental to current services and it is the view of the service that the changes will enhance patient pathway in providing improved out patient treatment whilst still retaining access to in-patient beds for more severe skin disease. Patient engagement has and will continue to take place to make sure patients are involved in any proposed changes	Ensure continual patient engagement during period of proposal and through any consultation
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 expected to complete core learn pro modules for Equality and Diversity as core part of education. Any additional either extended or specialist courses are encouraged for staff	Consider Equality Session as part of nursing education programme in Dermatology

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

Most consultations and interventions in out patient setting do not threaten patients right to life. Within in patient and out patient services - all policies are adhered to regarding all communications, capacity & consent, Do Not Attempt to Cardio Pulmonary Resuscitation (DNACPR) are in operation in both in patient and out patient setting.

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

All staff are up to date with Child and Adult Protection training and are fully aware of actions required if any concerns are raised.

Prohibition of slavery and forced labour

No issues regarding this are routinely observed though staff aware of escalating if any concerns raised.

Everyone has the right to liberty and security

No issues regarding this are routinely observed though staff aware of escalating if any concerns raised.

Right to a fair trial

No issues regarding this are routinely observed though staff aware of escalating if any concerns raised.

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

Patient confidentiality mechanisms have a high profile within service delivery married with strong culture of person centred care.

Right to respect for freedom of thought, conscience and religion

As previously highlighted all faith, religious or political views are respected and a non judgemental approach is taken by staff delivering care.

Non-discrimination

As previously highlighted a non discriminatory culture is expected and promoted amongst all staff delivering care.

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.

The service provides a fair and equitable service for all - no specific good practice identified at present but there is an expressed commitment to develop an improved service for vulnerable adults over the coming months in out patient areas by recognising that patients who have additional needs such as dementia, learning disability and sensory impairment need to have need met regardless of length of time attending a department. This should be clearly reflected in the quality of experience within in patient and out patient departments.