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1 Mainstreaming Equality Report

2 Accessibility If you would like this document in a language or format of your choice including large print, audio etc contact NHS Lanarkshire or if you have any questions or want to feedback please contact: Call Hina Sheikh E- Mail Languages Hina Sheikh Write to: Hina Sheikh Equality and Diversity Manager NHS Lanarkshire Law House Airdrie Road Carluke ML8 5ER 2

3 Contents 1. Introduction 2. NHS Lanarkshire About us 3. The Equality Act Legal Requirement Page 5 Page 6 Page 8 Page 9 4. Mainstreaming Page 13 NHS Lanarkshire s approach 4.1 Lanarkshire s Commitment: Leadership and Governance 4.2 Equality and Diversity Impact Assessment 4.3 Partnership Working Page 13 Page 14 Page Community Partnerships NHS Lanarkshire Public Partnership Forum Partnership Working with Staff 4.4 Care Experience, Accessibility and Communications Patient Experience Indicators Patient Appointments Communications Health Improvement Initiatives delivery consistent with the needs of communities Deliver appropriate Religious Care to patients and staff Equality of access to all NHS Lanarkshire premises 4.5 Workforce Workforce Data Equal Pay Staff Development 4.6 Procurement 4.7 Data Monitoring NHS Lanarkshire update on data collection of the protected characteristics group NHS Lanarkshire Data Collection Systems 4.8 Dealing With Complaints 5. Equality Outcomes 6. Conclusion Page 19 Page 24 Page 27 Page 28 Page 31 Page 32 Page 33 3

4 Foreword by Chair to be added Neena Mahal 4

5 1. Introduction NHS Lanarkshire s Equality Mainstreaming report outlines how we are working to ensure equalities are mainstreamed into the functions and activities of our organisation and details our commitment to meeting the general and specific duties set out under the Equality Act As a Board we are building on a foundation of existing good practice in equalities as we have an established Single Equality Scheme (SES). This provides us with a strong base to take this agenda forward. This report describes the actions agreed and delivered in support of NHS Lanarkshire s SES which was published in April 2010 see link: ( Scheme-April-2010.pdf). This report also shows how we have been active in identifying and removing discrimination and how we intend to embed equalities into all our actions in line with the requirements of the Public Sector Duty. Within this report we identify how our core activities contribute to the performance of our general duties under the Equality Act and set out how we propose to continue to meet our commitment to the equalities agenda and our legal equality duties over the next 4 years. Our core activities are around the following themes: Leadership, Corporate Commitment, and Governance Equality Impact Assessment Partnership Working Care Experience, Accessibility and Communications Workforce and Workforce Development Procurement Monitoring Data, Reporting and Publishing Dealing With Complaints 5

6 2. NHS Lanarkshire About Us NHS Lanarkshire (NHSL) is responsible for improving the health of more than 563,185 people living within the North and South Lanarkshire local authority areas and currently employs approximately 12,000 staff (Headcount). At present, NHS Lanarkshire provides acute hospital services at Wishaw General, Hairmyres and Monklands hospitals. Each of these hospitals has an accident and emergency (A&E) department and provides a range of specialist medical and surgical services. Maternity services are based at Wishaw General Hospital. Primary health care is provided in the community and includes general practitioners (GPs), dentists, pharmacists, health visitors and a wide range of health professionals. These services are overseen by North and South Lanarkshire Community Health Partnerships. NHS Lanarkshire's primary care facilities include health centres and community and day hospitals. A Healthier Future NHS Lanarkshire has recently launched A Healthier Future a strategic planning framework detailing our four strategic aims to deliver the Scottish Government s 2020 Vision. A Healthier Future establishes our quality ambitions of providing healthcare that is person-centred, safe and effective by: Reducing health inequalities, improving health and healthy life expectancy. Supporting people to live independently at home through integrated health and social care working. Models of hospital day case treatment as the norm, avoiding admission where possible. Improving palliative care and supported end of life services. 6

7 A Healthier Future also establishes the organisational values of: Respect; Fairness; Working together and Quality This will increasingly influence our ambition for quality improvement and the way in which we work to deliver improved care and service to our communities. Further details of A Healthier Future are available at: 7

8 3. The Equality Act 2010 The Equality Act became law on 1 October 2010 and replaced previous Anti-discrimination laws with a single Act. It simplified the law into a single source and ensures that everyone who is protected under law from discrimination, harassment or victimisation is afforded the same level of protection. The Equality Act introduced the concept of nine protected characteristics. These protected characteristics (PCs) are: Age Disability Gender Reassignment Pregnancy and Maternity Race Religion and Belief Sex Sexual Orientation The Equality Act also applies to marriage and civil partnership, but only in respect of the requirement to have due regard to the need to eliminate discrimination. The Act stipulates that all Health Boards across NHS Scotland (as are all public bodies) are required to produce and deliver a set of equality outcomes to further one or more of the three needs of the Public Sector Equality Duty (PSED/also know as General Duty). The PSED requires Scottish public authorities to pay 'due regard' to the need to: Eliminate unlawful discrimination, harassment and victimisation Advance equality of opportunity Foster good relations between people. The General Duty is supported by Specific Duties, set out in regulation, which came into force on 27 May The requirements of the Specific Duties are as follows: 8

9 Duty to report progress on mainstreaming the equality duty Duty to publish equality outcomes and report progress Duty to assess and review policies and practices Duty to gather and use employment information Duty to publish gender pay gap information Duty to publish statements on equal pay, etc Duty to consider aware criteria and conditions in relation to public procurement Duty to publish in a manner that is accessible Duty to consider other matters Duty of the Scottish Ministers to publish proposals to enable better performance The focus of this report is to provide details of the progress NHS Lanarkshire has made in mainstreaming the equality duty, as well as gathering and using employment information in relation to equality. 3.1 Legal Requirements We will meet our General Duty through the activities identified in the Specific Duties which are listed below with actions: Specific Duty NHSL Actions/Timeframe Leading Department Duty to report progress on NHSL will publish its Equality and Diversity mainstreaming the equality mainstreaming report on its duty public website by 30th April 2013 Duty to publish equality NHSL will publish its equality Equality and Diversity outcomes and report outcomes and progress mainstreaming report on its public website by 30th April 2013 Duty to assess and review This continues to be Equality and Diversity policies and practices mainstreamed into the organisation through the use of Equality & Diversity Impact Assessment as part 9

10 Specific Duty NHSL Actions/Timeframe Leading Department of policy development and review Duty to gather and use employment information NHSL will gather and use the following information within the identified groups and timeframes: Disability Increase the proportion of the workforce identifying as disabled from the current level of 0.29% to at least the public sector average by Human Resources Duty to publish Gender Disability Black and Minority Ethnic (BME) Pay gap information Ethnicity Increase the proportion of staff identifying as BME be increased from the current 2.8% to at least the public sector average by The level of staff designated as unknown in identifying ethnicity, currently at 32.01%, be reduced to less than 10% by 2015 and to be less than 5% by 2017 NHSL will : Publish gender pay gap information by 30 April 2013 The pay gap between staff with a disability and nondisabled staff to be quantified by April The pay gap between staff who identify as BME and Human Resources 10

11 Specific Duty NHSL Actions/Timeframe Leading Department those who identify as non- BME to be quantified by April Where the pay gap exceeds 5%, NHS Lanarkshire will take all action required to reduce the pay gap to less than 5% by 2017 and to zero by 2020 Duty to publish statements NHSL will : Human Resources on equal pay Publish a statement on equal pay between men and women by 30 April Include the protected characteristics of race and disability in the second and subsequent equal pay statements from 2017 onwards. Duty to consider award NHSL will : Procurement criteria and conditions in relation to public procurement Ensure that all purchases are made in full compliance with Government Legislation. Utilise Nationally agreed Terms and Conditions constructed by the Scottish Governments Central Legal Office for the purchase of all goods and services. Duty to publish in a manner that is accessible NHSL will publish its mainstreaming report on our public website by 30th April 2013, which is able to make reasonable adjustments as when required. Equality and Diversity Communications 11

12 NHS Lanarkshire s Equality and Diversity Steering Group has core responsibility for promoting and delivering the work on the equality agenda and ensures the organisation monitors, delivers and marks progress against set plans to meet the legal requirements in line with the duties. The group will oversee the: Publication of the set of Equality Outcomes Mainstreaming report Employment data information by 30 th April 2013 and thereafter ensure that NHS Lanarkshire; publishes a four yearly mainstreaming report and oversee the publication of the progress report on the achievement of its equality outcomes every two years The Equality and Diversity Steering Group reports to the Clinical and Staff Governance Committees and to the NHS Lanarkshire Board. 12

13 4. Mainstreaming NHS Lanarkshire s Approach Mainstreaming is a specific requirement for public bodies implementing the Equality Act Mainstreaming is defined as integrating equality into the day-to-day working of NHS Lanarkshire and taking equality into account in the way we exercise our functions. In other words, equality should be part of everything we do. The benefits of mainstreaming equality The Equality and Human Rights Mainstreaming Guidance identifies that mainstreaming the equality duty has a number of benefits including: Equality becomes part of the structures, behaviours and culture of an authority An authority knows and can demonstrate how, in carrying out its functions, it is promoting equality Mainstreaming equality contributes to continuous improvement and better performance. See link: Our Single Equality Scheme commits us to meeting all aspects of the general duty and to mainstreaming equalities into all our functions. What this report evidences is the benefits that we have started to see through our mainstreaming work, it also highlights areas that require further development and re-enforces our commitment to mainstreaming equalities. 4.1 Lanarkshire s Commitment: Leadership and Governance Mainstreaming the Equality Duty is an organisational responsibility to which NHS Lanarkshire s Board is committed. Its significance, as part of our core business is demonstrated by the existence of regular reporting to the Board through our governance structures and the nomination of an Executive Lead for equalities on the Board and within the Corporate Management Team. 13

14 The Board also ensures that clear and consistent messages are given to senior managers about the importance of meeting the equality needs of service users and employees. To achieve the above, NHS Lanarkshire s Board will: Continue its public commitment by supporting and endorsing NHS Lanarkshire s equality outcomes and mainstreaming report and ensuring these documents are published by 30 th April 2013 in line with the requirements of the Specific Duties of the Equality Act Ensure Equality and Diversity business and progress is regularly reported to the Staff and Clinical Governance Committees, including through annual reports. Ensure that executive and non-executive members are aware of their individual and corporate responsibilities, through training and the provision of information where appropriate to guide Board members in their role. 4.2 Equality and Diversity Impact Assessment An Equality and Diversity Impact Assessment (EDIA) is a careful examination of a proposed policy, strategy, service or function, to see if it could affect some groups unfavourably; especially minority groups who may experience inequality, discrimination, social exclusion or disadvantage. It applies equally to internal and external policy, strategy, functions and services. All managers are responsible for incorporating EDIA into their policy, functions and service developments, and for assessing the equalities impact. This should be a continuous process, starting at the very beginning of the project/review of service and continuing through to evaluation and monitoring of the work completed. In delivering its commitment to mainstreaming EDIA: NHS Lanarkshire continues to actively promote the standardised EDIA which is part of our policy writing guidance 14

15 All NHS Board policies, strategies and plans are equality impact assessed as standard practice. Capacity continues to be built across the organisation as relevant staff are trained and provided with guidance and support to complete the standardised EDIA effectively. This is done through training and bespoke sessions delivered to departments and teams. 4.3 Partnership Working We have a commitment to working in partnership with other agencies and organisations from the public, community, voluntary and private sector as well as with our staff and service users, to plan and deliver services. Our aim is to ensure that our services meet the needs of the whole community in the most effective way Our partnership processes allows us opportunities to look at creative ways to advance equality of opportunity and foster good relations between people who share a protected characteristics and those who do not Community Partnership NHS Lanarkshire supports and funds a number of community based groups that represent and articulate the needs of some of the groups who share protected characteristics. Our aim is to ensure that we advance equality of opportunity and that we do not discriminate against any section of the community. These groups are involved in consultation and design of services e.g. NHS Lanarkshire s Disability Engagement Group (DEG) is a group hosted by NHS Lanarkshire. This is a partnership group that has been meeting since DEG meets four times a year and group members include representatives from local and voluntary sector disability and carers groups within Lanarkshire. The group identifies and addresses any barriers experienced by people with disabilities when accessing NHS Lanarkshire services. The groups, work supports future developments and changes to services. 15

16 DEG carried out a Wayfinding exercise, which looked at access and the patient experience in accessing our three main hospital sites, the findings of the report identified area of improvement and development and the report has subsequently been used in our planning processes to inform a number of areas of work. DEG also, recently contributed to the redesign of the car parking facilities at one of our acute sites. By doing on-site visits they were able to advise on where to best place the disabled parking bays and drop off zones. NHS Lanarkshire also funds specialist posts within existing projects which target specific hard to reach groups e.g. The Princess Royal Trust Carers project employs to two Black and Minority Ethnic (BME) workers to support to Black and Minority Ethnic carers in the community. NHS Lanarkshire works in partnership with Lanarkshire Ethnic Minority Action Group (LEMAG) is a BME umbrella group and has been in existence for over 10years. LEMAG holds regular involvement events with the strategic and statutory partners and BME communities. NHS Lanarkshire has also been targeting BME communities in raising awareness and anti-stigma work around mental health and well-being, with a number of targeted initiatives run within local mosques e.g. a group of young BME children over a period of sessions attended an adapted mental health first aid course and then designed Tip cards for their families, friends and community with messages on ways to maintain good mental health and well being. 16

17 NHS Lanarkshire has a clear policy and procedure based on national guidance for someone presenting themselves to our services and requiring transgender services. The protocol was consulted on at national level and has been adapted for use locally in Lanarkshire. NHS Lanarkshire also engages with a number of locally based Lesbian, Gay, Bisexual and Transgender (LGBT) groups through its health promotional activities and outreach work NHS Lanarkshire s Public Partnership Forums (PPFs) The main purposes of the PPFs are to:- keep local people informed about the range and location of services engage users of the health service, carers and the general public in discussion about how to improve local health services support wider public involvement in planning and decision-making about health services that are delivered locally NHS Lanarkshire supports hard to reach groups in our communities to participate in the structures of PPFs North and South Lanarkshire. PPFs are attended Lanarkshire Locality PPFs. NHS Lanarkshire is currently engaging with PPFs in over 30 different groups or service developments. 17

18 Membership of locality or community forums is welcomed from any group or individual. Work is on-going to encourage greater diversity of membership. The PPFs have sought the active engagement of a number of equality groups, with varying degrees of success. This is an area of work which is on-going and requires further development, both from the PPFs and NHS Lanarkshire Partnership Working with Staff The development of the Staff Governance Standard and its subsequent enshrinement in law have enhanced the value and importance of partnership working as the most appropriate and modern employee relations framework for the NHS in Scotland. Within NHS Lanarkshire partnership working with staff and their representatives underpins everything that we do. Through a structure of partnership working, including the Staff Governance Committee, Area Partnership Forum, Stakeholder Engagement Group, Human Resources Forum and Divisional Partnership Forums we ensure that staff are able to influence how we work. We give staff the opportunity of early consultation and involvement, thus enabling them to influence decision making. The local partnership approach, involving operational managers and trade union representatives, helps to ensure consistency and fairness across the organisation. NHS Lanarkshire has a number of local and national policies that meet the needs of the diverse range of staff we employ, e.g. carers leave, maternity/paternity leave, flexible -working and anti-bully and harassment policies. 18

19 4.4 Care Experience, Accessibility and Communications Understanding how different people use our services is an important step in mainstreaming equality into our services and how we deliver them. Ensuring that the care and services provided meet cultural, social and religious needs and are person and needs led. In doing this we have not only gather evidence and data but also communicate effectively in an inclusive and sensitive way in gaining such understanding Patient Experience Indicator Historically complaints and letters of compliments have been used as an indicator of experience however there is recognition that these measures are not sensitive enough. Patient satisfaction surveys have also been used but again there is recognition that patients may be satisfied with our service but not had a good experience. The Patient Experience Indicator (PEI) has been developed locally as part of both the Better Together programme and the Leading Better Care programme as a means to assist Senior Charge Nurses to have a measure and use data to improve the quality of the experience of care. 19

20 Internal NHS Volunteers are members of NHS Lanarkshire staff who are not directly involved in the delivery of hands on care within the ward environment carry out over 250 interviews every month across the inpatient sites on issues varying from staff attitude, issuing of medication, cleanliness of the wards and general experience of the hospital during their stay. Initial feedback is given at point of completion to the Senior Charge Nurse (SCN) for the area in order that they and their teams can identify areas of strength and areas for improvement. The data from the PEI is stored within the LanQIPs system (internal collection systems), which allows the SCN to review their results and monitor trends. This system also enables information regarding each of the questions to be aggregated across sites and divisions. The data is discussed, in conjunction with Scottish Patient safety data and other Quality improvement data as part of the General ward work stream programme, thus ensuring that patient experiences are viewed as equally important to safety and effectiveness in care delivery Patient Appointments Consultation and involvement has highlighted a number of areas of concern for disabled groups and carers, including a greater need for greater flexibility around appointment times and a more inclusive appointment system. There are new systems in place to offer enhanced flexibility around appointment times and the aim is to not only reduce Do Not Attendees (DNA) but also improve patients experience of the service. For example a new text reminder system which is helpful to British Sign Language (BSL) users. Along with changes to the interpreting policy this is encouraging the use of telephone interpreting and text (for BSL users) prior to appointments to confirm with patients the date and time and that an interpreter has been booked. 20

21 4.4.3 Communications NHS Lanarkshire has a Communication Strategy and accompanying Good Practice Guide to Written Information which is promoted within the organisation. The strategy supports good practice in ensuring that our literature and the information that we share with patients, carers and staff is clear, concise and easily understood. Patient information is produced in line with NHS Lanarkshire s Policy for Written Information Leaflets. Core patient information is currently available in the 3 most commonly used community (non-english) languages, additional information that is required to be translated is available upon request. Patients, Carers or staff can request translated information. Leaflets produced in line with NHS Lanarkshire Policy are produced using the principles of Plain English and are available in different formats upon request A series of Easy Read leaflets are available explaining hospital admission and medical screening / tests. The Scottish Consortium for Learning Disabilities has adapted these for use nationally. The Adult Learning Disability Service is currently working with Sexual Health Services to develop Easy Read information for sexual health awareness. Development of a more efficient and patient centred interpreting service was launched in January 2013 and is being delivered in partnership with NHS Greater Glasgow and Clyde Health Board (GGCHB). By using GGCHB, NHS Lanarkshire now has access to a wider pool of trained and qualified interpreters. NHS Lanarkshire s patient information services are able to arrange for translation of information in most languages upon request and also are able to provide pictorial information in certain services Health Improvement Initiatives delivered consistent with the needs of communities In designing health improvement initiatives to meet out our national targets and priorities we take into account that we need to eliminate unlawful discrimination and 21

22 advance equality of opportunity. Our data showed us that that there were certain sections of the community with shared protected characteristics whose health needs were not being met through our services. As a result we have a specific equality outcome to meet these needs which will include the provision of outreach and community based health check services for BME, older and disabled people. Staff continues to actively engage with communities to identify on-going needs and the support required. Staff are also developing their understanding of the cultural and religious context when delivering services or carrying out outreach work Deliver appropriate Religious Care to patients and staff Spiritual and religious care is provided to all patients, carers, staff and volunteers regardless of their faith or belief. Links with local faith and belief groups are maintained and utilised for support upon the request of individuals. Facilities within the three acute care hospitals are being upgraded to ensure that people from all faith groups and none, have an appropriate space of sanctuary for quiet reflection or prayer and celebration. A Spiritual Care Advisory Committee (SCAC), consisting of representatives from local faith and belief groups, meets bi-annually to ensure that local needs are met. Through the SCAC, local faith and belief groups have been supported and encouraged by NHS Lanarkshire and Local Authorities to support people with mental health problems through the signing of the See me pledge. We are currently developing more pro-active links with community faith and belief groups to support older people in the community. 22

23 4.4.6 Equality of access for all to NHS Lanarkshire premises In the building, designing or refurbishment of NHS Lanarkshire s premises/facilities NHS Lanarkshire works in line with the requirements of the Equality Act 2010 and ensures equality is a core consideration at the design stage to ensure compliance with statutory obligations, to ensure that: Signing for all new build and refurbishment works are taken into account at the design stage. Fire safety requirement for people with disabilities is included at the design stage for all new builds and refurbishments. In any audits carried out in existing buildings, reasonable adjustments are identified by premises managers responsible for the management of safety at work and are encompassed in the design and delivery. Fire Safety advice and assistance is provided to managers by our internal Fire Safety Advisors Guidance is also issued by the Nominated Officer Fire to managers in accordance with NHSL Fire Policy (2010) and NHS Scotland Fire Policy Chief Executives Letter 25 (2008) and the document Practical Fire Safety Guidance for the Evacuation of Disabled Persons from Buildings is also used in other NHS Lanarkshire premises but not used in NHS Lanarkshire Hospitals. NHS Lanarkshire through its capital and minor capital investment programmes has made the changes to ensure that all NHS Lanarkshire hospitals wards now provide single sex accommodation for patients. 23

24 4.5 Workforce NHS Lanarkshire is committed to providing a positive working environment, based on constructive working relationships and it greatly values the contribution of its employees in the delivery of health services to local communities. As an employer we are committed to equality and treat our staff with dignity, respect and consideration. We aim to help staff to reach their full potential at work and we support them with policies that reflect a modern workforce and its needs. We also recognise that a diverse organisation with a range of abilities, experience and skills is more likely to be sensitive to the needs of the diverse community that we serve. Staff members working in NHS Lanarkshire, whether directly or indirectly employed, have a responsibility to treat others in a respectful way and are entitled to respectful treatment themselves. As an employer we are legally bound to ensure that there is no unfair discrimination in the application of its policies and that all legal obligations are met. Discriminatory criteria such as age, sex, ethnicity/race, marital or civil partnership status, sexual orientation, religion or belief, pregnancy or maternity, or gender reassignment will not be used to make any employment related decisions. The exception to this would be if positive action would be the legitimate way to advance equality of opportunity to address under-representation and low participation rates of those who share particular protected characteristics Workforce Data Equalities monitoring and reporting systems are established and information and data gathering is improving. However further work is required to fully embed a consistent approach in the actions required to address any adverse trends identified. As at 31 st March 2012, NHS Lanarkshire employs WTE (11510 head count) staff. NHS Lanarkshire currently has robust data regarding gender and age however, data on the protected characteristics of ethnicity, religion, sexual orientation and disability is limited; only covering 14-66% of the workforce. 24

25 The workforce consists of 84% female and 16% male staff and 68% of the workforce are 40 years old or older. Information on gender and age is available for all staff but limited information is available regarding the protected characteristics of ethnicity (66%), disability (14%), religion (42%) and sexual orientation (39%). This has limited NHS Lanarkshire s ability to identify inequalities. A proportion of staff (approximately 10-15%) have previously provided equality monitoring data but have declined to provide information on certain protected characteristics. As new members of staff are recruited to NHS Lanarkshire, they must complete an equality monitoring form, although they can decline to provide specific details. With a current turnover of 6% of staff per annum, it is anticipated that through current recruitment our data on protected characteristics will increase but it could take some time to establish a complete data set for all staff. The introduction of electronic employee records will improve the capture of equalities data at the point of recruitment and each interaction thereafter. The capture of this data will provide the opportunity to improve the accuracy of information in relation to equality. NHS Lanarkshire has completed a comprehensive demographic report on the workforce, to track development and trends within our existing workforce. The report also highlights areas that need further development and improvement. The report will be annually reviewed and updated in line with the changes in the staff. Workforce report link: 25

26 4.5.2 Equal Pay NHS Lanarkshire is committed to the principles of equality of opportunity in employment and believes that staff should receive equal pay for the same or broadly similar work, or work rated as equivalent and for work of equal value, regardless of their age, disability, ethnicity or race, gender, gender reassignment, religion or belief, marital or civil partnership status, pregnancy, political beliefs or sexual orientation. NHS Lanarkshire recognises that in order to achieve equal pay for employees doing the same or broadly similar work, work rated as equivalent, or work of equal value, it should operate pay systems which are transparent, based on objective criteria and free from unlawful bias. In line with the General Duty of the Equality Act 2010, our objectives are to: Eliminate unfair, unjust or unlawful practices and other discrimination that impact on pay equality Promote equal opportunities and the principles of equal pay throughout the workforce. Promote good relations between people sharing different protected characteristics in the implementation of equal pay In line with the requirements of the specific duty NHS Lanarkshire will produce and publish a report on the gender pay gap by April See link: Staff Development NHS Lanarkshire recognises the importance of embedding equalities into the learning and development for new and existing staff. As such, we provide all new staff with information on equality and diversity as part of their induction programme when joining the organisation and equality and diversity training is a core development topic for staff. 26

27 We currently deliver a number of training programmes on equality and diversity including: 1day equality and diversity training course for all staff ½ day equality and diversity training course for consultants and junior medics 3 day Equality Champions programme delivered in partnership with a local authority ½ day Equality Impact Assessment 2 day Gender Based Violence training 1 day Child Protection and 1 day Adult Protection 12 week Basic Introduction to Sign Language We regularly review our training based on assessments or feedback to allow us know that the training is meeting the need, to adjust content or re-focus. With a view to more integrated and partnership work, we intend to continue to work collaboratively with other agencies and organisations both locally and nationally to promote and embed equalities through joint learning and development. 4.6 Procurement In regards to our duty under procurement NHS Lanarkshire has: Ensured contracted services are fully aware of their duties and responsibilities for Equality and Diversity performance. Awards have NHS Terms and Conditions embedded. These Terms and Conditions include a Clause related to Diversity provided by the Central Legal Office of NHS Scotland and reflect current legislation. Contracted services to demonstrate compliance with Equality and Diversity legislation. All purchase orders refer to the Standard Terms and Conditions therefore every recipient has constructive notice of its obligations under the various Acts 27

28 Ensured all commissioned services embed equality diversity and human rights in policies and practice. The majority of the main suppliers to NHS Lanarkshire are awarded contracts by National Procurement who carry the responsibility of Contract Monitoring. However, NHS Lanarkshire has launched a supplier review programme where Equality and Diversity monitoring will form part of the review. 4.7 Data Monitoring Monitoring is an important aspect of our commitment to equality, diversity and inclusion. NHS Lanarkshire is dedicated to ensuring that its services are used and accessed in a fair and equitable way and that its services are designed to meet service users needs. Collecting and analysing equality data enables us to recognise trends and identify any barriers facing specific equality groups. To support this we continue to promote the importance of equalities data collection through training programmes and data collection systems. Equality data collection is built into our service delivery and design to ensure that services are reflective of the needs of the target groups NHS Lanarkshire s updates on data collection of the protected characteristic groups: Age and Gender is routinely recorded within existing systems. Ethnicity data: NHS Lanarkshire has consistently been one of the leading Boards in the collection and collation ethnic minority data within our acute and primary care settings over the last 8 years. We are above the NHS Scotland Scottish Morbidity Return (SMR) national average for data collection in relation to ethnicity, with our quarterly returns averaging between 85-90%. Areas of ethnicity marked as unknown have been decreasing since the introduction of new systems, through undertaking continuous development work with front-line and senior staff within the organisation. NHS Lanarkshire has introduced a number of measures to ensure that support that data is collected, an example being that all patients are asked to complete and return 28

29 the ethnicity data along with their contact detail sheets when attending both in and out patients appointments. See link for figure on captured data publications: Disability: Disability data is collected and shared through the Scottish Care Information (SCI) Gateway which is a formal mechanism to share information between primary care and secondary care. General Practitioners (GPs) use SCI to electronically refer to acute/hospital services and are able to add information on additional needs. This system requires further development to build in disability monitoring to allow NHS Boards to collate and use the information. Religion and Belief: Patients are asked their religion or belief upon admission to inpatient services within our hospitals but not within our primary care services unless it is relevant to the service being provided. Sexual Orientation is not routinely recorded and only requested in specific specialist services. Transgender: No routine data is currently being collected based on transgender identity. This is an area that needs to be further developed in partnership with local and national transgender groups. There currently no active transgender groups active in the NHS Lanarkshire area and we are dependent on national links NHSL Data Collection systems: NHSL has three patient information management systems in place; the InterSystemTrakCare (TRAK), Mutli-Disciplinary Information System (MIDIS) and Scottish Care Information (SCI) Gateway. These systems have core nationally agreed data collection information which is required to inform both national and local outcomes. TRAK: NHS Lanarkshire introduced InterSystemTrakCare (TRAK), a new national patient management system in October 2011/12 which supports the centralising of patient information and aids our day to day working practices within our acute 29

30 services. The new system will help to speed and improve the effectiveness of patient care in Lanarkshire by ensuring patient information will only need to be entered once to make it immediately accessible by authorised staff in other care settings. NHS Lanarkshire was part of a Consortium of five NHS Boards involved with this national framework agreement. MIDIS: The Mutli-Disciplinery Information System or (MIDIS) is a clinical system that is hosted in NHS Tayside and is used by several other Scottish Health Boards as part of a consortium arrangement. MIDIS was first implemented in Lanarkshire in 2009/2010 for Long Term Conditions (LTCs) nursing in one locality. Since then access to the system has been provided to all of LTCs as well as Public Health nursing, Addictions and Community Maternity services. Midis has "core" functions which all consortium members use, an example of these are patient registration and referral functions. The MIDIS system primarily supports to inform primary care services within NHSL. Importantly MIDIS also provides for a significant level of flexibility in allowing Boards to develop/localise their own forms for data capture that allows system use to be dovetailed with local and national priorities, i.e. data capture for Lanarkshire s Getting it Right for Every Child (GIRFEC), Core MIDIS enables capture of specific data items in support of equality in the provision of care, these include Preferred Language (if not English), Interpreter required, Any Sense Issue (i.e. sight, hearing), ethnic origin, religion, whether an individual lives alone and so on but the system also allows additional data that is reflective of factors pertaining to Lanarkshire to be built in, for example, rurality or socio-economic factors. The Scottish Care Information (SCI) Gateway (See disability above). We have ensured that that equality data collection is built into our equality outcomes where appropriate, to inform not only the way we deliver services and resources, but also to ensure that the service meet the needs of the target groups. 30

31 4.8 Dealing with Complaints NHS Lanarkshire is committed to managing all forms of feedback in accordance with the Patient Rights (Scotland) Act 2011 and the related guidance from the Scottish Government called Can I Help You? This includes feedback, comments, concerns and complaints. NHS Lanarkshire has a policy and procedure for handling concerns and complaints about its services. Details of how to raise a concern or make a complaint are available in a range of ways: By speaking to staff. NHS Lanarkshire also has a Patient Affairs Manager in each of our three acute hospitals and one based at our headquarters who are available to speak directly to patients and their families. By using the leaflet called Giving Feedback or Making a Complaint about the NHS. The standard English version is available in our wards and departments or via our website. Alternative versions (audio, BSL, easy read, large print and ten community languages) are available via our website or from staff. From the Patient Advice and Support Service (PASS) which is delivered by local Citizens Advice Bureaux. The latest version of the booklet and fact sheet information is available electronically on the staff intranet. The NHS Lanarkshire public website is linked directly to Health Rights Information Scotland site where foreign language versions and alternative formats are available. Printed copies (English) are available from all ward information points. 31

32 5. Equality Outcomes Equality outcomes are results intended to achieve specific and identifiable improvements in people's life chances. These changes may be for individuals, groups, families, services or communities, they can relate to changes in behaviour, decision-making, attitudes, or better awareness. NHS Lanarkshire s equality outcomes will provide evidence of how we intend to meet one or more of the three of the general duties. Equality outcomes have been proposed on the basis that they are short to medium term (2 4 years). A Summary of our outcomes are listed below see link for detailed information: Equality Outcome 1: Black and minority ethnic, older and disabled people will have a positive experience of health check services and the uptake of these services will increase within these groups. Equality Outcome2: Women in vulnerable groups and their babies will get the best start in life through improved engagement and uptake of antenatal care. In addition the provision of vital pregnancy screening programmes and early healthcare interventions will be targeted to those who may be at more risk of conditions due to ethnicity, age, disability or social disadvantage. Equality Outcome 3: Looked after and accommodated children in the community will experience an increased sense of wellbeing and associated positive health outcomes Equality Outcome 4: People from LGB &T communities within Lanarkshire will have an increased awareness of mental health service provision and experience informed and sensitive healthcare responses. Equality Outcome 5: Young people who are disabled and socially disadvantaged experience equality of opportunity in relation to training and employment within NHS Lanarkshire For detailed information on each equality outcome see link: 32

33 6. Conclusion In this report we have given an update on our progress towards mainstreaming equalities in NHS Lanarkshire. In certain areas we have achieved levels of progress and success and this demonstrates that we have been proactive and have a strong commitment to improving and changing the experiences of our service users and staff in a meaningful and inclusive way. The report also indentifies where we still need to do more work. We have continued building on our commitment to mainstreaming equalities across the range of our functions and structures. In two years we will report on progress on the areas that we have made commitment to as well as the areas that require further improvement. 33

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