3. Rapid Impact Assessment summary report

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1 Audit Risk Level: HIGH (Risk level will be added by EQIA steering group) 3. Rapid Impact Assessment summary report Each of the numbered sections below must be completed Interim report Final report x (Tick as appropriate) 1. Title of plan, policy or strategy being assessed. Potential withdrawal of Diabetes Cardiovascular Risk Clinic (DCVR) at SJH. 2. What will change as a result of this proposal? Since 2005 cardiovascular risk reduction clinics have been run for patients with diabetes of ethnic minority and white Scottish origin at SJH. These clinics have ensured that patients risk factors for worsening of cardiovascular disease including hypertension and adverse lipid profiles are optimised and risk factor targets achieved. In addition, the clinics facilitate improvements in healthy lifestyle such as weight loss, increased exercise and smoking cessation. There is the potential that clinic funding is no longer available to support this clinic. Withdrawal of the clinic at SJH would result in clinics of this type being available only at the WGH and Leith CTC. This would result in an inequitable service whereby patients living in West Lothian will have no access to a DCVR clinic. In addition, the only DCVR clinics for patients of ethnic minority origin would be available at the WGH and Leith CTC. 3. Briefly describe public involvement in this proposal There has been no direct public involvement in this proposal to date. 4. Date of RIA 16 th November Who was present at the RIA? Identify facilitator and any partnership representative present Name Job Title Date of RIA training James Glover Nov 2008 Karen Adamson Lubna Kerr Head of Equality and Diversity. Consultant Diabetologist, Diabetes MCN Clinical Lead. Diabetes Cardiovascular

2 Alison Cockburn Risk Pharmacist. Lead Diabetes Cardiovascular Risk Pharmacist 6. Evidence available at the time of the RIA Evidence Available? Comments: what does the evidence tell you? Data on populations in need Y Wider population data available Data on service uptake/access Y Clinic non-attendance rate at SJH clinic is similar to the other DCVR clinics Data on quality/outcomes Y DCVR clinics achieve targets for improvements in cardiovascular risk factors Research/literature evidence N Patient experience Y Anecdotally from patients information Consultation and N involvement findings Good practice guidelines N Other (please specify) 7. Population groups considered Older people, children and young people Women, men and transgender people (include issues relating to pregnancy and maternity) Disabled people (includes physical disability, learning disability, sensory impairment, long term medical conditions, mental health problems) Minority ethnic people (includes Gypsy/Travellers, non-english speakers) Potential differential impacts The majority of patients who are referred to the DCVR clinic are greater than 60 years old. There are a greater number of women than men who attend the clinic. Many patients with long term medical conditions attend the clinic and many have mobility problems which could make it difficult for them to attend any other clinic more distant from their homes. Patients attending the clinic comprise 60% ethnic minority origin and 40% white Scottish origin patients (approx.) Most are of Pakistani origin for whom English is not their first language and would require either an interpreter or an Englishspeaking carer to attend the clinic with them. The pharmacist running the clinic is

3 Refugees & asylum seekers People with different religions or beliefs Lesbian, gay, bisexual and heterosexual people People who are unmarried, married or in a civil partnership People living in poverty / people of low income Homeless people People involved in the criminal justice system People with low literacy/numeracy People in remote, rural and/or island locations Carers (including parents, especially lone parents; and elderly carers) fluent in a number of ethnic minority languages. No significant differential impact as likelihood very low. The majority of patients attending the clinic are Muslim and the pharmacist requires to have an understanding of their culture and beliefs in order to maximise the effectiveness of the clinic in achieving benefits for patients. No data on the sexual orientation of patients, unlikely to be a differential impact. The majority of patients attending the clinic are married. No differential impact. Many patients attending the clinic have a low income which can result in them having a higher cardiovascular risk and therefore greater need to attend the clinic. None. None. Many patients of ethnic minority origin have low literacy levels for reading and writing in English and in their own language. This can present difficulties if patients are given written information such as patient information leaflets about their medication. This emphasises the need for patients to be spoken to in their own language within the clinic. Some parts of West Lothian are remote and have limited transport facilities. This would make it very difficult for such patients to travel to a clinic far away from the clinic at SJH. Carers need to take time off work to attend clinic appointments with the patients. If the clinic was closed and patients required to attend other clinics further away e.g. at the WGH, this would result in carers having to take longer periods off work and therefore incurring loss of income. Also the non-attendance rate at the clinic would increase due to

4 Staff (including people with different work patterns e.g. part/full time, short term, job share, seasonal) OTHERS (PLEASE ADD): carers possibly refusing to take patients to their clinic appointments. If the clinic closed the patients would either attend their GP or another DCVR clinic resulting in increased workloads. Also the outpatient waiting time for appointments at these clinics would increase. The pharmacist running the clinic at SJH would be redeployed into a non-clinic post resulting in loss of expertise and job satisfaction. 8. What positive impacts were identified and which groups will they affect? Impacts Affected populations Closure of the DCVR clinic at SJH will have no positive impacts on the patients currently attending the clinic. Patients with diabetes at high cardiovascular risk. 9. What negative impacts were identified and which groups will they affect? Impacts Affected populations Closure of the clinic will result in a significant negative Patients of ethnic minority impact affecting all patients due to the need for them to and white Scottish origin. attend clinics more distant than SJH and the possible lack of availability for appointments at alternative clinics with the specialist pharmacist who currently runs the clinics at SJH. Also patients of ethnic minority origin may not be reviewed by the specialist ethnic minority cardiovascular risk pharmacist and therefore not benefit from the culturally sensitive service provided at the DCVR clinic at SJH. These negative impacts suggest that closing the clinic at SJH would be indirectly discriminatory against patients from ethnic minorities who live in West Lothian. Closure of the clinic would also have a negative impact on lifestyles, the social environment, transport and travel and on access to and quality of services for all patients attending the clinic. Both patients of ethnic minority origin and white Scottish patients may not achieve improved cardiovascular risk factor targets such as reduction in blood pressure and lipid levels with the consequent increased risk of adverse cardiovascular outcomes. This Patients from ethnic minority backgrounds. All patients attending the clinic, patients who may attend the clinic in future; especially those from ethnic minority backgrounds.

5 could result in increased hospital admissions due to an increased rate of adverse cardiovascular outcomes such as stroke or MI in this patient group. There will be a negative impact on carers resulting from the need for them to take more time to bring patients to clinics at WGH or CTC. The extra cost may be reimbursed however this is a bureaucratic exercise which some will find difficult. Carers and family members of patients in the above groups 10. What communications needs were identified? How will they be addressed? If the proposal goes ahead there will be very significant communication issues and the likelihood of indirect discrimination as identified above. Should the decision to close the clinic be made, patients currently attending the DCVR clinic at SJH will need to be informed of the closure of the clinic and alternative arrangements for their care. Patients GP s will also need to be informed of the change. 11. Additional Information and Evidence Required None. 12. Recommendations Due to the adverse effect on service provision and the strong likelihood of indirect race discrimination to patients of ethnic minority origin it is recommended that the DCVR clinic at SJH be maintained. 13. Specific to this RIA only, what actions have been, or will be, undertaken and by when? Please complete: Specific actions (as a result of the RIA) Who will take them forward (name and Deadline for progressing Review date The findings of the RIA will be discussed at the Metabolic Business meeting in November. contact details) Karen Adamson End November 2012 December How will you monitor how this policy, plan or strategy affects different groups, including people with protected characteristics? Clinic waiting times and attendance rates for patients diverted to other DCVR clinics will be monitored. Manager s Name: Alison Cockburn, Lead Diabetes Cardiovascular Risk Pharmacist Date: 20/11/2012

6 Please send a completed copy of the summary report to: James Glover, Head of Equality and Diversity Note that you will be contacted by a member of NHS Lothian s impact assessment group for quality control and/or monitoring purposes.

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