Annual Report for Equality, Patient Access and Experience 2015

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1 Annual Report for Equality, Patient Access and Experience 2015

2 Contents Page Introduction 3 Healthwatch 4 Legal context 5 EDS2 7 EDS2 Results 2014/15 9 Our Equality Objectives and EDS priorities 11 Recent achievements at LCH 13 Interpretation and Translation 16 Equality Monitoring 18 Patient Experience 20 Equality Analysis 23 Contact the Team 24 2

3 Introduction This report summarises the main actions that the trust has undertaken in the last 12 months to promote equality and eliminate unlawful discrimination in the delivery of healthcare. It sets out our legal and contractual obligations for 2015/16 for equality and demonstrates how we plan to meet them over the coming year. Equality at LCH Equality and diversity for Liverpool Community Health is about promoting health equalities for our staff and all groups and communities in the city by identifying and overcoming barriers to access and inclusion across the range of health services and practices. For our communities, this means a service that is fair, flexible, engaged and responsive to cultural, physical and social difference. Our Vision Our vision is to be a champion and leader in promoting diversity, managing diversity and challenging discrimination. Diversity implies that we acknowledge people s differences whether they are visible or non-visible and attempt to promote the differences in a positive way. We deliver our services via a workforce that is made up of many talented individuals with a large diversity of backgrounds, perspectives, styles and characteristics. 3

4 Feedback on our work from Throughout 2014 and the first part of 2015 LCH has been proactive in terms of its willingness to engage with Healthwatch Liverpool. The Trust has set and maintained quarterly meetings with Healthwatch Liverpool, at which the Trust gives updates and discusses progress on its performance regarding the quality and equality of its service, and the Trust also informs Healthwatch Liverpool about its engagement with patients. The Trust has facilitated Healthwatch Liverpool to Enter and View some of its services to observe them in action, and the Trust has invited Healthwatch Liverpool to LCH engagement events. Healthwatch Liverpool is encouraged to find that the [Trust s] Quality Account contains a section on Equality. This addition is a clear recognition by LCH that providing a quality service is not possible without taking full account of the need to ensure that the service is accessible to people from all sections of our diverse local population. The Equality section is also structured well, in that it gives brief updates on achievements followed by information on what comes next. So, this section has the potential to show how the Trust is progressing over the coming years. Healthwatch Liverpool would like to see LCH maintain this useful Equality section in future editions of the Quality Account. May

5 The Legal Context Equality Act In 2010 equalities legislation was significantly updated with the passing of the Equality Act. The Equality Act has two aims, which are to harmonise and consolidate the different strands of discrimination law (over 100 pieces of separate legislation) into one single act. Therefore simplifying and strengthening the law to support progress on equality. There are nine protected characteristics covered by the legislation The Equality Act makes it unlawful to discriminate against people who share a protected characteristic and applies to services and public functions, premises, work and education. The Public Sector Equality Duties The public sector has additional duties placed on them within the Equality Act which help public authorities avoid discriminatory practices and integrate equality into their core business. The General Equality Duty Since 5th April 2011 public authorities must have due regard to the need to: Eliminate unlawful discrimination, harassment and victimisation and any other conduct that is unlawful under the Equality Act Advance equality of opportunity Foster good relations 5

6 The general duty is underpinned by specific duties which include the requirement for us to:- Set specific, measurable equality objectives. (At least one every 4 years) Analyse the effect of our policies and practices on equality and consider how they further the equality aims. (Known as equality analysis) Publish sufficient information to demonstrate we have complied with the general equality duty on an annual basis. (Equality monitoring information) The Human Rights Act The Human Rights Act 1998 came into force in the UK in October It is based on the European Convention for Human Rights which mean that individuals can take human rights cases to domestic courts. They no longer have to go to Strasbourg to argue their case in the European Court of Human Rights. All public authorities and anyone carrying out public functions must comply with the Human Rights Act. The Act sets out the fundamental rights and freedoms that individuals in the UK have access to. They include: Right to Life Freedom from torture and inhuman or degrading treatment Right to liberty and security Freedom from slavery and forced labour Right to a fair trial No punishment without law Respect for your private and family life, home and correspondence Freedom of thought, belief and religion Freedom of expression Freedom of assembly and association Right to marry and start a family Protection from discrimination in respect of these rights and freedoms Right to peaceful enjoyment of your property Right to education Right to participate in free elections 6

7 The Equality Delivery System 2 (EDS2) The Equality Delivery System aims to improve the equality performance of the NHS, embedding equality into mainstream business and ensuring all NHS organisations are meeting their obligations under the Equality Act Within EDS there are 18 outcomes over 4 goals which are: 1. Better Health Outcomes for All 2. Improved Patient Access and Experience 3. A Representative and Supported Workforce 4. Inclusive Leadership Based on transparency and evidence, commissioners, Healthwatch organisations and other interested groups locally agree one of four grades annually for trusts. Based on the grading annual improvement plans will show how the most immediate priorities are to be tackled, by whom and when. Each year, organisations and local interests will assess progress and carry out a fresh grading exercise. In this way, the EDS will foster continuous improvements. To implement EDS2 we need to:- 1. Collate evidence on how we perform against each of the 18 outcomes. We should consider each of the nine characteristics protected under the Equality Act when we do this (age, disability, gender reassignment, pregnancy/ maternity, marriage/ civil partnership, religion/ belief, race, sex, and sexual orientation) 2. Work with local interests (patients, public, staff, and community representatives) to analyse our performance against the outcomes 3. Work with local interests to agree grades for each of the 18 outcomes (either undeveloped, developing, achieving, or excelling) 4. Based on evidence and grades, agree equality objectives with local interests 5. Integrate equality objectives into mainstream business planning 6. Publish grades and objectives EDS2 is a method of auditing how well a Trust is doing in embedding equality and diversity into everyday business. It is being rolled out nationally and LCH is committed to working within the framework. The Equality Delivery System will assist the Trust in meeting its obligations under the Equality Act It should also assist the Trust to deliver on the: the NHS Outcomes framework the right and pledges of the NHS Constitution for patients and staff addressing health inequalities in general, improving outcomes and reducing gaps 7

8 What We Have Achieved in 2014/15 Goal 1: Improved equality monitoring information that we collect from patients so that we can improve the design of our healthcare services. We have developed some of our IT systems to enable them to collect information about age, ethnicity, disability, religion and belief and sexual orientation. We have developed a DVD, written guidance and training to promote equality monitoring to staff and patients. Next Steps: Collection of equality monitoring information to be embedded across all services and quarterly reports produced that evidence progress Goal 2: Improved Interpretation and Translation Services. We retendered for interpretation and translation services and deliver ongoing awareness sessions for staff. The quality of the services are regularly monitored to ensure consistency. Next Steps: Quarterly patient and staff experience reports that highlight positive experiences Goal 3: Review of Complaints Procedure for People with Protected Characteristics. We have reviewed the way in which people can make a complaint to ensure that there are no barriers, equality monitoring information has been included in paperwork and patient information has been reviewed. Next Steps: Audit of patient satisfaction and action plan in place to address any identified improvements to the service Goal 4: Raised Awareness Amongst Staff and Partner Organisations of Domestic Abuse and Harmful Traditional Practice. A conference was held for staff and partner organisations that raised awareness of domestic abuse, harmful practice and Female Genital Mutilation. Next Steps: Review Domestic Abuse Steering Group, Strategy and corresponding action plan using feedback from the event. Goal 5: Improve Involvement and Engagement for People with Protected Characteristics Patient Experience and Involvement Workshop was held for patients and staff. The discussions held there informed the development of our Patient Experience and Involvement Strategy. Next Steps: Patient Involvement to be embedded within LCH decision making processes. Goal 6: Raise Awareness of Hate Crime Amongst Staff, Patients and Their Families LCH webpage completed and working closely with other NHS Trusts to promote campaign. Next Steps Continue to work with partners to raise awareness of hate crime. 8

9 EDS Grading LCH were successful in gaining a grade of for all goals in the EDS framework, except for one which was graded as Excellent in 2013/14. We have worked hard to progress our EDS action plan but believe that we need to take the identified next steps before we can truly call ourselves Excellent. EDS2 Results for 2014/15 There are four performance levels: Underdeveloped Developing Excellent EDS Goal 1.1 Services are commissioned, designed and procured to meet the health needs of local communities, promote well-being, and reduce health inequalities 1.2 Individual patients health needs are assessed, and resulting services provided, in appropriate and effective ways 1.3 Changes across services for individual patients are discussed with them, and transitions are made smoothly 1.4 The safety of patients is prioritised and assured. In particular, patients are free from abuse, harassment, bullying, violence from other patients and staff, with redress being open and fair to all 1.5 Public health, vaccination and screening programmes reach and benefit all local communities and groups 2.1 Patients, carers and communities can readily access services, and should not be denied access on unreasonable grounds Grade 2013/14 Grade 2014/ Patients are informed and 9

10 supported to be as involved as they wish to be in their diagnoses and decisions about their care, and to exercise choice about treatments and places of treatment 2.3 Patients and carers report positive experiences of their treatment and care outcomes and of being listened to and respected and of how their privacy and dignity is prioritised. 2.4 Patients and carers complaints about services, and subsequent claims for redress, should be handled respectfully and efficiently Excellent Excellent Goals 3.1 to 3.6 are included in the Workforce Strategy 4.1 Boards and senior leaders conduct and plan their business so that equality is advanced, and good relations fostered, within their organisation and beyond 4.2 Middle managers and other line managers support and motivate their staff to work in culturally competent ways within a work environment free from discrimination 10

11 Our Equality Objectives and EDS2 Priorities for 2015/16 The Equality Act (2010) has an important impact on the work of NHS organisations. It requires LCH to publish at least one equality objective that is specific and measurable at least every four years. Working with Healthwatch we have decided to concentrate on the objectives below this year. We think these objectives will improve equality in all the healthcare services that we deliver:- Objective Action EDS2 Goal Lead Target Progress Improve the collection of information related to patients protected characteristics Put Equality Monitoring Action Plan in place 1.1 Services are commissioned, designed and procured to meet the health needs of local communities Kate Jones 10/15 Assess the quality of interpreting services we commission Conduct satisfaction surveys with staff and patients and make improvements as necessary. 2.1 Patients, carers and communities can readily access services, and should not be denied access on unreasonable grounds Kate Jones 12/15 Patients with protected characteristics are able to access the complaints procedure Complete complaints patient satisfaction survey and develop improvement plan 2.4 People s complaints about services are handled respectfully and efficiently Customer Service Manager 02/16 Increase staff awareness of domestic violence and harmful practice Review Domestic Abuse Steering Group, Strategy and corresponding action plan using feedback from the One Chance to Ask the 4.3 Middle managers and other line managers support and motivate their staff to work in culturally competent ways within a work Debby Wilson 03/16 11

12 Question conference environment free from discrimination Patients and carers play a greater part in LCH Patient Experience and Involvement Action Plan is established and operational 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care Kate Jones 01/16 People with Learning Disabilities do not face discrimination or disadvantage in the NHS Learning Disability action plan devised 1.2 Individual people s health needs are assessed and met in appropriate and effective ways Kate Jones 01/16 12

13 Recent achievements at LCH Patient Experience and Involvement Workshop LCH is committed to gathering feedback from staff and patients that will help us to improve our services. In order to bring together staff, patients, carers and the public to explore some of the practical ways that we can involve different people in our future decision making we held a Patient Experience and Involvement Workshop in February The event was a valuable exercise which informed our involvement plans. Between the sheets The second Between the Sheets event for HIV positive women living in the Merseyside area was held in February at Blackburne House. It aimed to address issues faced by women living with HIV in today s society. It also aimed to boost selfconfidence and create a safe place where they could discuss topics such as health, contraception and anxiety and depression relating to self-esteem and sex. As part of the event two women shared their moving personal stories about how they came to terms with having HIV and how they have learnt to overcome stigma and effectively manage aspects of their lives with support from the HIV team. The HIV service is also planning to host more such events in the future. Easy guide to better health LCH has developed an Easy Guide to Better Health - a helpful tool to give patients and health professionals greater access to health information. It was launched in February when the Trust s Public Health promotion team hosted a celebration event to showcase the new guide which was specifically designed for people with learning difficulties. A range of local partners and service users were invited to recognise the work from individuals from the Learning Disabilities Service, Mersey Care, Oakfield Day Centre and People First who all helped produce the guide. The guide is important because there is very little information available for adults with learning difficulties that encourages and supports them in making healthier lifestyle choices. It is written and designed in a way that is easy to understand using a combination of minimal text, colour coding and visuals. 13

14 Liverpool Pride LCH supported the fifth annual Liverpool Pride Festival by hosting a series of fringe events. To tie-in with the Pride theme, Glam Fairytales, the Trust s Sexual Health Service, Armistead, Health Promotion and Public Health Teams hosted a glamorous fairy-tale themed health event. Festival-goers and members of the public were invited to drop in throughout the day to chat to staff and pick up free information and advice on a wide range of health and lifestyle issues all with a special glamorous fairytale twist. Powerful, hard hitting, eye opening just a few of the comments used by over 80 LCH staff who attended the One Chance conference on 6 February. The conference, organised by the LCH Equality and Patient Experience Team and Debby Wilson (Domestic Abuse Specialist Nurse), used actors from Afta Thought to show the true impact of different types of abuse. Throughout the day delegates watched scenarios which explored domestic abuse, FGM, forced marriage and honour based violence. There was plenty of time for discussion and there was also a presentation from Merseyside Police. During lunch delegates browsed the market place where various organisations provided useful additional information. The Conference will drive future work at LCH where Debby provides Domestic Abuse awareness sessions which are available to all staff Changes to our Interpreting service LCH staff are familiar with using interpreters to communicate with our diverse population. In December 2014, following a comprehensive tendering process, LCH changed interpreting supplier from Global Accent to Language Line Solutions. This involved a great deal of awareness raising with staff. Training on the new process was provided by the Equality and Patient Experience Team and staff from Language Line. Wheelchair in a day for adults Liverpool Wheelchair Service is launching the UK s first Adult Wheelchairs in a Day scheme. This ambitious new scheme will dramatically reduce patient waiting times and completely transform the 14

15 way that wheelchairs are provided to members of the community. Under Adult Wheelchairs in a Day the majority of adult wheelchair users will be able to be clinically assessed and fitted for an NHS wheelchair to take away with them all on the same day. In contrast, in the past wheelchair users have typically been required to wait anywhere between 8 20 weeks for wheelchair parts, depending on the complexity of the type of wheelchair needed. The scheme is a huge undertaking and will involve a major redesign of the service but we expect to be able to offer this service to most of our service users by Spring Transgender awareness training Transgender Equality Training was provided to LCH staff in February. The threehour sessions were suitable for all staff and covered: Images, stereotypes and myths (including language and terminology) Barriers that trans people face Prejudice Medical and social transition Best practice What the law says The sessions were well received by those who attended. DVD about Equality Monitoring The LCH Equality and Patient Experience Team, working with other trusts in Liverpool, produced a DVD explaining the importance of equality monitoring. Entitled Sharing your Equality Information Why We Ask Those Questions, it features staff from LCH and the Royal who kindly volunteered to participate. The short film is one strand of our drive to increase the quantity and quality of the monitoring information we collect. It s intended that the film, which will be shown in public waiting areas, will answer some of the questions people have about sharing their personal information. It can be viewed at 15

16 Interpretation and Translation LCH is committed to ensuring that all patients who are not able to communicate in English have access to professional interpreting and translation services. Patients attending trust services may have alternative and / or additional communication needs, including people who are deaf or have a hearing impairment, and those who do not use English as their first language. It is the policy of the trust to use professional interpreters who are bilingually competent, neutral, independent, professionally trained via our interpreting and translation providers. Interpreting services LCH has a contract with Language Line to provide telephone and face-to-face interpreters to all its services. Prior to December 2014 face-to-face interpreters were supplied to LCH by Global Accent. Following a competitive tendering exercise which emphasised quality, Language Line was awarded the contract to supply face to face and telephone interpreters. British Sign Language (BSL) interpreters are provided to LCH by Action on Hearing Loss. Face to Face Interpreting In the period April 2014 to March 2015 in the Liverpool and Sefton areas LCH provided 3,163 face-to-face interpreting sessions for patients who do not use English. Table 1. Languages requested for face-to-face interpreting appointments at LCH for the period April 2014 to March

17 Telephone interpreting All services have access to the telephone interpreting service accessed through Language Line. Language Line allows staff to access an interpreter quickly. It can be used in an emergency to deal with an immediate communication difficulty. The service is available 365 days of the year and covers over 170 languages. In the period April 2014 to March 2015: LCH staff accessed telephone interpreters proficient in 43 different languages. The most popular languages requested were Arabic, Romanian, Czech, Mandarin, Polish and Farsi. LCH staff used the telephone interpreting service on 1,152 occasions. British Sign Language (BSL) interpreters Action on Hearing Loss provides interpreting and communication services for deaf and hard of hearing people. They are contracted to provide LCH staff with BSL interpreters and lip speakers for appointments with any patient living in the Liverpool, Sefton or Knowsley areas. In the period April 2014 to March 2015 LCH staff arranged 185 appointments requiring BSL interpreters. Written translations The trust s Equality and Patient Experience Team regularly arranges professional translation of documents, reports and leaflets on behalf of LCH services. In the period April 2014 to March translations were processed. Most of these translations were carried out by the company K International. The trust also has an arrangement with the Bradbury Centre (a local charity for people who are blind or visually impaired) to translate documents to Braille, large print or audio format when required. Easy Read The trust subscribes to Photo symbols which is a photo library for Easy Read information. This is particularly useful for information suitable for people with a learning disability. Assessing the quality of the service In 2015 surveys of staff and patients will be undertaken to assess the quality of the service provided by interpreter suppliers. 17

18 Equality Monitoring Equality monitoring is important because we want to make sure that services are delivered fairly and remove any disadvantage or discrimination based on: age, race, disability, religion or belief, gender reassignment, sex marriage/civil partnerships, sexual orientation pregnancy and maternity, Patient Age Profiles % Years 6-16 Years Years Years Years Years 66+ Years Without monitoring, it s hard to know whether our policies and services are being delivered fairly or meeting the needs of all people. Wherever you go, people want to know about your background so that they can get things right for you. So where does the information go? It s used to see the take up of services and to direct future services. This can t happen without your help. 18

19 For example - If the information shows there are higher Did Not Attend (DNA) rates for Black and Minority Ethnic (BME) patients we will look at alternative ways of communicating. Patient Ethnicity Profiling 2014 White - Irish 0.40 White - British White - Any other White background 1.81 UNKNOWN 0.10 Other Ethnic Groups - Chinese 0.60 Other Ethnic Groups - Any other 1.41 Not Stated Not Specified 0.31 Mixed - White and Black Caribbean 0.19 Mixed - White and Black African Mixed - White and Asian Mixed - Any other Mixed background Black or Black British - Caribbean Black or Black British - Any other Black Black or Black British - African Asian or Asian British - Pakistani Asian or Asian British - Indian Asian or Asian British - Bangladeshi Asian or Asian British - Any other Ethnicity Results

20 Patient Experience LCH aims to be a value based customer focused organisation that puts patients and families first. In doing so it is envisaged that we will be a provider of choice for the community. How Do We Measure Patient Experience There are many ways to assess patient experience with the most common being surveys, patient stories and feedback cards. LCH provides a diverse range of services across a wide geographical patch. Therefore we recognise that there cannot be one effective tool for measuring patient experience. Each of our services has their own unique Patient Experience and Involvement action plan detailing how they will measure and respond to patient and carer satisfaction. There are a wide range of methods for seeking, receiving and proactively measuring patient experience; this section outlines the key processes the Trust will use: Friends and Family Test The Friends and Family Test (FFT) was introduced by the NHS as a simple one question survey that provides a baseline metric for patient experience. FFT has been introduced across all LCH services and compliance is monitored by the Patient Experience Sub Committee via a monthly report that indicates response rates and result for each service. Local Survey Programme We are developing a wide programme of patient feedback exercises across all areas of the trust. We use a variety of methods to obtain patient feedback such as paper questionnaires, online and telephone surveys, one to one interviews and focus groups. 20

21 The Trust also undertakes PLACE inspections and patient experience survey on wards, which cover key areas such as cleanliness, communication, involvement, dignity and respect, and the quality of care. Complaints, comments, concerns and compliments Complaints and other feedback mechanisms offer a valuable chance for the Trust to understand how our services are performing. The number of complaints should not be seen as a marker in itself to how well or how poor the service is perceived but repeated trends and issues should be addressed to stop them from reoccurring. NHS Choices and Patient Opinion is a rich source of qualitative patient experience data and the information is in the public domain so can significantly affect the public perception of the organisation. Other tools that can be used to measure patient experience include:- What do we mean by Involvement? Patient involvement refers to approaches which engage individual patients in the management of their health and healthcare, and in the decisions that are made in the course of it. Public involvement is at the core of the NHS Constitution. Patients have the right to be involved in discussions and decisions about their healthcare, and to be given information to enable them to do this. Patients have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services. LCH is committed to working with patients and carers to:- Monitor Services Procure Services Improve the quality and safety of services Identify future service requirements Transform and redesign services 21

22 How will we involve Patients, Families and Carers Patient experience occurs at three primary levels. Involving patients and families in their own care and supporting them to make informed choices about their treatment and care. Using patient experience in a particular area or areas to improve services. At a strategic level to ensure the public are able to actively contribute to the Trust strategic direction Patient Experience Cycle 22

23 Equality Analysis What is Equality Analysis? LCH is responsible for making a wide range of decisions. Equality analysis is a way of considering the effect on different groups protected from discrimination by the Equality Act. The two main objectives for equality analysis are to consider if there are any unintended consequences for some groups and to ensure that the policy will be fully effective for everyone. It involves using equality information, and the results of engagement with protected groups and others, to understand the potential effects of the decisions that are made. Equality analysis can help identify practical solutions to tackle negative impacts, to advance equality and foster good relations. What should be analysed? The term policy has been used broadly and has been used to explain, all of the policies, practices, activities and decisions that we take, whether they are formally written down or whether it is informal custom and practice, all new and reviewed policy should be analysed. In addition the effect of how a policy is implemented by LCH when it has been developed outside of the organisation must be analysed. For example, the changes to service as a result of a reallocation of budget from commissioning organisations or the implementation of NICE guidelines. When should equality analysis be done? Equality analysis of proposed policies will involve considering their likely or possible effects in advance of implementation. How LCH completes equality analysis Once our staff have completed equality and diversity training they go on to complete an equality analysis workshop with members of the Equality and Patient Experience Team. This enables them to complete equality analysis on the decisions that they make. Their analysis is quality assured by the Equality and Patient Experience Manager and ratified along with their decision. For further information about Equality Analysis at Liverpool Community Health go to: 23

24 If you would like to know more about the work of the Equality and Patient Experience Team at LCH contact: If you would like to request this report in an alternative format or language please contact:

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