SCREENING TEMPLATE Proposal to relocate 2 Thoracic Outpatients clinics from Belfast City Hospital (BCH) to the Royal Victoria Hospital (RVH) site. For further information on screening, please refer to the Guidance Notes, which are also available in hard copy from the Health and Social Inequalities Team. 1
SCREENING TEMPLATE For further information on screening, please refer to the Guidance Notes, which are also available in hard copy from your organisation s equality contact. (1) INFORMATION ABOUT THE POLICY/DECISION 1.1 Title of policy/decision Proposal to relocate 2 Thoracic Outpatients clinics from Belfast City Hospital (BCH) to the Royal Victoria Hospital (RVH) site. 1.2 Description of policy/decision what is it trying to achieve? (aims/objectives) how will this be achieved? (key elements) what are the key constraints? (e.g. financial, legislative) The proposal would bring together all outpatient Thoracic Services thereby providing a streamlined service for patients and bringing the clinical/medical Thoracic team together; patients would have multi- disciplinary expertise readily available to them on one site. The bulk of Thoracic Surgery Out patient s activity is carried out at the RVH by 3.5 WTE consultant Thoracic surgeons and consultant Cardiothoracic surgeons (head count 5 Surgeons). Consultant Outpatient Clinics And Location 1 Alternate weeks 1 RVH and 1 BCH 2 1 RVH weekly 3 1 RVH weekly 4 1 RVH weekly 5 1 RVH weekly 2
Under this proposal all of the consultants OP clinics at the RVH. (New Directions) The clinical/medical and managerial team believe that this re-location would make clinics more effective with one point of entry, one triage point, one patient record and one Patient Administration System (PAS) record. Additionally, Thoracic Services would benefit from being based at the RVH in terms of closer access to cardiac surgery services. 1.3 Main stakeholders affected (e.g. staff, actual or potential service users, other public sector organisations, voluntary and community groups, trade unions/professional organisations or private sector organisations) Outpatients and inpatients Thoracic Services staff 1.4 Other policies/decisions with a bearing on this policy/decision what are they? who owns them? Belfast Health and Social Care Trust- New Directions Integrated Elective Access protocol (BHSCT) Centralisation of specialisms will afford the patient easier and more efficient access to a specialist Cardiothoracic multi-disciplinary team. (2) SCREENING THE POLICY/DECISION 2.1 In terms of groupings under Section 75, what is the make up of those affected by the policy/decision? Group Gender Please provide details In terms of gender patients present in virtually equal numbers. The table below shows a slight majority of males whilst another 3
period table might show a slight majority of female patients. Mr McManus BCH Outpatient Clinic Period of Report: 1 st April 09 to 31 st March 2010 (as at 16/2/11) Age Range Female Male 3-18 8 10 19-26 11 13 27-35 10 11 36-45 13 7 46-60 16 27 61-70 18 26 71-82 20 12 Total 96 106 Age In terms of age range those patients between 8-13 years are in the minority, whilst the majority are aged between 46-72 years; this is entirely consistent with the nature of the service. 4
Religion The service does not collect this data the table below gives some indication: Statistics, 2001 Denomination Adherents % Roman Catholic 678,462 40.2 Presbyterian Church in Ireland 348,742 20.7 Church of Ireland 257,788 15.3 Methodist Church in Ireland 59,173 3.5 Other Christian (Including Christian Related) 102,221 6.1 (Total non-roman Catholic Christian) 767,924 45.6 Other Religions and Philosophies 5,028 0.3 Political Opinion Source: UK 2001 Census This data is not collected however, the Trust aims to provide a welcoming environment for all of its users and will display its good relations statement prominently in all Trust buildings. As of 2007, 36% of the population define themselves as Unionist, 24% as Nationalist and 40% define themselves as neither. Source NISRA 2011 Assembly Election Results Summary The 108 Assembly seats DUP UUP Alliance Others SDLP Sinn Fein Seats won (2011) 38 16 8 3 14 29 Vote share (2007) 30.0% 13.2% 7.7% 7.9% 14.2% 26.9% Seats won (2007) 36 18 7 3 16 28 Vote share (2007) 30.1% 14.9% 5.2% 8.0% 15.2% 26.2% Marital This information is not collected by the service: 5
Status There were 8,510 marriages registered in Northern Ireland in 2008, a decrease of 177 ( 2%) on the 2007 figure of 8,687 marriages; The number of marriages registered in 2008 was significantly higher than the lowest number recorded in 2001 of 7,281 marriages. Marital Status (based on over 16s) Single (never married) Married Re-married Separated Divorced Widowed 38.9% 39.5% 2.4% 5.1% 4.8% 9.2% Dependent Status Disability Ethnicity Source: NISRA Research indicates that 1in 8 people in Northern Ireland have caring responsibilities. There are 185,000 Carers in Northern Ireland child and Source: Carers NI Northern Ireland Statistics and Research Agency (NISRA) carried out a Northern Ireland Survey of Activity Limitation and Disability (NISWALD) which reported early in 2007: Results from NISWALD have found that in 2006/07 18% of all people living in Northern Ireland have some degree of disability, The prevalence rate for adults is 21% and 6% for children Service staff are culturally sensitive to the needs of people from minority ethnic backgrounds. An interpreting service is available if needed: 40,200 migrant workers registered in NI between April 08 March 10 2347 Births were registered to mothers born outside the UK Source: UK Borders Agency School attendance by children of migrants in 2009/10: primary school 5130 post primary 2402 6
42 languages spoken in NI schools Source: Northern Ireland School Census Sexual Orientation The service does not collect this data However research indicates that 1in10 of the NI population is gay, lesbian or Bisexual STAFF The proposal will have minimal effect for staff as only 1 consultant will be changing the location of his clinic and he neither he nor his secretary will be required to change their permanent base, 7
2.2 Is there any indication or evidence of higher or lower participation or uptake by different groups? Group Gender Age Religion Political Opinion Marital Status Dependent Status Disability Ethnicity Sexual Orientation Yes/No/ Don t Know Please provide details More males than females are seen at thoracic clinics (this would be indicative of the nature of thoracic surgery whereby lung cancer/pectus repairs tend to affect more males than females. Patients would predominantly be aged 50 years. This accords with the nature of Thoracic Services The Trust does not collect this data. The Trust provides a sensitive, welcoming service to all patients/users The Trust does not collect this data however Trust buildings are designed to provide a welcoming environment to all users. Please see information at 2.1. Please see information at 2.1 All of our patients are debilitated by their condition and some are disabled, Service staff are experienced in caring for this client group and provide a person centred service in terms of individual needs. The Trust provides a culturally sensitive service and there are telephone and face-to-face interpreter services available. In addition to mandatory Equality training Cultural Diversity training is also available to all staff. The Trust provides a sensitive service to this client group. Training on Sexual Orientation is available to all staff. 8
2.3 Is there any indication or evidence that different groups have different needs, experiences, issues and priorities in relation to the policy/decision? Group Gender Age Religion Political Opinion Marital Status Dependent Status Disability Yes/No/ Don t Know Please provide details Users are assessed holistically and services are provided according to the individual s needs which would include cultural and religious needs..more males than females are seen at thoracic clinics which is indicative of the nature of thoracic surgery whereby lung cancer/pectus repairs tend to affect more males than females. There are people of many religions resident in the Belfast area. The Trust has links with Ministers of all the most popular religions; a guide on religious belief will be provided to all staff. The Trust is also aware that some people may still experience a chill factor in some areas of the city. The Trust will mitigate if possible. All Trust services, wherever located are provided inclusively and sensitively according to the individual s need The Trust is cognisant of its duty to mitigate for those who experience a chill factor, in terms of location, while Northern Ireland is in a period of normalisation. The Trust ensures that all of its premises display its Good Relations statement and provides a welcoming atmosphere to all patients/users. Services are provided to patients/clients in a sensitive holistic way taking into consideration the individual s needs. Patients are booked under the partial booking system which does afford elements of patient choice for appointment times this is a corporate policy in place throughout the BHSCT. The Service is staffed by specialists in the care of the client group and as such provides support, aids and 9
Ethnicity adaptations based on individual need. The department is fully accessible to those with a mobility disability, the reception has a loop system making it accessible to deaf and hard of hearing people, British and Irish Sign Language interpreters are provided if necessary. Services are provided to patients/clients in a sensitive holistic way. Sexual Orientation The Trust provides a sensitive service to this client group. 10
2.4 Is it likely that the policy/decision will meet those needs? Group Yes/No/ Don t Know Please briefly give details Yes. Services are person led - person - centred N.B. continue as appropriate 2.5 Is there an opportunity to better promote equality of opportunity or good relations by altering the policy/decision or working with others in government or in the larger community? Group Suggestions No. The service works to provide sensitive treatment and care to all patients and users. N.B. continue as appropriate 11
2.6 What changes to the policy/decision if any or what additional measures would you suggest to ensure that it promotes good relations? Group Suggestions The Trust gives due consideration to Good Relations in the planning and delivery of services 2.7 Is there an opportunity to better address the health and social inequalities of groups/areas of greatest social, economic or educational need by altering the policy/decision or working with others in government or in the larger community? Group Suggestions No. 12
2.8 Have previous consultations with relevant groups, organisations or individuals indicated that particular policies create problems that are specific to them? Also, please detail information used to answer any of the questions above (e.g. statistics; research reports; views of colleagues, service users, or other stakeholders). 1. The Surgeon was consulted via face to face meetings and is content with the move to the RVH. This will increase productivity in terms of a reduction in travel time between sites which may result in an increase of patients seen. 2. OPD manager was consulted via face to face meetings with in terms of the increased number of thoracic clinics being held monthly however the impact is zero because there are sufficient staff in place to manage these clinics 3. There are no staff affected from admin and clerical point of view. 4. The Trade Unions are satisfied that there are no adverse effect on staff. 5. A small sample of new patients in thoracic BCH clinic were consulted with by letter and questionnaire. There were two comments relating to transport concerns with one specifically indicating that it was due to their caring responsibilities. The RVH department is fully accessible to those with a mobility disability, is accessible by major bus routes and there is an internal bus service between BCH and RVH. 2.9 Please detail what data you will collect in the future in order to monitor the effect of the policy/decision on any of the groups under Section 75? Details of what aids and adaptations are provided to disabled people Complaints/compliments Feedback from staff /users/user groups which will be reported to the Health and Social Inequalities Team annually for two years. 13
(3) SHOULD THE POLICY/DECISION BE SUBJECT TO EQUALITY IMPACT ASSESSMENT? Equality impact assessment procedures are confined to those policies/decisions considered likely to have significant/major implications for equality of opportunity. If your screening has indicated that a policy/decision is likely to have an adverse differential impact, how would you categorise it? Please tick. Significant/major impact Low impact Do you consider that this policy/decision needs to be subjected to a full equality impact assessment? Yes No Please give reasons for your decision. Centralisation of services provides easier and more efficient access for patients to a specialist cardiothoracic multi-disciplinary team. There are bypass facilities on the RVH site which are not available to the BCH site This move enables the consultant to see more patients (travel time reduced which would free up 1 hour equalling 3 new or 6 review patients monthly) Benefits to the junior medical rota in not covering two separate sites. 14
(4) DISABILITY DISCRIMINATION 4.1 Does the policy/decision in any way discourage disabled people from participating in public life or does it fail to promote positive attitudes towards disabled people? The Service is staffed by specialists in the care of the client group and as such provides support, aids and adaptations based on individual need. The department is fully accessible to those with a mobility disability, the reception has a loop system making it accessible to deaf and hard of hearing people, British and Irish Sign Language interpreters are provided if necessary. Other ethnic interpreters are available if required 4.2 Is there an opportunity to better promote positive attitudes towards disabled people or encourage their participation in public life by making changes to the policy/decision or introducing additional measures? There are no adverse impacts in this area. 4.3 Please detail what data you will collect in the future in order to monitor the effect of the policy/decision with reference to the disability duties? Details of what aids and adaptations are provided Complaints Feedback from staff /users/user groups which will be reported to the Health and Social Inequalities Team annually for two years. 15
(5) CONSIDERATION OF HUMAN RIGHTS 5.1 Does the policy/decision affect anyone s Human Rights? [PLEASE COMPLETE THE TABLE BELOW] ARTICLE POSITIVE IMPACT NEGATIVE IMPACT = human right interfered with or restricted NEUTRAL IMPACT Article 2 Right to life Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment Article 4 Right to freedom from slavery, servitude & forced or compulsory labour Article 5 Right to liberty & security of person Article 6 Right to a fair & public trial within a reasonable time Article 7 Right to freedom from retrospective criminal law & no punishment without law. Article 8 Right to respect for private & family life, home and correspondence. Article 9 Right to freedom of thought, conscience & religion Article 10 Right to freedom of expression Article 11 Right to freedom of assembly & association Article 12 Right to marry & found a family Article 14 Prohibition of discrimination in the enjoyment of the convention rights 16
1 st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education If the effect you have identified is positive or neutral please move on to Question 5.3. 5.2 If you have identified a likely negative impact who is affected and how? N/A At this stage we would recommend that you consult with your line manager to determine whether to seek legal advice and to refer to Human Rights Guidance to consider: whether there is a law which allows you to interfere with or restrict rights whether this interference or restriction is necessary and proportionate what action would be required to reduce the level of interference or restriction in order to comply with the Human Rights Act (1998). 17
5.3 Outline any actions which could be taken to promote or raise awareness of human rights or to ensure compliance with the legislation in relation to the policy/decision. None Policy/Decision Screened by: Patricia McKinney (clinical Co-ordinator cardiothoracic surgery) On behalf of Service Group Maureen Doyle, Equality Manager On behalf of Health and Social Inequalities Miriam Gibson HR Manager On behalf of Employment Equality Date: 22 May 2012 Please note that having completed the screening; you will need to ensure that a consultation on the outcome of screening is undertaken, in line with Equality Commission guidance. 18