There are several tangible benefits in conducting equality analysis prior to making policy decisions, including:

EQUALITY ANALYSIS FORM Introduction CLCH has a legal requirement under the Equality Act to have due regard to eliminate discrimination. It is necessary to analysis the consequences of a policy, strategy, function, service or project on groups of different people, both patients and staff. The analysis has to consider people s age, disability, gender reassignment, race, religion / belief, sex, sexual orientation, marriage / civil partnership, and pregnancy and maternity are now known as protected characteristics'. We also include other vulnerable groups who may not be protected under the Equality Act but their needs should be considered. There are several tangible benefits in conducting equality analysis prior to making policy decisions, including: Higher quality decisions as a result of more complete management information Reduced cost as a result of not having to revisit policy that is not fit for purpose Enhanced reputation as an organisation that is seen to understand and respond positively to diversity. Most importantly, through equality analysis we are able to take into account the needs of our different groups of staff and patients. Changes being proposed through policy, strategy, transformational programmes or other methods need to be analysed from an equality perspective and the results considered before decisions are made. Where negative impacts are identified, ways to to mitigate or minimise them need to be put in place. For the purpose of this document the term proposal will be used as shorthand to describe a function, project, service, policy or strategy that will be assessed. Before starting if you are unfamiliar with doing an Equality Analysis contact the Equality & Diversity team for guidance. Part A of the form is the initial screening of a proposal which assesses the likelihood of a negative impact on different groups of people. For example, a policy change in financial management systems may be considered major but has no negative impact. The initial screening form (Part A) needs to be completed to decide if a full Equality Impact Assessment (Part B) should be undertaken. A full assessment 1

makes sure that any negative impacts have been considered and ways to minimize the impact are specified. Further guidance is available on page 7. PART A - INITIAL SCREENING FORM Section One Name of proposal Directorate / Service carrying out the assessment Name and role of person undertaking this Equality Analysis Give an overview of the aims, objectives and purpose of the proposal Section Two Equality Groups: People of different ages People of different religions / beliefs. People with disabilities (physical, mental or learning) Women Men Transgendered people People from different ethnic groups Lesbian, Gay or Bisexual Refugees and asylum seekers Human Rights breaches Could the proposal have a positive impact (give details) Could the proposal have a negative impact (give details) 2

Section Three Is this proposal a major change in terms of scale or significance for CLCH? Is there a clear indication that, although the proposal is minor it is likely to have a major affect for people from the equality groups? Yes High risk: Complete a full EIA starting with section 5 No Low risk: Go to section 4. Section Four It this proposal is low risk please give evidence or justification for how you reached this decision: Sign off that this proposal is low risk and does not require a full Equality Analysis: Head of Service Signed: Date: 3

PART B - FULL EQUALITY ANALYSIS Section Five Consultation and Research a) Give details of involvement, consultation or research undertaken for each relevant equality group which has a positive or negative impact from the proposal: Equality Groups Give details and any relevant information People of different ages People of different religions / beliefs. People with disabilities (physical, mental or learning) Women Men People from different ethnic groups Transgendered people Lesbian, Gay or Bisexual Refugees and asylum seekers Human Rights breaches 4

b) What consultation was undertaken, give details. If no consultation or engagement has been undertaken give a justification. Do you need to undertake any further consultation? If so, what, and with who? Section six Action Plan a) If NEGATIVE impact have been predicted, what actions are planned to minimise the impact and improve this proposal Issue Action Deadline Section Seven Monitoring and publishing a) How will the proposal be monitored and by whom? b) What are the arrangements of distributing this Equality Analysis, where and by whom? 5

Sign off this Equality Analysis Senior Manager Signed: Date: Equality and Diversity team: Date: 6

Guidance Background An Equality Analysis is a risk assessment tool for improving the work of Central London Community Healthcare making sure we do not discriminate and exclude patients or staff due to their protected characteristic. Equality Analysis is a way to make sure individuals and teams think carefully about the likely impact of their work on particular groups of people and take action to improve services, policies and functions. Completing an Equality Analysis is similar to a risk assessment as it involves predicting and assessing the implications of a policy on a wide range of people with different needs. This should not be carried out in isolation but with the involvement, support and advice from others. Effective involvement and consultation with stakeholders is a key ingredient in conducting equality analysis. When undertaking the assessment you should take into consideration the different perspectives of service users and staff. When? All new policies or services, including changes and updates to or reviews of existing policies must be initially screened for their likely impact on equality and diversity. This ensures that we meet our public duties under the Equality Act 2010. A full Equality Analysis should be undertaken on those policies where impact is likely to happen or where there is any chance that the impact could be significant. This screening should be undertaken at as early a stage as possible, in order to address any issues which are identified before firm decisions are made. Equality Analysis should be done before implementing any changes. What s included? Any new policy, strategy, functions, or service as well as any changes (ie. revised policy or strategy, changes to opening hours, location, merging of services. It is also important to remember that there are unwritten policies, in the form of long-standing custom and practice, or new policies that evolves gradually without ever being formally set out, and become the way we do things. These may need to be considered in relation to their potential impact on various equality groups as much as formal written policies, but be much less likely to be considered for equality analysis. 7

COMPLETING THE FORM Section One Details of the proposal Give concise and relevant detail on the purpose of the proposal. Any information that could set the context for the proposal and help the reader understand (the reader could be a staff member, board member, patient, external stakeholder, voluntary organisation etc). State clearly if the proposal affects staff, patients or service users. Section Two Impact of proposal This section is the most important part, as it starts the analysis of the impact of the proposal upon different groups of people based upon their protected characteristic.. At the initial screening take an objective look at each equality group to assess the impact of the proposal. Make use of previous research / consultation, personal knowledge and experience, and gain the views of staff with previous experience of similar proposals. If there is limited local data or information concerning a particular group then other regional or national research could be used. The difference between positive and negative impact is explained below: Positive impact: a policy or practice where the impact on a particular group of people from an equality group is more positive than for other groups, (e.g., outreach smoking services for Bangladeshi men). Negative impact: a policy or practice where the impact on a particular group of people from an equality group is more negative than for other groups (e.g., reducing opening hours, closing a service, or health and safety measures) Neutral impact: a policy or practice with neither a positive nor a negative impact on any group or groups of people, compared to others. Within the positive impact column state if the impact is neutral. A list of questions to determine the impact should be asked: Policy proposals: What do we know about the experience of staff or patients from equality groups in relation to the area of activity covered by this policy? Does this policy create any problems of barriers to any equality group whether patients or staff? Will any group be excluded because of the policy? Will the policy have a negative impact on our organisation s relations with staff or patients? 8

Could this policy lead to discrimination and is this policy compliant with the Equality Act including CLCH s Diversity & Equality Policy? Does the policy have a greater impact upon a particular groups of staff because of their protected characteristic? Such as their gender, ethnicity, age, disability, sexual orientation, gender reassignment, marital or civil partnership status, or pregnancy / maternity status. If you have identified a negative impact are there reasons to explain this? Where job requirements set higher entry-level criteria, rigid work patterns and locations, or greater mobility requirements than necessary, does this exclude some people such as carers and disabled people. Service proposals: Is there evidence that particular equality groups have particular needs in relation to the proposals? Will the changes create access issues or communication barriers for patients because of their protected characteristic (eg, ethnicity or disability)? Will there be provision for patients who have limited command of English? Think about whether the inability to read print generally or exclusion from certain informal communication networks often contributes to a lack of service uptake amongst some communities. Do opening hours or location of the service affect patients because of their protected characteristic compared to all patients? Are cultural or religious needs and preferences identified and met? For example, if re-designing a building has a quiet area for prayer and meditation been identified? Have the age profile of existing patients been analysed and will the change affect people from different age groups? Have there been any complaints of discrimination or lack of equality for patients for the existing services or consultation on the proposed changes to the service? Does the profile of patients accessing the service match those expected to use the services? Will the service offer interpreting or translation services and also to make information available to local minority organisations or the minority press? Is there too much emphasis on communicating via electronic media? As this only impacts positively where communities are computer literate and have access. Have safety been considered which affect some groups? For example women and people from minority ethnic groups have a greater concern over their personal safety. Appropriate lighting around site locations for example or other safety precautions might therefore require consideration. Has access been considered for disabled people and parents who care for small children? They might have a need for special adaptations or facilities and for appropriate sign posting to direct them to such accessible provisions. 9

Does publicity material use a range of images /photographs to show our diverse populations? If publications exclude certain groups, individuals from those communities may feel uncertain if they would be welcome or whether their needs and wishes will be respected at events or when in need of a service. Human Rights breaches The Human Rights Act 1998 means that all public authorities including NHS Trusts must comply with the Human Rights Act to ensure that the human rights of individuals are not infringed. Human rights are our basic needs as human beings which are based on core principles like dignity, fairness, equality, respect and autonomy. There are three main types of rights: Absolute rights - These rights are not limited. The state can never withhold or take away these rights. Limited rights These rights maybe limited under explicit and finite circumstances. Qualified rights These rights require a balance between the rights of the individual and the needs of the wider community or state. Interference with qualified rights is permitted only if there is a clear legal basis which is necessary and proportional such as in the interest of national security and public safety. Proportionality - Most of the rights in the Human Rights Act are qualified rights. A key element of Human Rights is the principle of proportionality. This means that any interference with people s Human Rights must be necessary and proportional, and is particularly relevant for NHS Trusts. This ensures that NHS Trusts practices, policies and strategies that breach human rights are kept to a minimum and are always reasonable. Certain questions should be asked when amending or developing new policies or protocols to decide if they are proportionate, these include: Is this breaching a person s rights (either patient or employee) if we put this policy into action? If a blanket approach has been taken is it reasonable? Is there another solution to the problem that is less drastic? The specific articles that are relevant to NHS Trusts include: Article 2 Article 3 Article 5 Article 8 Right to life Prohibition of torture / inhuman or degrading treatment Right to liberty and security Right to respect for private and family life 10

Article 9 Article 10 Article 14 Freedom of thought, conscience and religion Freedom of expression Prohibition of discrimination For more information and examples see the Human Rights Policy and guidelines on the intranet. Section Three - Decision It needs to be carefully considered whether a full Equality Analysis is needed. Some proposals such as developing specific projects or services with the primary aim of addressing health inequalities would have a positive impact and unlikely to have a negative impact upon equality groups. In contrast a proposal to reduce or close a service could have a greater negative impact upon people from equality groups. For example, such as closing a service that helps older people or those with a disability will have a greater impact compared to younger people or those without a disability. Therefore, a full Equality Analysis is necessary to look at ways to reduce the negative impact, the actions required and how the proposal will be monitored. Section Four Justification The decision to undertake a full Equality Analysis should be taken with caution as a decision to proceed to full assessment can always be reversed if evidence suggests that the policy does not in fact have a significant impact. Any proposal that does not need to proceed with full assessment must be properly documented, with a record of the steps you have taken to reach this conclusion, and the evidence base for deciding that the proposal is of low risk. If you have carried out the initial screening properly, you should be well equipped to defend your decision, in the face of any challenge, whether internal or external. Give a full explanation for why the proposal does not require a full Equality Analysis; include any research, evidence or consultation that has been undertaken. 11

Full Equality Analysis Section Five Consultation and engagement Where there are gaps in our understanding and evidence regarding the impact of a policy on particular groups of people, then their views and advice should be sought. Representatives may be sought from several sources, such as: Staff Staff networks, trade unions or Staff Side Other public bodies Voluntary and community groups Focus groups Residents Patients Service users Carers It is important to ensure sufficient time and resources are dedicated to the involvement and consultation process to encourage full participation, particularly by those sections of the community who have not been involved in the past or are seen as under-represented. The amount of involvement and consultation undertaken needs to be reasonable and proportionate to the scale of the impact of the policy on people. Ask the Patient Participation Engagement team for their assistance. For this section, give any relevant details of any consultation or research that has been undertaken and explain how it shows the positive or negative impact upon each relevant equality group. If there has been no or limited work undertaken then give a justification for this decision. If there is a lack of data or information concerning a particular area this should not be a reason to stop the process. If the likely impact on a particular group is unknown then action needs to be taken to acquire this information. Therefore, future activities should be planned and details given. Section Six Action Plan The real value from doing an Equality Analysis comes from the action that will take place, and the positive change that will result from this exercise. If evidence of any negative impact is found during the equality analysis, the assessor has four options: 12

Justify the proposal as originally proposed even when it could affect some groups negatively, because of its importance, for example, to meet special needs of particular groups and there is no other way of achieving the aims of the proposal. Change the proposed policy by satisfying concerns raised by staff or stakeholders, where possible. Consider ways of putting the proposal into place that will remove or reduce its potential for negatively affecting the impacted group/s. Find alternative means for achieving the aims of the proposal that do not cause the same level of negative impact. These decisions should be included within the action plan. Alongside detail on how the negative impact will be minimised. Go back to section 3 and detail the issues that have been identified whether negative or positive. The action plan should detail the actions that will remove or mitigate the potential for the activity to unlawfully discriminate or impact less favourably on one or more communities in a way that cannot be justified What should go in the action plan? The action plan should include description of the issue and the actions that will remove or mitigate the potential for the activity to unlawfully discriminate or impact less favourably on one or more groups of people because of their protected characteristic in a way that cannot be justified. How long should the action plan be? The action plan should provide a focused set of priorities for improvement. It should only include the key activities that are likely to have the greatest impact. It should not be a comprehensive list of all the possible things that might help. Section 7 Monitoring Failure to properly monitor the actual impact of a proposal (remember this could mean a policy, strategy, function, service or project) may leave a public authority such as CLCH open to legal challenge. A vital part of the Equality Analysis is to develop systems which enable monitoring of the actual impact of the proposal and should be set out in section 6 of the form. In developing these monitoring systems, the following should be considered: What the type of data needed is and how often it will be analysed? This could include using the Annual Equality Patient Profile. Any patient satisfaction surveys completed or analysis of complaints could show the impact of the proposal. 13

How will relevant groups, staff or communities be involved in the implementation and monitoring of the proposal? Who will be responsible for the monitoring the actions? Publishing Once the Equality Analysis has been finalised and signed, it needs to be published on the CLCH website and this is the responsibility of the Equality & Diversity team. The Equality Analysis could also be publicised in other ways such as sending the results to voluntary organisations or patient groups. For further information contact: Lesley Soden Head of Equality & Human Rights 7 th Floor, 64 Victoria Street, London, SW1E 6OP Telephone: 020 7798 1407 Email Lesley.soden@clch.nhs.uk Melissa Berry Deputy Head of Equality & Human Rights 7 th Floor, 64 Victoria Street, London, SW1E 6OP Telephone: 020 7798 0868 Email melissa.berry@clch.nhs.uk 14