(Paper No)

Ayrshire and Arran NHS Board

Monday 30th March 2015

Mainstreaming Report 2013 – 2015

Author: Elaine Savory, Equality and Diversity Adviser

Sponsoring Director:Ann Gow, Interim Nurse Director

Date: Wednesday 11th March 2015

RecommendationThe Board is asked to approve the attached Mainstreaming report as an account of the work NHS Ayrshire & Arran has undertaken in the last two years to progress and embed the equalities agenda and meet the requirements of the Equalities legislation.

Summary

It is has been two years since the publication of NHS Ayrshire & Arran’s Equality Outcomes and initial Mainstreaming Report. Attached is NHS Ayrshire & Arran’s Mainstreaming Report, incorporating the equality outcomes progress. The report is produced to ensure that NHS Ayrshire & Arran, in line with legislative requirements and its duty, publishes a two year progress report.

Key Messages:

The report outlines our requirements under the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 to:

progress on mainstreaming equality into business progress to achieve agreed equality outcomes a report on the breakdown of staff statement on equal pay gender pay analysis information on how we gather and use employee information

Hyperlinked documents are available on request.

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Glossary of Terms 4AT

AoHLASDBMECAMHSEHRCEQIAFGMFNPGAGBVGPsHSCPsICULGBTMASTPDSRNIBSISLTSMRTRIWRAP

A validated rapid assessment test for delirium and cognitive impairmentAction on Hearing LossAutistic Spectrum DisorderBlack and Minority EthnicChild and Adolescent Mental Health Services Equality and Human Rights CommissionEquality Impact AssessmentFemale Genital MutilationFamily Nurse PartnershipGeneral AnaestheticsGender Based ViolenceGeneral medical practitionersHealth and Social Care PartnershipsIntensive Care UnitLesbian, Gay, Bisexual and TransgenderMandatory and Statutory TrainingPublic Dental ServiceRoyal National Institute for the BlindSensory ImpairmentSpeech and Language TherapyStandardised Morbidity RatioTrust Rugby InternationalWellness Recovery Action Planning

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I1. NHS Ayrshire & Arran Mainstreaming Report 2013 - 2105

NHS Ayrshire & Arran’s Mainstreaming Report 2013 – 2015 is attached to this paper and outlines our progress to embed the equalities agenda and meet the requirements of the Equality Act 2010, Public Sector Equality Duty and Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 .

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Monitoring Form

Policy/Strategy Implications The content of this paper will support meeting the requirements of the Public Sector Equality Duty which specifies that public authorities must demonstrate that they have due regard to:

Advance equality of opportunity. Eliminate discrimination, harassment and

victimisation. Foster good relations between groups of people

who share protected characteristics (of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, sex/gender, race, religion or belief, sexual orientation) and those who do not

The content of the paper also provides evidence of NHS Ayrshire & Arran’s requirement under the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 to:

progress on mainstreaming equality into business progress to achieve agreed equality outcomes a report on the breakdown of staff statement on equal pay gender pay analysis information on how we gather and use employee

information

Workforce Implications It is expected that the work will be undertaken within existing resources.

Financial Implications It is expected that the work will be undertaken within existing resources.

Consultation (including Professional Committees)

The development of the equality outcomes two years’ ago included consultation with staff, patients, carers and any other users of health care services. This is a progress report towards achievement of the equality outcomes as well as other areas of work towards embedding equalities into day-to-day practice. This report will become publicly available via our public website.

Risk Assessment Failure to publish our two year Mainstreaming Report outlining our progress on equality outcomes, mainstreaming the equality duty and workforce information could result in the organisation being prosecuted for failure to comply with legislation.

Best Value All best value themes are relevant.

- Vision and leadership- Effective partnerships- Governance and

accountability- Use of resources- Performance management

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Compliance with Corporate Objectives

Compliant with the corporate objectives specifically:

Deliver services that are clinically effective, safe, efficient and patient-centred;

Promote and embed the Caring, Safe, Respectful culture and support all staff to demonstrate the required behaviours and appropriately challenge when this does not happen.

Single Outcome Agreement (SOA) A number of the equality outcomes and areas of work undertaken links to SOAs in terms of achieving local and national outcomes, in particular the reduction of health inequalities.

Impact AssessmentThe attached report is a progress report on the work being undertaken to integrate equality into the day-to-day working across NHS Ayrshire & Arran and does not require to be impact assessed.

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NHS Ayrshire & ArranMainstreaming Report 2013 – 2015

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AccessibilityIf you would like this document in a language or format of your choice including large print, audio or Braille contact us:

Call Elaine Savory0800 169 1441

E- Mail ses@aapct.scot.nhs.uk

Fax

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01292 513665

Write toElaine SavoryEquality and Diversity AdviserNHS Ayrshire & Arran61 Lister StreetCrosshouse HospitalKILMARNOCKKA2 0BB

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ContentsPlease note the page numbering is out of alignment as a result of the cover paper.

Section 1

1.1 Introduction Page 4

1.2 NHS Ayrshire & Arran - About Us Page 4

Section 2

2.1 Mainstreaming Page 6

2.2 NHS Ayrshire & Arran’s approach2.2.1 Leadership Page 6

2.2.2 Organisational Commitment Page 7

2.2.3 Equality Impact Assessment (EQIA) Page 8

2.2.4 Ayrshire and Arran’s Equality Profiling Page 8

2.2.5 Staff Training Page 9

2.2.6 Equality of Access to NHS Ayrshire & Arran Services Page 9

2.2.7 Partnership Working Page 11

2.2.8 Procurement Page 13

Section 3

3.1 Equality Outcomes updates Page 15

Section 4

4.1 Employment and Employee information Page 26

4.2 Employment Monitoring Page 26

4.3 Use of Equality and Diversity Workforce Data Page 26

4.4 Equal Pay Page 27

4.5 School’s Work Experience Placement Programme Page 27

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SECTION 1

1.1 Introduction

In 2013, NHS Ayrshire & Arran published its very first Mainstreaming Report. The report informed our service users, their carers, visitors, staff and partner organisations how we as an organisation worked toward ensuring that equalities was being mainstreamed into the functions and activities of our organisation. It also provided information on our employees, reported by their protected characteristics, and demonstrated the ways in which we were meeting the general and specific duties as set out in the Equality Act 2010.

In this two-year update report we highlight the progress being made to embed equalities and our commitment to ensuring the ever-changing demography and multiple identities of our population are person-centred and that our core function of providing health care and prevention of ill-health for all meets the needs of those who access it. Going beyond our legal requirements is a clear statement of our intent to deliver services that reflect and respond to the needs of all the communities we serve within NHS Ayrshire & Arran.

It should be noted that the content of the report highlights progress up to and including 31 December 2014 to allow for our internal governance processes prior to publication in April 2015.

1.2 About Us

NHS Ayrshire & Arran is here to help our population stay healthy and provide safe, effective and person-centred care if you become ill. We are committed to providing a safe and high-quality service designed to meet the needs of patients and their carers and families. Our purpose is:

“Working together to achieve the healthiest life possible for everyone in Ayrshire and Arran”

NHS Ayrshire & Arran is also committed to ensuring patients, carers, families and staff are treated with dignity and respect, no matter their protected characteristics. We strive to provide the best care and treatment we can, within the resources available to us, while ensuring everyone working in the NHS has the right training and skills for their job within a safe and clean environment.

NHS Ayrshire & Arran manages an annual budget of around £700 million, employs approximately 10,500 staff and is responsible for providing health and care services and improving the health of the population (approx 367,000) of Ayrshire and Arran.

NHS Ayrshire & Arran delivers a wide range of comprehensive services across East, North and South Ayrshire. Recent changes to the delivery of public services have resulted in integrated services being provided through Health and Social Care Partnerships (HSCPs), who are the joint and equal responsibility of health boards and local authorities.

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Within NHS Ayrshire & Arran there are three HSCPs, integrating health and social services to improve outcomes for our communities. Each partnership is led by a Director of Health and Social Care, who reports jointly to the Chief Executive of NHS Ayrshire & Arran and the Chief Executive of the local authority. The commissioning of health services from general medical practitioners (GPs), dentists, pharmacists and opticians is overseen by the Partnerships.

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SECTION 2

2.1 Mainstreaming

Mainstreaming is a specific requirement for public bodies in relation to implementing the Equality Duty 2010. In simple terms it means integrating equality into the day-to-day working of NHS Ayrshire & Arran, taking equality into account in the way we exercise our functions. In other words, equality should be part of everything we do.

On 5 April 2011 the Equality Act 2010 introduced a new public sector equality duty (also known as the General Equality Duty) which requires public authorities, in the exercise of their functions, to have due regard to the need to:

1. Eliminate unlawful discrimination, harassment and victimisation and any other conduct that is prohibited under this Act

2. Advance equality of opportunity between people who share a relevant protected characteristic and those who do not share it;

3. Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

Since our first mainstreaming report, NHS Ayrshire & Arran have continued to embed equalities into our functions and our committed approach continues as outlined below.

2.2 NHS Ayrshire & Arran’s Approach

2.2.1 Leadership

NHS Ayrshire & Arran’s approach to continuous improvement and embedding of equalities into practice across the protected characteristics spectrum continues through visible leadership, organisational commitment and staff training amongst other initiatives.

Leadership is ‘unlocking someone’s potential to become better’ and in NHS Ayrshire & Arran we believe everyone should be given the opportunity to be a leader regardless of role. In May 2013, NHS Ayrshire & Arran’s Board approved our new purpose (front cover), commitments and values statements (below). To ensure the views across the range of protected characteristics were being considered, these were developed over a period of nine months in partnership with 3,000 staff from every corner of NHS Ayrshire & Arran, along with trade unions, professional organisations, non-executive Board members and the Corporate Management Team.

Engagement with staff was undertaken through a variety of methods including the use of electronic surveys, face to face meetings and engagement sessions across a wide variety of disciplines.

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Our commitments are:

Our service users and communitiesWe will work with you and your family to:

Promote and improve your health Improve your safety, outcomes and quality of experience while in our care Live up to our customer care commitments

Our workforceWe will work together to create an open, fair and just culture where:

We are all valued, respected and developed to be our best We are all informed, involved, listened to and treated fairly and consistently We are all safe and are supported to improve our health and wellbeing

Our partnersWe will work together with partners to:

Improve health, prevent disease and reduce inequalities Join up our service delivery to improve outcomes Make best use of our resources

Our values are:

Caring I will show concern for others and care about the health, safety, and wellbeing of everyone I come into contact with. Safe I will do my job well, striving to learn and do things better, while taking responsibility for the quality, safety, and effectiveness of my actions.

Respectful I will see everyone as an individual, be open, approachable, and treat everyone with dignity and respect.

2.2.2 Organisational Commitment

In our 2013 mainstreaming report, NHS Ayrshire & Arran committed to putting equality at the heart of our organisation by shifting the focus from being a “bolt on” aspect of delivery to an integral part of the way we perform our functions.

One area of the Public Sector Equality Duty where we recognised NHS Ayrshire & Arran could advance equality of opportunity and foster good relations was through commitment to the Project SEARCH initiative. Project SEARCH is a supported internship programme, hosted by NHS Ayrshire & Arran, designed to help young people with learning disabilities and/or those on the autistic spectrum into work.

Project SEARCH interns take part in a programme of work training via a series of work placements with NHS Ayrshire & Arran over an academic year. During this period, the interns undertake three rotations within three different departments.

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The programme aims to secure and retain full time employment for interns with NHS Ayrshire & Arran or to ensure that interns leave the programme ready for work and are, therefore, better placed to secure employment elsewhere.

The pilot programme proved to be very successful and on Friday 13 June 2014 all ten interns successfully graduated from the programme after 36 weeks of meaningful and practical work experience in a busy hospital environment. Of the ten interns, five have secured temporary six month contracts and one is undertaking a Modern Apprenticeship. The remaining four interns have gone onto further supported employability programmes.

The programme is a partnership between NHS Ayrshire & Arran, East Ayrshire Council, Ayrshire College, MERGE and Skills Development Scotland.

2.2.3 Equality Impact Assessment (EQIA)

NHS Ayrshire & Arran continues to ensure the ongoing importance of embedding equalities into the organisation through the use of equality impact assessment (EQIA). Support for policy development and service change is provided by the Equality and Diversity Adviser through staff training sessions as well as one-to-one discussions with staff on the use of EQIA and what should be considered. More recently with large scale developments and service changes, the Equality and Diversity Adviser has been an integral part of the process to ensure equalities are considered and any mitigating actions addressed.

One large development within NHS Ayrshire & Arran is the ongoing ‘Building for Better Care’ initiative. From the outset, public and staff engagement was essential along with consideration of the service change assessment and equality impact assessment.

2.2.4 Ayrshire and Arran’s Equality Profiling

Within NHS Ayrshire & Arran we recognise the importance of equality profiling our population to ensure when accessing our services we can best meet people’s needs, as well as providing a sound basis for planning and service delivery in the context of local and national developments.

The characteristics of age and sex are routinely collected and recorded within our existing systems. However, work towards improving the collection of the other protected characteristics is ongoing. Over the past two years our data collection in relation to ethnicity has increased and we continue to do so. For SMR00 (new outpatient appointments) we have increased to 44.2% with 43.6% being a valid ethnic group recorded. We are also continuing to progress recording for SMR01 (acute hospital discharges) with a figure of 61.8%, again with 61.1% being a valid ethnic group recorded. Nationally, it has been recognised that high numbers recorded known ethnic group includes the valid code Refused/Not provided’, however, NHS Ayrshire & Arran have very low refusal rates in the recorded statistics.

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The collection of data for patients with additional support needs has also been raised as a national issue and further work nationally is being taken forward to support Boards in collecting, recording and using this information to better plan patient care. NHS Ayrshire & Arran continue to progress this work whilst being mindful of the national work.

2.2.5 Staff Training

During 2013-14, NHS Ayrshire and Arran reviewed its approach to Mandatory and Statutory Training (MAST) to ensure all staff are up to date with the essential organisational training required for their post to minimise any potential risk to themselves, patients, colleagues and also the organisation. To facilitate this reviewed approach, a MAST passport was developed to enable staff to take ownership of their own learning by recording their training to ensure they are compliant with organisational requirements.

The passport focuses on the 12 Corporate MAST topics, of which Equality and Diversity is one, and provides the opportunity for staff to record MAST undertaken and any additional MAST which is specific to their job role. It also helps staff to identify and plan when refresher training is due.

As well as the inclusion of Equality and Diversity training in the MAST programme, NHS Ayrshire & Arran continues to provide a robust programme of learning through a range of mediums including corporate induction, eLearning modules and class room based training. Ad hoc specialist equalities training is also undertaken on a needs-led basis.

Specific training was procured during 2014 from LGBT Youth Scotland to strengthen the organisation’s LGBT Champions knowledge which in turn is supporting the Board wide work taking place to raise awareness of the issues faced by LGBT people. Most of the members of the group found the training extremely beneficial and it has given them greater confidence to champion this area of work and challenge where necessary.

2.2.6 Equality of Access to NHS Ayrshire & Arran Services

Improving Communication in Intensive Care through Adaptive and Augmentative Communication

NHS Ayrshire & Arran’s Intensive Care Unit (ICU) embarked on a project in October 2013 to improve communication with ventilated patients which would also lead to a better patient care experience in Intensive Care. Using a multi disciplinary team approach, ICU staff linked with Speech and Language Therapy (SLT) and in particular the Alternative and Augmentative Communication Department.

Communication in Intensive Care is compromised due to non-verbal barriers (Endotracheal and Tracheostomy ventilation). These barriers can have a negative impact on patient care, resulting in frustration and misunderstanding between patient and staff. By introducing a new education and resource tool our aim was to improve standards in communication with the ventilated patient. Furthermore, ICU staff planned to improve multi-disciplinary collaboration, patient outcomes and gain the best possible ICU environment for ‘Every patient, every time’.

Initially ICU conducted a survey of their staff and also all other NHS Scotland Intensive Care staff. The results of the survey highlighted the lack of resources and skills to effectively communicate with the ventilated patient, not just locally but nationally.

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We introduced new communication boards and purchased software to personalise them for individual patient use. By creating an educational resource staff have become more aware of the importance of non-verbal prompts. Additionally, we have looked at ways of improving the unit environment and have introduced the use of visual aids; Day/Night clocks and sensory aids. Relatives of patients with a Cognitive Impairment are encouraged to contribute to complete the “Getting to Know Me” booklet which we have recently introduced. This allows staff to gain insight into the patient and enable them to talk to them about familiar and personal interests thus enhancing individualised, person-centred care.

We successfully trialed the use of an Electrolarynx (which is an artificial larynx) on a ventilated patient. This had never been done, as far as we are aware, in the UK prior to our trial. Our patient was able to effectively communicate with relatives and staff alike with the use of an artificial voice.

This project has highlighted the need for improving communication practice throughout the organisation and we are now in the early stages of developing a learning resource for all staff which can be mainstreamed across the organisation.

JumpStart Programme

Jumpstart is NHS Ayrshire & Arran’s Child Healthy Weight initiative. It has been running since March 2009 and has delivered programmes to over 1500 children who are above a healthy weight.

JumpStart is specifically designed for children and young people aged five to 15 who are overweight or obese. It is aimed at providing children and young people and their parents/guardians with a programme that offers support, advice and interactive activities around healthy lifestyle choices and weight management. The overall goal of the programme is to ensure that children do not necessarily lose weight but either maintain their weight or reduce the rate at which they gain weight, while their height increases.

The programme recognised the need for further expansion to allow inclusion of children with additional needs. Therefore, specific service pathways and delivery mechanisms were developed to accommodate children and families with additional needs. Through the development of new referral pathways from Child and Adolescent Mental Health Services (CAMHS), Social Services and specialist services, the programme has received an increase in referral rates for children with additional needs.

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JumpStart Health Coaches received specific training in relation to some of the main issues that arise through working with children who require extra support. This has led to a specific process of assessment and programme pathway development for children and families that require this extra support.

Through initial assessment, Health Coaches discuss with parents the

needs of each individual child. If it is found that the level of need is not too great then children are integrated into mainstream programmes, thus fostering relations between children with additional needs and those without. However, specific programmes have been run that have incorporated higher staffing levels and specific activities allowing more individualised and tailored support to both children and parents/carers.

2.2.7 Partnership Working

Trust Rugby International (TRI)

In our first Mainstreaming Report we highlighted the establishment of ‘The Clan’ which is Ayrshire’s Trust Rugby International (TRI) team. TRI is an integrated rugby charity where people with learning disabilities play rugby in the same team as non-learning disabled individuals. The main aims of this initiative is to increase access and improve physical activity, mental health and wellbeing, improve socialisation, increase integration, develop co-ordination and ball skills, and enhance confidence for the players.

An evaluation of this project was undertaken in 2014. Results show that TRI has successfully provided physical and mental wellbeing benefits to people with a learning disability. TRI has achieved this by delivering a range of taster sessions to break down barriers and attitudes, by employing young apprentices, and a Regional Development Coach, and they are delivering touch rugby sessions within day services and after school provision. TRI has also begun introducing Strength and Conditioning Programmes, Player

Development Pathways, expanding the volunteer network, and work with other Sport Providers and governing bodies to promote and support a unified approach to rugby in all its form.

The young apprentices are all males aged from 18 – 26 and have a learning disability. One also has a diagnosis of Autistic Spectrum Disorder (ASD). The apprentices currently provide support at training sessions by giving them the opportunity to coach some parts of sessions under supervision, and to attend any Coach Education Programmes. They also provide a buddy system for new team members who require additional support due to their disability, allowing them to be fully engaged in participation. Two apprentices are currently paid for 16 hours per week, and the other is initially voluntary as a beginner.

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Some of the health benefits are a reduction in those smoking, with one person stopping altogether, weight loss and a reduction in alcohol intake. In terms of enabling and empowering people, TRI have built a rapport with parents and carers which has reduced anxiety and the people they support have been attending the trips and overnight stays.

Every player interviewed felt that TRI had given them an opportunity to meet new people, have friends, and be part of a team, which they never had before. Lacking social opportunities is common for those with a learning disability, and can contribute to poorer health, including depression and inactivity due to lack of motivation. TRI therefore provides a combination of physical activity and social interaction to improve both the physical and mental health of participants. Parents and carers have also observed the positive effect of TRI for improving social interaction.

TRI has commenced working with other mixed ability sports areas, and are introducing rugby to individuals who use a wheelchair. This project was launched in June 2014 at an open day, where people were able to see and try out the wheelchairs. This level of rugby is suitable for both wheelchair users and non wheelchair users, and TRI hope that some of their current players may also try this. This initiative is ongoing.

Hear To Help

A project that has been running over the past two years in Ayrshire is the ‘Hear to Help’ project which delivers hearing aid batteries and basic hearing aid maintenance in local communities as opposed to our two general Hospital sites. Essentially, the project works across health care, social care and third sector, and came about as a result of listening to the needs of our local population.

Fundamentally, the project was born from the Scottish Government’s early conversations around the need to develop a National Sensory Impairment (SI) Strategy. The two large charities Royal National Institute for the Blind (RNIB) and Action on Hearing Loss (AoHL, previously RNID) made contact with NHS Ayrshire & Arran and our three Local Authority partners to discuss sensory impairment in general and ways in which we could work together to improvement the patient’s experience. Ayrshire was noted as an area that embraced the concept of a Sensory Impairment Strategy early on, in advance of a draft national strategy being available.

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As a result, a group with representation from health, local authorities and the third sector bodies was established. Access to some fixed term funding was attained which allowed a variety of pieces of work to take place including the introduction of a Volunteer led service in local communities where hearing aid users can pick up consumable supplies, have basic maintenance and care provided as well as receiving general advice and support and signposting to a broader range of services as required.

Feedback from the third sector organisation that runs, and manages, this project has been extremely positive as has the anecdotal feedback received from NHS Ayrshire & Arran staff and service users who attend Audiology.

The main benefits of this project are:

Availability of earmould tubing services locally as opposed to centrally at the General Hospital sites of Ayr & Crosshouse.

Access to replacement supplies of hearing aid batteries locally as opposed to attendance at Hospital or use of postal service.

Social contact/interaction and support from Volunteers where contact with others is important i.e. reduction in social isolation.

Meeting the needs of our local population – patients asked for this service to be closer to home and we have responded.

Signposting to other Services where service users are often unaware of other services that are available to them and may be of benefit.

Excellent example of cross agency working – led by third sector, supported by Health and Local Authority.

2.2.8 Procurement

In our 2013 report, NHS Ayrshire & Arran outlined how we would mainstream equalities into our procurement functions. Below outlines ways in which we have continued to ensure this.

NHS Ayrshire & Arran ensure we carry out public procurement in line with mainstreaming the general equality duty, through use of a standard Pre-Qualification Questionnaire which is used as a template for the selection of suppliers including Equality and Diversity.

NHS Ayrshire & Arran agreed that the degree to which equality and diversity requirements are specified and incorporated within procurement documentation would vary according to the goods, services or works being purchased and these are assessed on a case by case basis. Our operating procedures and Policy Handbook include guidance on Equality and Diversity and are currently being updated in line with the Public Procurement Reform (Scotland) Act 2014.

The majority of the main suppliers to NHS Ayrshire & Arran are awarded contracts by National Procurement and as such National Procurement are addressing Equality and Diversity in all their procurements carried out on behalf of NHS Scotland. A recent example of where equality and diversity is considered is the national uniforms contract which was awarded to Dimensions UK Ltd working with Haven PTS. This is a supported business and provides 30 jobs for disabled people.

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SECTION 3

3.1 Equality Outcomes

In April 2013, NHS Ayrshire & Arran published seven intermediate outcomes in line with our business commitments with 11 equality outcomes falling under the specific areas outlined below:

Intermediate Outcome 1 - Within NHS Ayrshire & Arran everyone gets the best start in life, and is able to live longer healthier lives.

Intermediate Outcome 2 - People are able to live well at home or in the community in Ayrshire and Arran.

Intermediate Outcome 3 - Healthcare is safe for every person, every time across NHS Ayrshire & Arran.

Intermediate Outcome 4 - In Ayrshire and Arran everyone has a positive experience of healthcare.

Intermediate Outcome 5 - In NHS Ayrshire & Arran staff feel supported and engaged.

Intermediate Outcome 6 - The best use is made of available resources for the population of Ayrshire and Arran

Intermediate Outcome 7 - Across NHS Ayrshire & Arran inclusive leadership is portrayed at all levels.

With the current increase in pressure on NHS Boards, some of the actions to achieve our outcomes have slipped. Whilst we recognise the pressures on Boards, we are mindful of our commitment to embedding the equalities agenda. Therefore, to continue on our improvement journey a number of the actions we set have been extended to ensure NHS Ayrshire & Arran progresses with our commitment as well as the addition of some new actions to further support this work.

Over the next two years, and bearing in mind current public service reform, NHS Ayrshire & Arran will engage with our local people, and work alongside our partners, to ensure our commitment to embedding equalities reflects the needs of our local population.

Below is a short summary of the work undertaken and progress made over the last two years towards achievement of our equality outcomes. For a more detailed progress report, including updates, please go to include hyperlink to covalent report.

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During the period 2013 – 2015, the actions to progress the outcome for improvement in early years through initiatives such as adopting the universal parenting approach and the Family Nurse Partnership (FNP) work were all completed.

Through the various initiatives, we can report: Sustained increase in breastfeeding across Ayrshire and Arran Maintained reduction in teenage pregnancies Satisfaction feedback from families with enhanced Health Visitor / Family Nurse

contact and relationships Smoking behaviour changes in teenage mothers Continued higher than Scottish average of Immunisation update for children

An example of the success of the Family Nurse Partnership work is outlined as follows. One client, an 18 year old care leaver, was recruited to FNP while living in supported accommodation, isolated from her family and her baby’s abusive father. She was not in education or training and had extremely low confidence, and little trust in professionals.

The client’s Family Nurse was persistent in her attempts to engage her in the FNP Programme providing a consistent safe space for the client to begin to build trust and explore her difficulties.

The client’s Family Nurse used motivational interviewing to support behaviour change and various programme materials to support basic parenting skills. The client learned about trust, love, baby cues, play and attachment in an interactive way and applied this in the care of her baby. She also gained insight into her negative relationship patterns, and with the support of her family nurse, made the decision to leave her abusive relationship. She found appropriate housing and created a warm, loving home, and a small but supportive social network. The client has also found employment and started college.

Moving forward for the period 2015-2017, further actions and indicators have been set to further the work in the early years field. These are:

Introduction of the 27-30 month assessment for all children 85% of all children meet their Developmental Milestones at 27-30 Months by 2017

(Early Years Collaborative) 100% of families are offered a child assessment at 27-30 months 100% of families are offered increased home assessments carried out by HV

Family Nurse Partnership programme – Improve the health outcomes and life chances of teenage parents and their children receiving a preventative early intervention programme

20% of clients will be exclusively breastfeeding at 6/8 weeks 95% of babies born to born clients at term will not be of low birth weight Less than 10% of clients’ babies/children will present at A&E with injury/ingestion

between 0 and 24 months 100% of clients’ babies/children will receive full immunisations up to age 30 months

Introduction of Children and Young People Act (2014) Part 4 Named Person – anticipated date for legislation enactment August 2016

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Equality Outcome 1.1 – To improve outcomes for children through early intervention, improved parenting ability and capacity in the early years.

NHS Ayrshire and Arran will provide 100% of known children from birth to school age with a Named Person

Named Person services will be available to all children 0-5 years All children aged 0-5 years will have a child’s plan initiated by the Named Person

These additional actions have been added to our original equality outcomes document to continue to show the progress in this area.

The GBV programme continues to be very active with Routine Enquiry being implemented in five priority settings (maternity, children and families, sexual health, mental health and addictions), with Accident and Emergency partially implementing Routine Enquiry.

However, within these areas, there are variations in fidelity to the practice as well as many other areas within the overall service that could be included. F or example, community adult mental health teams across Ayrshire are implementing Routine Enquiry, but inpatient services are not. There is much to be done.

Many training courses have been offered and hundreds of staff trained in Routine Enquiry, but many courses are also cancelled as staff find it difficult to get away for training. This is an enduring and challenging issue. In the next action plan, we will be exploring alternative models for training delivery.

As Routine Enquiry is being undertaken in the five priority areas, challenges with the data capture and reporting have become increasingly evident. There is now a major push to improve our data capture from the FACE system (Health Visitors, mental health and addictions) so that we can provide more meaningful data to our own staff and to partners. Once that has been done, we need to ensure that the other systems (Eclipse and Symphony) can also provide equally robust data.

From an employer’s perspective, NHS A&A now has a sound GBV policy which allows staff and managers to feel confident when responding to GBV as it affects people in the workplace. This needs to be promoted regularly and staff on the training courses are reminded of it.

For the future, there is considerable activity by the Scottish Government on Forced Marriage, Human Trafficking and Female Genital Mutilation (FGM). These areas will require to be responded to in our next three year action plan, which will start in April 2015 – March 2018.

The Scottish Government also produced a new national action plan for GBV in summer 2014; locally a draft action plan has been produced by the GBV group and will be endorsed at the next meeting with a view to starting implementation in April 2015.

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Equality Outcome 2.1 – Improve the early identification of women and men experiencing Gender Based Violence (GBV) in identified areas of NHS Ayrshire & Arran.

Equality Outcome 2.2 – People from BME communities experience a reduction in the risk of developing cardiovascular disease.

The Keep Well programme continues to include people from BME communities in the delivery of health checks. A recent report on the outcome of the health checks demonstrates the number of people who have received this service within General Practice and the findings in terms of their cardiovascular disease risks.

Based on this information, the programme will continue to be delivered to minority groups within society via primary care however further work will not be undertaken by the team to actively target such groups.

Local demographic changes have a profound impact on the demand for health, social and long-term care services. The largest percentage change between the 2001 and 2011 census was in the population aged 80 years and over. The increase in this population age group has shown higher demands for health and social care relating to frail elderly people, such as an increased proportion of people with dementia.

Work towards achievement of the actions outlined within the ten year older people’s strategy ‘Reshaping Care for Older People’ continues. A range of interventions are being implemented across Ayrshire and Arran to support this work. These include Anticipatory Care Planning, Intermediate Care and Enablement Services, Out of House services, and Telehealthcare.

One initiative which sought to support older people to increase the length of time that they were able to live as independently as possible in their own homes was the post diagnostic dementia support. The initiative also sought to increase the extent to which carers felt sufficiently supported to enable them to fulfil their caring role. The aim was to provide early support via telecare to individuals and families where a diagnosis of dementia had been made. Such early intervention gave the opportunity to become familiar with, and be able to use effectively, telecare equipment before the illness progressed. The aim was that individuals and carers would be better able to manage their own support needs and to maintain their informal support more effectively, and for a more sustained period.

A total of eleven individuals and families were referred to the project. Of these, only three were in receipt of a care package, typically covering support with the administration of medication. However, four of the individuals and their families had already had informal discussions with social work staff about the possible option of a long-term care placement. Over the twelve months of the implementation of the project, only one of the three who had been in receipt of a care package required their care package to be increased significantly, the other two being largely sustained through telecare and the support which that provided for their carers. In addition, one of the eleven participants, due to changing needs, was reassessed as requiring a substantial care package.

At the end of the year seven of the 11 are still supported solely through telecare and the informal support provided by their carers.

The family/carers reported feeling less stressed and more supported, allowing them to continue to support their family member. None of the individuals involved have been

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Equality Outcome 2.3 – Older People are supported to live independently in their community.

admitted into long term care as well as being able to self-manage and remain independent for longer.

The Community Listening Service has been running for two years and is currently available within five GP practices as well as the Ailsa Hospital site. Good working relationships have been established with GPs and regular referrals are being received.

Patients have attended with a variety of issues, predominantly bereavement but also loss in other senses, including relationship difficulties. The patients seldom have single issue problems and this has involved continued consultation with them and also collaboration with other agencies – feedback to GPs, with the Mental Health Team and Psychiatrists, with Citizens’ Advice Bureau, Break the Silence and other support groups – referring them on while occasionally continuing to see them.

Patients have been signed off with the understanding that they can refer back if circumstances change and in a few cases this has happened, such as family bereavement, suicidal ideation, etc.

The following is an example of the Community Listening Service and the benefits for service users. Mrs X was referred to Community Listening Service for bereavement support. Her mother had died within that year and it seemed that Mrs X, who had previously appeared to cope well with life, was not managing. On meeting her for the first time, it became clear that the bereavement issue was not isolated. Her mother’s death had raised unanswered questions in relation to experiences of abuse which Mrs X had encountered when she was younger but never shared. Although she had received excellent pastoral support from local clergy at the time of her mother’s death, Mrs X was unable to get closure on the other issues.

At the second meeting with Mrs X, an urgent referral to Break the Silence was made and from there the lady began a two month programme with them which was to prove very beneficial. Mrs X continued to access the Community Listening Service in relation to her bereavement issues as well as the opportunity to discuss anything else she may have been anxious about.

Over a period of four months the lady dealt with her bereavement and anxiety, along with the abuse issues. When the woman finished accessing the Service, what had been a dull, depressed and anxious lady had developed into a shining, confident lady with a renewed enthusiasm for life, back at work and relating well with her family. Whilst this lady has left the Service, should the need arise she can re-refer herself but to date this has not proved necessary.

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Equality Outcome 2.4 – People are supported to gain psychological/spiritual strength to allow them to continue to live independently in their community.

As part of the local delivery of the Person Centred Health and Care Programme, NHS Ayrshire and Arran has delivered a range of improvement to individualised person centred care. This includes establishment of a real-time patients experience programme, which provides wards and departments with real-time feedback on patient experience, in order to deliver improvements for patients and their families as quickly as possible. Current feedback demonstrates that 90% of patients have a positive experience.

One example of where the real-time patients experience work has had an impact was when a gentleman with Parkinson’s disease was admitted to one of our acute hospitals. Whilst in hospital the patient was being administered his medication as part of the usual drug rounds on the ward. However, this was having an impact on his condition as the medication was routinely taken at a different time when at home. By discussing this with the real time reviewer, the reviewer was able to raise this with the nursing staff who discussed this with the patient, allowing arrangements to be made for the medication to be given at the same time as they would have taken it at home. By involving the patient in the decisions about their healthcare, the patient was better able to stabilise their condition. The real time programme is an example of where fostering good relations between patients and staff is having a positive impact on the care experience.

A great deal of work has taken place over the last two years to equip staff with the skills and knowledge required to meet the needs of people with dementia / delirium. We have an ongoing training programme for staff within the NHS and partners in place as well as making environmental adaptations to support patients. The case study below highlights the impact of good education as a first step to ensuring safe, effective and person-centred care in acute settings.

Mrs X, a 91 year old female, was admitted from home with a new onset of confusion and reduced mobility. On transfer to one of our care of the elderly wards Mrs X required significant nursing care.

One afternoon, the Charge Nurse noticed during visiting time that the family were just sitting at her bedside staring and looking very upset. The Charge Nurse approached and introduced herself and very quickly the family explained that they just didn’t feel like anyone was listening to them. They advised that their mum was not like this normally; she was normally mobile, continent, chatty and loved to sing. They felt frustrated and let down.

Some investigations were undertaken and a 4AT (a validated rapid assessment test for delirium and cognitive impairment) was carried out which made the possibility of delirium very likely. Empowered with this information discussions with Microbiology and the Consultant resulted in treatment for a Urinary Tract Infection being commenced. Within days Mrs X was sitting up and joining in with staff singing.

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Equality Outcome 3.1 – Individual patients’ health needs are assessed and responded to effectively to allow informed decisions about their healthcare to be made.

Equality Outcome 3.2 – Care for older people in acute hospital is sensitive to individual need.

She still required assistance of two nurses to transfer, however, she was able to interact again with her family. By listening to Mrs X’s closest relative who knew she was different, the ward were able to implement person-centred care which resulted in an improvement in her condition. She was eventually discharged home.

Mrs X does have regular admissions which are for lengthy periods however her daughter is now aware that her mum had a hypoactive delirium previously and she can now alert any new medical/nursing staff to this very valuable information.

Over the past 2 years the Learning Disability Service has continued to deliver on a vision for the service which has enablement at its core. Through work such as the piloting of Wellness Recovery Action Planning (WRAP) for people with a learning disability and their carers, and partnerships such as that underpinning the very successful TRI rugby initiative, the service has sought to make mainstream activities more accessible to service users, with considerable success.

The enablement of staff has also remained a key aim. The work of the three Primary/Acute Liaison Nurses has been of great significance in this regard, in relation to their delivery of training to acute and primary care staff, and their collaboration in the development of e-learning materials intended to raise the awareness of mainstream practitioners regarding people with a learning disability. Ongoing work in relation to a refresh of the 2009 health improvement strategy, ‘We Want Good Health…The Same as You’ continues to highlight the relevance of that activity, as well as creating new expectations in relation to this (particularly in relation to acute services), and other areas of work. Increasingly, there is recognition of the overlapping needs of people with a learning disability with other groups. The focus on neighbourhoods and localities which the integration agenda necessitates provides an opportunity to collaborate with communities in responding to those needs, potentially to the benefit of all.

Research evidence shows that women with a learning disability are less likely to attend for cervical smears and within NHS Ayrshire & Arran this is no different. One area where we recognised a gap was accessible information for women with a learning disability on cervical smears. Therefore, a local cervical screening leaflet was developed by two local nurses (one Learning Disabilities Nurse and one Sexual Health Nurse working with people with learning disabilities) in collaboration with patients to give a simple explanation of smear testing. Along with the leaflet additional training has been undertaken to support women with a learning disability resulting in an increase in the number of women coming forward for a cervical smear. Even those who do not have the cervical smear are now provided with accessible information to allow them to make an informed choice. To complement this, a visual explanation of the cervical smear procedure was developed and is available on the NHS Ayrshire & Arran sexual health website. Anecdotal feedback from general medical practitioners has found this visual aid to be effective for encouraging individuals across all protected characteristics who previously refused to have the procedure undertaken.

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Equality Outcome 4.1 – Increased staff confidence in responding appropriately to the range of protected characteristics specifically focusing on people with physical and learning disabilities, and the lesbian, gay, bisexual and transgender (LGBT) community.

Another area where NHS Ayrshire & Arran continue to support people with learning disabilities is through our oral health programmes. The Public Dental Service (PDS) is aware that often repeat general anaesthetics (GA) are required for dental treatment for adults with learning disabilities, as well as other health care interventions. In an effort to reduce unnecessary repeated exposure to GA, the PDS have been highlighting to colleagues in secondary care that the Service can be available to attend other procedures to carry out a dental examination and, if necessary and feasible, any dental treatment required.

Work towards achievement of the LGBT Charter Foundations Award continues and over the past two years much has been undertaken to promote NHS Ayrshire & Arran as an inclusive organisation. The establishment of an internal LGBT Champions Group, chaired by the Human Resources Director, to take forward specific areas of work ensures that the needs of LGBT people are included in our policy development, training provision and marketing campaigns.

NHS Ayrshire & Arran has provided targeted LGBT training for staff to increase awareness and confidence in responding to LGBT people and feedback has been extremely positive in helping our staff to be better educated to support individuals when accessing our services, as well as consideration for fellow colleagues who identify as LGBT.

There has been concerted work and effort towards delivery of the equality outcome for staff. The Health, Safety & Wellbeing strategy has provided the foundation against which the organisation strives to deliver against its organisational commitment to our workforce to create an open, fair and just culture where:

We are all valued, respected and developed to be our best; We are all informed, involved, listened to and treated fairly and consistently; and We are all safe and are supported to improve our health and wellbeing.

The actions detailed within the last plan have directly contributed to the improvement in the organisational sickness absence rate and improving the health and wellbeing of staff. We recognise that improvement requires to be sustained and will take time to become fully embedded, however, the results of the national staff survey 2014 validate the approach taken specifically the local questions linked to our organisational values:

I feel cared for at work – 50% positive response rateI feel safe at work – 77% positive response rateI am treated with respect at work – 65% positive response rate

An example of how the organisation has pro-actively supported a staff member with a protected characteristic under the terms of the Equality Act 2010 is outlined below.

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Equality Outcome 5.1 – Staff are supported in accessing appropriate support services to improve their health and wellbeing which are sensitive to their protected characteristics.

Staff member ‘A’ commenced employment as a porter. He loved his job but within two months of commencing in post suffered a deterioration in his health which significantly affected his eyesight. Following clinical assessments it was determined that staff member ‘A’ was no longer fit to undertake his role and that likewise, redeployment may not necessarily afford any appropriate opportunities.

He shared with the organisation that he had previously worked in a position where ‘touch typing’ was required and did not believe his deterioration in eyesight would impact on his ability to undertake such a role if one became available.

A rehabilitation opportunity has therefore been identified within an administrative setting where he will also receive the support of the Occupational Therapist working within the Occupational Health Team to identify any reasonable adjustments or equipment required in order to support him to undertake such a role.

NHS Ayrshire & Arran have in place a Communication Support Policy which covers communication support needs for deaf/Deaf, DeafBlind as well as community languages and translations. This policy was developed over a number of months with engagement from external organisations such as RNIB, Action on Hearing Loss (previously known as RNID), DeafBlind Scotland and our BSL service provider, Sign Language Interactions.

This process took a number of months, along with the establishment of a central internal budget for communication support needs. The policy is currently being reviewed and it has been noted that access to community language interpretation required to go out to tender as a result of the increase in usage, which evidences staff awareness of accessing the service.

During 2013-2015, NHS Ayrshire & Arran have provided all wards, GP practices, and outpatient areas across the hospitals with posters and contact information about the use of communication support services and these were recently updated and re-circulated. The posters provide both an awareness raising element for staff and for service users. Information is also available on our internal intranet site for staff as well as support provided via switchboard.

As outlined under Equality Profiling (page 8) work is ongoing to improve the collecting, recording and usage of data on our patient management system to support staff to provide person-centred culturally sensitive care.

As well as providing support across acute and community healthcare provision, a recent situation arose where a patient was being admitted to the local hospice. Through the support of the Equality and Diversity Adviser, appropriate communication support was put in place to allow the patient to be admitted and be able to communicate with the healthcare professionals as well as allow appropriate consent for necessary medical interventions to take place.

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Equality Outcome 6.1 – Service users have access to timely and appropriate healthcare information in a person-centred culturally sensitive way.

To ensure the NHS Board is committed to conducting business so that equality is an integral part of service design, all Board papers require to evidence that an equality impact assessment has been carried out and, if not, the reasons for this must be provided.

By carrying out an equality impact assessment, the Board can ascertain if proposed policy or service changes are like to have a disproportionate impact on some groups, particularly minority groups. Where adverse impacts are identified, NHS Ayrshire & Arran are committed to ensuring mitigating action is put in place.

Further evidence which outlines the support senior and line managers are giving to their staff to deliver equality sensitive practice is the increase in use of communication support methods. The increase in the use of communication support highlights that staff have a greater awareness of the need to eliminate discrimination by ensuring support mechanisms are in place to allow clear communication between staff and patients.

As well as the strategic work to support equality sensitive practice, the case studies outlined in the equality outcomes above highlight the ongoing work across NHS Ayrshire & Arran, supported by Senior and Line Managers, to mainstream equality into practice.

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Equality Outcome 7.1 – Senior and line managers have developed and applied leadership skills to support and motivate their staff to deliver practice this is equality sensitive.

SECTION 4

4.1 Employment and Employee Information

NHS Ayrshire & Arran 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 the dignity, respect and consideration they deserve, helping staff to reach their full potential at work. 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.

As outlined in our 2013 mainstreaming report, NHS Ayrshire & Arran continues to provide opportunities for flexible working practices balancing both individual and organisational needs. We are also continuing to offer employability training to staff in line with the Government’s Work and Health agenda.

4,2 Employment Monitoring

NHS Ayrshire & Arran has established equalities monitoring and reporting systems but acknowledges the gaps which exist in its staff identifying themselves by the protected characteristics of disability, race, religion and belief and sexual orientation.

Recognising the gaps and following the release of the Equality and Human Rights Commission (EHRC) report Measuring Up? Report 2, the NHS Human Resources Directors and NHS Equality and Diversity Lead Network jointly established a short life working group to assess current practice and recommend improvements which would increase the quality and consistency of staff equality data collection, use and reporting across NHSScotland.

This group carried out a scoping exercise which identified both cultural and practical barriers to data collection and analysis. The group is developing an improvement plan to support joint action across NHSScotland. The actions seek to increase disclosure rates, facilitate consistent reporting through establishing standard metrics and reporting processes, and use the capabilities of a new Human Resources management system to support data analysis at individual board and national NHS level. The short life working group will submit their proposed action plan in 2015.

Our equality and diversity employment monitoring report can be found on our website (insert hyperlink). The workforce data represents the figures for 2013/14. As part of our mainstreaming approach, future iterations of our workforce equalities data (2014/15) will be included in our Workforce Plan which will be published in August 2015 and each year thereafter.

4.3 Use of Equality and Diversity Workforce Data

Equality and diversity workforce data is routinely used to support both workforce planning and Human Resources activities.

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Age and gender strands have a particular focus within workforce planning and are routinely used and reported within workforce plans and intelligence. This detail has also been essential in work undertaken in relation to the Working Longer Review. It has been agreed that future iterations of the organisational workforce plan will incorporate equality and diversity workforce data in order to mainstream publication.

The full range of equality and diversity strands are used in the context of employment relations, recruitment, redeployment, and promoting attendance undertaken by Human Resources staff. The use of online recruitment has made a significant contribution to improving the disclosure of equality strands by applicants. It is anticipated that the implementation of the new national Human Resources system (referred to above), providing self service functionality, will assist in addressing gaps in the equality and diversity dataset where data is unknown / undisclosed for some of the workforce.

4.4 Equal Pay

NHS Ayrshire & Arran 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 protected characteristics. To achieve this, pay systems require to be transparent, based on objective criteria and free from unlawful bias. Our equal pay statement can be found on our website (insert hyperlink).

4.5 School’s Work Experience Placement Programme

NHS Ayrshire and Arran acknowledges the importance of supporting young people into the workplace. With the current economic situation, we recognise employment opportunities are limited and therefore believe the work experience placements programme is a vital component to ensuring young people reach a positive destination.

NHS Ayrshire and Arran, working in partnership with the Ayrshire Chamber of Commerce and local schools, endeavours to provide opportunities for secondary school pupils (normally third through to sixth year). This involves taking secondary school pupils for one week’s placement within various departments throughout the organisation. Working with the Ayrshire Chamber of Commerce, we attempt to ensure pupils are linked up with areas of interest, thus giving the pupils some understanding of the working environment and also ensuring that they are better prepared for working life. It can also identify if a chosen profession may not necessarily be the right field of work, thus avoiding unnecessary placements at university for the young person.

Within NHS Ayrshire & Arran, we offer approximately 300 places throughout the school year within a variety of departments. Not only does this forge links with the local community, it also helps promote ourselves and attract local school leavers as future NHS Ayrshire & Arran employees.

As well as the work experience placements offered, we also support pupils with self found placements, which is working in conjunction with the school pupil directly, the school and the Ayrshire Chamber of Commerce to offer the same opportunities as that identified above.

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