Public Sector Equality Duty
Equality & Inclusion Service User Monitoring & Assurance Report; 2014
Patient & Customer Focus, Accountability, Continuous Improvement, Respect
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Table of Contents
1. Executive summary Page 3
2. Introduction Page 4
3. Key achievements in 2014 Page 6
4. Ongoing work streams Page 12
5. Service user and population profile by protected characteristics Page 15
5.1 Salford overview Page 15
5.2 Gender profile Page 16
5.3 Age profile Page 17
5.4 Ethnicity profile Page 19
5.5 Religion and Belief profile Page 27
5.6 Disability profile Page 30
5.7 Sexual Orientation profile Page 33
5.8 Transgender profile Page 33
6. Recommendations Page 34
7. References Page 36
Page 2 of 37 1. Executive Summary
This report is one of the mechanisms that the Trust uses to demonstrate, on an annual basis, progress to meet the requirements of the Equality Act 2010 and the Public Sector Duty. Organisations are required to publish information to outline the actions it has progressed and outcomes it has achieved.
This report outlines progress made over the last 12 months, Oct 2013 to Sept 2014, across all our work streams, key demographic profiles of the local population compared with our service user profile and how these can impact on the delivery of care and identifies key recommendations to ensure that the Trust’s action plan is reviewed, transparent and fit for purpose.
The following have been identified as key recommendations:
Continue to improve the processes and systems for recording equality data including; supporting staff training and confidence and reduce the number of patients recorded as ‘not known’.
Continue to gather information from staff on the changing population of Salford and the impact this has on their ability to deliver safe, clean and personal care.
Undertake a review of the pilot ‘Meet, Greet & Support’ service, identifying areas for improvement to support and improve the patient experience.
Continue to develop the role of the Service Users Forum and Sensory Impairment Working group, including working with the QI team & Governors to improve their knowledge of inclusion across the patient experience work stream and develop the project plan for the ‘Model Ward’ programme, identifying current impact on patients with sensory loss.
Improve and embed the Trust’s Equality Analysis & Engagement Process for Service Transformation Projects, to ensure they are timely and meet with legislative standards.
Update & review the Trust’s current equality objectives in light of the key recommendations form this paper to ensure that they are robust, effective and fit for purpose.
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Introduction
2.1 Scope and Background of Report
In line with the Equality Act and Public Sector duties, NHS Trusts are required to publish, on an annual basis, evidence to demonstrate that they are working towards meeting the aims and objectives of this legislation. Undertaking this data analysis enables the Trust to monitor the impact of our policies, procedures and services on protected groups and identify actual or potential health inequalities and identifies key recommendations and actions. The report reviews patient profiling data from inpatients, outpatients and community services from the period October 2013 to end of September 2014 by protected groups, where this data is currently available It also offers a snap shot of diverse communities residing in Salford, and Greater Manchester measuring their characteristics and revealing their geographical locations. Analysis of patient data in comparison to local communities, enables us to review the accessibility of our services in relation to the local population and identify areas that may require further scrutiny to identify positive and negative impacts. The recent local growth in the diversity of the local population means that increasing volumes of individuals from diverse backgrounds, will be turning to the Trust as a provider of hospital, specialist and community services. The data contained within this report will enable services to identify key areas for improvement and should be used to inform and shape decisions making process in relation to service improvement and service transformations processes.
A range of available data, from a variety of sources has been used in its compilation, including the most recent census 2011 data where possible. NB Patients data reports are based on the single visit/admission of a patient as opposed to number of times a patient has been admitted. There are however gaps in some areas due to lack of information and this is highlighted throughout the report.
2.2 Trust Equality Objectives The Public Sector Equality Duty requires Trusts to publish equality data at least every four years. Specific objectives have been set for service delivery and for our workforce.
Details can be found on the Trust website Equality Diversity Performance Report (page 5)
2.3 Equality Delivery System 2 (EDS2) In 2012 the department of health introduced the Equality Delivery System (EDS) It required all NHS organisations to benchmark themselves against 18 core outcomes. By using the
Page 4 of 37 EDS we are able to demonstrate compliance with the requirements of the Equality Act as well as the ‘Essential Standards of Care’ required by our regulator and licenser the Care Quality Commission (CQC), Monitor, NHS Constitution and other legal and mandatory requirements.
Through the implementation of the Equality Delivery System 1 the Trust was one of 6 organisations to achieve a national award from the EDS team and were actively involved in developing EDS2. The Trust undertook a review of its existing EDS scores in April 2014 with both public and staff. Our results shows the Trust has progressed in several areas and developed agreed actions in EDS 2 outcomes; Access to Services (2.1) and Free from Abuse (3.4).
Current Scores can be found on the Trust website Equality Delivery System.
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Page 5 of 37 3. Key Achievements in 2014
3.1 Service users forum continue to help the Trust make improvements The forum was launched in November 2012 and provides a platform for individuals from local community/protected groups to have direct dialogue with the Trust and identify key areas for joint working, and number of developments were agreed based on the experiences reported by its members, they have been involved in several significant work streams over 2014.
Key Outcomes Provides a patient voice and examples of patient experience, in particular for patients with disabilities. Included in the Trust’s Accessibility Audit, ensuring a reflective and inclusive audit was undertaken. Actively involved in developing accessible information for outpatients Reviewed and supported us in developing a new mandatory training package for staff. Instigated set up of the Sensory Impairment Working Group, by identifying poor patient experiences of this group when accessing services. Supported and assisted in the development of the Trust’s ‘Meet, Greet & Support’ service.
3.2 Selected as Health Champions Stonewall 2014/15 Stonewall is the leading lesbian, gay and bisexual (LGB) charity in Britain established to promote the human rights of LGB people. As Health Champions we have been receiving support to address any unmet needs and improve experiences. At present we are still in the process of delivering this project and work on this area will be on-going.
Key Outcomes Supported the Trust is setting up a stonewall working group which identified 3 key areas for improvement for the Trust (targeted training, equality monitoring data and equality champions). Targeted training delivered to the Alcohol and Drug Team, to identity key outcomes to improve patient experience and access in relation to this service. Raised the profile of LGB patients and staff across the organisation.
3.3 E&D Partners status in 2013/14 E&D Partner status is determined against a number of measurable indicators put forward by ‘NHS Employers’. In doing so we have demonstrated that the Trust can be held up as an
Page 6 of 37 exemplar in the field of equality and diversity and we have a robust equality and diversity work plan. (Single Equality Scheme 2013 – 2015 )
Key Outcomes Applied and were successful, second year running , of being awarded E&D partner status from NHS Employers. This is a nationally recognised award and enables the Trust to share and engage with leading organisations on this agenda, while continuing to raise the profile of the Trust.
3.4 Governor led engagement plan published for seldom heard groups The Equality and Diversity Team have supported the Governors work in ‘engaging with seldom heard groups’. Targeted training was delivered to Governors in 2014 including Men’s health and Sensory Impairments.
Key Outcomes Review of Accident and Emergency by carrying out semi-structured interviews with patients including actively collecting the views of people with disabilities. Various other projects planned to address key health inequalities. A copy of the Governors Engagement Plan can be found at Public & Staff Engagement & Training Events
3.5 Identity and Impact staff briefings Training session delivered by external and internal subject experts to support staff to explore how best to care for patients and develop interventions given specific considerations. A series of briefing session were delivered by external organisations and subject experts to increase staff knowledge and understanding of patient’s needs. Topics included supporting people with hearing loss, guiding people with sight loss, dyslexia awareness, religious awareness including Islam, Judaism and Christianity, positive interventions with men, Transgender awareness and asylum seekers and refugees.
Key Outcomes Staff better informed to care for patients and meet the diverse needs of staff in the workplace. Given opportunity to ask questions relevant to individual departments.
3.6 Improved staff awareness and action to improve access to services for people with sight and hearing impairments
Page 7 of 37 A sensory impairment improvement programme is underway across the Trust. A considerable number of departmental staff across the Trust have signed up to making improvements for patients and staff with visual and sight impairments.
Sensory simulation training has been delivered to staff to provide first hand experience and understanding of the needs of these patients, which has been accessed by Executives, Senior Mangers, Leaders and departmental staff across the Trust.
Key Outcomes Gaps have been identified in individual departments and improvement projects are underway supported by the Equality and Inclusion Team. Staff better informed about the barriers faced by patients and staff with visual impairments and how to address these.
3.7 Flying the flag for IDAHO 2014 On May 17 the Trust took part in the International Day against Homophobia and Transphobia by flying the Rainbow Flag at the front of the hospital. Resources were also available to staff to support their learning.
Key Outcomes Trust visibly showed its support for taking positive action to celebrate lesbian, gay, bisexual and Trans individuals and raising awareness of the impact that homophobia, biphobia and transphobia has on these communities. Staff more aware of the needs of LGBT patients and staff leading to improved experiences.
3.8 Pride The Trust joined forces with local public, third sector and private organisations, for the first time, to take part in the Pride Parade over the August bank holiday weekend. The event was a huge success. Key Outcomes Participation reinforces positive images of the Trust striving to meet the needs of our diverse patients and staff. Greater awareness across the Trust leading to positive staff experiences
3.9 Sensory Impairment Working Group The group was launched in 2013 and is made up of members of the public and staff with sensory impairments to identify and support improvements. The group met with staff from across the Trust who have pledged to make improvements for these communities.
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Key Outcomes The event allowed personal interaction in a safe environment to learn about their experiences and identify issues to tackle within individual departments. Input into the review of the mandatory equality and diversity training. Input into the outpatients customer information.
3.10 Launch of pilot ‘Meet, Greet and Scooter Scheme.’ Acting on concerns brought forward by the service users panel, the Trust has purchased mobility scooters to help patients get around the hospital. Fully trained volunteers support requests and also accompany patients to and from hospital appointments.
Key Outcomes Project will benefit patients and carers with mobility and sensory impairments to easily get to appointments, support to uphold their confidentiality and independence and provide respite for carer
3.11 Review of outpatient’s information to improve access. Accessible information and materials have been developed to improve patient’s experience. Members of the service user forum and sensory impairment working group have had an input.
Key Outcomes Materials developed are more accessible and meet the needs of our diverse service users profile to allow greater understanding and improve accessibility
3.12 Celebration of Black History Month and information stalls. An information stand was displayed to celebrate this event and information resources were developed for staff. It promotes and celebrates the cultural diversity of our society as well as the achievements of black people throughout history.
Key Outcomes Greater respect and understanding of the issues faced by Black and minority ethnic staff and service users
3.13 Equality, Diversity & Human Rights week celebration – NHS employers.
Page 9 of 37 Action from Hearing Loss and Action for Blind people held information stands with the equality and Inclusion team in the hospital to raise awareness of the issues that people face and to support staff.
Key Outcomes Greater respect and understanding of the issues faced by staff and service users with visual and sight impairments. Presented an opportunity for people to learn about the equipment available to support communication requirements . Raise awareness of support organisations and how they can help. Allow more signposting to improve experiences .
3.14 Signage and accessibility. Bury Coalition for Disability Living has conducted an accessibility review in the hospital taking into account the needs of people with disabilities. It has identified ways to improve way finding, including signage and equipment requirements. The action plan has been reviewed and priorities set which will be implemented over a five year period. The service users panel have had direct input.
Key Outcomes Improved accessibility within the hospital
3.16 Introduction of accessibility feature on the website. Browse aloud has been added to the intranet site to allow us to reach patients with visual impairments. It has provided speech and reading support to our website facilitating access and participation for those people with print disabilities, dyslexia, low literacy, mild visual impairments and those with English as a second language.
Key Outcomes Meets the needs of patients to access information about our services
3.17 Car parking consultation. A full consultation has been taken with patients, the public and staff to review the Trust’s car parking services including charges, accessibility and concessions rates.
Key outcomes Accessible consultation implemented including easy read, large print and web
Page 10 of 37 based version. Improved concessionary rates for groups identified as having additional support needs including blue badge holders, carers, cancer patients, long stay visitors and frequent attenders.
3.18 Better environments for people with dementia. There are huge strides being made to improve the experience of people living with dementia and their carers. Various projects have been implemented including the Reminiscence Pods (RemPods) which are replicas of various settings including a 1950s lounge and a pub. Other projects include an ongoing patients and carers group and a new courtyard being built which provides a relaxing haven for patients to help them reminisce. The Nurse responsible, Janice McGrory has been crowned the Best Dementia Nurse Specialist/Dementia Lead at the 5th National Dementia Care Awards 2014.
Key outcomes Various improvements projects in place and facilities available to improve the experience of dementia staff. Increasing staff knowledge and awareness to better care for patients with dementia .
3.16 Language interpretation services. All services are able to access Language Line to provide telephone and face to face interpretation when required. Over 150 languages can be catered for. BSL interpreters are also available through a contract secured with Action on Hearing Loss. The service is reviewed on a regular basis through the Diversity and Equality Committee to ensure it continues to meet the needs of patients and staff.
Key outcomes Services are accessible to patient’s who need to communicate in a language other than English improving accessibility, experience and outcomes.
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4. Ongoing Work Streams
This section details the structures and initiatives we have in place to meet our requirements
4.1 Governance arrangements The Equality and Inclusion Sub- Committee is the organisations working group on equality and inclusion related issues. The membership of the sub-committee consists of senior managers representing the various areas of the Trust and staff side representation.
It reports to the Patient and Staff Experience Committee who are responsible for giving the Board of Directors assurance of compliance with national standards and public duty in accordance with the relevant legislation.
4.2 Equality Outcomes Analysis The Trust is committed to ensuring the needs of diverse groups are included in decision making. As such the Trust continues to use Equality Outcome Assessment (EOA) templates to provide structure to the process, and provides staff training. All new and revised policies & leaflets require an EOA to be completed as part of the document control process. Any policy that is identified as having a potential or actual impact has to undergo a full outcome assessment
The Trust has recently been undertaking work on identifying how we can improve the effectiveness and robustness of EOA’s, key improvements have been included in the recommendations section of this paper.
4.3 Patient and Public Engagement We value the opportunity to hear the experience of our patients and the public we serve to check we are delivering a high standard of care to everyone. Opportunities are presented to them to influence health service planning and delivery. It is only by working in partnership with local people and our staff can we develop services that meet local need and are utilised effectively.
Active engagement takes place with our trust members and a number of patient groups are set up across the Trust that come from a variety of backgrounds and are working with the individual services to identify gaps and help to make improvements.
Page 12 of 37 4.4 Patient Access and Experience The Trust has a positive record on Patient safety and is committed to removing barriers to access and ensuring all our patients have positive experiences. Examples of existing initiatives include single sex accommodation provision and carers resource files on all ward. However through continued engagement, as illustrated above, we will be able to gain a greater understanding of any issues and work to address any potential inequalities.
Our patient recording system includes asking about the needs of our service users such as language and translation, use of hearing aids etc
Additionally the Equality and Inclusion Team have worked with the Quality improvement Team to embed a consideration of equality needs within their projects across the Trust. The Team have also facilitated joint working with Action on hearing Loss to improve the experiences of patients with hearing impairments on the Wards
Various surveys are conducted on a regular basis to quality check our services and identify where improvements are needed such as the friends and family test , dementia, bereavement amongst many others
4.5 Specialist Teams The Safeguarding Team is dedicated to providing advice to staff and protecting vulnerable patients, such as people with Learning Difficulties. Easy read resources have been developed and cascaded to aid communication and support people with learning disabilities in accessing our services.
To support good quality specialist care, the Trust employs a Dementia Lead Nurse, Domestic Violence Lead Nurse and Mental Health Lead Nurse who can share their knowledge with link nurses on all the wards and provide good quality patient care.
4.6 Equality in Complaints, Complaints and Comments from our patients The Patient Advice & Liaison Service (PALS) offers help, support and advice to patients, relatives or carers, if they wish to make enquires, compliments or raise concerns in relation to the hospital. PALS routinely collect diversity monitoring data. It is however limited to age, gender and ethnicity at the moment due to the I.T equipment we use, but we are in the process of reviewing how to develop this information.
Complaint data is currently not broken down by equality groups but is being be manually recorded at the moment. PALS and complaints information is available in different formats and patients and carers with language barriers are supported with the use of interpreting services.
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Data shows that a diverse range of people use the service. Through engagement in the future the Trust will check with diverse communities how easy they find it to make a complaint or comment.
4.7 Equality in our Membership and Governorship As a Foundation Trust our Membership and Governors are an integral part of the patient and public feedback process. The elections are transparent and available to all and representative of the community we serve.
Our current membership broken by protected characteristics shows it is reflective of the local population. Our Governors are the voice and representatives of the membership. They engage with the public, patients and Trust members to raise issues or concerns and both support and challenge the Trust on key areas of service provision. They have been recruited from various backgrounds.
Page 14 of 37 5. Service user and population profile
The patient profiles below are offered in comparison to the local and regional population profile. We aim to identify any gaps in access in doing so.
5.1 Salford Overview
Total Population Salford has a population 233,933 residentsi. 92.8% of residents responded to the Census 2011 (compared to 92.9% for Greater Manchester and 93.9% for England), which gives the results a good degree of accuracy.
Deprivation ii The health of people in Salford is generally worse than the England average. Deprivation is widespread across the city. Salford is ranked as the 15th most deprived local authority area in England. 13,100 children live in poverty. Life expectancy for both men and women is lower than the England average which amounts 12.1 years lower for men and 8.2 years lower for women in the most deprived areas of Salford. The reasons for this are varied and include social factors such as the high deprivation rates, high unemployment and poor housing and lifestyle factors.
Figure 1 : Population by Ward
20% 16% 12% 8% 4%
0% % of % TotalPopulation
Page 15 of 37 5.2 Gender
Service User Data Figure 2: Gender of Service Users
Not Specified, 7, (0%) Male, 127099, (44%) Female, 158808, (56%)
There are slightly more women that use our services than men, amounting to a difference of 31,709 patients. Only a very small proportion of patients, 7 in total, do not have their gender recorded.
Local Population Data There is an almost 50/50 split between men and women residing in Salford and within Greater Manchester
Figure 3 : Local and Regional Population by Gender
100 49.9 50.1 49.4 50.6
50
%of Population 0 Salford Greater Manchester
Male Female
Comparative Findings The percentage of service users broken down by gender, when compared to the local and regional data indicates more women access our services than men.
Recommendations Encourage and support services to assess if accessibility differs at service level
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5.3 Age Refers to a person belonging to a particular age (e.g. 32 year olds) or range of ages (e.g. 18 - 30 year olds).
Service User Data
Figure 4 : Service Users Age Ranges
60000 53017
50000 40798 40485 40287
37706 40000 33512 30536 30000
No.of Patients 20000 9575 10000
0 71 and 61 - 70 51 - 60 41 - 50 31 - 40 21 - 30 16 - 20 15 and Over Under Age Ranges
People aged over 71 access use our services more than any other group. 50% of all service users are aged over 51 years of age. The majority of children under 15 accessed community services, making up 35% of all community patients, compared to 4% of patients using inpatient services and 5% using outpatient services in the hospital.
Local Population Data
Page 17 of 37 Figure 5 : Age of Population
25 20 15 10 5
0 % of Total Population Population Total of % Age
Salford Greater Manchester
The average age of people in Salford is 37, while the median age is lower at 35 Salford has a predominantly young population - 62% of the population is under 45 years old.
Comparative Findings The 2011 Census indicates that although Salford has a predominately young population (62% under 45), 50% of all our service users are aged over 51 years.. Similarly, people aged over 70 are more likely to use our but yet they make up only a small proportion of the local and regional community. Health deteriorates with age and therefore these figures are expected for our organisation.
Recommendations Raise staff awareness of the link between age and the increased risk of patient’s having sight, hearing and physical barriers and suffering from dementia. Greater awareness of how these may impact on accessibility issues .
Page 18 of 37 5.4 Ethnicity service user and population profile
Refers to a group of people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.
Service User Data
Figure 6 : Ethnicity of Service Users Other , 4741, (2%) Not stated , 15638, Mixed, 2825, (1%) (5%)
Asian or Asian British , 10758, (4%) White , 246268, (86%) Black or Black British , 5686, (2%)
The majority of service users are White British (82%) 9% of the total patients who have disclosed their ethnicity are of a black and minority ethnic (BME) background and 4% are either White Irish or White Other. We see more patients who identify as Asian or Asian British than any other BME groups. Almost 5% of total patients do not have their ethnic origin completed. This number varies dependent upon the type of service accessed as indicated in the table below. Further work will be carried out to reduce this gap.
Page 19 of 37 Figure 7 : Patinets Ethnicity Not Disclosed 10495 12000 (11.39%) 10000
8000 4657 6000 (3.20%) 4000
NumberofPatients 2000 486 (1.01%) 0 Inpatient Outpatient Community Services
The service user breakdown within the sub categories are listed in the following table:
Figure 8 : Ethnic Profile of Non-White British Service Users 9000
8000
7000
6000
5000
4000
3000
2000
1000
0
Having removed the White British service users as the majority and those that have not stated their ethnicity, leaves us with 506,165 patients. The ethnic profile of the remaining groups shows us that people from White Other backgrounds are the largest users of
Page 20 of 37 SRFT services, followed by Pakistanis (5031 patients) , Africans(3796 patients) and other ethnic groups (3519 patients).
Further analysis is required to identify the groups within the non-White British category who are most likely to use our services, which may include Eastern Europeans. This will lead to identification of language and cultural needs which relate to their county or origin.
Local Population Data
Figure 9: Local and regional population profile by ethnicity
Greater Salford Manchester Ethnicity Number % of Total % of Total English/ Welsh/ Scottish/ White Northern Irish/ British 197445 84.4 79.8 Irish 2882 1.2 1.3 Gypsy or Irish Traveller 193 0.1 0.1 Other White 10342 4.4 2.6 Mixed/multiple ethnic group White and Black Caribbean 1647 0.7 0.9 White and Black African 1058 0.5 0.4 White and Asian 929 0.4 0.6 Other Mixed 982 0.4 0.4 Asian/Asian British Indian 2553 1.1 2.0 Pakistani 1843 0.8 4.8 Bangladeshi 605 0.3 1.3 Chinese 2547 1.1 1.0 Other Asian 1881 0.8 1.1 Black/Black British African 5354 2.3 1.7 Caribbean 666 0.3 0.7 Other Black 521 0.2 0.4 Other Arab 1425 0.6 0.6 Other ethnic group 1060 0.5 0.5
Salford has a higher representation of White British residents than the average for Greater Manchester. 16% of Salford residents are non-white British which amounts to 36, 488 The next most populous ethnic group is ‘White Other’ who form 4.4% of the total population, which is much higher than the regional average. There are far less Asian / Asian British residents residing in Salford when compared to other districts in Greater Manchester. African communities are well represented in Salford.
Page 21 of 37 Figure 10 : Salford Non White British Residents profile
Other, 2485
Black/Black British, 6541 White, 13417
Asian/Asian British, 9429 Mixed/multiple ethnic group, 4616
This chart illustrates each BME group in proportion to the overall BME population. The largest group are Non White British, followed by Asians/ Asian British.
The ethnic populations are mostly concentrated in the wards to the east of the city near the boundaries with Manchester, Salford and Bury. There are higher numbers of BME communities in certain neighbourhoods. The breakdown is as follows: o East Salford is more ethnically diverse than other areas of Salford, mainly the Broughton and Kersal Wards. Swinton and Pendleton also have a rich mix of diverse communities. o There is a substantial Yemeni community living in Eccles, centred on Liverpool Road. They are one of the oldest established Minority ethnic communities in the City. The older generation still tend to be Arabic speakers. o There is also a significant Somali community living in the Broughton area, making up approximately 300 households. This is a relatively new community with distinctive cultural heritage and needs requirements. o The Kurdish community in Salford which is spread across Eccles, Broughton, Pendleton and Little Hulton.
Comparative Findings Our service users are fairly reflective of the local population, apart from the Pakistani community who are more likely to use services and may reside in the Greater Manchester area. We see slightly more ‘White Other’ service users than the regional average which reflects the local population figures.
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Recommendations Develop staff projects to improve the recording of data. Work also required to review the impact of the changing demographics of Salford upon the delivery of services ensuring staff are made aware of cultural requirements and ensuring appropriate advice is given
5.4.1 Interpretation requests
Service User Data For the period July 2013 to June 2014, the top ten most requested languages are as follows:
Figure 11: SRFT top ten interpretation requests
Language % of total language interpretation requests Polish 19% Arabic 8% Mandarin 6% Urdu 5% Czech 5% Farsi 5% Spanish 5% Portugese 5% Cantonese 4% Hungarian 4%
Local Population Data
Figure 12 : Salford residents country of birth
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Figure 12 : Top Languages Spoken
86% of Salford residents were born in the UK 11% were born outside of the UK
Comparative Findings The top three most requested language interpretations were for the Polish, Arabic and Chinese languages, which also reflect the diversity of Salford. French is the third top language spoken in Salford but did not feature in the top ten for request by patients. Urdu is frequently requested which represents the profile of service users across the region originating from Pakistan and India.
Recommendations Review access to interpretation services including how to improve costs and value for money
5.4.2 Economic Migrants
An Economic Migrant is someone who makes a voluntary choice to leave their home country to seek work in the UK including all those who obtain work permits from the Government to fill labour shortages in the UK. Most migrants are fr om the European Union [EU] or Eastern Europe but they can be from other countries if they have the appropriate visa.
Local Population Data National and local data sources on international migration are limited as there is no comprehensive count of migrant.
Page 24 of 37 In 2009 National Insurance Numbers were issued to Salford-resident non-UK nationals from 65 countries including Poland, India, Nigeria, France and Czech Rep. Polish nationals represented the largest proportion of CEE migrants who were living in Salford, along with other nationalities including: Czech, Slovak, Slovenian, Romanian and Latvian. Consistent in-migration of notable numbers of the main nationalities include Chinese, Pakistani, Indian and Nigerians, coming to work in Salford. Local intelligence suggests CEE migrants primarily live in areas of East and Central Salford including Broughton, Lower Kersal, Seedley, Langworthy, Charlestown, Peel Green and Eccles.iii
Recommendations Ensure staff are made aware of cultural requirements and ensuring appropriate advice and support is given. Service reviews to ensure services are accessible
5.4.3 Asylum Seekers and Refugees
A refugee is a person who has a well-founded fear of persecution because of their race, religion, nationality, membership of a particular social group or political opinion, who is outside their country of nationality (or habitual residence if no nationality) and who is unable or unwilling to avail him / herself of the protection of that country. (United Nations Convention 1951)
An asylum seeker is a person who has claimed protection in a host country that is a signatory to the UN Convention and is awaiting a decision by the authorities of that country as to whether his or her case fits the above definition. Countr ies that have signed the UN Convention are obliged to provide support to people who are waiting for decisions on their asylum applications.
Local Population Data There are no accurate statistics available for the number of asylum seekers refugees residing in Salford. Nevertheless the diversity of languages is a good indicator. 61 different ethnicities were recorded for young people in Salford schools in 2010. Recommendations Ensure staff are made aware of cultural requirements and ensuring appropriate advice and support is given. Service reviews to ensure services are accessible
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5.4.3.Gypsies and Travellers and Travelling Showpeople
There are three broad groupings of Gypsies and Travellers in England: traditional English (Romany) Gypsies, traditional Irish Travellers, and New Travellers. There are smaller numbers of Welsh Gypsies and Scottish Travellers. ‘Gypsies and travellers are defined as ‘Persons of nomadic habit of life whatever their race or origin, including such persons who on grounds only of their own or their family’s or dependants’ educational or health needs or old age have ceased to travel temporarily or permanently, and all other persons with a cultural tradition of nomadism and/or caravan dwelling. iv Travelling Showpeople are ‘self-employed business people who travel the country holding fairs, chiefly during the summer months’. v
Local Population Data vi There is an estimated Gypsy and Traveller population in the city of 1,374 people There are an estimated 501 Gypsy and Traveller households in Salford.vii One half to two thirds of Gypsies and Travellers live in houses ‘bricks and mortar’ / settled housing. viii Recent figures state there are 118 Travelling Showpeople households in Salford. There is one main recognised local authority Gypsy and Irish Traveller site with 31 pitches on Regent Park, Duchy Road, Irwell Riverside Ward. The Adjacent private Fairway Site, Clarence Street (Lower Broughton) is occupied by Travelling showpeople as well as Brookdale Park site, Ravenscraig Road (Little Hulton). There are established extended family groups living in Broughton and a long-established Irish Traveller community in Little Hulton.
Recommendations Ensure staff are made aware of cultural requirements and ensuring appropriate advice and support is given. Service reviews to ensure services are accessible
Page 26 of 37 5.5 Religion and Belief service user and population profile
Service User Data
Figure 13 : Religion & Belief profile of SRFT service users
Jewish , Hindu, Sikh 2% (0.5%) (0.18%) Buddhist 4986 1404 649 0.18% Muslim 458 4% Other , 12038 (0.16%) 383 Unknown 11% 30774 Christianity 64% No Religion , 184102 19% 54595
Religion Number Percentage Christianity 99305 68.27% No Religion 29850 20.52% System Generated 1 0.00% Muslim 7261 4.99% Hindu 848 0.58% Buddhist 268 0.18% Sikh 257 0.18% Other 239 0.16% Unknown 8349 5.74% Jewish 2292 1.58%
64% of our Service users are Christian making up the majority religion. 16 denominations were recorded where patients had self classified themselves. 19 % of service users state they have no religion. Those self classifying as Agnostics and Humanists’ are also recorded within this category. 11% of patients data has not been recorded. Reasons may include patients not wish to disclose. The other religious category includes Spiritualists and Pagans in line with the guidance issued by the Office of National Statistics. Muslim patients are the third largest group to use our services, which is much higher for the local population and thus reflects the regional client base.
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Figure 14: Gaps in data collection by SRFT service type 25,000
19,357
20,000
15,000
10,000
7,262 No.oF Patients 5,000 4,155
0 Inpatient Outpatient Community
The data table above shows that the largest groups of service users for whom we have no recorded data available are those that access our community services. Further work is required to understand the reasons for this.
Local Population Data
The breakdown of Salford’s population in relation to faith is demonstrated in the table below.
Figure 15 : Percentage Of Population Broken Down By Faith (2011 Census)
Greater Salford Manchester Religion Number % of Total % of Total Christian 150,111 64.2 62 Buddhist 1,040 0.4 0 Hindu 1,504 0.6 1 Jewish 7,687 3.3 1 Muslim 6,030 2.6 9 Sikh 324 0.1 0 Other 691 0.3 0 No Religion 52,105 22.3 21 Religion not stated 14,441 6.2 6
Figure 16 : Chart showing religious makeup of Salford residents (2011 Census)
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Salford has a much larger Jewish population compared with the regional average. This has grown to become the second largest community of its kind in the UK and continues to expand.ix Mainly concentrated in Higher Broughton and Kersal areas of the city, there are over 7,500 Jewish residents living in Salford. Salford has the second largest Orthodox community in the UK. There are approximately 30 synagogues. Official figures show children outnumber adults in Higher Broughton, a Jewish district in the city There are far less Muslim residents in Salford than that compared to the region. There is also a substantial Muslim community living in Salford, concentrated predominantly in the Eccles area, and Broughton ward, followed by Ordsall and Langworthy, and Claremont and Weaste. Although there is only one mosque in the City, residents living in east Salford tend to use facilities in Cheetham Hill, Manchester, and Prestwich, Bury. Other religious and belief communities are dispersed across the city. 14,441 people did not state a religion. 687 people identified as a Jedi Knight and 73 people said they believe in Heavy Metal.
In Eccles there is an Islamic Society and Mosque. Higher Broughton has three mosques and there is also one on the University of Salford campus. There is a Sikh Temple located in Broughton, and another just beyond the Salford boundary in Cheetham Hill. The nearest Hindu temple is located in Whalley Range, a distance of approximately 3 miles from the nearest part of Salford. The nearest Buddhist centre is located in Manchester City Centre, which is relatively easy to access from most parts of Salford.x
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Comparative Findings Of all religions the Muslim community are much more likely to use our services, followed by Hindus and people with no religion. Jewish patients make good use of our services which is reflective of the local population numbers.
Recommendations Improve data collection Review the impact of these groups accessing our services to identify where improvements are needed
Page 30 of 37 5.6 Disability service user and population profile
The Equality Act 2010 generally defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day activities. Disabled people including physical and sensory impairments, learning difficulties, long term health condition such as, diabetes, heart disease, cancer, people experiencing mental and emotional distress and those with a learning difficulty such as dyslexia.
Service User Data Currently unavailable as we do not currently record this information on our data collection systems.
Local Population Data Figure 17 : Salford Census response to Disability questions
Salford Census Questions response Number of people with a limiting long term illness 48,417 Number of people of working age with a limiting long term illness 25,696 Not limited 185516
48,417 people in Salford have a limited long term health condition which amounts to 21% of the total population. This reflects the national data estimates of 1 in 5 people have a disability. Half of these are of working age (25696 ).xi In 2007 16,505 people of working age claimed Incapacity Benefit or Severe Disability Allowance – this represents 13% of the working age population. xii There is a high level of spending on Incapacity Benefit (IB) claimants (with £586 per resident spent each year compared to £406 on average nationally).xiii In 2007, 3966 (approximately 2% of the total population) people had a sensory impairment. The breakdown according to age categories is available in the table belowxiv
Figure 18 : Breakdown of Salford’s Population With Sensory Impairments
Age Hard Of Deaf With Deaf Partially Blind Deaf Total Hearing Speech Without Sighted Blind Speech No DOB 4 1 0 2 2 0 9 Under 18 9 0 7 35 27 2 80 18-64 182 18 141 189 260 22 82 65-100 839 5 51 829 700 151 2575 100 75 0 1 149 200 74 490 Total 1109 24 200 1195 1189 249 3966
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5.6.1 Deafnessxv
Nearly 15% of the population have some degree of deafness. That works out at around 1 person in 7. Census 2011 data indicates 68 BSL users in Salford alone. In 2013-2014, 393 BSL requests were made which will include one patient requesting support at each admission.
5.6.2. Learning Difficulties xvi
Figure 19 : LD conditions by type for Salford residents
Local Population Data There are approximately 4295 adults with Learning Difficulties in Salford. (1.8%).
Page 32 of 37 Majority (79%) have mild Learning Difficulties whilst 21% (896 people) have moderate / severe LD. Most of these people are registered with GPs and Salford City Council. Congenital Cerebral Palsy is the most prevalent condition type for those with moderate or severe LD. 3% of service users are Jewish and 3% are from other ethnicities including people identified as Irish, Chinese, Pakistani, Arabic, Caribbean, Black British, Indian and mixed. Evidence suggests that there is an increased prevalence of LD in the British Asian population. Age profile data suggests that currently there are proportionally more adults aged 18 – 34 years with severe LD than any other age grouping. In Salford, 11% of the adults, are 65 years or older. However, the number of adults with learning disabilities aged over 60 is predicted to increase by 36% between 2001 and 2021. 14% increase in numbers expected by 2021(4560 people).
Recommendations Continue to work with services across the Trust to improve the recording of this data where possible e.g surveys, patient’s experience data, PAS etc
5.6.3. Mental Health xvii
Around 36,500 adults (20% of people aged 16+) and 6,000 children (12% of people aged 0‐18) living in Salford might have some kind of mental wellbeing need. Over 3,500 were treated as inpatients in 2008/09 for mental and behavioural disorders, 1,500 related to psychoactive substance use Around 650 people were treated as inpatients for self hard in 2008/09;
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5.7 Sexual Orientation population profile
Sexual orientation is the term used to describe the biological sexual preferences of individuals.
Local Population Data 1.3% live with a partner of the same sex. It is estimated that the LGBT community make up 6% of the population in Greater Manchester, with a significant population living in central Salford. Nationally Lesbians, gay men and bisexual people make up 5 – 7% of the UK population. xviii It is estimated that 1 in 15 people living in Great Britain is homosexual or bisexual. xix The Blackfriars, Greengate and Trinity areas is home to a thriving LGBT population attracted to the city centre.
Recommendations Long term objective to work with IMT to upgrade PAS to include data monitoring of this protected groups & to be included in patient experience data (surveys etc)
5.8 Transgender population profile
Sex is the biological difference between men and women. Th e term gender refers to the differences between men and women that are social rather than biological. It is generally assumed that someone's gender follows on from his or her biological sex and leads to a set of expectations . The term transgender refers t o someone who considers that they do not identify with the gender that was assigned to them at birth.
Local Population Data Data reflecting the number of transgender people in the UK is extremely limited. About 1 in every 11,500 people in the world are transsexual (DoH). Although the actual numbers of transgender people residing in Salford is unknown, there are estimated to be around 900 transgender adults within the Greater Manchester region in 2009xx. The actual figure however is considered to be much higher as the above figure only includes those who are seeking, intend to and have physically undergone Gender reassignment surgery. It does not include those not seeking recognition e.g. cross- dressers.
Page 34 of 37 6. Recommendations
In conclusion, the Trust has a long history of support for and commitment to the equality and diversity agenda. The Equality Act 2010 and the Human Rights Act provide the basis or minimum standards of expectations for the staff and patients who access services. Over the last 12 months the Trust has made a number of improvements in the delivery of accessible services for all, most noticeably, the pilot for the ‘Meet, Greet & Support’ service. However, we are aware that we must continue to drive forward the quality and improvement of services from individuals from our diverse populations.
Through continuing to implement, develop and work to embedding the EDS2 and equality objectives, the Trust will strive to go beyond the minimum standards set by legislation and create an environment that is safe, fair, personal and free from bias and discrimination. The Trust will also be clear and transparent and report on the progress that has been made on an annual basis.
On analysis of the information, the following have been identified as key areas to be addressed:
Based on the information gathered over the last 12 months across the organisation (recording of data and feedback from staff), improve the processes and systems for recording equality data including; supporting staff training and confidence, working with IMT to upgrade systems to ensure we can record all groups, reduce the number of patients recorded as ‘not known’ and identifying any services which may require more immediate targeted support.
Continue to gather information from staff on the changing population of Salford and the impact this has on their ability to deliver safe, clean and personal care. In particular, working with services to identify how these can link to key health inequalities and improving access to services and outcomes for target groups.
Undertake a review of the pilot ‘Meet, Greet & Support’ service, identifying areas for improvement to support and improve the patient experience. Developing a pro-active service and identify ways to ensure individuals with communication support needs receive the same outcomes across outpatients than the general population.
Continue to develop the role of the Service Users Forum and Sensory Impairment Working group, including working with the QI team to improve their inclusion in the patient experience collaborative
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Based on the feedback from service users locally and nationally, develop the project plan for the ‘Model Ward’ programme, identifying current impact on patients with sensory loss.
Equality Analysis & Engagement Process for Service Transformations; the Trust has identified that, at present, it does not have a robust process to ensure that timely and robust equality analysis and engagement process are in place when undertaking reviews of services. The Inclusion & Equality subgroup will take a lead role in this recommendation.
Updated & review the Trust’s current equality objectives in light of the key recommendations form this paper to ensure that they are robust, effective and fit for purpose.
The Inclusion & Equality subgroup to undertake a review of the Trust’s current action plan in light of this paper and develop a final list of key recommendations and objectives.
The Trust will continue to make progress and work to improving accessibility and outcomes of both patient and staff experience for all individuals regardless of their background. We know that the Trust works hard to ensure that we deliver safe and personal care to all but it is well evidenced that outcomes of care are impacted upon by an individual’s association with a protected group.
It is the fundamental aim of the Inclusion and Equality team to support the Trust to continue to identify and reduce unequal health outcomes. We will continue to develop a department that empowers and educates staff to identify these issues, support them to develop systems and innovative ways to improve the health and patient/staff experience regardless of an individual’s background.
Page 36 of 37 7. References
i ONS – Census 2011 ii Index of Multiple Deprivation (IMD), 2007 iii Central and Eastern European migrant communities in Salford and Bury/ University of Salford/ 2010 iv Office of the Deputy Prime Minister Circular 01/2006 v Government Office Planning Circular 01/06 vi Salford City Council data reporting vii Salford Infrastructure Delivery Plan – February 2012 viii EHRC Research report No. 12, 2009, ix The Orthodox Jewish Community Housing Needs Assessment, Salford City Council et al 2008, p.5 x Salford Infrastructure Delivery Plan – February 2012, Places of Worship xi Salford City council ward profiles, 2001 Census, http://www.salford.gov.uk/d/eccles-8.pdf xii http://www.salford.gov.uk/pd-sensory-commissioning.htm xiii Greater Manchester Local Economic Assessment: Salford / November 2010/ AGMA xiv Salford Disability Forum, Communities of Identities – Baseline Demographics Report’ / Partners in Salford/ February 2008 xv Deaf Awareness week newsletter, May 2011, Hearfirst xvi A Health Needs Assessment (HNA) for Adults with Learning Disabilities in Salford / NHS Salford and Salford City Council / February 2011 xvii http://www.salford.gov.uk/d/Salford_MWB_HNA.pdf xviii Dept of Trade and Industry, 2003. xix National Audit Office, Delivering Public Services to a Diverse Society, 2004). xx Northwest Regional Development Agency, 2009, Equality Interventions - the Evidence Base for NWDA interventions into Equality target Groups in the Northwest
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