Equality Outcomes– Progress to date (Full) Long term NHS outcome: Within NHS Forth Valley, everyone has the best start in life and is able to live longer and healthier lives. Aligned to Strategic Priority: NHS Forth Valley Integrated Health Care Strategy – in line with the Scottish Government’s 20:20 vision EQUALITY OUTCOME 1: LGB &T, Disabled, ethnic minority and people of various ages have a positive experience of services that are equality informed and are sensitive to their diverse needs and potential impact of discrimination What we set out to do Progress to date Actions 2015-17 1.1 Improved staff awareness on equality We have completed a range of methods to improve Although training is issues, patient needs & improvement in staff awareness of all Equality and Diversity, dignity and evaluated at the time practice. respect training relevant to individual protected of the session a characteristics via e- learning/face to face training, system is currently Indicators discussion workshops etc. Using E&D e-learning saw a being developed Evaluation of training completed significant increase in take up. which will enable us 1:1 Personal development to contact participants sessions conducted on an annual Over 3000 staff have completed a range of equality to identify: basis with staff training over the past 2 years to enhance current service What they have Concerns raised from management provision to our diverse communities and are sensitive to achieved in team their personal needs. practice with the information gained The Patient Relations Team have had No during face to face Concerns/Complaints raised by service users in relation to training sessions discrimination. Identify any best All staff are appraised on Equality and Diversity practice, gaps or annually as part of their Knowledge and Skills Framework further training (KSF) Core Competency 6 personal development review. needs. What difference has been made to date?
Significant uptake of training. NHS Forth Valley staff are more confident and better informed on equality and diversity matters and can engage with service users to deliver care which is person centred. No significant concerns from managers about staff’s behaviours in relation to Equality and Diversity that required further input from the Equality Manager.
1.2 Campaigns delivered, service data NHSFV have developed inclusive & targeted preventative Continue discussions demonstrates increased uptake of healthcare messages for LGBT services including ’Why NHS with NHS Health screening i.e. Cervical testing of lesbian ask about sexual orientation’ and information on screening Scotland and NHS women and men’s health and well being services including smear testing. Forth Valley Health programme Promotion Team Indicators Although we can target women accessing NHS Forth Valley Feedback from , Forth Valley LGBTI generic services, much of the work is completed by the Continue to ensure Steering Group, local LGBTI Scottish Cervical Call/Recall System. smear testing is community groups or individuals if any At present the NHS Health Scotland Lesbian and Bisexual embedded in Health discrimination or difficulties in Smear testing information leaflet only has this information Promotion Materials accessing services is noted. contained within it and is not a core content of the letter itself. developed for (To date there have been no issues It is proposed that this will be added after the review. community settings. raised) What difference has been made to date? Conduct online Through talks with NHS Health Services Scotland they are questionnaire with currently reviewing current information in patient LGBT Youth Scotland notification/recall letters to identify if a statement can be during 2015/16 included about the importance of cervical smear for lesbian & bisexual women.
Men’s Health Programme is in place It may take several years before we are fully aware of the long term outcomes or benefits of this national and local approach. Indicators Provision of specific information for Lesbian and Bisexual Report available women will extend patient choice and awareness to have Updates for the Board on actions and procedure completed. outcomes (6 monthly basis). Staff will continue to work to raise the confidence and Uptake of service provision awareness of Lesbian & Bisexual women to have this procedure completed. The Men’s Health Programme is now an integral part of NHS Work progresses to Forth Valley Keep Well. understand the gender influences in The Keep Well health assessment has been developed to health amongst recognise gender influences in health. various cultural and Additions to the assessment which have a strong gender ethnic groups. element include: 1. Use of Diabetes risk score Some of this can also 2. Screening for Atrial Fibulation be obtained within the 3. Risk of blood born virus Keep Well project as identified in Outcome Men continue to present with more health needs; men 3d are much more likely to be identified as high risk of developing cardiovascular complications. The men’s health weight management programme continues to provide successful outcomes for men who attend. Following published research the programme has influenced both national and international programmes aimed at addressing men’s weight problems. Outreach with gypsy travellers in Clackmannanshire is providing useful transferable learning for other areas and a report will be provided to the Keep Well steering group in the autumn 2015. Specific work with a men’s health group re ‘men experiencing mental health problems’ was carried out in Stirling. All NHS FV Keep Well staff received training on gender influences on health. The focus of this training was on how gender affects the health of some of the specific ethnic groups and other health vulnerable groups that Keep Well engages with. What difference has been made to date? Equitable uptake between the genders has been maintained mainly due to the provision of gender specific evening clinics.
Opportunities to increase uptake with men have continued through partnership work with local authorities. The aim was to increase awareness on men’s health issues and encourage men to attend for one to one health assessment. This has been achieved. The result is that over 200 male council employees working within manual labour jobs have attended. A similar programme targeting female workers will commence in 2015. A weekly clinic has been established to work with homeless men. Further to staff training, attendees now have an enhanced knowledge of how gender effects specific ethnic groups and vulnerable groups the project engages with. This has been evident from the positive feedback from communities accessing this project. 1.3 Recorded data on LGB &T and other To date we have: From discussion protected characteristics to increase Processes in place to gather evidence and data about with local equality and protected characteristics; ensuring patient communities and Indicators confidentiality is secure. from the evidence Systems in place to allow information to Patient administration system is currently under local contained within our be pulled to inform practice. review. As part of this review Equality and Diversity data involvement collection will be considered. activities in relation N.B This is also a Scottish Ministers Completed training with Medical Records Team June ’13 to our equality key equality theme for 2013-17 (50 people). Guidance developed for supporting staff, letter outcomes it has developed to be sent to patients. demonstrated: Age, gender is routinely recorded however ethnicity field is peoples lack of still not fully completed. No action taken to date re Sexual understanding Orientation and Religion and Belief. about the Some improvements in recording of Ethnicity we still have benefits of the work to do to enhance current data collection regarding NHS knowing religion & belief and Sexual Orientation. the identity of Information produced in a range of languages to identify the diverse why we complete equality monitoring and just as communities that importantly equality profiling of people. This should access our encourage people to understand the benefits of disclosure services and the impact it can have on service development and more importantly person centred care. how we use this All community involvement events completed by Public information to Partnership Forum identify profile of the population inform our attending. This information has proved beneficial to identify EQIA’s and groups we may not be fully reaching out to and put actions service provision in place. Work ongoing to enhance data collection is in place to LGBT specific address this issue actions will be completed with Information Services Division Figures support and advice (Feb ’15) Figures re ethnicity data collection from local multi Percentage of discharge episode records (SMR01) with a valid ethnic agency LGBT group: Quarters ending April 2013 - September 2014 Steering group, Year Apr- Jul- April ’13 – Sept ‘14 LGBT Youth Jun13 Sep14 Scotland and All NHS Scotland 79.0% 81.9% 2.9% + Stonewall
NHS Forth Valley 69.6% 69.3% 0.3% - Stonewall Scotland Percentage of new outpatient appointment records (SMR00) with a has offered to valid ethnic group Quarters ending April 2013 - September 2014 provide support in Year Apr-Jun13 Jul- April ’13 – Sept ‘14 introducing Sexual Sep14 Orientation Data collection including All NHS Scotland 67.3% 73.9% 6.6% + information for NHS Forth Valley 56.5% 69.7% 13.2%+ service users and training for staff. a) Transgender Reassignment Protocol, Transgender Reassignment Protocol is in place. This has Evaluate Transgender Employee Protocol and also been supported with the development of a DRAFT impact of Transgender etiquette is in place Transgender Employee Protocol and Guidance. Transgender Staff (short document setting out guidance Protocol. Transgender Etiquette is in place; Assessed by Scottish to staff on delivering person centred Further Transgender Alliance as an example of best practice. care to transgender people) discussions and What difference has been made to date? feedback from Indicators Over the past 5 years people have been supported with their Local Transgender Protocol in place, guidance and transition process using existing Transgender Reassignment Group and FFA etiquette in place Protocol; figures low Lay Advisors Evaluate any concerns or Evaluate complaints during 3 year life span of No complaints of discrimination received by our Patients through publications Relations Team from Transgender community. One concern development of was raised via intranet questionnaire when reviewing tool to support progress on equality outcomes 2015. Although did not outcome 1.1 if highlight where or when this occurred or what form this awareness discrimination took place. training has made any changes in practice or staff confidence in working with Transgender people.
b) Age appropriate ‘Apps’ available for NHS Forth Valley web site has been adapted to enable it to be We will evaluate this public usage. used as an App. after one year to Indicators This has been informed by young people and evaluated as a identify if it has further Mobile phone resource in place based on positive action by them. This was reflected in the recent enhanced people’s feedback from service users report completed by Central Scotland Regional Equality awareness of access Council whilst reviewing our Equality Progress to date with to services and community members. information to the diverse communities. What difference has been made to date? NHS Forth Valley service information and health promotion materials are more accessible to people who use smart phones. Young people are satisfied that their comments have been listened too and actions put in place to ensure information is provided in their preferred format c) Information sheet available in a range Information sheet designed based on feedback from It is difficult to of alternative formats for download by local communities and Fair for All in place to support measure if there staff and the public in top 8 NHS Forth communities to make best use of current services available has been a Valley community languages informing thereby enhancing direct patient care and preventing reduction of communities how to access inappropriate use of services. inappropriate Pharmacies, GP’s, Minor Injuries and attendance at Emergency Department. Information translated into top 8 languages. Public clinics, A&E by Partners and 3rd sector agencies and community groups community groups have agreed to disseminate this information through or a greater update Indicators internal sources. Thereby, people within NHS Forth Valley of NHS24 services Systems in place will be able to understand which services can meet their due to patient Evaluation by communities needs and generic information on access. This will be of confidentiality of Information available on line. particular benefit to those people new to the country and need for who are unaware of the various types of NHS Service Copies disseminated to consultation. delivery. communities and partner agencies Arrange for leaflets to be left in A&E This will support work being completed on inappropriate use of and Minor Injury Emergency Department rather than Minor Injuries Unit. areas What difference has been made to date? Feedback from English as a Second Language attendees was that they were delighted with the "Know where to go" sheets. People are more confident in accessing services. Information may also support local communities including older people etc. Feedback on resource has been positive during Public Participation events. Long term NHS outcome 2: Within NHS Forth Valley everyone has a positive experience of health care. Aligned to Strategic Priority: NHS Forth Valley Integrated Health Care Strategy - in line with the Scottish Government’s 20:20 vision EQUALITY OUTCOME 2a: NHS Forth Valley promotes and delivers on patient centred care and will meet best practice standards in relation to Equality and Diversity. What we set out to do Progress to date Actions 2015-17 2.1a Existing mechanisms enhanced to measure the patient Ongoing review to be What we set out to do: experience to reflect complaints specifically relating to completed during Patients and carers can readily access protected characteristics and other support needs. 2015/17 services and report positive experiences Young Carers Indicators Difficulties identified by young carers when accessing NHS Patient feedback comments, Forth Valley Services (see Mainstreaming Report 5.9.1). concerns and complaints reports which capture feedback comments Training DVD for staff completed. Now available ion and concerns can generate data if YouTube and launched at Person Centred Care event. complaint is in relation to a Protected http://nhsforthvalley.com/media-item/young-carers-in-forth- Characteristics. valley/ Action taken as a result of feedback comments and complaints is NHS Forth Valley Young Carers card developed by reported annually young people to support access to services and Results of NHS Forth Valley information. inpatient experience Survey increase Results from Patient Opinion What difference has this made to date? - Training materials has had over 600 hits on You tube. Evaluation completed by Young Carer & Befriending Project identified: The introduction of the young carer’s authorisation card and the increase in staff training regarding the needs of young carers. This has enhanced young carer’s confidence when accessing health services and speaking with staff. It gives young carers a mechanism that identifies them as a young carer more readily, knowing that the staff member will immediately understand. It has allowed the young carers to have a better understanding of the cared for person’s condition and ask questions, which reduces frustration and anxiety.
NHS staff are more aware of young carers giving them reassurance that when they do approach a professional who is supporting their family member they will be listened to and treated as an equal partner in care. This work needs to be ongoing, with continued opportunities for input with staff and opportunities to working in partnership with Local Carer Centres. A Presentation with the dental staff in December 2014 highlighted this, as many of their services can support young carers, greater understanding of the project, to ensure a good understanding and awareness of clients needs. It is proposed that these actions through partnership working will minimise the likelihood of young carers having negative experiences within health. 2.2a Arrangements have been reviewed to encourage feedback We will enhance What we set out to do: comments, concerns & compliments so that patents have the current measures in Feedback comments, concerns and opportunity to improve service development and learning place to ensure that complaints from services users or others within the organisation. we can identify any which reflects where possible specific feedback, comments actions taken to enhance care for people FFA Development Group member highlighted that they felt with protected characteristics their BME community members still experienced concerns and discrimination in service delivery & employment. NHS Forth complaints, which are Valley offered to attend meetings with particular groups specifically relating to experiencing problems. No uptake of support. protected characteristics. FFA Members now on distribution list for all emails regarding Public Partnership Forums. Information to be cascaded to Work to be completed communities as well as open invitation to attend events etc with BME held to identify any changes to service provision or concerns. communities to Profile of population attending meetings completed. ensure they are Patients Rights - Piloting in 5 key areas the new Safeguard aware of how to raise System’ that will support staff to gather comments, concerns, concerns etc feedback, compliments and complaints. The pilot sites have been testing the electronic data collection system for 2 months, about to carry out an evaluation of the pilot; this has been carried out and will inform us of any changes that may require to be made. There is to be a meeting with the service leads to discuss the Patients Rights and the role out of safeguard across the organisation.
Equality and Diversity was mainstreamed into the above process. Research also being completed to identify national and local areas of good practice. 2.3a Review and develop arrangements for planning, monitoring Further to discussions What we set out to do: and evaluating patient/public engagement to improve with some young NHS Forth Valley involves consults and effectiveness including develop Young person’s forum based people it has been offers the opportunity to inform or monitor on evidence from 2013 involvement activities. identified that short our actions in an equitable way working groups Public Partnership Forum (PPF) meetings currently maybe beneficial for Indicators develop an equality report on the profile of people some topics. However Implementation of young person’s group. attending them. This information is used to inform NHS FV a virtual forum or of audience gaps etc. This information has been feedback method Action Plan to be developed by group highlighted as best practice by the local Scottish Health could be completed Council and will inform future actions. using social media. PFP Coordinator and PPF Elected Representatives, This is being along with Local Office, Scottish Health Council conducted considered for sessions within Braes High School September 2013 and 2015/17 several other schools during 2014 to identify access to NHS services and information. Work continues to be NHS Forth Valley www.nhsforthvalley.com/about- completed to ensure us/equality-and-diversity/protected- that our approach to characteristics/age/service users have a range of methods engagement reflects in which to give comments and raise concerns including the diversity of all our the use of Patient Opinion: communities www.nhsforthvalley.com/news/2014/forth-valley-patient- encouraged-to-give-feedback-online Due to the limited amount of BME communities attending local NHS involvement events a programme of meetings and news updates are regularly disseminated via the Fair for All Community representatives and Police Lay Advisory Groups to inform them about the any meetings or community changes/actions thereby ensuring that we give people the opportunity to discuss with service leads areas of importance to communities thereby ensuring people are not discriminated against, advance equality of opportunity and that we foster good relations.
The quarterly PPF Community Involvement events during 2013-15 E&D specific topics as well as ongoing issues and improvements within NHS both local and national including: Reshaping Care for Older people; Integration of health and social care; Update on hospital transport, Primary & secondary interface, What you can get from your GP and Hate Crime/Incidents. An update was also given during February 2015 on actions to date regarding NHS Forth Valley’s (HNSFV) Equality outcomes and mainstreaming report.
In total the breakdown of attendees April – June 2013 – January 2015 has identified the breakdown as follows
Number of forms issued at Events – 933 Number of forms returned completed – 629 Average Age = 73 Disability Is your activity limited: No = 361 Yes a lot = 83 Yes a little = 182 Prefer not to answer = 3
Conditions that limit activity: Long Term Illness = 240 Physical Disability = 106 Deaf = 48 Blind = 12 Mental Health = 121 Prefer not to answer = 102
Gender Female = 467 Male = 162
Race/Ethnicity Scottish = 463 English = 97 British = 10 African/Scottish African/British African/Welsh/Irish/Other = 59
Religion, Faith or Belief Church of Scotland = 412 Roman Catholic = 137 Other = 49 Sexual Orientation Heterosexual = 554 Prefer not to answer = 10 Other = 65
Results from the evaluation of figures identified that few BME Communities or people from LGBT Communities attended these meetings. Despite information being disseminated to numerous local groups the above reflects that there is limited involvement of people from BME Communities or younger people. This information was fed back to Fair for All Group, which has community representation on it. Actions will be taken over the next few months to enhance work with younger people and to encourage BME Communities to attend local meetings.
With The support of Fair for All Lay advisors and Central Scotland Regional Equality Council people are informed through a range of means about meetings being held as well as updates on actions and activities taking place. Therefore people who share a protected characteristic will be more directly involved in the planning and delivery of Forth Valley services.
What difference has been made to date? - Through our involvement activities and in the use of patient feedback we are more confident and better informed on Equality and Diversity matters and will continue to engage with partners and stakeholders to effect change and improvement. 2.4a Review completed on interpreting, translation and Ongoing review to be What we set out to do: communication support arrangements, for languages other completed during Improve Interpretation and Translation than English, implement development plan including 2015/17 services demonstrating best use of limited processes for booking appropriate interpreters and recording resources and improved patient of generic translated materials. experience All bookings for Interpretation and Translation are now Indicators coordinated via the Disability Service using a single NHS Enhanced use of Language Line, Forth Valley point of contact. The Disability Service, receive reduction in Patients Do Not Attends all calls and allocate the appointment to the appropriate (DNA’s) when interpreter Booked provider as per the Service Level Agreements, this situation Evaluation of service, consider will remain until tender process completed. provision in relation to financial spend. During 2014 a tendering process was undertaken with Review changes to local population assistance from procurement and financial services to provide and health service needs. interpretation and translation services for languages other than English (not including BSL etc). It is expected that the Evaluation report on current award of business will be completed by Spring 2015. interpreter usage Better hourly rate, financial savings Better reporting mechanisms Centralised day/OOH booking system Consistency of interpreters provided Data of community populations Increased training opportunities Increased community engagement opportunities Smoother invoicing processes Language Line usage where appropriate Telephone reminder service Translation materials to be shared Having a central booking process has enabled appointments to be discussed, time allocation considered and geographical layouts highlighted e.g. where an interpreter already in that area could pick up an appointment rather than allocating a second interpreter. This system is more financially efficient and effective in ensuring patient communication needs are delivered. We have provided staff and patients with the direct number reducing confusion and allowing support to be provided quickly. A design management system has been operational since Sept ’13, reviewed continuously and improved and adaptations made where appropriate. The system provides; All appointment details, live and stored data Demographic profiling Did not Attend (DNA) capture and action Financial spend and area breakdown Services being utilised Statistical reporting Two community engagement/involvement events were undertaken in partnership with the Central Scotland Regional Equality Council (CSREC) in 2013 followed by a further three events during 2014. Having contact with our community members we have a better understanding of their needs and expectations, we also had the opportunity to increase community knowledge of the impact of Did Not Attend (DNA) relating to their health. This also highlighted the financial implications to the wider organisation relating to the management of missed appointments. As part of NHS Forth Valleys Community Language redesign, a monthly DNA report produced and where appropriate patients who DNA are contacted. Some of the DNA's are results of patient not receiving letters in their own languages, financial difficulties getting from a – b, childcare and health difficulties. The initiation of the telephone reminder system has reduced the DNA numbers and assisted in the rescheduling process where appointments have been unsuitable. Often patients do not have the resources to call directly to cancel or amend appointments due to their limited English proficiency. What difference has this made to date? Findings to date: In June 2013 NHS Forth Valley had 300 patients utilising community language interpreters, in January 2015 we now have 1256 patients registered and using the service on a regular basis. Appointments have increased from 250 per month to in excess of 550 across the broad spectrum of health services. DNA’s from people using community language services: o 2013 – 2014 = 89 DNA’s captured o 2014 – January 2015 there were 73 captured o however there was an appointment rise of over 50% and an increase of nearly 1000 new service users NHS Forth Valley staff training “What is an Interpreter” commenced in May 2014 in partnership with CSREC and Forth Valley Language Services. Generic session held in Sep 2014. Working on a customised programme with speech and language services, provided increased knowledge of the need for clear roles and expectations prior to appointments progressing. The need for language to be child friendly, for flexibility of the appointment space, and consistency of interpreter provision to support patient journey. For each appointment allocated, there is now a pre discussion takes place between the interpreter and the Speech and Language therapist and this has been a positive outcome. Since centralisation, feedback has been positive – staff are more confident and better equipped to understand the booking process. They have increased options when contacting patients directly or via the booking process. The centralised booking system enables better client – Interpreter match, more flexibility with interpreters, as they can be co-ordinated to other appointments whilst on NHS sites. Increased usage of the interpretation service, more appointments booked and completed that the previous year. Financial accountability and governance in place with data available to each service manager regarding overall spend, demographics of patients including language, age, gender and area of habitat. Data collection increased to include contact details of patients; this enables appointment reminders to be undertaken and any cancellations to be given to the patient, in their native language, therefore decreasing inconvenience and avoiding confusion. Review of Telephone Interpreting Solutions (telephone Ongoing review to be interpretation) contract and information regarding how to completed during access to this service has been disseminated and actions 2015/17 informed by NHS FV staff has been completed. Annual review undertaken of current cost and usage across NHS Forth Valley. New contract agreed and a further reduction to rate will be initiated from January 2015, making calls 68p per minute. Work underway with specific services to better understand and utilise telephone interpreting. Highlighting the need to contact patients in their own language when allocating or cancelling appointments. Information provided and discussion had with those services that may be utilising calls inappropriately, for example, calls over 30 minutes would indicate that perhaps the need for “face to face” interpretation should have been considered. Telephone contact/reminder service will continue to reduce the number of DNA’s to services. Telephone Interpreting calls have increased significantly; all telephone reminders for languages other than Polish are made this way, (Polish Interpreter is booked for 1 hour to do those reminders- more timely and cost efficient) other departments have adopted this system as a way of reminding/changing appointments. We are able to evidence that this has reduced face to face, offering a more enhanced overall service provision.
What difference has been made to date? Although there is increased usage within the interpretation service, financial accountability measures, reduction in core costs to contractors, as part of the service level agreements implemented, have enabled this increase in usage to be addressed and managed. The evidence collected across 2013 and early 2014 has enabled the tender and procurement process to be completed, again reducing the financial cost per individual appointment and ensuring we meet service/patient needs. A central direct contact point for interpretation booking has created better relationships and understanding with wider services. Speaking with the same team has increased the staff confidence to ask questions or phone for advice regarding what provisions would be most suitable. The Current text reminder service for Deaf service users mhas already reduced the number of DNA’s across the organisation.
What difference has been made to date?
Continuing the text reminder system for all health appointments has reduced the number of DNA’s and enabled appointments to be rescheduled where appropriate Meetings arranged with particular patients who have shown regular non attendance to assist them to understand the health implications and also to explain the best use of our financial resources. Disability Service has also been able to share information, with the patients consent, to services on with the patient has not attended. This has resulted in some areas making an alternative site or different clinic day an option, therefore enabling the appointment to take place successfully.
What we set out to do In 2013 there was no central point for the collection of Ongoing review to be Translated materials in other translated materials. At that time the Disability Service has completed during languages/health which are related are created a database to hold details of what was available 2015/17 available across the organisation. As part of the tender, we will provide leaflets in translated Indicators forms in a more proactive way and hold a data base of the Range of materials available materials to reduce duplication. The work considered creating letters in native languages to investigate consistent “Do Not Attend” service users. After discussion it was agreed to utilise language line to contact the patient and review the reasons for non attendance. The finding supported the tender and procurement process and our Access and Capacity Team have a better understanding of the causes for failures in attendance. With the management system, all translation requests are logged on to it. Patient Identifiable requests are held separately to ensure data protection. General leaflets, letters and booklets are logged to ensure no duplication of work - should another request come in for the same work.
What difference has been made to date? This is beneficial regarding the translation of documents with the Disability Service holding a central list of documents/publications, which have been translated and in what specific language this will be available in. They also provide indicative cost for translation to services prior to any work being completed, discussing options, for example only having a specific section of the document translated or booking an interpreter and going over the leaflet with the client to ensure a better understanding than the printed information alone. Community Language materials are available but have been independently funded including ‘Know where to turn to when you are ill” This has made significant difference to people knowing where to and how to access services. Review arrangements regarding Although work continues to meet requests, there is no There continues to be no translated materials in other languages, central budget to produce generic materials which are not identified budget which are organisationally provided to directly linked to a particular service. provided for organisational communities. e.g. community briefs or In 2013/14 Disability Service met the financial cost for community leaflets, briefs newsletters translated generic materials, all other materials are etc. Disability Service charged back to the requesting service. Some areas has arranged for some choose not to have information translated due to cost or information to be copy write issues/delays. cascaded to communities by utilising community member links Action Review of current provision within Pharmacies Ongoing review to be Language Line available in Pharmacies to completed re access to telephone interpreters, translations completed during enhance direct patient support re minor etc. This work was incorporated with-in the Interpretation 2015/17 ailments, patients to take ownership for and Translation re-design. own care and reduce wait and attendance Letter, flow chart and language line pack sent to all at GPs pharmacies at the beginning of July 2014. Targeted work also completed in relation to the Commonwealth Games Indicator and the possible increase of visitors to the area utilising the % of pharmacies with Language Line in services of either face to face or telephone interpreting. place What difference has been made to date? Evaluate use of language line by Identified during our tender and procurement review, some pharmacy services pharmacies highlighted they did not have the facilities to accommodate calls in private or a telephone access in the public area. Discussion had also taken place regards dual handset telephones and the rental costs involved. Action Renewal or re-tender of BSL contract as current agreement Ongoing review to be Review interpretation, translation and was due to come to an end Feb 2015, however after completed during communication support arrangements for discussion and some service amendments provision of British 2015/17 hard of hearing, Deaf and Deafblind Sign Language, Lip Speaker, Deafblind Guide Communication people are currently provided as part of a and Notetaker will be extended and remain with the current contractual agreement leading from the contractor until December 2015. 2011 Tendering and Procurement exercise. We have completed: Audit of service provision completed December 2013 and November 2014. This included both service user and NHS staff feedback. Small focus groups were undertaken to support service review in December 2013 and again in 2014 alongside a BSL formatted questionnaire. The outcome from the 2014 audit informed the new tender and procurement process. What difference has been made to date? The audit information and changes to the local population have required some amendments to service provision, these have been made. Increased requirement for Deaf Blind Guide Communication services has been identified and will be considered during the 2015 Tender and Procurement process. As a central booking point where, patients can make direct appointments or have information / letters adapted quickly and efficiently. Action What we did This service will Reduce costs of patients Do Not Attends The current text reminder service for Deaf service users has continue to be further to interpreter being booked already reduced the number of DNA’s across the organisation. provided and monitored and details What difference has been made to date? provided to the Continuing the text reminder system for all health appropriate services appointments has reduced the number of DNA’s and enabled appointments to be rescheduled where appropriate. Meetings have been arranged with particular patients who have shown regular non attendance to assist them to understand the health implications and also to explain the best use of our financial resources. The Disability Service has also been able to share information, with the patient’s consent, to services on why the patient has not attended. This has resulted in some areas making an alternative site or different clinic day an option, therefore enabling the appointment to take place successfully. Review current Interpreter and translation New flow chart disseminated to services across NHS Forth Ongoing review to be flow charts for British Sign Language and Valley with guidance on how to access interpretation completed during community languages services, translation and accessible format documents. 2015/17 August 2013 (ongoing). Indicator Reminder of flow chart sent to Acute service leads January Report available of actions taken 2014. Enhanced confidence in staff in arranging Payslip message sent in May 2014 in regards Interpreter an interpreter and Translation – “How to work with Interpreter” training commenced “A Day in the life of an Interpreter article has been developed and is currently in draft format awaiting approval and publishing for staff news. Information on access to Interpreters is now included on A_Z internet directory. (May 2014) As part of the ongoing work regards the wider Interpretation and Translation provision (Minority Language), updated flow charts will be distributed as part of the 2015 tender outcomes. Staff informed at Induction training, e-learning, midwifery training, Healthcare assistant training: on how to access interpreter services. Information also available for all staff to download from intranet site. What difference has been made to date? The flow charts have been widely distributed across NHS Forth Valley and to our contracted services. All new services requesting interpretation for the first time are provided with the chart and other materials, pocket cards etc, to support the use of the service. The one point of contact has improved the booking process for staff, with confirmation of the booking provided during the call. Reduction in double booking, if contact by another staff member or administrator from that service; we can confirm appointment details are already entered. Staff more confident in accessing appropriate usage of Interpreter Services. 2.5a NHSFV Disability Service supported by e-Health and the Ongoing review to be Robust systems in place to identify Health Records Teams initiated the requirement of access completed during particular needs incl community language and communication needs being recorded on the front 2015/17 and sensory impairment prior to page of SCI referral process. appointment being sent out from NHS FV Where details are provided in the electronic GP referral both acute and primary care. (SCI gateway) specific “access and communication requirement” box Health Records staff record patients Indicators special needs in their system and support transfer of Reduce DNA’s of disabled people relevant data or BME Communities Health Records staff can request alternative formats Total DNA's for NHSFV currently at including documents and appointment letters as and when 7.5% required by contacting the Disability Service. Reports from TOPAS OP Appt Put in place agreed systems to send appointment details to Booking system (HEAT Target) patients in their preferred formats. DNA’s of people with a disability Text messaging currently being explored for BME currently 6% reduce to 2% by 2017 Communities as part of tendering process. Reduced numbers of DNA’s, increase to number of appointments What we did rescheduled rather than cancelled Training and information sharing meetings carried out across GP teams and at Practice Manager Meetings. These were successful in gaining the practice point of view and encouraging completion of the “Access and Communication” box. Ongoing communication with GP Practices. Incidences continue to occur in regards access information not captured in the box (at referral point) or if it is, then it is not easily transferrable / recorded in secondary care. Where information box is completed Disability Service are alerted by health/medical records then all necessary steps are taken to support the patient pathway. On occasions when a person prefers to use a family member rather than the provision of a guide communicator or interpreter. Work continues to identify the reasoning for this preference and support staff to manage in these situations; staff are advised to document the patient’s choice in the appropriate records and signed by the staff member. Disability Service receives email from Referral to Treatment Team with any Access or Communication requests. These requests are progressed as required e.g. interpreter booked, Braille documents provided, Deafblind Guide Communication. Ongoing difficulties establishing financial accountability i.e. communicating when the matter is related to interpreting only and not when perhaps it is related to social work or police. What difference has been made to date? The Disability Service continues to provide translated or alternative format letters when requested by Health Records Teams.
2.6a (changed from 2.5a) Having support in place to meet the specific needs of this Final report Spring What we set out to do: client group has helped to break down barriers, and led to 2015 will reflect Systems in place to ensure gypsy effective signposting and partnership working with wider outcomes achieved travellers are equally informed about NHS service providers. FV services What difference has this made to date? Indicator Report currently under development. Patient experience survey with gypsy travellers 2.7a Action: Despite considerable What we set out to do: Where appropriate identify patients Religion and Belief work by the Spiritual We support the right of individuals and (R&B) in patient’s records. Care Team the groups to hold religious and non-religious Support patients where possible to complete personal evaluation on equality beliefs without experiencing discrimination observance. progress report identified that some Spiritual Care Service available to all Unfortunately there has been no further development community members people who hold religious and non- regarding patient’s records. We are still waiting to hear if we were under the religious beliefs. are either going to be part of the national pilot or whether we impression that the are going to design our own and progress that way. There is Indicator Spiritual Care Centre to be a short life working group of clinical staff who will be Evaluate feedback, comments and was mainly for involved in a few work streams of documentation so this will concerns and report within Spiritual Care Christian Worship. definitely stay as a work in progress. Annual Report 2014 This information will What we did be used to inform Patient Reported Outcome measure for Support in place with a variety of dedicated staff and actions for 2015/17 Spiritual Care. honorary chaplains. Evaluation to be completed regarding patient profile to ensure appropriate recording is in place. This will support Person Centred Care (PCC). Evaluation completed as part of reviewing Equality Progress report 2015. Discussions ongoing to ensure that Religion and Belief and Spiritual Care is recorded incl. Prefer not to answer on 100% of patient’s notes. What difference did we make to date? Religion and Belief reflected within Care of the Deceased Policy March 2014 and identification of religion, belief/none identified within Mortuary Care to enable Mortuary Staff and Funeral Directors to be aware of people’s specific needs. Completed. Reviews will be completed on an Annual Basis via the Spiritual Care Committee (completed). Annual Report of activities and actions available on request from Spiritual Care Service. 2.8 a Actions Ongoing review to be What we set out to do: Engagement as identified within ‘what we set out to do’. completed during Forth Valley sexual health needs Deliver a one page leaflet (available in different languages 2015/17 assessment will look at describing the on request) on sexual health services which will include; local BME population’s needs. Access to specific sexual health services and the Engagement will then be targeted to local services provided by primary care and pharmacy. people of BME communities, to ensure Where to access BBV testing, condoms, contraception, accurate information on local sexual Information on the cervical screening program. health and Blood Borne Virus (BBV) Plans to attend 'English as a foreign language' classes service provision and its accessibility. to discuss use of services and following on from this will Gaps in service provision may also be develop the leaflet. identified. This will allow this target group to make What difference have we made to date? informed choice about their health, and Black and Minority Ethnic (BME) population - Work has been the delivery of patient centred care. undertaken raising awareness of sexual health and Hepatitis C within the local mosques in Forth Valley. A DVD has been This will help reduce barriers to access produced for Urdu speaking women which also aims to raise and prevent inappropriate access to other awareness of both sexual health and BBVs. services for example, the emergency department. Indicators Numbers attending sexual health clinic from BME communities – ethnicity monitored Service user feedback Community engagement evidence and feedback- Confidence in the service and the client’s ability to manage their health.
EQUALITY OUTCOME 2b: All healthcare developments, polices and plans are informed by information on profile/protected characteristics of patients in the community. What we set out to do Progress to date Actions 2015-17 2.1b Respective managers take responsibility for fields on protected Continued actions What we set out to do: characteristics being completed. require to be taken SMR returns are completed. to enable the What we did: organisation to Indicators See point 1.3 and mainstreaming report section 2.3 Service user identify the ethnicity Monitoring and Recording SMR returns increase by 10% each year of people accessing 2013 -17 Significant work completed re the breakdown of statistics our services EQIA’s are informed by data results per department thereby identifying gaps in recording. Meeting with General Managers on 14th March ’14, a review of data collection and usage to be completed during April ’14-October ’14 in 4 areas (report available Feb 15 from ISD) Information Services Division. Findings from above to be used to inform future work to evaluate all service areas re EQIA process with direct patient care. Discussions continue in relation to the information collected by staff on initial contact with patients, transfer of information through existing IT systems, difficulties in transfer of information between systems. An issue however remains to be the lack of information from GP’s when referring patients to NHS Forth Valley Acute services. Equality Impact Assessment tool has been updated with links to national and local data. This ensures that staff have to promote equalities, ensuring that people have equality of opportunities as well as reduce inequalities of health outcomes. 2.2b We have developed patient information leaflets in a range of Ongoing review to Evidence available on other protected languages to inform people about the benefits of identifying be completed during characteristics including disability, sexual their protected characteristics not only in service delivery but in 2015/17 orientation & religion and belief enhancing patient care. Develop effective processes to gather evidence and data Indicators about equality profile of people using NHSFV services Reports available idenifying breakdown thereby enhancing patient care. 2015-17 What difference have we made to date? Revision completed by Medical Records Team on current patient information leaflet. Revised publication stored on line in top 8 languages. The Disability Service updated the demographics in relation to communication (barrier) requirements. I.e. Language Interpreter, Deaf blind, Lip speaker etc. Once completed (Oct 2014) this information will be forwarded to medical records and we have agreement this information will be updated in to Topas. Greater understanding and figures of people currently using Community Language and BSL service usage. Framework completed by Practice Development Team regarding patient profile data collection should support this area of work. Information also being disseminated through a programme of presentations to lead staff about the importance of profiling and the benefits to patient care and service delivery. 2.3b Improve and review the performance of NHS Forth Valley Ongoing review to National and local evidence available committees and services in completing EQIA’s. be completed during within EQIA on-line tool to support staff to 2015/17 complete EQIA’s. What we have done to date Revised EQIA Screening document produced. Pilot in Indicators Women and Children’s Services with positive result. Made EQIA framework is developed, shared and available on-line in August 2013. adopted across Audit completed on E&D, which reflected need for staff NHSFV and annual reports are available on EQIA to enhance skills in completing EQIA’s and services to take completed responsibility for completing them. Staff offered support and advice on a needs led basis. Biannual Report on EQIA completed on E&D EQIA web page. All NHS Forth Valley Board reports to be evaluated to identify if Equality considerations have been taken. 2011 Census data available to support understanding of local/national protected characteristics demographic profile. DRAFT Health and Social Care EQIA Tool currently under development based on NHS Lothian Model. It is envisaged that this resource will be available as offspring 2015. To launch same a master-class training session will be held which will also include a practical exercise to commence this joint EQIA programme on existing pieces of work. Date to be arranged. What difference have we made to date? All polices are EQIA’d prior to final approval. All staff involved in the process are fully aware of how to undertake same. Biannual Board Equality Report completed and available on web page. All Board papers have Equality Assessment on same indicating position statement. Staff have the skills in place to complete an EQIA and have access to support re same.
What we set out to do: Census report developed and placed on public site. NHS Forth Ongoing review to Census data available for staff completing Valley specific report developed and placed on intranet site for be completed during EQIA’s staff to support EQIA’s etc. 2015/17
Indicator What we have done to date Action completed. Information in place demonstrating local and national breakdown. What difference have we made to date? 100% staffs are fully aware of how to access this publication via Link to Scottish Government data base the intranet site. This information will inform EQIA’s is being also in place completed, although specific service equalities data will still be used to inform actions. EQUALITY OUTCOME 2c NHS Forth Valley is equitable in the way it employs and supports its workforce. What we set out to do Progress to date Actions 2015-17 2.1c Work ongoing to: A programme of Recruitment What we set out to do: Review arrangements for people from Training for all managers is Impact assessments completed on scheduled on a quarterly basis protected characteristics to apply for vacancies during 2015. recruitment pathway and actions within NHSFV including staff bank. addressed. Develop targeted training on E&D for staff who sit on recruitment panels. eEEs has been delayed due to Recruitment panel staff have completed national pilot in 3 Board. This is Establish a programme to improve workforce due to finish in March 2015, and Equality and Diversity training either face monitoring across all protected characteristics. to face or online roll-out will commence thereafter. What we have done to date Indicators NHSFV Associate Director of HR- HR Policies EQIA’d and outcomes Governance/Operational Human Resources and % staff trained on panels Recruitment Manager have been involved in national % of disclose of staff increases programme of work to review the Recruitment following full implementation of E- Pathway in line with best practice. eESS system National standard operating procedures have been received and are being aligned with eESS system nationally. This work has also been aligned with the requirements of the EESS/IREC implementation. EESS/IREC development continues at national and local level. NHSFV is working to be in a state of readiness for its implementation during 2014. Recruitment training review will be undertaken when national systems are finalised and new eESS system in place. What difference have we made to date? 68% of respondents in the 2014 Staff Survey thought that NHS Forth Valley acts fairly and offers equality of opportunity with regard to career progression/promotion. This is an increase of 6% since the last staff survey.
What we set out to do: We have: This is complete and will be Statement published with verifiable staff Prepared and published an NHSFV equal pay reviewed during 2017. and partnership involvement. statement. Report to be made available on annual basis Report available which demonstrates any which evidences pay bands, job families as well as pay gap and gender imbalance occupational segregation.
Indicator Statement in place What we have done to date Statement and Report available. Narrow % pay gap and gender This is an annual requirement and is imbalance undertaken locally and submitted also to SGHD.
N.B This is also a Scottish Ministers What difference have we made to date? Key equality theme for 2013-17 Completed What we set out to do: With support from Stonewall and LGBT Youth Review this action in 2015/17 LGBT staff network/dates in place with Scotland facilitate and establish robust staff led further to implementation of partner organisations from police and fire network to inform HR policies and service delivery staff transgender policy and brigade. where appropriate. LGBT Training packages
Indicator What we have done to date ‘Blue Light LGBT Staff Network’ in System in place and advertising completed. place. Uptake poor. To be reviewed following national workforce survey. National survey results are Evaluate actions completed 2015 to being further analysed by the NHSFV Staff Survey enhance current staff awareness and Steering Group. These are also mapped with other support as well as improve access to staff experience outputs. services. The focus of the survey is on the 5 elements of Staff Governance, including being treated fairly and consistently, with dignity and respect, in an environment where diversity is valued. Issues in relation to LGBT have not been identified through the survey, but all opportunities will be taken to support the work of the Network in partnership with local stakeholders
What difference have we made to date? Although commitment to the establishment of a network was supported by NHSFV there was little uptake regarding same
NHS Forth Valley has been awarded its LGBT Youth Scotland Foundation Award
2.4c Action: Transgender Hate Incident What we set out to do: Revise and launch dignity at work policy with clear protocol will support ongoing Dignity at Work policy embedded within organisational values work in relation to ensuring organisation Develop information and training package to Dignity at Work is maintained. support implementation Indicator Staff aware of Dignity and Respect at What we have done to date work policy and have completed This policy was approved on 18 March 2014 and awareness sessions launched summer 2014. This was after extensive development, consultation and review. Partnership feedback from RCN is that this is an impressive piece of work. The focus is now on implementation which will include: Awareness raising through staff brief and other messages. Development of a manager’s toolkit. Refreshed staff training. Links with the launch of NHSFV’s Values across the organisation.
What difference have we made to date? During 2013 -15 7 cases have been supported by Dignity at Work Advisers.
2.5c Direct support delivered by Occupational Health and Work will continue during What we set out to do: HR services and via Management team 2015/16 to achieve the 4% NHS Forth Valley supports a culture of Analysis and monitoring of sickness absence Attendance standard. openness and support for mental ill health rates. and promotes positive mental health and Refresh and reinvigorate ‘See Me ‘, Scotland’s The Senior HR Group chaired wellbeing for staff and reduces the stigma national campaign to end the stigma and by the HR Director focuses on of mental ill health discrimination of mental health with a focus on close scrutiny of all reports LGBT issues. and case management. It Indicator Mental Health First Aid training available for has developed a 2014/15 Achieve the Healthy Working Lives staff in Learning and Development Training mid-year Attendance Award programme. Management Action Plan. Review impact of ‘stress awareness training’ What we have done to date These actions include the Evaluate impact on staff attending This support is readily available and the Employee Winter campaign for ‘Mental Health First Aid Training’ Psychology service is also provided for complex Attendance and Wellbeing; a cases. new Attendance Audit Monthly monitoring and analysis of sickness programme where the absence data in relation to stress, anxiety and management of short term depression is in place. absence will be prioritised; a new protocol for Case See Me: - Where we are now: Planning group Conferences and a refresh of meeting quarterly, aims and objectives of group the Early Return to Work agreed, Leadership of the group and reporting Process. The Action Plan will structure in place. Links made with the national see be monitored monthly through me...campaign and other local activity e.g. Healthy the HR Director’s group with Working Lives. Information about 'See Me'...and quarterly updates to the Area related issues now available on Risk Management Partnership Forum and Staff web pages. NHSFV induction programme now Governance Committee. includes references to the see me....anti-stigma campaign.
Positive and active involvement from Stonewall Scotland ‘No Bystanders’ campaign, which focuses on bullying and harassment experienced by equality groups. Its impact on responding to hate incidences and its effect on Health and Well-being. NHS Forth Valley are leading on this project as part of ‘see me’ and are actively involving partner agencies both from public bodies and the 3rd sector. Launched in October 2014. What difference have we made to date? There were 7 Bullying and Harassment cases in 2013 and 7 in 2014. Actions put in place to meet identified needs and concerns. Long term NHS outcome 3: Within NHS Forth Valley, people are able to live well in the community. Aligned to Strategic Priority: NHS Forth Valley Integrated Health Care Strategy - in line with the Scottish Government’s 20:20 vision as well as National Priorities in relation to Hate Crime and Gender Based Violence EQUALITY OUTCOME 3: a People in Forth Valley are confident that diversity is respected; discrimination challenged and actively encouraged to report hate incidents motivated by malice or ill will based on racism, religious bigotry, homophobia, transphobia and disability related discrimination What we set out to do Progress to date Actions 2015-17 3.1a We have: Ensure that outcomes are What we set out to do: Published hate incident awareness materials and positive, preventative and NHS Forth Valley staff and contractors information on how to report Hate Incidents in Central measurable helps to are knowledgeable and confident in Scotland to staff, contractors and to local achieve better results for reporting hate incidents. communities. staff and service users. Collate NHSFV and partner agency reports on a This will be identified within Evaluation of Multi Agency Hate quarterly basis further actions during 2015- Response Strategy (MAHRS) Strategy Work with local equality groups and systems in place 17 2010-13 (completed in 2013) for staff to encourage reporting of hate incidents Works in partnership with pubic and voluntary sector More robust processes to Indicators services to monitor and tackle hate incidents. be put in place to ensure Reports of hate incidents provided Develop social media strategy for NHS Forth Valley. incidences are recorded on an annual basis Annual Report from MAHRS and staff continue to be Quarterly Analysis of Hate supported re same. Incidents and Action Plan What we have done to date Revision of MAHRS Strategy by Established and maintained structures within NHS December 2013 Forth Valley and across partnerships to promote Evaluation of training completed as positive relations and effectively deal with well as identification of reporting of harassment and hate crimes incidents in NHSFV 2013-15. Draft Hate incident protocol developed. To be Evaluation of training delivered to approved schools Stop Hate in Central Scotland film available on NHS Forth Valley website, commended by the Equality and Human Rights Commission as good practice. Posters distributed widely throughout NHS FV and on TV's at FVRH. Promotional materials targeted at black history month October 2013 and LGBT history month event February 2014 Staff attending face-to-face NHSFV corporate induction programme are informed about hate incident reporting.
Summary of reported incidences supplied by Police Scotland (Forth Division) attached at end of section 3.1. These figures are given in relation to incidences reported. Some cover more than one aspect of protected characteristics. Hate incident awareness delivered to 3 public involvement sessions during 2013/14 in partnership with Police Scotland Evaluation of MAHRS Strategy undertaken by Quality Manager in 2013 on behalf of MAHRS Stop Hate Group to ensure fit for purpose. Board approved new Social Media Policies for Business and Personal use in 2013. 100% staff were informed about system in place What difference have we made to date? 100% of staff attending face-to-face NHSFV corporate induction programme are informed about hate incident reporting. Hate incident protocol developed ensuring that NHSFV staff are empowered victims of hate crime/incidents The quality of training has ensured that staff are confident about care pathways in place to respond to any hate incident All staff are more confident and are aware of the accountability and responsibility within services to offer adequate support to victims of hate crime/incidents as identified by employees or service users Through the delivery of Equality & Diversity and hate incident training over 1000 secondary school pupils and 120 staff are more confident in and better informed on Equality and Diversity matters and can engage with their peers and school support to effect change and improvement to their health and well being. Further to involvement with young people, NHS Forth Valley developed a mobile phone resource with Police Scotland in relation to reporting hate incidences NHS Forth Valley staff are more confident in accessing pathways, mechanisms, including policies, procedures and contacts for reporting discrimination and harassment Long term outcomes are that “Individuals and communities who are affected by, and victims of, hate crime feel safe and secure” Reported incidences in Forth Valley for 2013 = 437 (9) Reported incidences in Forth Valley for 2014 = 438 (14) NHS Forth Valley figures in brackets Outcome 3 b. In collaboration with partner agencies, NHS Forth Valley will improve the early identification of women and men experiencing Gender Based Violence (GBV) within local health services; particular focus on A&E, Mental Health, Substance Abuse, Community Care, Sexual Health and Women and Children’s Services What we set out to do Progress to date Actions 2015-17 3.1b What we set out to do: Action: Ongoing review to be NHS FV GBV Steering Group to develop Continue to implement action plan developed from completed during 2015/17 as a 4-year GBV action plan. Chief Executive Letter (CEL-41) on GBV for 2013 -17; part of NHS Forth Valley GBV with a focus on; Community Health Visiting, Action Plan Indicators Emergency Department, Mental Health Services, Evaluation of reported incidents of Substance Misuse Service, Sexual Health, Women Data collection systems to be GBV annually from 2013 – 17 and Children Services review during 2015. Annual report available. Systems in place to address needs What we have done to date Enhance work completed with E-learning package in place. Uptake of 3500 cases reported to the Police Scotland Dental Practices to support training 2013-14 to form baseline Forth Division in 2013 -14. NHSFV GBV Strategy early identification and 50 % staff who completed routine currently not in place, although an action plan has support to people accessing enquiry training have completed been developed these services. refresher training Train the Trainers Course on Gender Based By March 2016 (Changed from 2014) Violence Work completed with partners in Local Enhanced awareness and Action Plan in place to inform progress Authority to identify common goals. direct referral system within Monitoring reports available on GBV Training in place either face to face or GP Practices to women’s aid biannual basis to evaluate online. is currently under discussion effectiveness of service and identify Dedicated support completed during festive breakdown of users to inform future period with A&E staff: Women's Aid Falkirk based Key action direction of work in Forth Valley area. from 7pm – 2am from 25th Dec - 4th Jan to NHS input into Multi Agency support cases of GBV: 2 cases identified during Risk Assessment this period. Police identified during similar period Conferences to be that 151 cases of Domestic Abuse were reported. progressed Approx 16.5% included physical Assault. Further 3 year action plan submitted to Director of Public Health for approval. Patient Pathway available within Services areas Increased data collection within key areas Female Genital Mutilation (FGM) protocol in place within Women and Children’s Services Specific information has been designed to support staff confidence in responding to abuse
Patient specific information has been developed to increase their awareness of identifying abuse as well as support available. This has also included specific materials for people with a learning disability designed in partnership with them.
What differences have we made to date? Progress has been made towards the reduction in violence against women by 2017 through a strategic and co-ordinated approach by agencies and women’s organisations.
Staff are more confident in completing routine enquiry and have clear pathways to refer patients where appropriate. What we set out to do: Continuation of GBV Routine enquiry within NHSFV Ongoing review to be Service monitoring data demonstrates completed during 2015/17 as implementation What we have done to date part of NHS Forth Valley GBV Routine enquiry is completed within maternity Action Plan services. There were 3251 deliveries in Forth Valley during 2014.
o 49 referrals to the Pre-birth Planning Service with current or historical abuse as one of the reasons for low level vulnerability, requiring additional support.
o 39 Midwife referrals to Social Work with current or historical abuse as one of the reasons for requesting Child Protection assessment
o 76 calls from Police Domestic Abuse Unit to update incidents where female involved has identified as being pregnant Direct referral can be made via secure email address from A&E to Women’s Aid, discussions ongoing about opening this up to GP’s and Dental staff
Mental Health and Substance Abuse staff have developed Functional Analysis of the Care Environment (FACE) clinical care and data recording system to incorporate GBV Routine enquiry questions as well as CAADA Dash Risk Assessment. CADDA DASH stands for Co-ordinated Action Against Domestic Abuse (CADDA) Domestic Abuse, Stalking and Honour Based Violence (DASH)
Sexual Health Team 102 attended where last sex was reported as non- consensual 140 others reported previous sexual assault: 50 in previous year; 90 more than 1 year ago Of the 242 above, 25%were men (33% of these were men having sex with men) Community Nursing: MiDiS System for Health Visitors etc has now started to develop reports re GBV recording. Sept 2012 – Feb 2014 there were 83 cases identified. This reporting methodology will be structured during 2014/15.
Emergency Department: No update regarding recording What we set out to do: Action: Ongoing review to be E-learning package in place for staff to NHSFV GBV Steering Group to identify key completed during 2015/17 as complete regarding Gender Based areas to target in relation to completing e-learning part of NHS Forth Valley GBV Violence. package. Action Plan Further develop refresher training for staff as Refresher training on GBV in place. identified within CEL 41 (2008) in relation to GBV. Programme of GBV Training to be developed following meeting with trainers in September 2014. What we have done to date Package completed and launched along with trafficking e-learning resource. From Sept ‘14. Figures to be collated on a 6 monthly basis of people completing it. 100% of staff on learn pro have access to it.
Training delivered in Partnership with Women’s Aid to Child Smile Team in June 2013. Approx 20 staff attended. Range of GBV training to be developed 2014/15. This has initially started with refresher training for midwifery staff completed on a monthly basis. GBV Awareness is included within Child Protection Training. Monthly training started Jan '14 for Maternity staff. Health Visitors have been receiving updates within existing training. Training for trainers course commencing June 2014 with members of local Women’s Aid attending the training with a view to delivering NHS package during 2014/15.
What differences have we made to date? 160 staff completed e-learning GBV package Jan 2014 – March 2015. 12 staff completed GBV Training for trainer’s course June 2014. Trainers included third sector providers. Positive evaluation from training completed.
All staff attending the Women & Children’s Clinical Unit; Continual Professional Development Midwives Study Day are more confident in completing routine enquiry and have resources to undertake same Evidence has shown that staff are more confident in identifying and responding to Gender Based Violence and are aware of where to get additional support internally and externally. What we set out to do: Action: Ongoing review to be Deliver on actions identified by NHS Use information from National Steering Group completed during 2015/17 as Health Scotland GBV Steering Group. to inform NHSFV GBV Action Plan. part of NHS Forth Valley GBV Launch and publicise Drop in facility at FVRH. Action Plan and Violence Drop in facility for GBV available on a Against Women Strategy (no monthly basis at Forth Valley Royal What we have done to date indicators published as yet Hospital Women’s Aid to evaluate amount NHSFV Group notified of national priorities. from national programme) of usage incl age, disability, gender, Drop in facility available at NHSFV but low sexual orientation and ethnicity of service uptake, so postponed. To be reviewed again users. Summer 2015. Drop in facility now also being offered at Slamannan Health Centre. Posters disseminated to all GP's and Pharmacies within NHS Forth Valley during 16 days of action.
What differences have we made to date? All staff that support people experiencing abuse are informed on national and local priorities.
What we set out to do: In partnership with Public Bodies and local voluntary Infrastructure in place to provide effective groups review current information available and advice and support at the point of contact patient pathways within NHS Forth Valley in relation to with front line staff GBV.
What we have done to date Patient pathways in place at A&E, Women and Children Services, Substance Misuse and Health Visiting only. Currently under development within Mental Health Services. Guidance on local contacts and support redeveloped November 2014 with partner agencies and is available on line. Discussions regarding direct notification to GP’s (with patients permission) following an incident happening involving the police. Infrastructure and support required under discussion. ON HOLD
What difference have we made to date? Detailed care pathways have been developed to provide advice and support at point of contact. What we set out to do: We require to further develop joint working Ongoing review to be Multi Agency Risk Assessment arrangement with partner organisations to establish completed during 2015/17 as Conference to be established to support MARAC system within Forth Valley/Fife. part of NHS Forth Valley GBV high risk GBV cases within NHSFV. Action Plan What we have done to date Indicators Report developed reflecting infrastructure MARAC reports available 2014 + with required to deliver MARAC within exiting NHS summary of actions taken and outcomes. priorities. MARAC system in place within the Forth Valley area as from August 2013. NHS Forth Valley as yet does not attend these meetings. To be discussed further in April 2014 with Director of Public Health who is the Executive Lead for GBV in NHSFV (completed).
What difference have we made to date? This has not been achieved during proposed timescales; currently under review. Discussions are ongoing regarding NHS Forth Valley Infrastructure required to inform this process. Equality Outcome 3 c NHSFV Employees (women and men) affected by GBV, including those with protected characteristics, are confident that they will receive support in the workplace and improved safety, health and well-being.
What we set out to do Progress to date Actions 2015-17 3.1c Action: Continue to monitor impact of What we set out to do: Establish and implement NHSFV GBV staff Policy policy and supportive actions. NHS Forth Valley Gender Based Violence Face to face and e-learning training available Staff Policy in place What we have done to date Managers are trained on implementation Policy implemented and is now available for all of policy staff to either inform them of their practice or as a support tool for people experiencing GBV Communication Strategy in place to inform staff about implementation of GBV National GBV Managers training being Policy and resources re support and developed. NHS Forth Valley GBV operational advice Leads on this working group to inform development and content. Resource should be Indicators available later this year. Date to be confirmed. Evaluate uptake of policy % of staff completing training. What difference have we made to date? Identify gaps in services not Through a range of methods of communication all completing training. staff are aware of GBV policy and are confident in how Evidence that task has been to access same. All staff can gain access and support completed from Hr, Occupational Health and GBV Manager. This has been achieved on several occasions. Reasonable adjustments in place to support people continue to work safely; this has been implemented including review of workplace, email address change and access to staff counselling. As staff counselling is confidential we can only identify how many people have accessed same – information is divided between work and non work related. In the non work related it then cites personal problem – so we have no way of knowing what this is about and could not say for certain what it pertains to. All staff have equity of access to counselling services if requested, or can self refer.
Outcome 3d Through’ Keep Well’ health promotion project NHS Forth Valley in partnership with other agencies will increase opportunities for health improvement and disease prevention in deprived and vulnerable populations What we set out to do Progress to date Actions 2015-17 What we set out to do: Actions: Deliver an on-going implementation plan, Project review to be Delivery of a programme of activity, the and consider how to mainstream longer term. completed 2015 main output being the delivery of person- centred, holistic, health assessments of at What we have done to date least 45 minutes in duration, with follow Annual Report April 2014 available. Summary up aimed at bringing about change which indicates that: will reduce risk and improve people’s lives The Keep well Forth Valley programme currently in general. delivers about 3000 health assessments per year. (Equivalent to 2.3% of the population aged 40-65). This is targeted at people experiencing 85% of those undergoing a health assessment are deprivation, and/ or being defined as experiencing deprivation. within a vulnerable group (experiencing The health assessment is greatly appreciated by homelessness, having substance use the clients. It invariably identifies opportunity for issues, being within a minority ethnic improvement, and often leads to health gains in a group, being in contact with the criminal variety of ways. This can be described as ‘co- justice system, being a carer etc.). production through a human therapeutic encounter’. In addition Keep well is and will continue The focus is deprivation and vulnerable groups as to be delivered with consideration of per the guidance for the programme nationally, gender sensitive health improvement to enhanced by a local focus on men’s health and meet the differential needs of men and employability. women and employability needs. The programme in Forth Valley has been developed to build capacity and enhance reach The service also has a focus on through core CHP service planning supported by employability (rather than delivered through) GP practices. There is continued commitment to Keep Well Forth Indicators Valley from NHS Forth Valley as a key component The Keep well database records all of primary anticipatory care work. Ring fenced information relevant to the above, and funding should be maintained to enable ongoing provides a means for measurement capacity building and extend reach. against objectives and outcomes We have introduced a 3 month follow up this year, which indicates significant behaviour change associated with goal setting.
Key themes emerging from this report are - ethos and approach, complexity (recognising and accommodating it), empathy and compassion, innovation and application of a new, unique approach, the importance of giving time; and underpinning it all an approach based on values and principles.
Progress identified September 2014 Programme remains on target over the past six months for numbers of assessments and anticipated outcomes based on last year’s annual report. Specific work targeting lower paid workers has been commenced Further developments have resulted in regular provision of service within the villages of Fallin, Plean and Westquarter - areas recognised as experiencing deprivation. A weekly clinic is now established within Falkirk’s mental health association resource centre and the Salvation Army soup kitchen. Keep Well has started providing a health drop in service for the travelling community in Clackmannanshire. Programme is building its reach and partnership capacity through specific task groups of single outcome delivery plans a) Stirling through the tackling poverty and inequalities group. b) Clackmannanshire is being explored through the new adult subgroup and Falkirk will be informed from learning in Stirling and Clackmannanshire. Reach and capacity is being built through core NHS services and a report has been completed with recommendations for joint work with community dieticians, learning disabilities and OT's working in integrated mental health services. Recommendations will be prioritised and included in the steering group action plan. What difference have we made by March 2015? Summary of Outcomes achieved to date: Keep well has been successful in identifying people at high risk of developing cardiovascular disease (1 in 10 people having an ASSIGN score of 20 or above). Significant health gains are reported by those who attend, including earlier detection of disease, e.g. our data show that on 3 month follow up of 660 people 123 people with high blood pressure were identified, 43 with Chronic Heart Disease and 18 with diabetes (plus smaller numbers of other conditions including: Chronic Obstructive Pulmonary Disease, depression, breast lumps including cancer, lupus, fibromyalgia, thyroid disease, diverticulitis, chronic pain, gastro- intestinal conditions, Irritable Bowel Syndrome ,hernia etc.) Health behaviour changes were also identified in the 660 people followed up at a 3 month review. This included 24 who had quit smoking, 28 who had reduced their alcohol intake, 26 reported an increase in their mental wellbeing, 121 had lost weight and 2 that had been helped to gain employment. Although it is difficult to quantify the health gain to our population precisely, Keep well does seem to represent a significant intervention. In addition this early identification and management represents a more cost-effective use of resources (though again difficult to quantify). If Keep well were not in place, the longer term costs to the NHS would be considerably greater. At a community level Keep well contributes significantly to capacity building for health improvement in regeneration areas and with vulnerable groups by a joined up agency approach e.g. walks, fruit barrow, galas, other community events, drop-ins, smoke free homes, resource development, volunteering, access to information i.e. welfare reform. Health is jointly managed (clients/patients are supported by services that are better integrated and co-ordinated). Joint ownership of the health inequalities agenda can be demonstrated. Individuals can access person centred services that meet their needs. Increasing numbers of care service staff are providing holistic person centred care. Sustained behaviour change is being evidenced. Increased participation in employability activity.