Group Equality Analysis Report

Name of Group: Wellbeing and Community Services – adult services

Date of Analysis: January 2016

Officers Involved:

Geoff Matthews Policy Officer Irene Fisher, Policy Officer Keith Thompson, Rights Team Manager Contents

2 PART 1 – Overview of the Key Functions and Services

This Group is responsible for adult social care services for the whole of the county. This equality analysis focuses particularly on the impacts on service delivery for the public and builds on our analyses completed in 2011/12, 2012/13, 2013/14 and 2014/15. A separate equality analysis is available on council employment equality issues.

Adult Services has an overall gross budget of around £127.6 million for 2015/16

All the services provided by this Group have a direct impact on equality for the people that use them.

Adult Social care

Social care aims to remove or reduce the barriers experienced by disabled people and to enable them to live a life as close as possible to that of the community as a whole. Its services therefore – by definition – are directly relevant to the disability protected characteristic of the equality legislation.

However, the analysis below shows that for many individuals the legislation has a multiple impact. To address our statutory obligations we must therefore deliver services in a way that integrates the equality issues for more than one “characteristic” of the legislation. In particular, the analysis below shows that many disabled people are older people (covered by the age protected group), and substantially more than half are women (the gender protected group). The impact of our services on disabled people, older people and on women is therefore particularly important.

Table 1 Key Equality Groups

Key equality impacts Primary impact Other key impact

Adult social care Disability Age, gender

1.1 Adult Social Care Functions and Services

"Social care" support for ill or disabled adults in Northumberland is operated by Northumbria Healthcare NHS Foundation Trust under its partnership with the County Council. (Support for working age adults with mental health problems is operated by the Northumberland Tyne and Wear NHS Foundation Trust, under a separate partnership).

The key functions and services of Adult Social Care Services that are likely to be relevant to equality are outlined in Table 2 below:

3 Table 2 Key Functions & Services likely to be relevant to Equality: Social Care

Function/Service Description

Crisis Support  For people who urgently need help after a health crisis or a serious accident. Focuses on: ensuring that immediate needs are met; recovery; & independence Self Directed Support  For people with longer term support needs putting them in charge of their own support arrangements through a personal budget Short Term Support  Multi-disciplinary team working with adults who have Service become ill or disabled, or just out of hospital, to help them regain their independence, skills & confidence Equipment  A wide range of equipment can be provided to help with long term illnesses or disability Adaptations  Support to people to receive adaptations to their home to help them live freely and independently. Home care  Care managers can arrange help at home for people who need personal care

Day care  Care managers can help arrange participation in a variety of daytime support including traditional day care services or individual services with enabler help Care homes  Care managers can arrange residential placements for people who need a high level of support to a high standard Short break care  Care managers can arrange short breaks of various kinds for people who need them, to give their carers a break Housing support  Contract with a range of organisations to provide housing related support to people who need help to remain living at home Support for Carers  Carers may provide emotional, physical or practical help. Support is available to help carers in this role Shared Lives  Offers short term care to adults who are unable to live on Northumberland their own (without a full time carer) and the people who care for them Protection of  Care managers can advise and help if a vulnerable adult vulnerable adults may be being abused in some way. A specialist safeguarding adults team is in place Occupational therapy  Occupational therapists support people to regain their independence through advice, arranging equipment or adaptations to people’s homes Employment/ training  Support to access employment, education and training opportunities. A Supported Employment and Education Service is in place. Person Centred  A way of working with people to help them plan out the Planning way they want to live their lives and achieve their goals Direct payments  People who need social care services can choose to be paid the cost of the services and make their own arrangements Out of hours  The Emergency Duty Team is available at all times when offices are closed 4 Function/Service Description

Charging  There are charges for services which are processed within adult social care

Commissioning &  Establishing services in response to customer needs and contracting monitoring quality

PART 2 – Information Analysis

Whilst this analysis considers specific groups sharing each of the Equality Act 2010 protected characteristics in turn, it also acknowledges that people have multiple aspects to their identity and equality impacts are likely to span across different groups.

2.1 Disability

Disabled people face a range of barriers in accessing services including: physical and environmental barriers (such as poor access to buildings); communication barriers (such as poor access to BSL interpreting, accessible information, loop systems etc.); social inclusion barriers (such as poor access to public transport and community facilities); and attitudinal barriers. Disabled people have long recognised that equality will only be achieved if the focus is on the barriers that disabled people face in society, rather than on disabled people’s impairments.

This concept of a ‘social model of disability’ and the related framework of ‘independent living’, developed by disabled people, are now accepted as key principles by government and in the personalisation agenda in social care.

2.1.1 What do we know?

The estimated proportion of people aged 16-64 in Northumberland who were disabled (based on the Equality Act definition) from Oct 11 – Sep 12 was 11.7%. The figure for England was the same although the North East was lower at 14.1% for the same period. For those people who were classed as both work-limiting disabled and disabled, Northumberland and England had similar figures of around 20.4%, but the North East region had a far higher proportion (24.0%).

Table 4 Disability amongst people aged 16-64 (Oct 2011-Sept 2012)

(based on the Equality Act definition) Northumberlan North England d East % disabled 11.7 14.1 11.7 % work-limiting disabled 3.8 4.2 3.6 % both work-limiting disabled and disabled 20.5 24.0 20.4 5 Source: ONS Neighbourhood Statistics Local Authority profiles

Adult Social Care

According to our client information system SWIFT (December 2015), there are currently 7,763 people accessing adult social care services in Northumberland. All of these people will have some form of disability, illness or long term condition. Clients are broken down into the following teams: Physical Disability, Learning Disability and Mental Health as shown in Figure 3:

Figure 3 Profile of Clients by Team Type

Learning Disability 18%

Physical Disability 47%

Mental Health 35%

Source: Swift Dec15

Uptake of some of the key different types of services or support people arranged through care management is shown in Table 5:

Table 5 Proportion of Clients Accessing Key Services or Support

Service/Support No. of Clients % of Total Residential / Nursing Care 2262 35 Home Care Services 2513 39 Day Care Services 910 14 Receiving Direct Payment 711 11 Source: Swift, costed services, Dec 2015 – some clients receive more than one service

From the JSNA (2012), in Northumberland, we estimate that around 500 adults aged 16- 60 may have severe to profound deafness, and 12,000 may have mild to moderate deafness. The proportion of people with hearing loss rises gradually with age throughout adulthood, increasing rapidly over the age of 50. Over 1,500 people in Northumberland 6 are registered as severely sight impaired, blind, sight impaired or partially sighted. Our Joint Strategic Needs Assessment provides more valuable information about the health and social care needs of the population in Northumberland.

Regular and ongoing mechanisms for gathering people’s experiences of using care management and care services are in place and feedback is generally very positive. A survey of social care clients conducted in 2014/15 found that overall 94% were satisfied with the care and support services they receive, 78% said they found accessing information and advice about care and support either ‘Very’ or ‘Fairly’ easy, and 61% said that the support they receive and the way they are treated makes them ‘feel better about themselves’. . Figure 4 gives a breakdown of overall satisfaction by primary client group:

Figure 4 Client Satisfaction with Care and Support Services broken down by Primary Client Group

A survey of clients using our in-house services was conducted in 2013 demonstrating a high level of satisfaction with the care and support provided. 232 people completed a questionnaire. 97% said that the staff were friendly and polite and 90% said that they felt the staff treated them with respect. 93% said that if they were not happy with an aspect of the service they would feel able to tell someone about this to get it put right.

A review of the complaints, comments and compliments indicates that the highest number of complaints were from adults with a physical disability or illness, although so were the highest number of compliments. Key themes from the complaints related to: disagreements over eligibility for services and around charges; missed home care visits; delays in receiving equipment, services or information; and staff attitude. Key themes from the compliments received related to: the impact of services on quality of life; the approach and dedication of staff; and the level of support received.

In Northumberland 11% (35,700) of residents were giving care in 2011, the same percentage as in 2001 (11%, 33,600). The North East (11%, 286,400) had the same percentage of residents giving care as in Northumberland, while in England 1% fewer gave unpaid care (10%, 5,430,000). In 2011 almost two fifths (38%, 13,400) of residents in Northumberland provided 20 or more hours of unpaid care per week which is an increase of 5% on 2001 (33%, 10,900).

2.1.2 What are the key impacts on disabled people?

 Self-directed Support and Direct Payments in social care mean disabled people have more choice and control over the services and support they receive to help maximise their independence. It also shifts the perception of them from ‘service users’ to that of

7 ‘consumers’ giving them a greater profile, presence and power in public life and their communities.  Resource Allocation System in social care improves transparency and aims to ensure that the levels of support allocated are consistent and rigorously based on need. For some disabled people this may lead to more innovative ways of meeting their critical needs providing them with more choice and control.  Specific changes in service provision in social care will impact on some groups of disabled people more than others (e.g. changes to in-house day services will have a disproportionate impact on people with a learning disability as they are the greatest users of these services) and so this needs to be taken into consideration, and the equality impact assessed, as any future changes are made.

2.1.3 What have we got in place?

 Direct Payments and Support Planning in social care to help disabled people have more choice and control over their lives.  Multi-disciplinary Hospital to Home teams plan the return home for people with more complex care needs in a more timely fashion.  Support Planners signpost people to support and activities which are available in the local community.  The Short Term Support Service - established to help ill and disabled people regain their independence and facilitate improved discharge from hospital.  Mechanisms to involve disabled people in quality assurance and service planning and development (e.g. User Forums, representation on strategic groups, the Single Equalities Forum, Mystery Shopping).  Training for staff on issues around disability equality.  Systems to provide appropriate BSL interpreting and information in other formats such as Braille and easy read.  Monitoring arrangements to check disabled people’s satisfaction with our services.  Safeguarding arrangements to protect vulnerable people at risk of harm or harassment.  Commissioning and contract monitoring arrangements to check quality in independent sector provision of care services.  Performance management processes in place to monitor quality against key local and national indicators.  Support for carers of ill and disabled people, working in partnership with the likes of Carers Northumberland.  The Health and Wellbeing Board to improve opportunities for ill and disabled people.  Social care and health information points (SCHIPS) and Single Point of Access (SPA) exist to provide advice, information and support for ill and disabled people and carers.  With Bernicia and the Learning Disability team we have ensured a commitment to improved housing for clients with learning disabilities through facilitation of the design and development of 10 new bungalows, the re-provision of existing accommodation, and the development of a sheltered housing scheme in Bedlington.  Learning Disability Partnership Board restructured the involvement mechanism to support greater involvement of people in their local areas through a network of forums. Provided a programme of training for people with learning disabilities on being a representative and leadership skills. 8  The Home Improvement Service provides assistance including disabled adaptations, a handy person service and the fitting of tele-care equipment.  Applicants with housing need that are related to their disability are recognised and additional priority is awarded.

2.1.4 What else do we need to do?

 Continue to engage with different groups of disabled people to ensure they continue to be involved in planning and developing services that meet their needs.  Continue to evaluate the impact of the Short Term Support Service, JELS and In- house services to ensure they are being provided in the right way and are delivering positive health and social care outcomes.  Further develop our approach to prevention, especially the contribution of our Ageing well in Northumberland campaign; a wider role of Support Planners; and integrating extra care housing into the community.

2.2 Sex

Sex equality means to be treated the same as others in society regardless of being a man or woman, and to have the same opportunities. This means, the same access to services and to job opportunities at the same rate of pay (relative to experience and qualifications), to work within polices and guidelines which do not discriminate because a person is a carer or parent, man or women; and the same opportunities to develop careers and still have a family/home life.

Adult Social Care:

There are a higher proportion of women accessing social care services in Northumberland than men. This is due mainly to the fact that the life expectancy of women is higher than that of men, although there is evidence that the gap is now narrowing. Figure 5 illustrates the gender profile of clients:

Figure 5 Gender Profile of People Accessing Social Care Services

Male 41%

Female 59%

Source: SWIFT, Dec 2015

9 A significant majority of the population of older people, and in particular frail older people, are women, as women tend to live longer than men. (According to recent mid-year population estimates from the Office for National Statistics, 45% of people over 65 in Northumberland are men: 55% women.) Life expectancy is 9.7 years lower for men and 6.2 years lower for women in the most deprived areas of Northumberland than in the least deprived areas (Source: Northumberland Health Profile, 2014).

From the last survey of social care clients in 2014/15, levels of satisfaction with care and support services do not appear to differ greatly between men and women as shown in Figure 6:

Figure 6 Satisfaction with Care and Support broken down by Gender

2.2.2 What are the key impacts on men and women?

 Having a choice of gender of professional to provide personal care may sometimes be difficult to accommodate given that the vast majority of social care staff are females. This may therefore have a particular impact on men accessing social care services. Also, clients may also prefer a particular gender of staff member to provide support and advice, particularly in situations where gender is a central issue, such as homelessness as a result of domestic violence.  It is important to acknowledge that services may need to be provided differently to men and to women in order to achieve the same outcomes (e.g. may have different ‘motivators’ in reablement).  There are some types of gender related disabilities/long term conditions e.g. breast cancer, prostrate cancer, and also a greater prevalence of some conditions amongst men or women (e.g. more women than men are diagnosed with MS).  In Northumberland there are estimated to be around 35,000 carers providing unpaid caring support (Census, 2011). Overall, women are more likely to be carers although there is evidence that as age increases, a higher proportion of older men become carers. Older men may find it particularly challenging if they have previously taken on more ‘traditional roles’ within the relationship and home and may therefore need extra support to continue to provide care.

 Statistically, women are still likely to have fewer financial resources than men. The overall impact of this is that means tested charges for services (particularly significant in adult care) will generally have a greater impact on men than on women.  Women are more likely to be victims of domestic violence.

 Older women - who may have caring and other family responsibilities, or who may be coming to terms with other life-changing events – appear to be deterred from taking their own health issues seriously

10 2.2.3 What have we got in place?

 Processes to accommodate choice in the gender of worker wherever possible both for in-house and commissioned services.  Activity planning in day services that takes account of gender related preferences and needs.  Provision of gender specific equipment as appropriate (e.g. urinal equipment, specialist watches that come in a range of sizes etc.).  Dedicated domestic violence service for women, but also floating support for male victims of domestic violence.  Access to health information targeted specifically at conditions impacting on men or on women (e.g. cervical screening, prostate cancer etc.).  Commissioning and contract monitoring arrangements to ensure that services are providing a range of gender appropriate activities within residential and day services.

 Continue to monitor satisfaction rates with different services between men and women.  We need to continue to monitor the gender profile of people accessing different services, within social care. Given that a high proportion of staff are female, there is a need to monitor whether male service users are having problems with personal care because of the lack of choice of a same-sex support worker, with the possibility if problems do emerge that we would need to consider using ‘Positive Action’ to recruit more male staff.  Evaluate the take up of referral to health services from wellbeing checks, with specific reference to gender differences.

2.3 Race

According to CSCI (2008), the key to achieving appropriate social care services for black and minority ethnic people is personalised support that addresses the needs of the individual, rather than adapting services based on generalisations about cultural requirements. Services need to take a systematic approach to removing barriers that may prevent black and minority ethnic (BME) people receiving appropriate support. These barriers include organisational processes or assumptions and the behaviour of individual staff, which may amount to either intentional or unwitting discrimination.

According to a recent report ‘Living in the Margins’ produced by the Afiya Trust in 2012 suggests that, nationally, the cuts in adult social care are having a disproportionate impact on BME groups with many councils failing to undertake proper equality impact assessments relating to race when making funding decisions. However, in Northumberland, robust mechanisms are in place to ensure that race is fully considered alongside each of the other protected characteristics in making such decisions.

11 Adult Social Care:

Most of the people accessing adult social care are classed as ‘White’ which is consistent with the ethnic profile of the county’s population as a whole although there is a slightly higher proportion than in the overall Northumberland population. This is shown in Table 8:

Table 8 Ethnic Profile of People Accessing Adult Social Care Services

Ethnic Group No. of % of % in N’land (headline categories taken from the Clients Total Population 2011 census) (Dec 2015) (census 2011)

White 7,574 97.6 98.4

Asian / Asian British 18 0.24 0.8

Black / African / Caribbean / Black British 5 0.06 0.1

Mixed / multiple ethnic groups 10 0.13 0.5

Any other Ethnic Group 12 0.15 0.1

Gypsies and travellers form a minority ethnic group in Northumberland and for the first time were identified separately in the 2011 Census which indicated that there were 156 people from this group living in the County.

The Equality and Human Rights Commission published research in 20091 which found extensive inequalities experienced by the Gypsy and Traveller communities and identified specific challenges that social care services need to address in order to ensure that the needs of this group are fully met.

Six in ten Northumberland residents who live in a diverse community (62%) agree that people of different background get on well in the local area which is higher than the council’s consortium average (58%). (Northumberland Place Survey 2012).

2.3.2 What are the key impacts on people from different racial groups?

 Through the introduction of Self Directed Support and Personal Budgets, the opportunity to put in place more “personalised” forms of social care support for Black and Minority Ethnic disabled people may mean they have greater access to more culturally appropriate support where relevant.  However, it should also be acknowledged that given the race profile of Northumberland, there is likely to be a shortage of culturally appropriate services and workers available locally.

1 EHRC (2009) Inequalities experienced by Gypsy and Traveller communities: A review. 12  There may be a need to arrange access to an interpreter or to have information translated into other languages in order to enable BME clients make informed choices about services and support.  There may be a need for increased flexibility of service times and tasks to help BME clients maintain contact with their communities and meet their cultural/religious needs.

 Particularly in the delivery of home and residential care, there may be some cultural issues to take account of in relation to dietary needs or the delivery of personal care or end of life care.  Certain ethnic groups, particularly Gypsies and Travellers, face prejudice in the community. In addition, because of their itinerant lifestyles, Gypsies and Travellers’ ability to access services can be limited.

 Mechanisms are in place to provide interpreters and to get information translated into other languages.  Staff training which covers race equality.  Leaflets about rights to an interpreter and how to make a complaint in a range of different languages.  A DVD has been produced for the GRT community to support their ability to access services  Diversity of images used in public documents to reflect different racial groups.  Specific strategy and working group in place for improving services and support for Gypsies and Travellers, and a liaison officer.  Links with regional BME groups who can act as a source of advice and support to improve community cohesion, and race relations.  The Voluntary and Community Sector Assembly to help us engage better with different groups of people from across the range of protected characteristics.

 We need to continue to monitor the racial profile of people accessing social care services and support. If there is a significant changes in the numbers of BME clients, we may need to consider using ‘Positive Action’ to recruit greater numbers of BME staff to help us provide more culturally appropriate services.  We need to continue providing awareness training to staff around race equality and some of the specific considerations in relation to social care, health and housing.  Continue to identify ways to further engage with the BME communities to inform service development ensure services are fully inclusive and accessible.  Consider specific consultation with Gypsy and Travellers as their transient lifestyle may make it difficult to consult them on allocation policy and service issues.  Develop options for Gypsy and Travellers to ensure that they have a safe place to stay.

13 2.4 Sexual Orientation

Research has shown that lesbian, gay and bisexual (LGB) people experience prejudice and discrimination both in relation to employment and as users of health and social care services, resulting in poorer outcomes in key areas including mental health, substance misuse, screening and housing.

A recent survey conducted by Stonewall (2011) into LGB people in later life found that nearly half of their respondents would not feel comfortable about being out to care home staff, and a third would not feel comfortable about being out to a housing provider.

Significant numbers of disabled LGB people also reported they have not accessed the social care, mental health or health services in the last year that they felt they needed.

Adult Social Care:

Our current approach to collecting information on sexual orientation is through anonymous user surveys, rather than administratively on SWIFT. However, care managers are expected, during assessments, to explore and address issues around sexual orientation as appropriate. Government actuaries estimate that 6% of the population is lesbian, gay or bisexual which would equate to around 458 clients. Feedback from a survey of LGB people (2011) conducted jointly by the Council and Northumbria Healthcare NHS Foundation Trust indicated that more attention needs to be focused on:

 Ensuring policies and public information are inclusive of LGB people using appropriate language and images.  Ensuring staff treat all people with respect and dignity and have a clear understanding of the specific health and social care needs of LGB people through better training.  Strengthening engagement with LGB groups and communities.

In a survey undertaken by CSCI (2008), 45% of LGB people using social care services said they had faced discrimination whilst using services. A local study from NCDN in 2012 in Northumberland suggested that some LGB people still do not feel comfortable being open about their sexual orientation in different settings including health settings.

2.4.2 What are the key impacts on people with different sexual orientations?

 Like all other clients, LGB clients need support to live the lives that they choose; with choice about their social life, leisure activities and relationships. For many people, this means support to have contact with other LGB people. Therefore, this needs to be something that LGB clients feel comfortable about exploring in assessment and supporting planning, and it is essential that members of staff respond positively when a client ‘comes out’ about their sexuality to enable them to discuss how this may impact on their choices around services and support.

14  Often assumptions made by staff can make it difficult for LGB people to talk openly about their sexuality. Assumptions such as: there are not likely to be any LGB people using the service; that disabled people or older people are unlikely to have any issues around sexuality; and that the needs of LGB people are no different to heterosexual people can all have an impact.  LGB people are more likely to be single, live alone, less likely to have children and less likely to be in touch with their family. Therefore, they are much less likely to have a carer to support them through illness or disability. Reduced carer support needs to be taken account of in assessment and support planning.  It is possible that same sex couples may face prejudice in finding care home placements and social housing, and therefore it is important to monitor that the same policies that apply to heterosexual couples wanting to live together in care homes or social housing are applied to same sex couples.  There is a greater prevalence of homelessness and substance misuse amongst LGB people, therefore this needs to be taken account of in service planning and development.

 Personal budgets and individual support plans allowing greater flexibility to choose support that can take account of sexual orientation diversity.  Process in place to review key policies to ensure they are inclusive of LGB people in relation to use of language and rights.  An LGBT Champion and LGBT Staff Network to act as a source of advice, support and raise awareness about issues that LGBT people face when accessing health and social care services.  Staff training that includes LGB equality.  Mechanisms to engage with the LGB community and links to local LGB groups including the Voluntary and Community Sector assembly and regular active participation in the PRIDE event.  Stonewall Diversity Champions status allowing us greater access to information and support.  Our older people’s network group considered issues for LGBT people – including care in retirement homes and the involvement of ”families of choice”, extended “families” within the gay community

 Continue to ensure that staff are aware of the specific health, social care and housing needs of LGB people and address it appropriately in assessments and the development of support plans.  Continue to engage with LGB people to ensure social care and housing services are inclusive and accessible.  Through commissioning and contracting, monitor that independent services are inclusive of LGB people.

15 2.5 Age

Age equality is concerned with responding to differences between people that are linked to age, and with avoiding preventable inequalities between people of different age groups. Ageism, the attitudes of others, and the assumptions they make, can have a dramatic effect on people – on their quality of life, access to services and choices, employment, and other opportunities.

Research has indicated that the majority of people aged over 65 think that health and social care staff do not always treat older people with dignity.

Adult Social Care:

The need for social care support increases with age and therefore there is a higher proportion of older people accessing adult social care services as shown in Table 10:

Table 10 Age Profile of Adult Social Care Clients

Age Range No. of Clients % of Total

Under 18 6 0.1 18-24 years 365 4.7 25-44 years 945 12.2 45-54 years 709 9.1 55-64 years 801 10.3 65-74 years 1026 13.2 75-84 years 1731 22.3 85+ years 2180 28.1 Source: SWIFT, Dec 2015

From the last survey of social care clients in 2014/15, levels of satisfaction with care and support services do not appear to differ greatly between different age groups as shown in Figure 7, over.

Figure 7 Satisfaction with Care and Support broken down by Age Groups

2.5.2 What are the key impacts on people of different ages?

 Moving from children’s services into adult services (transitions) can be a significant change for young disabled people and have a big impact on their lives. Similarly some opportunities and availability of support changes when someone moves from being a

16 ‘working age adult’ to ‘an older person’. There are similar key life transitions affecting people’s housing needs.  Interests, the type of activities people may want to engage in, and the type of support and the way it is delivered may differ depending on the age of the person and so services need to take account of this and provide age appropriate services.  Many disabilities and long term conditions are age dependent.  Older people are more likely to live in poverty and poor housing, and are often more vulnerable to certain types of abuse.  As the proportion of home owners amongst older people increases, the problems of repair and maintenance will also become more significant.

 Self-directed support and Direct Payments provide the opportunity to put in place more “personalised” forms of social care support for people of different ages.  We have a Supported Employment and Education Service (SEEds) which provides support for working age adults to gain work experience & employment opportunities.  The age criteria for the Short Term Support Services has been extended from ‘over 65’ to ‘18 and over’ to enable adults of all ages to access the service.  A transitions protocol is in place to support an effective move from children’s to adult services.  Safeguarding arrangements to protect vulnerable people of any age.  Young carers support.  The Ageing Well Northumberland initiative.  Dementia walks, Blooming Well events offer alternatives to people with dementia and their carers.  A Young People’s Participation Network Involving young people with additional needs, such as young carers, teenage partners, and young people who identify as LGBT.  Intergenerational projects.

 Need to continue to monitor the take up of key welfare benefits for older people.  Continue to modernise day services to ensure they provide support that better meets individual needs.  The Ageing Well in Northumberland Programme has funded research into older people’s priorities and aspirations for meeting their housing needs in the future. The results will be used to inform emerging housing and support strategies and policy within the Council and Northumbria Healthcare Foundation Trust.  Develop Lifetime Neighbourhoods which offer a range of appropriate services in the same area, as indicated in the draft Core Strategy- the council’s statutory planning document.  Ageing Well involvement forums will offer a rolling programme of topics likely to help people to live well with dementia, focusing on people talking in a practical and non- threatening way about the impact of dementia on everyday life.

17 2.6 Religion or Belief

Religious and cultural views on the beginning of life can influence attitudes towards a range of social care and health issues. Views on dying, death and the afterlife can also influence attitudes e.g. towards pain relief, coping strategies for people with a disability or illness and for terminally ill people. The degree to which we respect Religion or Belief reflects the organisation’s commitment to delivering patient centred care and how well it responds to our local communities.

Adult Social Care:

The Religion or Belief of 63% of clients is currently recorded on SWIFT, a breakdown is given in Table 12, although there appears to be an under representation of people who have no religious beliefs in these figures:

Table 12 Religion/Belief Profile of Adult Social Care Clients

No. of Clients % of Religion/Belief (where Religion recorded) Total Church of England 2874 58.4% None 586 11.9% Christian 436 8.9% Roman Catholic 401 8.2% Methodist 283 5.8% Church of Scotland 53 1.1% United Reformed 50 1.0% Presbyterian 44 0.9% Jehovah's Witness 33 0.7% Atheist 27 0.5% Protestant 24 0.5% Salvation Army 17 0.3% Agnostic 15 0.3% Baptist 11 0.2% Anglican 10 0.2% Spiritualism 10 0.2% Jewish 7 0.1% Muslim 6 0.1% Buddhist 5 0.1% Church of Jesus Christ of Latter-Day Saints (Mormon) 5 0.1% Evangelist 4 0.1% Hindhu 3 0.1% Humanist 3 0.1% Sikh 3 0.1% Orthodox 2 0.04% Quaker 2 0.04% 18 Baha'i 1 0.02% Church of Ireland 1 0.02% NonConformist 1 0.02% Pagan 1 0.02% Plymouth Brethren 1 0.02% Unitarian 1 0.02% Source: SWIFT, Dec, 2015

2.6.2 What are the key impacts on people with different religions/beliefs?

 People with different religions or beliefs may have specific needs around food preparation (e.g. Muslims and Halal food, and Jews and Kosher food) – this may impact on home care, day care and residential care services.  Enabling people to continue to practice their religion or beliefs should be considered in support planning and use of personal budgets.  People with certain religions or beliefs may have particular views and requirements around death and dying. Therefore services (such as residential care) need to take these into account in providing and arranging care for terminally ill people, for example, and their families.  May be certain religious festivals or key religious events that services and staff need to acknowledge and respond to (e.g. Christmas, Eid etc.) and some people may need support to enable them to take part and get involved.  For people with certain religions, specific days/times of day, are considered to be sacred, therefore services may need to take account of the opening time of services to ensure they do not conflict with any religious requirements.  People with certain religions or beliefs may need to prayer at specific times during the day, therefore consideration may need to be given to providing a quiet space to enable this to happen (e.g. in day services, at consultation events etc. ).

 Personal budgets which allow greater flexibility for people to continue with the things that are important to them, including support to continue practising their religion.  Training for staff which includes religion or belief equality.  Direct Payments and support to employ care workers directly, supporting a more fallible and individualised approach.  Promote different cultures and religions – staff newsletters etc.  Links with local groups and networks supporting diversity within communities including religious diversity, humanist organisations and membership of the North East Regional Faith Network  Improved links with key religious groups in Northumberland.

 Need to improve the recording of religion or belief. 19  Increase awareness of different religions and beliefs amongst staff and better promote religious festivals and events.  Ensure religion or belief are taken account of in commissioned services.

2.7 Transgender

Commissioners and providers of health and social services face challenges in caring for the trans community. The growth in the number of people, of all ages, who are seeking medical treatment for profound and persistent gender dysphoria is likely to place an increasing strain on both health and social services for trans people in the UK.

Adult Social Care:

We do not currently record on SWIFT if someone is transgender.

2.7.2 What are the key impacts on transpeople?

 Some transgender people may have specific personal care needs and handle these sensitively; for example, trans women who have transitioned later in life may still need to shave regularly. Trans people who need assistance going to the toilet or bathing require support from workers who understand that their body may not match their gender identity.

 Confidentiality around someone’s transgender status is important. Whether someone wishes other people to know about their status may change over time, particularly if the person is in transition.

 Gender Reassignment can have major implications for mental health, with trans people more likely to experience depression and attempt suicide.

 Training for staff which includes trans equality.  An LGBT Champion and LGBT Staff Network that act as a source of advice and guidance for staff and service users.  A Young People’s Participation Network project has targeted young people who have additional needs, including young people who identify as LGBT. 

 Further engagement with all groups to ensure services are accessible and fair.  Continue to work in partnership with Northumbria Healthcare NHS Trust to raise awareness and reduce health and social care inequalities.

20  The Young People’s Participation Network will improve the way that services are branded, advertised and delivered to engage better with young people including those who identify as LGBT,  to engage effectively with young people

2.8 Pregnancy and Maternity

A woman is protected against discrimination on the grounds of pregnancy and maternity during the period of her pregnancy and any statutory maternity leave to which she is entitled. In the non-work context, protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.

Adult Social Care:

The Government’s policy position is that the main difficulty facing disabled parents and carers stems from the lack of suitable support for their needs, rather than from their disability or caring responsibilities (the social model of disability).

The government has therefore made it clear that help with parenting for disabled adults is an essential task for adult social services teams, and that children should not automatically be seen as in need of help just because they have a disabled parent or carer.

An increasing number of adults with learning difficulties are becoming parents. In about 50% of cases their children are removed from them, usually as a result of concerns for their well-being and/or an absence of appropriate support, but research also suggests that closer working between different agencies could help prevent this.

A local study of LGBT people in Northumberland (NCDN, 2012) suggested that same sex couples may need more support also around pregnancy and maternity.

2.8.2 What are the key impacts around pregnancy and maternity?

 Pregnant disabled women and their partners may have particular anxieties about pregnancy, childbirth and being parents and may need extra time and support. Women with a learning disability, for example, may need information about pregnancy and parenting in other formats that explains information in a more accessible way.  Pregnant disabled women with progressive conditions such as MS or rheumatoid arthritis may fear exacerbation of their condition following birth, and women with existing mental health problems may be more prone to post natal depression.  Disabled parents and ‘teenage’ parents may face particular prejudice from others in society, and assumptions are made by some about their ability to be parents.  Parents with a learning disability may face barriers to the provision of appropriate support due to negative, or stereotypical, attitudes about parents with learning difficulties on the part of staff in some services.

21 2.8.3 What have we got in place?

 Self-directed support and personal budgets allow greater choice and control over the support disabled people who are pregnant or have young children or are breastfeeding receive.  Information about pregnancy, birth and parenting available in a range of different formats and languages.  Targeted work with people with a learning disability about sex, relationships and parenting.  Training for staff which includes pregnancy/maternity equality.  Close links with Children’s Social Services.

 Review what additional support may be needed for parents and prospective parents with a learning disability.  Continue to work closely with children’s services to ensure that the right support is made available to disabled parents.

2.9 Addressing the Data Gaps

The equality analysis has identified a number of areas where consideration of strengthening or reviewing data could be made. These include:

 Whilst recording around Religion or Belief is improving it is still not recorded for all social care clients.

 We need to do more detailed work on the housing needs and aspirations of excluded groups, particularly: - older people and disabled people in rural communities - black and minority ethnic groups, and - young people not engaged with services.

 The principles established in the extra care and telecare strategy will be applied to specific opportunities as they arise.

2.10Key Equality Issues

Priority equality objectives for adult social care services

It is clear from this equality analysis that adult social care services have a number of potential impacts, positive and negative, on all of the protected equality groups both specifically and collectively.

For adult social care, the key equality impacts are on disabled people in the county. Adult social care plays a major and direct role in more closely aligning their life experiences with to those of non-disabled people and thereby in reducing inequality.

22 1. Improving access to community activities and facilities: Ensuring disabled people access a life like any other - facilitate access to community based activities and services

The support we can offer those disabled people in the wider population to whom we cannot offer more direct help is therefore a key equality issue if we are to maximise their independence and quality of life – and reduce the number of people needing adult care services in the first place.

A priority equality objective for adult care is therefore to make the most effective use of the activities, facilities and services that are available to the community as a whole where adult social care is not able to provide or commission a service itself – e.g. better information; more pro-active signposting; and facilitating the development of these resources through partnership with other Council services and other bodies.

2. Understanding our customers better: the analysis showed that to deliver services related to existing housing and to plan the construction of new housing, we need to improve what we know about what different people want. A priority for promoting equality is therefore collecting more detailed information about the people who use our services and improve our understanding of how they experience it. Large quantitative based surveys have not provided enough detail of minority groups and do not give us the information about their views of the quality of the services they receive.

3. Increasing choice and control: For people who need support for the everyday activities of daily life, any action to maximise choice and control helps align their lives more closely with the rest of the population and has an important equality impact. The “personalisation” of services which has been an important part of the vision of successive governments for adult social care therefore has an inherent equality priority.

This can mean working with people to make sure support plans more closely reflect their individual needs (through self-directed support); devolving control over the commissioning of services (using personal budgets); giving a greater emphasis to maximising people’s independence as quickly as possible after a health crisis (the Short Term Support Service). It can also mean improving our understanding of the diverse nature of our clients and their experience of services.

23 PART 3 – Equality Objectives

Group Equality Analysis Report PART 3 – Equality Objectives

Protected Characteristic 1. Improving Human Rights access to S e x mainstream Pre u gn services and al anc O A facilities y Disability Sex Race ri g &M e e ate n rnit Help more ta y ti closely align o the lives of n       disabled people and those with housing disadvantage to that of other groups in the community

How? By Who? Progress Success Next steps By When? measure 1.1 Continue to promote direct We have encouraged Comparison We will continue to encourage providers December 2016 payments, improving support providers to develop with national to develop new individually tailored arrangements in the light of new individually statistics. services which improve (both funded experience to maximise their tailored services and self-funded) clients’ access to impact which improve (both community activity using Market funded and self- Position Statements for different needs

24 How? By Who? Progress Success Next steps By When? measure funded) clients’ groups. access to community activity using Market Position Statements for different needs groups.

1.2 Consider lessons from the Improvement of Proportion of Continue to make improvements in SPA December 2016 evaluation of the impact of first Single Point of service users to ease access/referral and consistency five Social Care and Health Access (SPA) to and carers of response. Information Points (SCHIPs), ease access/referral who find it and develop future access and consistency of easy to find arrangements in the light of this response. information about services. 1.3 Continue to improve information Support Planners Clients who Ensuring information about support and October 2016 about support and access to now give more are not access to services reflects the reforms services and further develop information about eligible for in the Health and Social Care Act 2012. other channels for information support and services public for disabled people, including which are available in support internet channels the community, using receive information from the appropriate Northumberland Life information Website and from and advice. knowledge gained from area-based working.

1.4 Continue to work with We have encouraged Increased The Market Position Statements for January 2015 independent providers of social providers to consider flexibility and different needs groups will encourage care and related services to more flexible and innovation in providers to develop new individually

25 How? By Who? Progress Success Next steps By When? measure develop a greater choice of innovative support at the sector. tailored services which improve (both more flexible and innovative the Forums which are funded and self-funded) clients’ access support part of the Quality to community activity and services. Management Framework.

We have contributed to joint work at regional level on a Market Position Statement for people with Learning Disabilities to serve as template for a programme of similar documents for other needs groups. 1.5 Monitor how easy it is to access Mystery shopping Improved Continuous evaluation of the other first Ongoing the right adult social care has been carried out customer points of contact with social care services using Mystery shopping measuring the quality satisfaction services - the information, advice and of first contact of the with social support made available and the level of Single Point of care services’ service. Access (SPA). first point of contact

26 Protected Characteristic 2. Human Rights Understandi S e ng our x u customers al O Pregna better A ri ncy Disability Sex Race g e &Mater e n nity Establish a t a clearer ti understandin o n g of the       specific needs of our customers in relation to equality issues

How? By Who? Progress Success Next steps By When? measure 2.1 Continue to collect feedback Surveys of the Short A com- Continue the programme of surveys of Ongoing from our customers about their Term Support prehensive user/carer experience of other services experiences and views and Service, and the data set of compare experiences across Joint Equipment information characteristics Loan Service; Long about Term Wheel Chair; customers CHC; have been exists that completed. can be broken down 2 minutes of your by protected time has been groups

27 How? By Who? Progress Success Next steps By When? measure implemented across the Community teams. Equality monitoring information is collected. 2.2 Continue to work on improving The religion or belief Social care We will continue to improve the Ongoing the recording of Religion or of 63% of clients is client proportion of social care clients for whom Belief in social care currently recorded information we have recorded their religion or belief. on SWIFT - up from includes 60% and 52% in religion or previous years. belief

28 Protected Characteristic 3. Human Rights Increasing S e choice and x u control a l O Pregnanc A r y Deliver high Disability Sex Race g i &Maternit e quality e y n services that t meet the a ti specific o n needs of       people from different groups

How? By Who? Progress Success Next steps By When? measure 3.1 Complete the evaluation of the A report from High levels of October 2015 impact of personal budgets on Newcastle client the lives of those who are using University found satisfaction them positive impacts on across all health and well- characteristics being and informed revised working arrangements for Support Planners.

29 How? By Who? Progress Success Next steps By When? measure 3.2 Continue monitoring the quality A Quality Monitoring Compliance Strengthen equality requirements in December 2016 of independent social care Framework (QMF) and ongoing contracts and monitor using updated provision through the Quality has been introduced improvements criteria. Weighted Payments Scheme covering services made where (QWPS) for people with identified learning disabilities and home care.