Proforma: Equality Impact Assessment

17th September 2012 1

Equality Impact Assessment – Healthwatch Cumbria

Directorate Chief Executive Unit/Team Policy Planning and Communities Assistant Director Responsible for EIA Dawn Roberts Service EIA or Proposal Service EIA - delivery though an outsourced organisation

Aims of the EIA Purpose of the EIA The Health and Social Care Act 2012 requires each local authority area to set up a new organisation called Healthwatch Cumbria (HC) to be in place by 1st April, 2013.

A range of consultation methods have been employed and the results have helped the County Council understand what is required and expected from HC by local people, members and partner organisations at community and strategic levels.

This EIA evaluates the impacts of the proposed Healthwatch Cumbria service, with regard to the Equality Act 2010

Diversity profile of Cumbria

The Cumbria Intelligence Observatory provides Equality Profiles showing the makeup of the population of Cumbria and districts broken down by each of the nine protected characteristics in the Equalities Act 2010.

http://www.cumbriaobservatory.org.uk/Population/equality.asp

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Summary of findings The key issue for Healthwatch Cumbria to demonstrate, is that it can channel the experiences of all sections of the community. Some groups struggle more than others to have a voice, and specific steps are required to redress the balance.

To help ensure that this happens, potential contractors will be asked to demonstrate how they intend to reach and involve individuals who share the protected characteristics Scope of the EIA: HC will be procured by Cumbria County Council and delivered by a Social Enterprise  One directorate from 1st April, 2013  Cross directorate  Outsourced organisation

Phase 1: Gathering information List examples of background information that you think are relevant. If carrying out an assessment of a proposal this section should include the data used to establish whether the proposal has an impact. Type of information Findings Developing HC and Independent Respondents say that advice and information to help people access and make Advocacy Service (Cumbria IAS) choices about health and social care, needs to be made accessible through a range of methods to suit the needs of all people. 62.2% of respondents currently use the internet to find advice and information CCC On-line public consultation – and 51.1% seek advice from their GP. How to ensure a strong voice for local people on health and social care issues The following information resulting from recent consultation illustrates local (81 responses) aspirations and expectations for Healthwatch Cumbria:

Healthwatch Cumbria statutory function 1 - Provide information and advice to people across Cumbria about accessing health and social care

services and choice in relation to aspects of these services

 Very strong brand, very well publicised, all people aware it provides information and advice on health and social care services.  Central hub of information with multiple points of access. Multiple modes of access including: the internet, through GP services, community and voluntary groups. All groups able to access information and advice with particular reference to older adults, people who live in rural areas and young people.  Very user friendly  Very clear signposting to services and service providers  Work with health and social care professionals to ensure awareness of all services available to people of Cumbria.  Information must be kept up to date and accurate across all provision points.  Recognise the value people of Cumbria place on the support of family and friends and develop services the aides people to act as advocates.  Avoid duplication of services.

Healthwatch Cumbria statutory function 2– Promote and support the involvement of local people in the monitoring, commissioning and provision of local care services – including targeted activity to reach people protected by the Equality Act

 Allows and encourage all demographic groups to be involved.  Identify how to reach out to harder to reach and lesser heard groups; with consideration to people’s physical abilities, logistical issues, access to technology, working commitments, caring commitments and all other possible barriers to participation.  Variety of ways to become involved, including meetings to help to plan

and monitor services, or to represent views of people to service providers, signposting and providing ‘expert’ patient advice, providing advocacy, supporting to gather public and patient views and administrative support.  Involve young people ensuring through engaging activities that match their skills and interest.  involvement via a array of different methods such as; internet, discussion forums, meetings, drop in centres and community and voluntary groups.  People a properly supported in their involvement, consideration for training needs, travel/logistical support, expenses incurred, access to high quality information, and support different user groups to communicate.  Good lines of communication between public and service providers, honest feedback and clear outcomes demonstrated as a result of people’s involvement.

Heathwatch Cumbria statutory function 3 – Obtain the views of people about their needs for and experience of local care services and make those known to those involved in the commissioning, provision and scrutiny of care services

 High profile, well publicised, all aware how to have their say  People able to share views and experiences in many ways  Consideration to how people are able to give feedback. Take account of access to the internet, travel/mobility issues, communication needs, advocacy needs, needs in rural areas and involving young people  Effective and excellent feedback systems to all. Manage expectations, be clear about scope of engagement/consultation methods  Work to improve people’s confidence that voice is valued and has impact.  Engage with service providers to ensure they do listen, act, feedback

Healthwatch Cumbria statutory function 4 – Make reports and make recommendations about how those services could be improved

 Have ability to collate relevant information to inform quality of service provision and identify gaps  Collate new information through various engagement methods and include existing information.  Develop systems for effective sharing of information, good practice, report findings and recommendations  Have the required expertise to analyse information using genuine knowledge whilst still showing the ‘real’ views of Cumbrians.  Reports and recommendations made available to the public.

Healthwatch Cumbria statutory function 5 – Make the views and experiences of people known to Healthwatch England helping it to carry out its role as national champion

 Effective researcher in gathering views and understanding information.  Understand the service provision needs of people  Joint working with local community and service user groups  High quality administrative functionality

Healthwatch Cumbria statutory function 6 – Make recommendations to Healthwatch England to advise the Care Quality Commission (CQC) to carry out a special review or investigation into areas of concern (or, if the circumstances justify it, go straight to the CQC with their recommendations, for example if urgent action were required by the CQC.

 Independent, able to demonstrate independence, no vested interest.

 Demonstrate an understanding of, and committed to using the powers granted via the Health and Social Care Act  Ability to carry out effective and rigorous monitoring of services.  Able to follow up complaints/concerns raised by service users effectively ensuring there are appropriate outcomes if required.

Our Life consultation events in All six events covered possible improvements for the full public and patient Cumbria’s six districts 140 attendees in engagement and involvement system and focused on the establishment of total. Participants included members of Healthwatch Cumbria as part of this. the public and representatives from specialist organisations (including Issues highlighted include: those with protected characteristics)  Fragmentation and complexity  Poor communication  Communities with most need to be ‘heard’ are least able to have a ‘voice’(loudest voices heard)  Bureaucracy  Attitudes of professionals  Unimaginative consultation  Lack of feedback  Unreliability of information  Financial constraints  Geography and transport  Poor transparency and accountability  Lack of power to influence decisions  Lack of knowledge about services available or where to go

Participants identified the following as high priorities for HC:

 Single point of contact  Clarity about structures and communication  Card with free phone number and explanation HC  Focused terms of reference, defined representation and independent effective chairing  Simplicity  One stop shop – trusted and owned by the community  Locally provided  Feedback provided  Accountable for outcomes  Want to see effect/results in response to what is said  Single point of access/contact  NHS/service providers/CCG – signed up properly to engagement. Listen and learn, accountability, formal relationships, working together, mutual respect, makes changes  Proactive – go out and meet people  Funnel system – multiple points of entry, identified places which can collate concerns – localities  People can get involved/have their say in a range of ways, e.g. phone calls, email, meetings, panel, conversation on street, but all fed in and collected; different methods of engagement  Communicate to all residents in Cumbria how they can access and make their ideas and concerns known to commissioners (e.g.media and internet)  Umbrella organisation – collate patient and public engagement, including statutory remit  Co-ordination – engagement, feedback, outcomes  Clarity about purpose of engagement and when/how decisions will be made (i.e individual up to macro)

 Opportunities to link where people feel comfortable i.e. local county, condition specific

AWAZ Cumbria feedback on what is AWAZ statement: required to enable BME people to participate in public engagement in the Anecdotal evidence suggests that equality in and equality of access to health health sector and receive a high quality and social care services for many BME people at the time of their need advocacy service (Cumbria IAS) continues to be a challenge across Cumbria.

There is a need for further comprehensive research to identify underlying issues, barriers and unmet needs, and a proactive policy as well as service delivery response to alleviate the health inequalities among BME communities.

HC should be independent, accountable, committed to having a specific (SMART), published action plan to develop and enhance inclusive community engagement. It should demonstrate how it will provide:

 Support to increase the engagement of BME patients, carers, citizens and stakeholders in making decisions for individual’s personal health and social care, and;  Empower and involve them in the decision making processes for the design, development and delivery of health and social care services.  Work in partnership with BME Voluntary and Community sector organisations, to publicise the availability and existence of HC and Cumbria IAS and where possible, make arrangements for inter-agency referral as well as contribute in building the capacity of BME groups/organisations to work in partnership with HC and Cumbria IAS.

The County Council should ensure consistency in monitoring and evaluation of performance and outcome reports by HC and how HC, at its board, volunteer

and staff level is representative of the communities it will serve and represent.

Reports should include information on and demonstrate how HC has acted in accordance with Equality Act 2010 and evidence compliance and progress against the three main aims of General Equality Duty (set out in section 149 of the Equality Act 2010) and the Freedom of Information Act 2000

How HC has carried out engagement and gathered the views of its local people, what it has achieved and has a SMART action plan for the coming year. Cumbria Local Involvement LINk has been approached by one of its member organisations (AWAZ), Network(LINk) Annual Report 2011- because they had been told that some people were having difficulty accessing 2012 Health and Social Care Services. Consultation raised genuine concerns around the difficulties people were experiencing because of language barriers. Page 6 – Language Barriers LINk agreed to undertake a piece of work to see where the problems lie and what could be done to solve them, Cumbria LINk has commissioned AWAZ to explore these issues further. A report is expected during 2012. Cumbria LINk Pathfinder Report – The Pathfinder Report is included in the ITT documents. June 2012

Watching out for Youth: event Young people felt that HC should work for young people with the same summary and project evaluation. principles as Youth Councils – should be fun and interactive and what young July 2012 (A series of three events people say should make a difference. A wide variety of young people should be held across the North West run by able to get involved through a variety of methods. North West Regional Youth Work Unit and The Transition Alliance). The HC could promote itself in schools and colleges, with traditional publicity and events looked how Healthwatch and online. how it could involve young people. The events were for adults and young HC should link to things that already exist to give young people a voice, such as people. youth councils and other projects

Focus groups – Elected Members Members focus group – HC provides a good opportunity influence how (13) monitoring of health services can involve everyone in every community. Effective community engagement is critical to the success of Healthwatch.

Few people know about LINk and Public and Patient Involvement forums

HC members need to feel they are in a position to influence and make a difference.

The HC contract must address how it will engage with communities in order to gather information and gain evidence to support/back up issues of concern to residents. Neighbourhood Forums were suggested as a conduit, along with Local Area Partnerships and GP surgeries.

Pensioners focus group - Pensioners group (14) Don’t make the system more complicated. GP surgeries seen as good places to get information about health and social care services. Family and friends, specialist staff and organisations such as Age UK, also seen as important. Some older people may not use computers. Would like face-to-face contact, close to home.

Parent and Toddlers Group - Parent and Toddlers group (22 Currently use GP, other health professionals, and specialist organisations. None parents) of the group had heard of PALS or LINk. Not convinced that HC would be any different.

Previous LINk tender – text relating to Participation in LINk needs to be accessible to all elements of the population;

Equality duty young and old, unwaged, working, householders, tenants and homeless, disabled, migrant workers and other minority groups. The service will also have to demonstrate Equality Impact Assessment. There are six strands: ethnicity, religion/belief, gender, disability, sexuality and age; and the host organisation will need to show that these will not be disadvantaged when accessing the service. For example how will non-English speakers resident in the county, be able to engage and have their views heard?

KPI 10 – used to evaluate how appropriate the service is to people’s needs County Council Consultation with Feedback from this consultation: OutREACH Cumbria October 2010 Participants discussed all aspects of health including mental health and wellbeing. The feedback showed that many LGBT people do not feel comfortable or confident in revealing their sexual orientation to a GP, in smaller communities LGBT people are fearful that confidentiality might be an issue, e.g. shared reception/waiting rooms. Other factors affect the decisions of LGB T people about when who and where they will access health services, e.g. uncertain of the reception they might receive, judgemental GP’s, or because of the health professionals lack of understanding about LGBT T health needs, e.g. lesbians being refused such services as basic screening.

As LGBTT people get older they will need to access social and health care, how they are received and treated is of concern. Many of these people will not have come ‘out’ in the sense they have lived their adult lives hiding or being very selective about who they have come out to. Good equality training for staff is a vital part in helping ease this burden, it is also essential that other service users are aware of the rights of others in residential care settings.

A combination of external factors, such as homophobia in schools and in work and the discrimination experienced, has a profound effect on the lives of many LGBT people, higher use of alcohol and drugs are used to offset many

conditions which have a negative impact on the health and well being of individuals, this leads onto depression, self harm and in extreme cases suicides.

Phase 2 Impacts From the evidence above use this section to identify the risks and benefits according to the different characteristics protected by the Equality Act.

All/general: Any issue that cuts across a number of protected characteristics Issue Positive Impact or benefits Negative impact or risks Action Required

Healthwatch Strong brand made known through Can HC be all things to all people? Ensure that Cumbria as a one good marketing and communications Potential that some disadvantaged tendering scores for stop shop/’sorting will raise the profile of HC and its groups may still not be properly how a provider office’ – filtering services. More people aware of its represented, reached or heard, due would build links information/views role and how to access its to lack of resources or knowledge of with user networks. and spotting trends services/information/support and feel how best to reach them. it is well informed and influential. HC needs to show Potential problem if information is not how it will undertake produced in formats or locations that research through HC will be monitored by the County people can access. e.g. some people specialist Council and will be required to do not have internet access or organisations to demonstrate how links are being transport to travel to GP surgeries or identify most made with users under the protected events. efficient and characteristics. effective ways to Users of existing services have trust reach and involve in current contacts and organisations, individuals with and fear loss of skills and protected experience. characteristics.

Close partnership May find problems with sharing working is essential information due to data protection or to avoid duplication other issues. and make best use of resources. Time and resources might restrict the ability of HC to undertake effective HC will need to build engagement with all individuals with trust with partner protected characteristics unless organisations and be effective partnerships are developed. clear about what information it needs Access to internet and use of online or is able to collect services varies across the county. from other organisations. Access to personal or public transport and distance from GP Ensure that the surgeries will affect access if these service is monitored are used as the main point of by protected contact. Difficulties are likely to be characteristic and more pronounced for those with compared to the certain protected characteristics e.g. population profile of older people or those with disabilities. Cumbria.

Ensure that KPIs cover aspects required under the Equalities Act 2010.

Disability and health and wellbeing: All forms of disability recognised under the Disability Discrimination Act including sensory impairment, mental health, learning disabilities, mobility related conditions, conditions such as heart disease, diabetes, asthma. This also covers any impact on health and well being Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Seek clarification in appropriate sought in the tender: potential impact is: tender on how HC information and would reach people engagement  Information gathered in one  Disabled people are not able with disabilities and place by well informed staff will to access information due to work closely with save disabled people having to lack of transport, or not able to condition specific go to several places for get information in suitable organisations to find information. Health inequalities formats to meet their needs. how best to engage between disabled and non  Some disabled individuals and provide -disabled people narrowed as struggling to have their views information for people are empowered by heard people with specific having their views heard.  The complexity of different needs Carers of disabled people able disability groups means that to express their views and not all groups in Cumbria are influence service provision. supported to engage with HC  Specific expertise on different kinds of disability helps HC champion positive action on disability throughout the health sector

Gender, Transgender and Marital Status Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Seek clarification appropriate sought in the tender: potential impact is: within tender for how information and the provider would engagement  Information gathered in one  A one size fits all approach provide targeted place by well informed staff will that fails to address the way in services on the save people having to go to which the health needs of men grounds of gender. several places for information – and women differ – potentially particularly relating to care and leading to greater health HC staff to be well treatment that is gender inequalities between males trained in order to be specific – i.e. prostate cancer, and females. aware of gender cervical screening etc.  A service that lacks the ability specific issues  Empowerment for transgender to work with people who are people and women who transgender or experiencing experience domestic violence, domestic violence acknowledging the potential for exclusion to impact on their health and well being

Health and wellbeing improved because people feel empowered to help themselves because they know where to go for information relating to health and wellbeing and how to have their views heard

Ethnicity: All ethnic groups including Asian, Black, East Asian and white minority ethnic groups, including Eastern Europeans and Gypsy and Travellers. Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Seek clarification appropriate sought in the tender: potential impact is: within tender on how

information and the providers might engagement  Information gathered in one  A one size fits all approach meet the needs of place by well informed staff, means that HC is unable to BME people and and with multi-lingual and inter- build links to existing BME Travellers and cultural formats, that will save individuals and communities. recent migrants. BME people from having to go to several places for  Information, advice and HC staff and information access points may not be volunteers will need provided in most appropriate training and support formats. to provide an  Health and wellbeing of BME effective service. people improved because  Time and resources might people feel empowered to help restrict the ability of HC to BME volunteers themselves because they know undertake effective might help reach where to go for information engagement with all BME communities and relating to health and communities unless effective increase HC’s wellbeing . partnerships are developed. understanding of  Issues such as access to GP specific barriers and interpreters could be issues. considered in terms of equality of access, standards and costs CCC should ensure consistence of monitoring reports by HC to measure how its members, staff, volunteers and partners are representative of the communities it will serve and represent. Reports should

include info on how HC has acted in accordance with the Equality Act 2010 and how it has carried out engagement and gathered the views of its local people.

Sexual Orientation: including heterosexual, gay, lesbian and bisexual people Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Seek clarification appropriate sought in the tender: potential impact is: within the tender on information and how the provider engagement  Opportunity for LGBT people  A culture of inequality where it would reach and who have raised issues about is difficult for LGBT people to support LGBT the NHS to have their concerns be ‘out’ people about healthcare channelled  Potential for issues around and addressed depression, substance misuse and ill health arising from homophobia to go unaddressed  Lack of connection between HC and local LGBT groups

Age: Where a person is at risk of unfair treatment because of their age group Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Seek clarification in appropriate sought in the tender: potential impact is: the tender on how information and the provider would engagement  Representation on HC reflects  HC is biased towards a reach and engage the diverse age profiles of narrow rate of age groups, young and older Cumbria and action is taken to leading to skewed feedback people. target underrepresented age and lack of action on some groups. aspects of health and well Some people may  Information and signposting being. need help in available in one place resulting accessing in less complexity and age information online. appropriate services.  Older people’s needs are Effective marketing addressed in terms of access required to make all to services, internet services ages aware that HC and engagement – this is is there to represent especially important in areas their views and offer with high levels of rurality – appropriate especially Eden and South signposting and Lakeland information.

% of population aged 65+ in rural areas:

England and Wales 24.2 Cumbria 55.1 Allerdale 71.3 Barrow 17.7 Carlisle 34.3 Copeland 61.0

Eden 71.2 S. Lakes 67.1

 Effective partnerships in place to ensure face-to face contact and specific activity and information suited to the needs of young people and older people.  Effective action is taken to raise awareness of health issues that disproportionately affect younger people – i.e. Chlamydia, breastfeeding for young mothers etc.

Religion/belief: all faiths including Christianity, Islam, Judaism, Hinduism, Buddhism, Sikhism and non religious beliefs such as Humanism Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Develop links with appropriate sought in the tender: potential impact is: inter-faith forums information and engagement  Opportunity for individuals and  HC is unable to champion the community groups to express experiences of people from their views and raise issues diverse faith groups. relating to their specific

religion/belief or circumstances  HC unable to engage or reach  Better use of the potential of all groups unless effective faith groups to open access to partnerships are developed HC  Potential to link in with chaplaincy and multi-faith visiting services as a way to get intelligence on the impact of services

Socio-Economic Status: This can include people on low incomes, as well as issues around rural and urban deprivation Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Develop links with information and sought in the tender: potential impact is: other support and engagement advice services  Reduce complexity of the  Continued barriers to access existing system and support for people on low incomes in people on low incomes to have Cumbria due to cost of a greater voice. transport and internet access  Identify trends in health and wellbeing against areas of high deprivation and champion actions to address this.  Work with schools, children’s centres and other public services to promote health and well being in areas of high deprivation or rural isolation.  Reduce the barriers of cost of

distance that prevents people on low incomes or rural isolation experience in access to services

Community Cohesion: This is where a decision or a change to services may risk creating tensions between community groups in a local area. Issue Positive Impact or benefits Negative impact or risks Action Required

Access to Potential benefits of HC that will be If these issues are not addressed the Monitoring of service appropriate sought in the tender: potential impact is: provision and information and contact compared to engagement  Health and wellbeing improved  Potential imbalance of population profile of as people feel empowered to provision and engagement Cumbria help themselves because they could lead to service delivery know where to go for benefiting or producing information relating to health disadvantages for some and wellbeing and how to have community groups their views heard.  Perception that HC is  All sections of the community dominated by people who are empowered and specific have the loudest voices and steps are taken to ensure that not the whole community people with less authority or voice are able to take part Phase 3: Action Planning Based on actions raised in the action required box above Area for further Actions proposed Lead officer When Resource Outcomes action implications

Check tenders The service provider Sue November Requires tender Provider best meets against issues will have to Stevenson 2012 documentation to the Council’s raised in the EIA demonstrate Equality specify how requirements on Impact Assessment. choice of provision Equality The provider will will be scored need to show that individuals with protected characteristics will not Requires tender be disadvantaged documentation to when accessing the specify how service. equality will be scored. Ensure that the tender scores the provider based on how they will meet Requires provider users based on to have monitoring ethnicity, age, sexual systems that orientation, gender capture client data and disability. by protected characteristic. Monitor access to and engagement with HC by all protected characteristics.

Documents appended to the Equality Impact Assessment:

Quality Assurance and EIA completion Date completed 17th September, 2012 Lead officer Sue Stevenson EIA taken through Directorate Equality Group/or DMT Have staff been involved in developing the EIA? Yes – specific advice and information Have community organisations been involved? Yes – through the various consultation activities Date of latest update of EIA

17th September 2012