Single Equality Scheme

2011 - 2014

This document is available in larger print and other formats and languages on request.

Contents

Page numbers

Foreword 4

1. Introduction 5

Strategic Vision 6

2. Demographics 7

3. Governance 10

Key Responsibilities 11

Communications 11

4. Workforce Strategy and Profile 12

Workforce Profile 12

More Than a Workplace 13

Employee Wellbeing 13

5. Learning and Development 14

Equality Impact Assessment and Equality Analysis 17

6. Patient Engagement, Involvement, Consultation and Experience 18

7. Procurement 20

8. Legal Context 23

The Equality Act and Duties 23

Human Rights Act 1998 24

9. Single Equality Scheme Context 25

Meeting needs through adjustments 26

Co-operation and collaboration 27

Positive action – meeting individual needs 29

Engaging and Consulting 31

Publicising and Reporting 31

10. Single Equality Scheme Action Plan 2011-12 31

Appendices

Appendix 1 – Committee Structure 32

Appendix 2 – Workforce Profile Analysis 33

This document is available in a range of alternative formats including various languages, large print, audio cassette and Braille. Please Contact:

The Customer Care Team: [email protected]

Telephone: 0151 600 1517

We welcome feedback about its content, format and ways we could improve it:

In writing to:

Head of Organisational Development & Learning Liverpool Heart & Chest Hospital NHS Foundation Trust Thomas Drive Liverpool L14 3PE

Single Equality Scheme Foreword

This Single Equality Scheme has been written as evidence of our commitment to ensure that Equality, diversity and human rights (EDHR) considerations are at the centre of our Trust and the way that it operates. This document is a development from our earlier scheme and is intended to outline our strategies and actions for the foreseeable future. Our equality objective action plan will be the baseline from which further plans will be developed in order to meet the requirements of the Equality Act 2010.

The contents and action plan have been developed by drawing on current information and with reference to comments received in regard to our earlier scheme. Its preparation has provided us with an opportunity to scrutinise current practice, assess progress in relation to EDHR and identify any gaps in provision and practice.

The Trust achieved Foundation Trust status in December 2009 and actively engages with members. Our mission is to provide excellent, safe, compassionate care for every patient every day. We have developed a Patient Experience Strategy which describes a compelling vision for patient experience which also includes relatives and carers.

Involvement and consultation are extremely important to us and we invite comments and suggestions with regard to this Single Equality Scheme. This is the first stage in an ongoing process and we look forward to receiving your feedback.

Neil Large Rajesh Jain

Chair Chief Executive

1. Introduction

The Liverpool Heart & Chest Hospital (LHCH) has developed this Single Equality Scheme (SES) to demonstrate our commitment to ensuring that equality, diversity and human rights (EDHR) are an integral and important part of the way that we operate as an organisation. The SES is a continuation of an ongoing process which provides a framework within which we can assess the current state of play with regard to the ways that the organisation operates. It will also help us further enhance current practice in our approach to EDHR.

Central to this commitment, and also to our intention of ensuring that EDHR considerations become a core part of our business, is the process of linking EDHR into all systems and procedures at strategic and operational levels. We will publish the required data relating to EDHR and will ensure that our SES and Action Plans address all aspects of equality.

As part of our journey towards Foundation Trust status we recruited 9,548 members. The membership is drawn from as diverse a group of people as was possible but we continue to work closely with our Council of Governors to encourage participation from under-represented groups. The Membership Strategy will be refreshed during 2011 and will include a review of the membership database to ensure that information is requested and monitored for all equality groups.

The SES encompasses all stakeholders including the Board of Directors, Council of Governors, members, employees, service users, sub-contractors and partners.

A diverse population requires a diverse workforce and we will not discriminate against anyone on the grounds of the protected characteristics1 of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation, caring responsibilities or any other relevant characteristic or need.

We are well prepared to implement the equality duty that is included in the Equality Act 2010. This brings together the public sector duties of race, disability and gender and focuses on advancing equal opportunities and combating discrimination and victimisation based on the protected characteristics that are listed above.

We have incorporated our vision, values and behaviours into the SES, along with the underpinning strategic objectives, because we believe that focusing on these throughout the SES is the most likely approach to help us succeed in our aim.

We are aware of our obligations to comply with the Care Quality Commission registration requirements. Integral to this is to recognise that our services need to encourage respect for people’s human rights and promote actions to reduce inequalities of people’s health and experiences of healthcare.

1 Equality Act 2010 5

The NHS Constitution2 signalled the beginning of a new relationship between staff and service users. It sets out what everyone can expect of the NHS - staff and service users – and what is expected of them. The seven principles stress that care should be available to all, the importance of high standards and professionalism and that service delivery should address the needs of patients, their families and carers. The importance of working in partnerships, with local communities and the wider population, the efficient and fair use of resources and the need for accountability are also included. All these principles support and complement the equality and diversity agenda and have been taken into consideration when developing the SES and Action Plan.

This SES is seen as providing the baseline from which objective based action plans for the future will be developed. These will be based on evidence of need, influenced by ongoing feedback from all stakeholders and targeted to meet the needs of our population, including equality target groups. Care will be taken to ensure that our legal duties are met and a watching brief will be kept on the requirements set out within the implementation timetable of the Equality Act 2010.

Strategic Vision

The Trust’s mission is to deliver excellent, compassionate and safe care to every patient every day. To support this the Trust has developed a vision for patient experience which will be implemented by April 2013. The vision is conveyed by way of a patient story which can be summarised in the six steps shown below:

2 NHS Constitution – Department of Health – AHP Bulletin Issue 69

Delivering the vision can only be achieved by staff who demonstrate the right values and behaviours at all times. These behaviours have been consulted on and agreed with staff and are listed below:

Our values and behaviours have been developed to ensure that all staff understand what is expected of them in dealing with patients, relatives and carers, colleagues and other stakeholders. The behaviours further demonstrate the Trust’s commitment to treat everybody equally and to recognise the benefits and value that a diverse workforce can bring to the population we serve.

2. Demographics

The LHCH is based in Liverpool, is a specialist tertiary centre, and delivers its services to 2.8 million across the North West, Merseyside, parts of Cheshire and Lancashire. In addition, individuals from the Isle of Man and North Wales access the service. The demographics of Merseyside are obviously relevant when compared with the workforce profile, and this issue will be explored further in Section 4 the “Workforce Strategy and Development” part of this document.

With reference to service users, the following graphs demonstrate some differences between the health status of individuals relating to geographic area.

North West3 and North Wales Health Profile4

The Health Profile of England offers opportunities to present current health data by region and the summaries below highlight a selection of the key indicators that are relevant to the Trust. It is notable that health outcomes are relatively poor in the North West. Life expectancy rates are lower, and mortality rates from heart disease and cancer are higher than any other region for both men and women5.

Key for the following tables: ● Significantly worse than the English average ▲Significantly better than the English average ■ No significant difference from the English average

Merseyside Health Summary 2010

St Adults Liverpool Knowsley Halton Sefton Wirral Helens Smokers ● ■ ● ■ ▲ ▲ Binge Drinking ● ■ ■ ● ■ ■ Obese Adults ■ ■ ● ● ■ ▲ Life Expectancy Male ● ● ● ● ● ● (Eng. Avg. = 77.9) (74.3 yrs) (75.8 yrs) (75.5 yrs) (74.8 yrs) (77.0 yrs) (75.9 yrs) Life Expectancy Female ● ● ● ● ● ● (Eng. Avg. = 82.0) (78.8 yrs) (80.3 yrs) (79.2 yrs) (78.8 yrs) (81.5 yrs) (81.0 yrs) Early Deaths Heart ● ● ● ● ■ ■ Disease & Stroke

Lancashire & Cheshire Health Summary 2010

Cheshire West Adults Lancashire Cheshire East & Chester Smokers ■ ▲ ▲ Binge Drinking ● ■ ■ Obese Adults ▲ ▲ ▲ Life Expectancy ● ■ ▲ Male Life Expectancy ● ■ ▲ Female Early Deaths Heart Disease & ● ■ ■ Stroke

3 Health Profile of England 2010 http://www.apho.org.uk/default.aspx?RID=49802 4 Welsh Health Survey Results http://wales.gov.uk/topics/statistics/theme/health/health-survey/results/?lang=en 5 Regional LMI Report North West October 2007 8

Key for the following table: ● Worse than the Welsh average ▲Better than the Welsh average ■ No difference from the Welsh average

North Wales Health Summary 2007 + 2008

Adults Isle of Flintshire Denbighshire Conwy Wrexham Anglesey Smokers ■ ● ▲ ▲ ▲ Binge Drinking ■ ■ ▲ ▲ ■ Obese Adults ▲ ▲ ▲ ▲ ▲ Life Expectancy ■ ■ ■ ■ ■ Male Life Expectancy ■ ■ ■ ■ ■ Female

Isle of Man No definitive health statistics could be sourced for 2010 so no comparisons can be drawn from the Isle of Man with the North West and North Wales. However, the data below has been gathered from a variety of sources (see footnotes) and gives a “snap shot” of relevant data:

Isle of Man English Average Life expectancy - Male 75.86 years6 77.0 years Life expectancy - Female 81.93 years4 81.5 years Death rate from circulatory system 48% (all ages)7 33%8 Smokers 20-25% adults8 22%9 The following data taken from the Data Warehouse gives a snap shot of patient referrals to the Trust during 2009/10. The referrals from Greater Manchester and those identified as “other areas non specific” have not been captured as part of the overall demographic data presented. This is because these areas are out of the broad catchment area of the Trust and cannot be easily quantified.

Area Patient referrals Cheshire & Merseyside 26730 Wales 2071 Cumbria & Lancashire 821 Greater Manchester 170 Isle of Man 404 Other areas – non specific 284

6 CIA World Factbook https://www.cia.gov/library/publications/the-world-factbook/geos/im.html 7 A Strategy for Health for the Isle of Man 2005 8 Public consultation document “Proposed legislation on smoking in workplaces and enclosed public spaces July 2005” 7 ONS: Opinions Survey Report No. 40 Smoking-related Behaviour and Attitudes, 2008/09 8 BHF statistics database: www.heartstats.org

3. Governance

Currently, the Board of Directors oversees service delivery within the organisation. The Remuneration, Audit committees and Charitable Funds are sub-committees of the Board. In addition, there are 5 committees that report directly to the Board namely Clinical Quality, Patient Experience, Workforce , Corporate Readiness and Finance Committee.

The EDHR Steering Group reports to the Workforce Committee. In addition, issues relating specifically to patients, relatives and carers are also considered by the Patient Experience Committee.

The key objective of the EDHR Steering Group is the overview of the SES and Action Plan. Currently, we are using the NHS NW Equality Performance Improvement Toolkit (EPIT) as a supporting framework. Membership is drawn from a range of professions and departments. Group members are responsible for reviewing progress against the SES Action Plan and identifying good practice examples along with any areas for concern from their own areas of operation.

In addition, the Steering Group is becoming involved in and leading on a variety of activities. For example, members attended the Gay Pride event in Liverpool and, more recently, designed and delivered an awareness day for staff within the Trust. This was based on the premise that the group decided that it was imperative that equality and diversity continued to become an increasingly high profile part of the Trust's culture. With the implementation of the Trust's Patient Vision Experience and new Values and Beliefs a decision was made to hold an event that would raise staff awareness of Equality, Diversity and Human Rights, showing them what the Trust currently offers and educating them in the new legislation.

The event was held in September 2010 with over 100 attendees from all departments of the Trust, including the Chief Executive. External organisations/companies attended and provided information and resources materials. These included the LGBT & BME Staff Network, Disabled Motorists Federation, Bradbury Fields (Supporting Blind & Partially sighted people) and Women's Health Information & Support Centre all of whom commented positively regarding the attitudes and behaviours of the staff that attended. Some staff came to find out more information about particular issues whilst others came to update themselves in a more general sense.

An exercise was carried out in which members of the Equality and Diversity group asked attendees to write a statement or word that they feel related to the work of the group and also the wider EDHR agenda. All contributions were valid and many were similar in context and theme. The main themes to come out were understanding, fairness and equality to all staff and patients taking into account needs based on the protected characteristics. The day was also utilised as an opportunity to consult on the development of this scheme. This could be done in a variety of ways e.g. talking to Steering Group members, written suggestions and putting ideas in a Suggestion Box. There was also an opportunity for staff to become directly involved in the work of the group.

Following the success of the Equality & Diversity Launch we hope that we will be able to hold a similar day in the future, possibly regularly, to celebrate the equality and diversity of our staff and patients. With raffle prizes, fantastic attendance levels and a great mix of external sources the Equality & Diversity Launch was an overwhelming success for the E&D Group and Trust Staff.

Key Responsibilities

The document “Equality and Human Rights in the NHS – a Guide for NHS Boards”10 makes it clear that responsibility for ensuring legal compliance rests at the highest level.

“As CEO it is important that you feel confident in understanding the specific duties placed upon public bodies in order that you satisfy yourself that your organisation is operating within the law.”

It states that Board members are “directly accountable” and “personally responsible” for all actions and omissions in relation to equality and human rights and makes it clear that this accountability “cannot be delegated”. It also makes clear that “vicarious liability” applies to Board members.

Therefore, the Board of Directors has ultimate, strategic responsibility for ensuring that systems and resources are in place to ensure that the SES and Action Plan are implemented in a sustained and systematic way. The Board of Directors will receive regular reports regarding progress. Strategic responsibility for employees and service delivery will rest with the Workforce Committee.

The Board of Directors received a presentation outlining the current and forthcoming requirements for equality, diversity and human rights in January . 2011 and further updates will be incorporated in the Board Development Plan..

Communications

Responsibility for good communications, and for upholding our standards, lies with everyone who works for the Trust. However, it is the responsibility of the Public Relations and Communications team to co-ordinate and facilitate communications, internal and external, for the Trust.

We see effective communication as being central to the efficient running of the organisation because a well-informed and involved workforce benefits employees and service users alike. Communications across the Trust are underpinned by the following standards:

 Open – we create an environment of openness that is accessible across the Trust.

10 Equality and Human Rights in the NHS – A Guide for NHS Boards Department of Health December 2006 11

 Two Way – a structure exists for two way communications for all, with the opportunity to give and receive feedback and to contribute new ideas and opinions.  Clear – information is clear, concise, well informed and written in plain English.  Targeted – wherever possible, information should be targeted to meet the needs of specific individuals or groups.  Efficient – communication is delivered fit for purpose and cost effective, to budget and on time.  Consistent – our communication style and messages reflect a consistent view and corporate brand, values and beliefs.

It is also recognised that adjustments will need to be made to meet individual needs within the context of Equality, Diversity and Human Rights. For example, our Trust website11 is installed with “Browsealoud” which reads web pages aloud for people who find it difficult to read online. Reading large amounts of text on screen can be difficult for those with literacy and visual impairments. Over 7 million people in the UK have literacy problems, many of who have downloaded “Browsealoud” to their computer already. As a result, the Trust's website content is now accessible by a greater number of people.

In addition to this in order to make our membership events available for a wider audience, we facilitated a signer for our popular ‘Medicine for Members’ event to enable members with hearing impairments to benefit from the health awareness presentation. Our communications are written in plain English, avoiding jargon and abbreviations to ensure it is as accessible as possible.

The Trust has a dedicated Equality, Diversity and Human Rights section on both our external website and staff intranet enabling patients, visitors, members and staff to quickly access the information relevant to them. Other communications methods are also used to communicate Equality, Diversity and Human Rights initiatives across the Trust. For example, in September 2010 the Trust held an “Equality Diversity and Human Rights Launch” event – this was promoted widely to our staff via our weekly e-bulletin, global email notifications, monthly team brief and Trust notice-boards.

4. Workforce Strategy and Profile

Workforce Profile

The Liverpool Heart & Chest Hospital NHS Trust employs a varied workforce. The charts provided in Appendix 2 give an analysis of our workforce broken down by a number of factors as at 31st March 2011.

11 www.lhch.nhs.uk 12

More Than A Workplace

The Trust has always acknowledged that our most valuable asset and resource is our workforce. In 2005 the Trust was successful in achieving the Improving Working Lives (IWL) “Practice Plus” status and was commended for many areas of good practice including high board visibility, good internal communication channels, childcare/carer support smoking cessation service, staff indulgence days and a salary sacrifice scheme for crèche users. In July 2009, the Trust launched it’s own programme to build upon this work. Branded as “More Than A Workplace”, this initiative seeks to develop the support and opportunities available to staff based on the five key themes of Effective Management & Leadership, Value and Recognition, Developing Potential, Communication and Engagement, and A Healthy Workplace.

Currently the Trust offers a range of flexible working options that are supported by a number of family friendly policies including career breaks, emergency leave and flexi-time. The Trust has also been accredited with the “two ticks” disability symbol. This outlines five commitments relating to recruitment, retaining employees who develop a disability, consulting disabled employees, developing greater awareness of disability and reviewing our progress.

The Care Quality Commission undertakes a national Staff Survey of NHS Trusts on an annual basis. The results for the Trust for the year 2009 showed a continued and significant improvement over the results from previous years. Although there are some specific areas where improvement is still required, such as in connection to staff involvement, we showed an improvement in 22 out of the 36 key findings, and we were rated in the top 20% of acute specialist Trusts for twelve of them.

To continue our aim of improving staff satisfaction and motivation to deliver our Patient Experience Vision we have consulted with staff to develop our Staff Experience Vision.

This vision identifies 5 pillars highlighting our commitments to and expectations of our staff. A number of initiatives commenced in September 2011 with the launch of the vision which will continue on a monthly basis. The 5 pillars are:

 Reputation & Pride  Commitment & Attitude  Support & Wellbeing  Training & Learning  Achievement & Recognition

We have developed a pictorial representation of the vision (see below) which expands the underpinning principles supporting each pillar.

Employee Wellbeing

As an employer we can provide interventions in the workplace to improve the health status of our employees. We also recognise the importance of our staff as champions in communicating positive health behaviours in the wider community.

By improving the health of the workforce, we will potentially be improving local services by increasing performance and cost effectiveness and also be contributing to the overall improvement of health and wellbeing of the local population. The Trust has set a challenging target of 3.6% for sickness absence for 2011/12.

The Trust has a number of initiatives in place to promote the wellbeing of its employees including;

 Access to Health, Work & Wellbeing service (Occupational Health)  Staff counselling support  Well equipped staff gym  On site nursery  Childcare Vouchers  Stress Audits/Risk Assessments  Smoking Cessation Service  Cycle Scheme  Drug & Alcohol Support  Lifestyle Assessments/Health at Work days  Circuit Training Classes

The Trust is also a member of the Mindful Employer network and is in the process of developing a Wellbeing strategy. 14

5. Learning and Development

Learning and development are essential to the successful implementation of this SES. The Trust recognises that information becomes outdated and that there is a need for all Board members and employees to understand how a commitment to EDHR can influence and enhance service delivery. All new starters coming into the Trust continue to receive general awareness at Corporate Induction and from August 2010 this was included in the Junior Doctor Induction.

“Equality and Human Rights in the NHS – a Guide for NHS Boards”12 emphasises the need for “adequate education and training”. Appropriate levels of equality and human rights competence are also expected to be incorporated into the Knowledge and Skills Framework (KSF) training programmes. It makes it clear that Equality Impact Assessment (EIA) is a “specific obligation” and that the duties apply to employees and service users.

As part of the EDHR steering group, there is a Learning and Development sub group that meets to ensure that EDHR is included in all learning and development programmes within the Trust.

As a capacity building exercise a “Train the Trainer” programme was delivered to 6 key individuals and a workshop devised that was rolled out across the Trust from January 2011. These trainers will also participate in regular updates delivered by Diversity Action in order to ensure that they are fully conversant with the latest EDHR information.

The aims of the workshop are:

 To raise awareness and increase understanding of Equality, Diversity and Human Rights (EDHR) practices in the context of LHCH  To explore how this impacts on staff and their work  To update staff on the latest trends and developments including legal requirements  To help staff understand the reasons for the NHS needing to collect data

The Learning and Development Team are reviewing all training programmes and identifying opportunities for mainstreaming EDHR. An example of this is that all flyers now include a request for staff to inform the Learning and Development department of any ‘special requirements’ when booking training courses. This will enable L&D to inform the appropriate trainers before the course.

Safeguarding Days were held in June and August 2010 to raise staff awareness on all issues relating to safeguarding adults and children. An E- learning package “Safeguarding Vulnerable Adults” has also been devised for relevant staff to complete. Mental Capacity Act/Deprivation of Liberties

12 Equality and Human Rights in the NHS – A Guide for NHS Boards Department of Health December 2006 15 training has been delivered throughout the year and was included in the Consultant Mandatory Training days.

The number of staff receiving annual personal development reviews has increased over the last 12 months, this has been supported by L&D improving the paperwork and delivering training sessions for appraisers. Following an evaluation of the paperwork it has now been further streamlined and incorporates the Patient Experience Vision, Values and Behaviours expected of each individual.

The Trust has implemented a learning management system which incorporates competencies. This will support both Managers and staff in understanding competency requirements and the monitoring of them. The numbers of courses offered to staff to ensure they are competent and confident in undertaking the work that is expected of them has increased.

Medical Education

Work is currently underway with Consultant Educational Supervisors to ensure they are fully trained in supporting junior doctors within the Trust. This programme is being led by the Postgraduate Tutor and Medical Education Manager, with the support of the Mersey Deanery.

The Skills Pledge

The Trust fully maintains its commitment to support all staff in Bands 1 – 4 in achieving a minimum level 2 qualification (equivalent to 5 GCSE’s, grade C and above), as identified through the signing of the skills pledge. A key objective of the Trust is to ensure all staff are treated equitably. A common barrier to some staff accessing learning and development is a fear of being assessed against their numeracy and literacy abilities. The Trust overcame this barrier by adopting a whole hospital approach in encouraging all staff, from the Chief Executive to frontline staff to take the skills challenge. This removed the stigma and staff felt more confident in applying for learning and development opportunities. The ‘Test the Trust’ approach saw LHCH identified as an exemplar hospital in its approach to supporting staff by the Joint Investment Framework.

Apprenticeships

The impact of this approach has resulted in the significant achievement of recruiting over 100 staff to an apprenticeship programme in a variety of settings including health, business administration and customer services, supervisory management, ancillary support services and estates management. In relation to the size of the workforce, we are now the largest recruiter of apprenticeships within the NHS in England and continue to build on this success. Core components of all branches of the apprenticeship programmes include Employee Rights and Responsibilities and Equality and Diversity.

It is never too late to undertake further professional development and we encourage all out staff to take up opportunities for personal and professional development. For example, one of our employees has just enrolled on an 16 apprenticeship to support her new role as Pulmonary Function Assistant and her story has been featured as best practice in a recent event facilitated by NHS Employers:

Having worked in the NHS for fifteen years I joined LHCH in 2004. As a working Mum I had chosen to have a family instead of an education. Then I began to think about my own personal development but I wasn’t sure what I wanted to do or what I was capable of. As the years flew by and I got older I thought it would never happen to me. However, I went for interview and found out it was an apprenticeship and was offered the opportunity. I now feel like a totally new person and have much more confidence in myself. For this I have to thank my manager and the rest of the pulmonary function team for believing in me and giving me a chance. This has opened many doors for me. My manager and I have discussed my plans for when I complete my apprenticeship and this will involve enrolling me onto the assistant practitioner course. I now feel that instead of just having a job I have a career.

Other Accredited Courses

The Trust maintains close links with its partner Higher Education Institutes (HEIs). All staff enrolling onto modules or programmes are offered additional study support. If there is a previously diagnosed or potential learning need a robust assessment process is available within the Learning Support Units of the Universities from the student Inclusion and Diversity Officers. Examples of support provided include one-to-one tuition, extended examination and assessment times, adapted reading, adaptations for dyslexia and E-learning resources.

Equality Impact Assessment and Equality Analysis

Equality impact assessment (EIA) was a legal requirement under the previous public sector duties and the aim of the process was to assess policies, procedures, provisions, functions and strategies to ensure that no equality group or groups were suffering a detriment or adverse impact and that any differential in provision was intended and legal.

With the introduction of the Equality Duty from 6 April 2011 EIA has now been replaced by equality analysis (EA). This places more emphasis on the monitoring and review of the impact of policies13 on groups and individuals rather than on the often “one off” process of filling in a set of paperwork:

“Equality analysis starts prior to policy development or at the early stages of a review. It is not a one off exercise, it is going to be cyclical and it enables equality considerations to be taken into account before a decision is made.”14

13 “Policies” includes all policies, procedures, provisions, functions and strategies. 14 Equality Analysis and the Equality Duty: A guide for public authorities – England and non- devolved bodies in Scotland and Wales Equality and Human Rights Commission 2011 17

Over the last three years the EIA programme has been enhanced and regularly updated in the light of evaluation and changing case law to take into account new requirements. The documentation has also had some alterations in the light of feedback from participants. This will now be further enhanced to meet the needs of equality analysis.

Currently, the need to make equality and diversity considerations explicit is covered in both the EIA and the Equality Diversity & Human Rights workshops. All strategies, functions, policies and procedures which impact on employees and service users are equality impact assessed to ensure that they are free from bias and discrimination. Training has been delivered to 55 key staff with responsibility for writing policies. All EIA’s are published on both the website and the equality and diversity section of the intranet. This is regularly updated.

A newly updated training programme that recognises the list of “protected characteristics” identified in the Equality Act is now in place. As indicated above a review of the EIA paperwork within the context of EA will take place and training sessions will then be arranged. The purpose of these will be to train new managers in equality analysis and update those already involved in the EIA process.

The main purpose of EA is to consider the protected characteristics in relation to all functions with the following exceptions.

 In relation to marriage and civil partnership, the analysis applies only to the elimination of discrimination.  The duty does not apply to age discrimination in education and service provision in schools or in relation to children’s homes.

EA must be done by the people developing the policy and they must have the necessary skills, understand their responsibilities and know where to source data. These issues will be addressed within the training.

This SES will also undergo an equality analysis once complete, although we ensured that we were meeting all requirements of EIA as we worked through the development process. As indicated earlier, we are aware that in the future there will be a requirement to produce a plan that identifies equality objectives, measures of success and monitoring arrangements by April 2012. Our action plan that relates to this scheme is already grounded on that approach and we see no problem in moving through the transition.

Risk assessments have to take into account and address equality and diversity considerations. The Health and Safety Executive has developed clear guidance to help managers. The guidance includes assessing for a reasonable adjustment on grounds of disability and the issues to consider for new and expectant mothers. This guidance is flagged up on the intranet and during training15.

15 www.hse.gov.uk/diversity/index.htm

EIA considerations have been considered at every stage of development with regard to this Single Equality Scheme. A complete EIA will be available and will be found on the website and the EDHR section of intranet on completion of the consultation. This will be regularly updated and will include information and guidance on changes to EDHR together with minutes of the Equality and Diversity Steering Group.

6. Patient Engagement, Involvement, Consultation and Experience

We are required by law to engage and consult with a wide range of individuals and groups regarding the design and delivery of our services. The Trust strongly supports the involvement of our Foundation Trust members, patients, their relatives, carers and the general public in the continued improvement and development of the hospital and the services we provide. Our aim is to ensure that their views are taken into consideration on a regular and ongoing basis.

The Customer Care Team provides help and advice to patients, their relatives and carers. The team has a number of areas of responsibility within the Trust and these include complaints management, the production of patient information and supporting patients who require extra support including those with learning disabilities.

The enhancement of our Volunteer Service provides an opportunity to maximise the resource and resultant benefits to patients that may be accrued by aligning voluntary work to delivery of the patient vision. Volunteers who are appropriately selected and adequately trained can provide an invaluable contribution to the patient experience and a useful resource to paid staff. This well managed and effective volunteering scheme will potentially provide social benefits through the provision of pathways into paid work. Patients and relatives can inform the Trust of their views by completing one of the ‘Comments, Concerns & Compliments Cards’ – these are available in alternative formats by request and are available throughout the Trust.

Patient and relatives are also encouraged to share their stories and experiences by a patient story. Each directorate is required to collate at least two stories per month and these are shared with staff to help embed organisational learning. For example, a mother and daughter who has Downs Syndrome, were very pleased with the treatment they received.

My daughter is 31 years old and was born with a VSD16 hole in her heart. We spent her childhood in various hospitals but it wasn’t until we moved to Liverpool from the South seven years ago that we were offered a coronary angiogram. When my daughter was due to be admitted I asked if I could sleep by her bed and this was accommodated. From the moment of coming into hospital we were put at ease by everybody from consultants to ward staff. My daughter and I are on our own and it can be very isolating. I’ll never forget the

16 VSD – Ventricular Septal Defect 19 staff and how they helped and supported us. They brought me calm and safety.

When we moved to the ward the nurses and cleaning staff were equally marvellous. My daughter said “I love it here”. Despite the pain and trauma she knew she was in safe, happy and professional hands. She is also a very fussy eater but she loved the food. She ate everything and I couldn’t believe it. The Customer Care team were lovely, caring and supportive, offering tissues and cups of coffee. I can’t thank you all enough.

Further examples of good practice regarding information exchange, implemented by the Customer Care team include:

 All discharge information is printed in-house so can be regularly reviewed and kept up to date on yellow paper (preferred colour for partially sighted people). All discharge information is available in large print.  All patient information is available in different formats upon request.  The team hold an electronic library of patient information in other languages.  Patient information for the most common procedures including cardiac surgery, lung surgery, cardiac rehabilitation, having a pacemaker fitted or box change, coronary angiogram and percutaneous coronary intervention is readily available in audio format.  The development of a ‘story board’ for patients with learning disabilities which can be adapted for patient’s individual needs when coming into hospital.  The “Hospital Passport” has been implemented across the Trust for patients with learning disabilities.  An easy-read Complaints and how to raise your concerns leaflet is available – and is currently being reviewed, updated and consulted on.

Best practice example:

The Hospital Passport is presented in easy read format with illustrative pictures and symbols and uses a traffic light system for each section. Red equates to “things you must know about me”; Amber to “things that are important to me”; Green to “My likes and dislikes”. The Red section addresses eating and drinking; pain; medication; sight and hearing; support needs; challenging behaviours; safety; and “how I usually am”. Amber includes important people; level of support; toileting; personal care; moving around and sleeping. There are options for including a photograph and additional information. The passport is returned to the individual on discharge.

Employees are also supported in a variety of ways to ensure that they are aware of the best ways to address the individual needs of patients with learning disabilities. For example:

 Awareness sessions held with staff in relation to the processes they should follow when a patient comes into the trust with a disability.  The Hospital Co-ordinators inter-hospital transfer check list includes specific question relating to learning disabilities. 20

 Staff have developed guidance, including a flow chart, for the nursing of patients who require extra support  Training for clinical staff is delivered by Hill Dickinson and there is an E-training package available on mental capacity  The Customer Care Manager has completed an action plan which considers the CQC assessment for provision of healthcare for patients. This outlines the requirements in “Healthcare for All” and addresses training and learning, data collection, involvement of family and carers, reasonable adjustments, planning and delivery of service and advocacy arrangements.  The Customer Care Team contacts patients who have specific needs prior to admission to establish what their requirements will be when they are admitted to hospital. These include patients with learning disabilities and children. The patient are given a tour of the area they will be in and meet staff before being admitted. The team works closely with the community health facilitators attached to the Primary Care Trusts.

7. Procurement

In general, the Trust is committed to helping improve the efficiency of contracted suppliers through sharing information on performance measurement. The criteria for measuring performance is agreed with the provider / contractor and formally documented and monitoring takes place through monthly contract review meetings. It is possible that measurement criteria, including those relating to EDHR, will develop during the term of the contract and this is monitored and documented following agreement with our suppliers.

Specifically, we see procurement being a very valuable tool through which the importance of EDHR can be promoted to our providers. Our updated tender process is about to go through the equality analysis process and the opportunity has been taken to engage and consult with interested parties and make certain requirements relating to EDHR explicit.

For example, The Trust began a tender process in April 2009 for Patient Catering Services under the EU Procurement Regulations Restricted Procedure. Because this contract of necessity involved a tendering exercise it was clear that we had a responsibility to ensure that the provider we finally contracted with was compliant in both their practices as an employer and in the programmes that they deliver. Accordingly, the tender documents issued required bidders to provide written evidence of a commitment to Equality and Diversity and included the following statement:

Equality and Diversity

The successful Tenderer’s staff must at all times act in accordance with the principles outlined in the Trust’s Single Equality and Human Rights Scheme and without limitation have an obligation to eliminate unlawful discrimination and to promote equality of opportunity and encourage good relations between persons of different groups encompassing all requirements of UK Equality legislation and must:

 Have a written commitment to equality and diversity.

 Have in place a comprehensive Equality and Diversity (Equal opportunities) policy covering race, disability, gender, sexual orientation, age and religion and belief.

 Take action to monitor the representation of its staff from an equality opportunities perspective in relation to race, disability, gender, sexual orientation, age and religion and belief and report this on an annual basis.

 Demonstrate that recruitment practice and procedures are non- discriminatory and where there is evidence of under representation of any group in the staff profile in comparison to the population from which you normally recruit demonstrate a commitment to take action to recruit a workforce which year on year more closely resembles the make-up of the local population.

 Have attained the “Two Ticks” positive about disabled people accreditation with Job Centre Plus and renew this on an annual basis.

 Put in place mandatory equality and diversity training for all staff that meets minimum legislative requirements (equivalent of Tier 1 on Virtual Learning Environment) and provide evidence of the number of staff that have completed this on an annual basis.

 Monitor: recruitment and selection; staff that lodge grievances; are subjected to disciplinaries and capability; and leave; from an equality perspective and take action to address any evidence of discrimination.

 Include duties related to equality and diversity in the job descriptions of all staff.

 Co-operate with any investigation or proceedings concerning alleged contravention of equality legislation in performing the contract.

 Impose the above obligations on any sub-contractor

We also addressed issues of equality and diversity within the specification for the services by setting out explicitly what was required in terms of: induction and training packages, descriptions/terms and conditions for all grades of staff including management and general nutritional and dietetic requirements.

The process had EDHR issues threaded throughout including:

The specification was compiled by various stakeholders including the Matrons group, which has patient representation and informed by visits to potential suppliers to review the quality of new technology available. At the end of the engagement process the stated objective of the service was to provide a high quality meal and beverage service to patients, meeting their dietary, personal and cultural needs. 22

Following receipt of written tenders the evaluation team (comprising a cross- section of stakeholders including patient representative input) evaluated the proposals using the weighting criteria published in the official “Invitation to Tender Documentation”.

The dietetic requirements specifically included references to therapeutic diets, high protein high calorie diets, diabetic diets, cystic fibrosis diets, renal diets, gluten free diets, low residue diets and religious, cultural and ethical requirements. This approach resulting in the provision of meals tailored to patients’ needs rather than being based solely on what potential suppliers chose to offer.

The Trust also required the successful Contractor to involve patients and patient representatives in menu planning, surveying patients, food tasting sessions and other aspects of service provision.

The contract review meetings are now being used as a mechanism to monitor, review and manage all aspects of the contract and to emphasis the ongoing responsibilities for equality and diversity of both the Trust and the Contractor.

We are also aware of the need to differentiate between requirements for small and larger suppliers. Our aim is make the EDHR requirements explicit for each whilst ensuring that our approach is fit for purpose. This means avoiding a “one size fits all” approach whilst still ensuring that the Trusts commitment to EDHR is reflected in all our providers practice, whatever the size.

8. Legal Context

The Equality Act and Duties

The Equality Act 2010 is designed to bring together a number of separate pieces of legislation in order to achieve a more streamlined and efficient approach to the area of equality rights and responsibilities. It includes the following provisions:

 “Protected characteristics” are – age; disability; gender re-assignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation.  Definitions of discrimination change - The current “on the grounds of” will be replaced by “because” and “indirect discrimination” will apply across all strands.  Employers are restricted in relation to asking job applicants about health and disability before making an offer of employment.  A single objective “justification” test replaces the current tests for disability and the current list of capacities us removed.  The definition of harassment is extended to cover harassment based on “perception” and “association” and will cover employer liability for 3rd party sexual harassment for all grounds.

 Clauses in employment contracts which impose secrecy obligations regarding employee pay packages are outlawed.  Greater transparency is e.g. public sector organisations will have to report of their disability employment rate and tackle discriminations through the procurement function.  Gives effect to European law by outlawing discrimination by association.  The prohibition of allowing civil partnerships to take place in religious premises is removed.17  Women will be allowed to breast feed in public.  Tribunals will be able to make recommendations that benefit other employees.

The majority of the above provisions came into force on 1 October 2010. However, the Equality Duty is active from 6 April 2011. The main purpose of this is to integrate the current public sector duties into one duty and extend the scope from race, disability and gender to include age, gender re-assignment, sexual orientation, religion or belief, marriage and civil partnership, pregnancy and maternity.

There are two aspects of the duty – general and specific. The general duty applies to all Schedule 19 listed bodies e.g. health bodies, police and transport authorities, government departments. Other organisations that carry our public functions are also covered by the general duty e.g. voluntary sector or private bodies that carry out public functions. There are a few exceptions.

Those covered by the general duty must in the exercise of their functions have regard to the 3 “aims” or “arms” of the duty:

 Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the act (i.e. removing or minimising disadvantage suffered by people due to their protected characteristics)  Advance equality of opportunity between people who share a protected characteristic and those who do not (i.e. taking different steps to meet the needs of people from protected groups (PGs) where these are different from the needs of other people)  Foster good relations between people who share a protected characteristic and those who do not (i.e. encouraging people from PGs to participate in public life or in other activities where their participation is disproportionately low.)

The specific duties apply to virtually all bodies listed in Schedule 19 and require the listed body to:

 Publish sufficient information to demonstrate compliance with the general duty across all functions including: information on the effect that its policies and practices have had on people who share relevant

17 Implementation date still to be decided 24

PCs, to demonstrate the extent to which it furthered the aims of the general duty for employees and for others with an interest in its functions. (Public authorities with fewer than 150 employees are exempt form the employee provision)  All public authorities must publish: evidence of analysis that they have undertaken; details of the information considered; details of engagement they undertook; prepare and publish equality objectives that must meet one or more aims of the general duty.18  The published information must also be considered before preparing objectives that are specific and measurable; how progress will be measured must be stated. Information on objectives must be published at least every 4 years in an accessible format either separately or as part of another document. Progress must be reported on annually and it is recommended that this is done incrementally throughout the year.

Human Rights Act 1998

The Human Rights Act (HRA) has come into prominence of late and this increased profile has been aided by the work of the Equality and Human Rights Commission (EHRC). The HRA makes it unlawful for a public authority to breach the European Convention of Human Rights, unless an Act of Parliament allows a different course of action. The HRA is a complex piece of legislation and the following articles have been selected on the basis of their particular relevance to the SES:

Article 2 (Right to Life) gives the person an absolute right to have their life protected by law, apart from in very limited circumstances.

Article 3 (Inhuman Treatment) protects a person from being subjected to torture, inhuman or degrading treatment or punishment.

Article 9 (Freedom of Conscience) gives a person the rights to freedom of thought, conscience and religion, either alone or in a community with others. It allows a person to follow their religion or belief in worship, teaching, practice and observance subject to the interests of public safety, public order, health or morals, or for the protection of the rights and freedoms of others.

Article 10 (Freedom of Expression) gives an individual the right to hold opinions and express views as an individual or in a group. The right can be restricted in specified circumstances.

Article 14 (Prohibition of Discrimination) gives an individual the right not to be treated differently because of race, religion, sex, political views or any other status unless this can be justified objectively. Everyone must have equal access to Convention rights, whatever their status.

This does allow for differential treatment for positive reasons, for example when making a reasonable adjustment to take account of a disability. The Court of Appeal has also ruled that people with mental health conditions

18 First date for compliance 6 April 2012 25 detained under the Mental Health Act should be afforded the same protection as others under Article 1419.

9. Single Equality Scheme Context

Currently, there are significant changes taking place within the context of healthcare and wellbeing. The government white paper “Equality and Excellence – Liberating the NHS” when fully implemented will have major implications for the way that services are delivered, in particular those that are focused on primary care. There are commitments contained in the white paper that underpin implementation of the integrated equality duty:

 NHS Commissioning Board – “will play it’s full part in promoting equality in line with the Equality Act” and will champion patient and public involvement

 3.10 NHS Commissioning Board – will work with clinicians, patients and public: “The framework and its constituent indicators will enable international comparisons whenever possible and reflect the Board’s duties to promote equality and tackle inequalities in health outcomes.”

The new GP consortiums are specifically mentioned as being covered by the legislation in the current consultation paper regarding the new equality duty20. These changes will inevitably have an impact on acute and specialist trusts.

Within this climate of change we intend to continue to offer a first class service to all our service users and their carers. This includes supporting our staff by ensuring that they are well informed about issues of equality and diversity and feel confident in addressing and meeting a range of diverse needs.

Our last scheme linked to the standards of the Healthcare Commission. That body has now been replaced by the Care Quality Commission (CQC) and the CQC has been working with the Equality and Human Rights Commission to produce guidance for inspectors and assessors. The main aim of the guidance, created with the help of the “Voices for Equality and Human Rights Group” is to help inspectors and assessors judge whether providers are meeting the required standards relating to equality, diversity and human rights.

The CQC’s approach to equality is described as follows:

“The Care Quality Commission has adopted a ‘social model’ approach to equality. This means that we view equality as being about removing barriers faced by people from different groups, so that they can achieve equal outcomes. These barriers may be caused by negative attitudes, or lack of access or support. While the social model was originally developed in relation to disability, it is also applicable to other equality characteristics such as race, gender and sexual orientation.

19 N & G v Secretary of State for Health & Nottingham Healthcare Trust 20 Equality Act 2010: the public sector Equality Duty – promoting equality through transparency – a consultation Government Equalities Office Page 24 26

Using a ‘social model’ approach to checking compliance means that you are looking for evidence that the provider is addressing barriers to equality, whether these are:

 access barriers such as access to buildings or information  barriers caused by attitudes or behaviour of staff, and  assistance barriers, such as the provision of interpreters.”21

We recognise that the ways that we deal with our staff and deliver our services need to take into account that these may impact on individuals and groups differently. Health conditions can affect individuals from different groups in different ways and with regard to the protected characteristics of the Equality Act we can cite a number of examples of best practice that have been put in place and helped us to address specific needs. The Trust is aware that it needs to explore if there is a need for staff groups to be set up that are based in different areas of interest or need. This is identified in the SES Action Plan as an exercise that will be undertaken during the first year of implementation.

Meeting needs through adjustments

Adjustments are made for both staff and patients in a variety of contexts. For example, religion and belief are important considerations when caring for someone and a patient who is a committed vegetarian or vegan for example, is able to have their dietary needs met. The current menu offers 22 choices and work is being undertaken to develop more choices for specialist diets, although it is already possible to cater for any diet. Staff work with patients to identify what they usually eat, produce is locally sourced and grown and there is a chef on site. Pureed meals are also available for people who have difficulty swallowing.

The Trust supports people who have different religious beliefs via the chaplaincy team that comprises representatives of the Church of England and Roman Catholic Churches. Employees and service users can access the Hospital Chapel and Multi-faith Prayer Room and, if a patient need support or services from other religious or belief groups contact information can be accessed at any time of the day or night from the main switchboard.

The chaplaincy team works as part of the overall healthcare team, seeking to create a healing environment in which individual needs can be recognised, valued and safeguarded. Recently, a Muslim patient wished to wash in running water for religious reasons, although he was unable to leave his bed. The situation was addressed, in negotiation with the patient, by using a jug and bowl to achieve the effect of running water.

With regard to disability a number of examples of best practice with regard to patients can be found earlier in this document. Many adjustments have also been made for staff and these include a range of adaptations including

21 Equality and human rights in the essential standards of quality and safety – overview guidance for assessors and inspectors on the care Quality Commission Essential Standards – Draft for consultation EHRC & CQC November 2010 27 developing flexible working patterns and phased returns to work. Currently we are also ensuring that training materials are printed on coloured paper to meet the needs of a member of staff who has dyslexia.

The Trust has found that adjustments can be planned for and achieved over a period of time. Sometimes this can result in a change of job role as illustrated by the following example.

In 2007a nurse trapped her hand against a wheelie bin and a door when she was on duty. She was later diagnosed with Complex Regional Pain Syndrome (CRPS) resulting in her having to take significant time off work. The condition severely restricts movement of the affected hand and wrist and she has to wear a pressure glove. Symptoms also include the affected limb becoming extremely sensitive to touch and changes in temperature.

At first there was some confusion regarding what her sick pay entitlement was but this was resolved, along with identifying that she was eligible for the Temporary Injury Allowance (an NHS scheme which pays employees 80% of their salary whilst on sick leave if they are injured in the course of their normal work).

On her return to work she began to see how she could cope in the ward environment for a trial period. However, it was identified that there were a number of activities that she was unable to do such as making beds, preparing IV infusions, dispensing medication and basic manual handling of patients. At this juncture a new management team, including the CEO, joined the Trust. The HR Team and Occupational Health were then encouraged to work in partnership to identify if another role could be found for her.

They arranged for her to work within the Risk Management Team to undertake a variety of roles. These focused on patient safety and quality and included data collection for auditing purposes. This also involved a move of office from a building that was subjected to extremes of temperature at times, to an office that is less susceptible to temperature fluctuations. Other adjustments include the installation of voice recognition software and specially adapted arm rests.

Two and a half years on she is now being supported by the Trust to undertake health and safety training in order to fulfil the role of Health and Safety Advisor within the Trust, for which there is a vacancy.

Co-operation and collaboration

A number of our staff are members of the LGBT Staff Network, a group that mainly consists of Merseyside NHS Trusts and the Armistead Group22, and that is a sub group of the North West NHS LGBT group. The group meets monthly to discuss LGBT issues in the NHS and the wider community. Any issues raised go through the group secretary and group members communicate feedback directly through him. Group meetings usually have an

22 http://www.armisteadcentre.co.uk/services/ 28 external speaker that come in to discuss various topics e.g. a police officer to cover the topic of Hate Crime, and an advisor for those who have suffered domestic violence in LGBT relationships.

Members take part in community based events such as Pride and the group motto is “Pride in Health”. This was the aim of the activities in the summer of 2010 that consisted of a march and a stall that promoted health issues through a range of different information leaflets and resources. Information is fed back into our Trust, helps us keep abreast of developments and ensures that our practice reflects current issues whilst meeting individual needs. We also continue to refer to the Ten Point Action Plan23 drawn up in partnership by Stonewall and NHS Employers.

We have been working in close collaboration with Liverpool LINk24 which is a network of local people that promotes and supports the involvement of local people in the commissioning, provision and scrutiny of local health and social care services and which is “hosted” by Liverpool Charity and Voluntary Services. Liverpool LINk has formalised the appointment of volunteer Health and Social Care Ambassadors (HSCAS) who are to develop a positive relationship with trusts with a view to making useful contributions in a number of ways.

This relationship has already begun to be established with LHCH and a number of LINk members were invited on a fact finding “Enter and View” visit to the Trust. LINk members met with a range of staff including the CEO, clinical and administrative staff. A tour of the hospital took in the Outpatients Department, Consulting Room, Day Ward and Lounge, Admissions and Discharge Lounge and Ward E. A talk was also given on the catering arrangements.

Authorised LINk representatives were offered the opportunity to speak to patients during the visit and many positive comments were received25. A number of recommendations and observations were then made that were based on the visit. These included the need to share information regarding the availability of community based equipment on discharge, support for the introduction of a contact nurse to offer information and support throughout a patient’s journey, holding discussions with the NW Ambulance trust regarding discharge delays and making TV programmes more accessible via sub-titles and touch screen navigation. It was also agreed to arrange a follow up visit so that LINk can access information before making commentary on next years Quality Accounts26.

Positive action – meeting individual needs

Historically heart disease was thought of as a predominantly male disease but current statistics show that one in six women die from coronary heart disease and more women die from heart disease than breast cancer. Almost half the

23 Working with lesbian, gay or bisexual people – A ten point action plan – Stonewall and NHS Employers November 2007 24 LINk – Local Involvement Network 25 Stronger Local Voices for Health and Social Care – “Enter and View” visit- LHCH 2010 Page 13 for full details 26 Ibid Page 14 for full details 29 women who die each year do so from heart and blood vessel disease. Research has also demonstrated that women often display different symptoms to men when experiencing heart failure.

The Trust has worked hard to raise awareness about this through the “Red Dress” campaign. The original campaign was featured in the Guardian in 2004 as an example of best practice. It aimed to motivate women over the age of 18 to take their health seriously. It highlighted potential risks for women and offered advice regarding lifestyle changes. Activities included fundraising and the production of leaflets to raise awareness. We have subsequently built upon and developed this work and celebrate International Wear Red Day in February where we link with our international partners the National Heart Lung and Blood Institute, USA on a regular basis. Work will continue to develop this campaign further.

In addition to this, the Trust, in conjunction with Pfizer have signed up to a health awareness campaign aimed at women aged 40-70 living in the most deprived areas of Liverpool e.g. Knowsley, Bootle and Kirkdale/Everton to look after their heart. The campaign will focus on hairdressers within these areas urging women to look after their heart health. Research has shown women in this age bracket often do not see heart disease as a problem and see heart disease as a ‘man’s disease’ when in fact heart disease kills three times more women than breast cancer. This campaign aims to change this and to encourage women to look after themselves and to recognise the symptoms of heart disease.

With regard to meeting individual needs we have a number of patient experiences on record. Needs can span a very wide range of requirements and we make every effort to accommodate needs to ensure that patients feel listened to, safe and supported. For example:

In January 2010 a young 17 year old man from Sierra Leone, who spoke very little English, was admitted for a valve replacement. He was under the care of a foster parent, who was contacted by the Customer Care Manager to see if there was any support she could offer during the patient’s pending admission. This led to a meeting being set up, which involved all parties, and with the help of the interpreter the patient was asked about any fears he had. Information including the cardiac surgery book and cardiac rehabilitation was discussed, and an offer to have the information translated was also made. However, the patient was receiving English classes and he said that he preferred to use the English version because it would help him with both his English and understanding the operation. He was also given an audio version of the booklet which he said he would listen to whilst reading the booklet.

A tour of the hospital took place, with the support of the interpreter, and the patient was walked through the journey he would travel on admittance. This included the outpatient department where he would attend pre-admission and the surgical admissions ward. He was also taken to intensive care where he was met by a senior nurse who explained that he would be in a side room. He was then taken to a post operative surgical ward where he met nursing staff.

The foster parent explained that during the patients stay with us his visiting would be limited as he also looked after four other boys. The Customer Care 30

Team promised to visit the patient on to ensure he was receiving a visit and the patient also asked them to take him some chocolate!

The foster parent was very appreciative the service that had been provided pre-operatively. He had visited many hospitals with foster children/young adults and said that that he had never been offered such a personalised service before. The patients told the team that he found the booklet and CD helpful and six weeks after his discharge he called into the Customer Care Office. He was very pleased with how things had gone, and came to show his well-healed scar and say “hello”.

We have updated our handbook “Religion and Belief Needs of Patients” that has been developed by the Department of Spiritual Care. The guidance has been enhanced by taking into account new beliefs that are now recognised in law e.g. paganism and spiritualism and also taking into account the recognition that philosophical beliefs that are non-religious must also be recognised. The guidance addresses aspects of needs including end of life care and has a list of contacts for further guidance in addition to the support that is available within the Trust.

Engaging and Consulting

We engaged and consulted with the board, patients, staff, members and other stakeholders throughout the development of this SES. This included making it available on the intranet and website, e-mail communications and postal mailings to our members and a range of community groups.

Feedback has been helpful and actions that have resulted from this include reviewing the system for ensuring that patients who are hearing impaired have their needs met immediately on arrival and updating information on the advocacy arrangements available to Welsh patients.

Publicising and Reporting

We will regularly publicise and report on our progress against our commitments in the SES Action Plan. This will be done through our corporate reports, leaflets and other communication channels and partnership arrangements. We will continue to add to the list of individuals and organisations that we currently consult with.

The EDHR section of our website is one route by which we make our SES and related information available. Information is available in alternative formats and requests for translation into other languages can be met. Internal communication will be via the intranet, newsletter, briefing sessions, networks and groups.

10. Single Equality Scheme Action Plan 2011-2012 Draft priorities for the action plan formed part of this consultation. Progress achieved against this will inform and influence the evidenced based plans for forthcoming years.

Appendix 1 - The Liverpool Heart & Chest Hospital NHS Foundation Trust Committee Structure Council of Audit Governors Board of Directors Committee Remuneration Committee Charitable Fundraising Funds Committee Committee Robert Owen House Committee

Patient Experience Clinical Workforce Corporate Finance and Quality Readiness Performance

Appendix 2

Demographic profile of LHCH Workforce at March 2011

Liverpool % of Ethnic Origin Headcount as a Workforce whole A White - British 1167 84.69% 91.84%

B White - Irish 13 0.94% 1.22% C White - Any other White 30 2.18% 1.26% background D Mixed - White & Black 1 0.07% 0.53% Caribbean E Mixed - White & Black 3 0.22% 0.50% African F Mixed - White & Asian 3 0.22% 0.31% G Mixed - Any other mixed 7 0.51% 0.46% background H Asian or Asian British - 109 7.91% 0.43% Indian J Asian or Asian British - 5 0.36% 0.24% Pakistani L Any Other Asian 4 0.29% 0.30% Background M Black or Black British - 3 0.22% 0.25% Caribbean N Black or Black British - 8 0.58% 0.70% African P Any Other Black 2 0.15% 0.28% Background R Chinese 7 0.51% 1.17%

S Any Other Ethnic Group 7 0.51% 0.39%

Z Not Stated 9 0.65% 0.00%

Total 1378

Trust Liverpool as a whole

Female Male Female Male

74% 26% 52% 48%

Age Band under 21-30 31-40 41-50 51-60 61-70 71+ 20

Headcount 12 244 400 436 229 55 2

% of 1% 19% 29% 31% 17% 3% 0% Workforce

Staff Declaring Yes No Not declared themselves as disabled Headcount 42 750 586 % of workforce 3% 54% 43%

Sexual Gay Lesbian Bisexual Heterosexual Do not Undeclared Orientation wish to declare Headcount 5 3 5 793 117 455 % of 0.3% 0.2% 0.3% 57.5% 8.5% 33% workforce