NHS Greater Glasgow and Clyde Equality Impact Assessment Tool for Frontline Patient Services

Equality Impact Assessment is a legal requirement and may be used as evidence for cases referred for further investigation for legislative compliance issues. Please refer to the EQIA Guidance Document while completing this form. Please note that prior to starting an EQIA all Lead Reviewers are required to attend a Lead Reviewer training session. Please contact [email protected] for further details or call 0141 2014560/4967

Name of Current Service/Service Development/Service Redesign: Clinic P, Haematology Day Clinic, New Victoria Hospital, Regional Services Directorate, Acute Services Please tick box to indicate if this is a : Current Service X Service Development Service Redesign

Description of the service & rationale for selection for EQIA: (Please state if this is part of a Board-wide service or is locally determined). What does the service do? Clinic P is a Day Clinic, on the 2nd floor of the New Victoria Hospital, to provide Intravenous (IV) therapies for Oncology, Haematology and General Medicine (Rheumatology, Gastro and some Respiratory specialities). Clinic P also provides an outpatient haematology clinic. There are approximately 850 – 900 patients per month at this clinic that opens Monday – Friday 8am – 5 pm (core hours for patients is 8.30 – 4.30pm) The clinic also operates on public holidays apart from Christmas and New Years Day.

IV therapies can take anything from 30 minutes to 6 or 7 hours depending on the patient’s condition and specific need.

The Clinic works closely with Ward 24 at the Southern General Hospital which is for haematology patients.

Oncology patients will be diagnosed at another service area but may be referred for treatment by their oncologist. General Medical patients may have had some other form of treatment elsewhere in the NHS and this may have failed or they are referred for treatment to reduce their symptoms.

Patients who attend Nelson Mandela Place for Breast Screening, that receive a positive result re referred to the New Victoria Hospital. This means that these patients can be from the Lanarkshire area.

There is:  a reception and waiting area for 20 people  3 large treatment rooms (1x4 beds/chairs,1x6 beds/chairs and 1x9 beds/chairs )  7 single rooms with ensuite facilities  3 consulting rooms  2 rooms for doing patient’s dressings.

The service is for those age 16 and above with a dominant age range of 50-80.

There are several Nurse Specialists that work closely with the Clinic and the Clinic also has its own pharmacists to ensure that treatments are accurately prepared.

The Clinic also have introduced volunteers to assist with non nursing tasks, e.g. befriending patients.

Why was this service selected for EQIA? Where does it link to Development Plan priorities? (if no link, please provide evidence of proportionality, relevance, potential legal risk etc.) The Directorate Management Team selected this Clinic at random.

Who is the lead reviewer and when did they attend Lead reviewer Training? (Please note the lead reviewer must be someone in a position to authorise any actions identified as a result of the EQIA) Name: Date of Lead Reviewer Training: Laura Meehan, Senior Nurse, Haematology N/A

Please list the staff involved in carrying out this EQIA (where non-NHS staff are involved e.g. third sector reps or patients, please record their organisation or reason for inclusion): Healthcare worker; Senior Charge Nurse; Senior Admin Assistant; Staff Nurse; Deputy Staff Nurse; Senior Nurse; Quality Co-ordinator; Equality and Diversity Assistant.

Lead Reviewer Questions Example of Evidence Required Service Evidence Provided Additional Requirements (please use additional sheet where required) 1. What equalities information is Age, Sex, Race, Sexual Orientation, The Trakcare patient management Devise a plan to analyse routinely collected from people Disability, Gender Reassignment, - system routinely collects information equality data. using the service? Are there any Faith, Socio-economic status data on age, gender and postcode. barriers to collecting this data? collected on service users to. Can TrakCare can also record be used to analyse DNAs, access requirements for interpreter and issues etc. preferred language.

2. Can you provide evidence of how A Smoke Free service reviewed Not applicable. the equalities information you service user data and realised that collect is used and give details of there was limited participation of any changes that have taken place men. Further engagement was as a result? undertaken and a gender-focused promotion designed. 3. Have you applied any learning from Cancer services used information The Clinic conducts Situation, research about the experience of from patient experience research Background, Assessment and equality groups with regard to and a cancer literature review to Recommendations (SBAR) to help removing potential barriers? This improve access and remove health care workers standardise may be work previously carried out potential barriers from the patient communication. The goal of SBAR is in the service. pathway. to ensure the use of clear and concise communication of clinical information. Thus improving patient safety and clinical outcomes.

The Clinic won the Patient Centred Care Chairman’s Award. This award recognised that the staff tailor care to suit the needs of their patients.

The patient survey highlighted that patients receiving chemotherapy would like to visit the Clinic before commencing their treatment. Patients now have this opportunity.

4. Can you give details of how you Patient satisfaction surveys with The team work closely with Clinical Include an equalities have engaged with equality groups equality and diversity monitoring Effectiveness teams and the monitoring form with future to get a better understanding of forms have been used to make Research Practitioner at the Beatson patient experience surveys. needs? changes to service provision. West Of Scotland Cancer Centre (BWOSCC) on patient experience surveys. The most recent patient experience survey highlighted that patients would like more information on transport links to the hospital, and chemotherapy patients would like to see the Clinic before they commence chemotherapy. A development of this is the production of an information leaflet for Clinic P.

5. Is your service physically An outpatient clinic has installed There are several transport links at accessible to everyone? Are there loop systems and trained staff on the New Victoria Hospital – there are potential barriers that need to be their use. In addition, a review of a number of buses that stop outside addressed? signage has been undertaken with the hospital and a train station which clearer directional information now has a lift from the platform to ground provided. level and a ramp for train access. The train station also has signs to the hospital. There are disabled car parking spaces available in both the overground and underground car parks. There is a drop off point outside the main entrance to the hospital and at the rear entrance to the hospital. There are automatic doors at the main entrance to the hospital. There is a ‘meet and greet’ service at the main entrance, whereby volunteers can direct patients to the appropriate clinics. At the reception desk, at the main entrance, patients can request a wheelchair to take them to the clinic. There are lifts which have tactile buttons and voice announcers. The Clinic has a lowered reception desk.

6. How does the service ensure the A podiatry service has reviewed all Organise a portable loop for way it communicates with service written information and included The reception desk in the Clinic has a use in the treatment or users removes any potential prompts for receiving information in fixed loop system. consultation rooms. barriers? other languages or formats. The service has reviewed its process for Staff are aware of how to book Obtain a code for telephone booking interpreters and has interpreters and other forms of interpreting from briefed all staff on NHSGGC’s communication support. NHSGG&C’s Interpreting Interpreting Protocol. Service and a cordless Patient information is quality assured phone. to ensure it is patient friendly and complies with NHSGG&C’s Accessible Information Policy.

Appointment letters are generated by the Trakcare patient management system and comply with NHSGG&C’s Accessible Information Policy.

There is a display Clinic which contains information for patients about conditions and treatments etc.

Chemotherapy patients are given a ‘red book’ which contains information about their treatment; their consultant’s contact details; contact details for the clinic etc. If patients need to attend hospital, they can take this book with them and show it to the medical staff.

The Clinic has used NHSGG&C’s Interpreting Service to contact a patient who was not responding to appointment letters. 7. Equality groups may experience barriers when trying to access services. The Equality Act 2010 places a legal duty on Public bodies to evidence how these barriers are removed. What specifically has happened to ensure the needs of equality groups have been taken into consideration in relation to:

(a) Sex A sexual health hub reviewed sex There are some single rooms disaggregated data and realised available. very few young men were attending To give patients some privacy, there clinics. They have launched a local are curtains around the beds/chairs. promotion targeting young men and There are door screens on the glass will be analysing data to test if panels to the single rooms to ensure successful. privacy, even although patients do not need to undress for their treatment.

The staff in the Clinic are predominantly female; however staff would try to accommodate requests for a same sex health professional.

Staff would ask patients if they would prefer a same sex interpreter.

Patients have never disclosed any domestic violence issues, however, if they did, staff would signpost them to the appropriate agencies.

(b) Gender Reassignment An inpatient receiving ward held Staff are aware that there is a sessions with staff using the NHSGG&C Transgender Policy. NHSGGC Transgender Policy. Staff are now aware of legal protection Staff would ask the patient how they and appropriate ways to delivering wish to be addressed and would inpatient care including use of respect the patient’s chosen identity. language and technical aspects of recording patient information. (c) Age A urology clinic analysed their sex Staff have completed the on-line specific data and realised that Child Protection and Adult Protection young men represented a Training modules. significant number of DNAs. Text message reminders were used to Staff can refer patients to the prompt attendance and Teenage Cancer Clinic at the appointment letters highlighted Beatson if they prefer. potential clinical complications of non-attendance. Patients are welcome to bring a relative or friend with them to the Clinic.

If there were any issues with older patients, staff could refer them to the Day Hospital e.g. Falls Team etc.

If staff are concerned about how a patient is managing at home, they would liaise with the District Nurses. (d) Race An outpatient clinic reviewed its Staff are aware of how to organise The information leaflet for ethnicity data capture and realised foreign language interpreters. The Clinic P is to be translated that it was not providing Clinic also have a language id card to into the top 5 languages. information in other languages. It identify which language the patient provided a prompt on all speaks. Information will be provided information for patients to request in other languages upon copies in other languages. The Staff have encountered racist request. clinic also realised that it was behaviour from patients towards other dependant on friends and family members of staff. This behaviour interpreting and reviewed use of was challenged. Any future incidents interpreting services to ensure this will be recorded in Datix. was provided for all appropriate appointments. Some of the information leaflets supplied by Charities and external organisations are available in other languages.

(e) Sexual Orientation A community service reviewed its Staff are aware of the Civil information forms and realised that Partnership Act. it asked whether someone was single or ‘married’. This was Staff are aware of the importance of amended to take civil partnerships using appropriate terminology e.g. the into account. Staff were briefed on term ‘partner’ rather than husband or appropriate language and the risk of wife. making assumptions about sexual orientation in service provision. If staff encountered any homophobic Training was also provided on incidents, staff would challenge this dealing with homophobic incidents. behaviour and record the incident in the DATIX system.

(f) Disability A receptionist reported he wasn’t The Clinic has a lowered reception Some internal doors are confident when dealing with deaf desk for patients who may have a quite heavy to open. The people coming into the service. A wheelchair. site is currently awaiting review was undertaken and a loop The Clinic can accommodate additional work to hold the system put in place. At the same wheelchair users and there are hoists doors open. time a review of interpreting available. arrangements was made using Staff meet the patients at the NHSGGC’s Interpreting Protocol to reception desk in the Clinic and ensure staff understood how to escort them to the consultation book BSL interpreters. rooms. The single rooms all have en-suite accessible toilets, and there are an additional two accessible toilets in the Clinic. There are a variety of chairs available for patients who have mobility issues. Staff would contact NHGG&C Interpreting Service to arrange a British Sign Language interpreter or other forms of communication support. Staff have printed information in a large font size for patients with eyesight problems. For patients with learning disabilities, staff would liaise with family/carer if required. For patients with mental health issues, staff can liaise with their Community Psychiatric Nurse (CPN). There can be delays with the Patient Transport Service and patients can get agitated if they are late for their appointment. However, staff will ensure that the patients still get their treatment. Any issues are recorded in the datix system.

(g) Religion and Belief An inpatient ward was briefed on Staff can signpost patients to the NHSGGC’s Spiritual Care Manual Sanctuary on the ground floor of the and was able to provide more hospital. sensitive care for patients with regard to storage of faith-based Staff can contact the Chaplaincy items (Qurans etc.) and provision Team if they have any queries. for bathing. A quiet room was made available for prayer. The Faith and Belief Communities Manual is available on staffnet.

The Clinic provides sandwiches and yogurts, and there is always a vegetarian option. If these are unsuitable staff can contact the Catering Department, or patients may bring their own snacks.

There have been queries about the content of medication and staff have contacted Medicines Information for advice. Medicines Information provided a comprehensive report.

Staff are aware that Jehovah Witnesses will have a form saying that they refuse any form of blood products.

Staff gave an example, of a patient who wore a burkha. It is imperative that staff can monitor if a patient has a reaction to their treatment e.g. a rash. The staff explained this to the patient and after discussion they agreed to remove this.

(h) Pregnancy and Maternity A reception area had made a room Staff would liaise with colleagues available to breast feeding mothers from maternity services as and when and had directed any mothers to required. this facility. Breast feeding is now actively promoted in the waiting area, though mothers can opt to use the separate room if preferred. (i) Socio – Economic Status A staff development day identified Staff can sign post patients to the negative stereotyping of working Cashier’s office. Staff have not had class patients by some practitioners any complaints about the location of characterising them as taking up the Cashier’s office which is in the too much time. Training was Victoria Infirmary. organised for all staff on social class discrimination and Staff can signpost patients to the understanding how the impact this Patient Information Centre (PIC) can have on health. which is located on the ground floor of the hospital. There is also a MacMillan Money Advice Service at the PIC.

(j) Other marginalised groups – A health visiting service adopted a Staff can signpost patients to the Homelessness, prisoners and ex- hand-held patient record for Patient Information Centre (PIC) offenders, ex-service personnel, travellers to allow continuation of which is located on the ground floor people with addictions, asylum services across various Health of the hospital. PIC staff can advise seekers & refugees, travellers Board Areas. people on how to access information on a wide range of topics including: Money Advice; Support for carers and young carers; help with literacy; Lifestyle issues: smoking, healthy eating & weight management, alcohol, physical activity, stress.

There is a protocol in place for dealing with patients in the criminal justice system.

For patients with addictions, the staff can contact/signpost to the Addictions Team.

Staff can signpost patients to the Homeless Team.

9. Has the service had to make any Proposed budget savings were As with all departments costs saving cost savings or are any planned? analysed using the Equality and exercises are being implemented but What steps have you taken to Human Rights Budget Fairness it is not anticipated that these will ensure this doesn’t impact Tool. The analysis was recorded discriminate against any of the disproportionately on equalities and kept on file and potential risk equality groups. groups? areas raised with senior managers for action.

10. What investment has been made for A review of staff KSFs and PDPs There is a rolling learning and staff to help prevent discrimination showed a small take up of E- education programme with the priority and unfair treatment? learning modules. Staff were given being statutory and mandatory dedicated time to complete on line training. learning. All staff have E-KSF’s and have regular PDP reviews.

Staff have undertaken the on-line equality and diversity module.

If you believe your service is doing something that ‘stands out’ as an example of good practice – for instance you are routinely collecting patient data on sexual orientation, faith etc. - please use the box below to describe the activity and the benefits this has brought to the service. This information will help others consider opportunities for developments in their own services.

Actions – from the additional requirements boxes completed above, please summarise the actions this service Date for Who is will be taking forward. completion responsible?(initials)

Devise a plan for equality data to be analysed. Liaise with Trakcare team re data Include an equalities monitoring form with patient experience surveys. collection - Natasha Brown 6/12 Organise a portable loop for the consultation rooms. Now in situ Obtain a code for telephone interpreting from NHSGG&C’s Interpreting Service and a cordless Now obtained phone. Translate the information leaflet for Clinic P into the top 5 languages. At final stages- Natasha Brown - 3/12 Ensure that information is provided in other languages and formats upon request.

Ongoing 6 Monthly Review please write your 6 monthly EQIA review date:

July 2014

Lead Reviewer: Name Laura Meehan EQIA Sign Off: Job Title Clinical Haematology Lead Nurse Signature Date 06/02/2014

Quality Assurance Sign Off: Name Alastair Low Job Title Planning and Development Manager Signature Date 11th February 2014

Please email a copy of the completed EQIA form to [email protected], or send a copy to Corporate Inequalities Team, NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospital, 1055 Great Western Road, G12 0XH. Tel: 0141-201-4560/4967. The completed EQIA will be subject to a Quality Assurance process and the results returned to the Lead Reviewer within 3 weeks of receipt. PLEASE NOTE – YOUR EQIA WILL BE RETURNED TO YOU IN 6 MONTHS TO COMPLETE THE ATTACHED REVIEW SHEET (BELOW). IF YOUR ACTIONS CAN BE COMPLETED BEFORE THIS DATE, PLEASE COMPLETE THE ATTACHED SHEET AND RETURN AT YOUR EARLIEST CONVENIENCE TO: [email protected] NHS GREATER GLASGOW AND CLYDE EQUALITY IMPACT ASSESSMENT TOOL MEETING THE NEEDS OF DIVERSE COMMCLINICIES 6 MONTHLY REVIEW SHEET

Name of Policy/Current Service/Service Development/Service Redesign:

Please detail activity undertaken with regard to actions highlighted in the original EQIA for this Service/Policy Completed Date Initials Action: Status: Action: Status: Action: Status: Action: Status:

Please detail any outstanding activity with regard to required actions highlighted in the original EQIA process for this Service/Policy and reason for non-completion To be Completed by Date Initials Action: Reason: Action: Reason:

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Please detail any new actions required since completing the original EQIA and reasons: To be completed by Date Initials Action: Reason: Action: Reason:

Please detail any discontinued actions that were originally planned and reasons:

Action: Pleas Reason: e Action: write Reason: your next 6-month review date

Name of completing officer:

Date submitted:

Please email a copy of this EQIA review sheet to [email protected] or send to Corporate Inequalities Team, NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospitals Site, 1055 Great Western Road, G12 0XH. Tel: 0141-201-4560/4967.

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