MEETING THE REQUIREMENTS OF EQUALITY
LEGISLATION
A FAIRER NHSGGC PROGRESS REPORT 2018-19
Responsible Director:
Director of Public Health
Approved by:
Above
Date Approved:
Date for Review:
Replaces Previous Version:
N/A
[if applicable]
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Meeting the Requirements of Equality Legislation
A Fairer NHSGGC
Progress Report 2018-19
Table of Contents
1.
Introduction and summary of progress
Page 3
2.
Mainstreaming Actions
Page 9
3.
Outcome actions
Page 30
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1. Introduction and summary of progress in 2018-19
1.1 Aim of the report
In April 2016 NHS Greater Glasgow and Clyde (NHSGGC) published ‘Meeting the
requirements of Equality Legislation: A Fairer NHSGGC 2016-20’.
This report is our third annual update of the range of work underway across
NHSGGC to meet the mainstreaming and equality outcome actions and covers the
period between April 2018 and March 2019.
1.2 Where we have made a difference to patients in 2018-19
NHSGGC’s work on equality and human rights aims to ensure equitable access to
our services and to improve outcomes
where we have identified that we need to
make a significant difference for patients from equality groups.
Sections 2. and 3 in the report on Mainstreaming and Equality Outcomes give
specific updates on this work in 2018-19.
Key highlights include:-
1.2.1 Uptake of the equality and human rights e-learning module
There has been a significant increase in the uptake of the introductory equality and
human rights e-learning module: 71% of the workforce have successfully completed
the e-learning module equating to around 28,400 employees compared to 2,906 in
2017-18. This dramatic increase is due to the module now being included in the suite
of 7 mandatory e-modules. The module has also been revised to make it more
interactive and covers core Equality Act (2010) considerations together with broader
issues including hate crime, human rights in health and social care and promotion of
staff engagement groups e.g. Staff Disability Forum. An example of an e-module
question can be seen below:-
Question 7
You hear a manager making fun of the accent of a BME teammate. There’s a small
cluster of colleagues listening, some of whom laugh and join in with their own
parodies. You find this behaviour offensive, but would you:
a) Challenge it
b) Ignore it
√ a) Challenge it
Well done. This type of behaviour needs to be challenged whenever it is witnessed.
It may feel uncomfortable but you are doing the right thing by taking a clear stand
against it. Parodying accents and making other racial stereotypes directly
undermines a safe and secure environment for all out staff. Remember the Equality
Act provides protection to employees who challenge discriminatory behaviour – you
cannot be treated unfairly as a result of your challenge.
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1.2.2 Patient engagement
A wide range of engagement has been undertaken in 2018-19 to ensure we are
genuinely involving patients in improving our services. Some highlights include:-
Audiology - Eight hundred questionnaires were disseminated across our 8 Acute
Audiology Departments to collect patient feedback. The overall return rate was 92%.
The results showed that overall patient satisfaction with NHSGGC’s Audiology staff
and services is high; 87% saying they were very satisfied’ or ‘somewhat satisfied’
with the service. 518 patient satisfaction cards were also returned as part of a
suggestions box initiative and also showed a high rate of satisfaction. The Patient
Reference Group discussed the findings of the Patient Survey and suggested ideas
for improvement from their own experience of using the service. The Senior
Audiologist has attended the group.
British Sign Language (BSL) users - In October 2018 NHSGGC published its first
BSL Action Plan as part of our duty under the BSL Scotland Act 2015. In order to
develop the plan the Equality and Human Rights Team we held 10 public
engagement events with BSL users over a 5 month period. This included two in
Glasgow City and one each in Inverclyde, East Renfrewshire, Renfrewshire, East
Dunbartonshire and West Dunbartonshire in collaboration with Health and Social
Care Partnerships and Local Authorities where possible. In total, more than 100
BSL users participated in these events to inform the plan.
Online patient feedback system - Work was undertaken in 2018-19 to improve
uptake of the online patient feedback system by people with protected
characteristics, particularly Black and Minority Ethnic (BME) people. The Equality
and Human Rights Team engaged with 135 BME people over 4 language groups as
well as 20 sessions with third sector BME agencies. The sessions demonstrated how
to use the feedback system and gathered real time feedback at the events. In all, 90
staff for third sector organisations attended. Since 2017 – 18 there has been a
seven fold increase in the feedback from BME groups.
1.3 Where we have made a difference for staff in 2018-19
1.3.1 Staff Money Wellbeing programme
A post funded from endowments has been working to address financial issues of
staff in the workplace. This included commissioning research and implementing the
findings. The work has taken a whole system approach and identified key trigger
points which may result in financial worries, for example absence from work or
diagnosis of a long term condition. This has enabled NHSGGC to take a
preventative and early intervention approach which will support staff wellbeing.
1.3.2 Interpreting Service
The provision of interpreting across NHSGGC was reviewed in 2018-19. The aims of
the review were to promote greater consistency of good practice across the
Interpreting Service, maximise the potential for efficient and effective working and
ensure that the service is adequately resourced and sustainable in order to meet
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future demand. Training was delivered to over 500 staff across Acute and Primary
Care including: the policy and legal context; how to book interpreters both spoken
language and BSL; how to use telephone interpreting; how to use online interpreting
for BSL users, Contact Scotland and telephone interpreting to call out to patients at
home.
In 2018-19 interpreting provision was re-tendered as part of the review. The change
in providers aims to meet the aspirations in the review. In preparation for the change
in providers the following communications work was undertaken:-
A Core Brief went to all staff outlining the changes, supplying the new contact
details and linking to our new Interpreting web pages which contain links to
department codes, more detailed user guides and the language identification
codes.
Two global email has gone out to all staff as above.
'How to Access Interpreting Support' posters have been produced and
distributed to all of our Acute sites and primary care/community services.
Telephone Interpreting guides in the form of desk cards have also been
printed and distributed as above.
Additional materials which contain interpreting information, such as our
'Communicating with our diverse communities' Tip Cards have also been re-
printed and are currently being distributed.
The new details were promoted in Staff News in print and online.
1.3.3 Staff Resources
A wide range of information on equality and human rights issues is made available to
staff via the Equalities in Health website, Equalities Updates, Staff News and social
media. This includes: BSL Online Interpreting Service; Staff Training in LGBT issues;
Hate Crime and equalities legislation; Staff Disability Forum; NHSGGC at Pride;
Deaf & Mental Health Events; the LGBT+ Forum; and BME Staff focus groups.
Equalities Updates can be viewed at the
Equalities in Health website.
www.equalitiesinhealth.org
1.2.3 Human Rights
NHSGGC is an early adopter of Human Rights approaches. There is evidence that
when health and social care services adopt a human rights approach they can
achieve better patient outcomes, patients feeling more empowered and improved
staff satisfaction. Human rights link closely with the aims and values of the NHS to
deliver patient centred services which are free from discrimination and meet people’s
needs.
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In 2018-19 the Equality and Human Rights Team have focused on tests of change
around human rights to assess ways of achieving long term impact of human rights
approaches with staff and service users. This has included the following work:
Three hundred and ninety seven staff from across NHSGGC including
Primary Care, Acute and Mental Health have received training on a Human
Rights approach to delivering health services. The sessions were well
received by staff.
A poster was developed with young people taking a human rights approach to
Adverse Childhood Experiences- See Appendix I.
In February 2019, Turning Point staff and service users attended NHSGGC’s
Alcohol and Drug Services Person Centred Care and Equalities Group to
share the learning from their approach. Leads in this Group across NHSGGC
are supporting a human rights approach to the evaluation of recovery cafes
and networks.
Work with NHSGGC complaints staff to explore human rights approaches has
resulted in staff identifying changes to work practices such as improving
approaches with patients who are distressed or have complex issues.
Work with the NHSGGC’s Specialist Work and Health has found an
improvement in confidence, skills and knowledge around human rights issues
for staff. Comments included:
“I liked the concept of the Human Rights
flowchart and could see that when speaking with clients over the phone this
would a useful approach. The handout explaining this was good”.
Joint Work took place with Older People’s Acute Services over the past 18
months to develop staff knowledge and confidence in balancing human rights
and risks in care delivery in hospital settings. Following staff training on
human rights legislation and using FAIR model and PANEL principles, staff in
Ward 52 of Langlands, QEUH, delivered a Test of Change (ToC) which aimed
to provide holistic person centred care by meeting patients’ spiritual and
emotional care needs. Between June and December 2018, 53 patients were
referred by staff to spiritual care services. The case study below provides an
example of how patients might benefit from support from spiritual care
services.
Case Study:
Patient B was referred by the SCN to chaplaincy services due to
the complex nature of the patient’s spiritual distress. The patient’s
husband was a long term patient of a mental health unit in a
different hospital in Glasgow. A neighbour had called her an
ambulance and she was now in ward 52, with no way of letting
him know what had happened to her.
On arrival in the ward the chaplain met the patient who spoke
about the complexities in her relationship with her husband and
why she was so worried. With her consent it was arranged for a
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fellow chaplain to visit her husband in the hospital he was in to let
her husband know why she was unable to visit. As a team we
were able to reassure both the woman and her husband that the
other was ok. Both said they felt relief and valued this support and
the risk of mental distress hindering patient recovery was
alleviated.
Challenges remain, consistent with other similar organisations, in ensuring that
patients who are medically fit for discharge form hospital can be provided with
appropriate care where they lack capacity to make decisions. This means that a
move to a more residential setting may be delayed. NHSGGC are currently
engaging with the Equality and Human Rights Commission and the Mental
Welfare Commission to identify the most appropriate mechanism to providing
care in these challenging circumstances.
1.4 Health and Social Care Partnerships
In 2018-19 NHSGGC’s Equality and Human Rights Team (EHRT) supported HSCPs
with their equality outcomes for service users on request and where efficiencies can
be made by working together. The Head of Equality and Human Rights and the
team’s three Planning and Development Managers lead on this work.
East Dunbartonshire – East Dunbartonshire HSCP reviewed all outcomes,
performance measures and associated performance achieved from their 2017 –
2021 report, at a senior manager’s workshop, supported by EHRT. The HSCP
continues to invest in staff learning and education with organised class-based
sessions and a commitment for all staff to complete NHSGGC’s statutory and
mandatory Equality and Human Rights e-learning module (currently standing at 83%
of all NHS staff).
East Renfrewshire – EHRT staff facilitate ER’s equalities and human rights action
plan, as well as work on poverty. This has included: collation of mid-year and end of
year reports; ongoing problem solving on EQIA and assessment of financial plans;
implications of the Fairer Scotland Duty; follow up of an additional needs audit of
Eastwood HCCC; and support for Child Poverty Act work.
Glasgow City- The Glasgow HSCP Equality Group been active throughout 2018-19
and the Head of Equality and Human Rights attends the meetings in an advisory
capacity and to make links to Board activity where relevant. The EHRT has
supported engagement with Deaf people and Equality Impact Assessment training.
The EHRT have also worked with the sectors to develop actions on the Black and
Minority Ethnic (BME) Health and Wellbeing Survey. This has included advising
Glasgow Community Planning Equalities Group and Glasgow City Council’s BME
Working Group on aspects of the survey.
Mental Health Services and Alcohol and Drug Services - NHSGGC Mental
Health Service (MHS) has three priorities: financial inclusion, human rights and
sensory impairment. EHRT have supported reviews of the work on these topics
which are included in MHS’s annual report. A successful BSL and Mental Health
event took place in December 2018
. This work received the Scottish Sensory and
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Equality Award in March 2019 sponsored by DeafScotland, ScotRail and Disability
Equality Scotland. The work of the Deafness and Mental Health Improvement
Practitioner will continue in 2019-20. The EHRT have supported Alcohol and Drugs
Services Care Governance Group on service user engagement, staff reflective
practice and financial inclusion.
Renfrewshire HSCP has led on introducing routine enquiry on Gender Based
Violence within primary care mental health services.
West Dunbartonshire - Following the higher than average levels of domestic abuse
reported in the 2017 DPH report, West Dunbartonshire introduced a zero tolerance
policy on domestic abuse within its social housing properties. The No Home for
Domestic Abuse initiative introduces measures aimed at reducing homelessness and
increasing protection and rights of victims by:
ensuring victims have immediate access to practical help and specialist legal
assistance
introducing a presumption that all tenancies for couples are in joint names to
ensure the victim is legally entitled to remain in the home whilst the
perpetrator is legally removed, and prevented from returning.
offering tenants found guilty of committing domestic abuse only short-term
tenancies and ensuring the property is at a distance from the victim.
This work was supported by Public Health who carried out a comprehensive
literature review on prevention interventions.
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Update on activity in 2018-19 on Equality and Human Rights
2. Mainstreaming Actions
NHSGGC’s mainstreaming actions cover NHSGGC’s core functions to ensure equality considerations are embedded in the way we do
our business.
2.1 Planning and delivering fairer services
Action: We will equality impact assess (EQIA) future changes to Acute services to ensure they meet the needs of equality
groups and plan services to meet these needs.
Eleven Acute Equality Impact Assessments and 3 Corporate EQIAs have been undertaken across the reporting period.
In addition to the above, NHSGGC’s Equality and Human Rights Team have quality assured 32 EQIAs returned from aligned health and social
care partnerships (HSCPS).
EQIAs have been published on NHSGGC’s website and can be found at:
http://www.nhsggc.org.uk/your-health/equalities-in-health/equality-impact-assessments/2017-2018
2.2 Leadership on tackling inequality
Action: NHSGGC will continue to report on our progress against the Equality Act 2010 and produce new outcomes in 2021 The Equalities in Health website continues to provide up to date information on progress against equalities legislation. New sections this year
include signed pages on British Sign Language (BSL) activities and patients’ rights to a BSL Interpreter. Additional information is now also
available on the Fairer Scotland Duty and NHSGGC work to address socio-economic issues.
Seven Equalities Updates have been produced throughout the year highlighting issues such as Black & Minority Ethnic Staff Engagement;
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training on LGBT+ issues; Healthier, Wealthier Children initiative; BSL Mental Health A-Z resource, Inclusive Workplace event and Staff
Disability Forum.
Equalities Updates can be viewed at the Equalities in Health website.
http://www.equalitiesinhealth.org/public_html/current_activities_news.html
2.3 Listening to patients and taking their needs into account in improving services
Action: Develop innovative ways to engage with equality groups in partnership with the voluntary sector organisations that
support them.
Hard of Hearing
NHSGGC continues to engage with those using Audiology Services to ensure a continuous dialogue between patients and services.
The Patient Reference Group, set up in 2018, has met 3 times to provide a platform for patients to give feedback on our services. The Senior
Audiologist has attended this group. The Patient Reference Group discussed the findings of the Patient Survey (see below) and suggested
ideas for improvement from their own experience of using the service.
Eight hundred questionnaires were disseminated across our 8 Acute Audiology Departments to collect patient feedback. The overall return
rate was 92%. The results showed that overall patient satisfaction with NHSGGC’s Audiology staff and services is high; 87% saying they were
very satisfied’ or ‘somewhat satisfied’ with the service. 518 patient satisfaction cards were also returned as part of a suggestions box initiative
and also showed a high rate of satisfaction.
From the survey and discussions with the Patient Reference Group the following areas have been highlighted as requiring improvement;
provision of consistent information on care of hearing aids, loop systems, the National Standards and other relevant services, waiting times,
the appointment system and parking and access to clinics.
The next stage in this process of improvement is to use the patient suggestions boxes to ask specific questions relating to the areas requiring
improvement.
NHSGGC have this year reviewed staff guidelines on working with people who are affected by Deafness, including those who are Hard of
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Hearing and Deafblind. Third Sector agencies contributed to an update of these guidelines which will be published in April 2019.
Online Patient Feedback website
NHSGGC’s Online Patient Feedback website offers patients and carers the opportunity to provide suggestions for improvements and tell us
about their experiences of care. Voluntary organisations can support patients to leave feedback on the online system, enabling people from
equality groups to use it. From 11th April 2018 up to 31st January 2019, 697 comments were made, lees than the 994 comments
made in
2017/18.
The analysis by protected characteristics shows the following:
As in the previous year, there were more female contributors than male –
424 vs.
292; (out of those who stated their sex).
15 trans people provided comments (
11 preferred not to answer). Of these, 12 were positive and 3 negative. Negative comments
related to issues such as staff attitudes. Only one comment was connected with the gender reassignment procedure, which was
positive. All other positive comments were about caring staff.
In relation to sexual orientation, the comments came from
579 heterosexual,
9 Gay/Lesbian, and
15 Bi respondents (
13 stated “other”
and
50 preferred not to answer).
There was a range of ages, with the highest number of contributors being 55-64 (
269), followed by 45-54 (
207),
6 people under 16 years
and
12 over 75 years provided comments.
13% of comments come from disabled people
.
28 comments were made from Black or Minority Ethnic people which is an improvement on 2017-18, where only
4 comments were
made.
14 people reported requiring an interpreter, however it was not clear whether this is a spoken language or BSL interpreter
In relation to religion and belief
8 comments were from Buddhist, Hindu, Jewish, Muslim,
106 Church of Scotland and
80 Roman
Catholic.
130 stated they had no religion or were Atheists and
63 respondents preferred not to disclose their religion.
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Work was undertaken in 2018-19 to improve uptake by people with protected characteristics, particularly Black and Minority Ethnic
people. The Equality and Human Rights Team engaged with 135 BME people over 4 language groups as well as 20 sessions with third
sector BME agencies. The sessions demonstrated how to use the feedback system and gathered real time feedback at the events. In all
90 staff for third sector organisations attended.
The issues raised from these events covered; problems with getting interpreters at appointment in some languages, staff attitudes toward BME
patients whether they spoke English or not, inability to read letters that are sent in English leading to missed appointments, difficulties in getting
same day GP appointments and getting referrals on to mental health services and financial inclusion services.
Since 2017 – 18 there has been a seven fold increase in the feedback from those from BME groups.
British Sign Language Champions
We have supported the work of our BSL
Champions throughout 2018-19. The champions work is an innovative approach to
involving Deaf people in improving care. The champions have met 3 times as a group in 2018-19 and carried out the following work:-
Produced resources such as a leaflet entitled ‘Your Rights to an Interpreter’ leaflet for Deaf BSL patients to be used in waiting areas to
encourage Deaf people to ask for a BSL interpreter and inform staff of their responsibilities in ensuring interpreting provision.
Helped in the planning and running of engagement activity in relation to the development of NHSGGC’s BSL Action Plan.
Developed BSL videos for the Health Champions Facebook page to promote the hand held online BSL interpreting pilot.
The work of the BSL champions was also acknowledged in a Chairman’s Award which was presented to Scott Campbell for his work to
promote a barrier free NHS for BSL using patients.
Implementing the BSL Scotland Act
Ten public engagement events with BSL users were held over a 5 month period to inform NHSGGC’s BSL Action Plan. This included two in
Glasgow City and one each in Inverclyde, East Renfrewshire, Renfrewshire, East Dunbartonshire and West Dunbartonshire, where possible in
collaboration with Health and Social Care Partnerships and Local Authorities. In total, more than 100 BSL users participated in these events.
In addition, an event was held on the 23rd May where 8 mental health professionals and 8 Deaf service users met to discuss psychological
therapies for Deaf people. A celebrated Deaf comedian, John Smith, worked with the group to deliver this innovative approach to engagement
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and consultation.
Action: Use staff and patient feedback to ensure that we address concerns around the provision of British Sign Language (BSL)
interpreters In 2018-19 the number of hospital sites who can access online BSL interpreting for emergency use has expanded. Feed back from the BSL
Patient Reference Group felt that a reduction in complaints and an increase in the fill rate for face to face interpreting were indicators of
success.
The BSL Patient Reference Group also expressed concerns around online interpreting such as: concerns about online interpreting replacing
face to face interpreters; potentially poor Wi-Fi connections in some hospital sites; this technology excluding some Deaf people with less
confidence to use it; the need for staff training on how to use the online system and the need for feedback from Deaf people on the use of the
service. These issues are being addressed through ongoing training on interpreting (see throughout report).
Deaf 3rd sector organisations met twice last year with NHSGGC to feed back on interpreting. Their concerns focussed on: how we can better
promote online interpreting to the community; that we need to be able to ensure the quality of interpreters and the need for guidelines for Deaf
people on the role of the interpreter. We have addressed these concerns by a continuous communication plan utilising social media to
promote the online service. Concerns around quality of interpreters are being addressed through the re-tendering of our BSL face to face
provision. A guide has been produced in BSL and disseminated.
We employ a BSL mediator who has informed Deaf people how to check if their interpreter has been booked and how to give feedback or
complain. The service has been developed to utilise video telephony for Deaf people to use BSL to raise issues with interpreting in real time.
Action: Use staff and patient feedback to ensure that we address concerns around the provision of spoken language
interpreters. Reference Groups
NHSGGC supports a range of reference groups who we meet to get feedback from different perspectives on communication support.
The Staff Interpreting Reference Group feed back concerns from the practitioner’s perspective. They face challenges in accessing specific
languages groups e.g. Amharic, Kurdish Sorani / Badini, Herero and Vietnamese. This was raised in relation to face to face interpreters for
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mental health appointments. We have recently re-tendered all of our interpreting provision which will improve language access and also
recruited sessional staff with an emphasis on rarer languages.
The 3rd Sector Reference Group feed back on behalf of their service users.
The Interpreters Reference Group took part in Mental Health and Sexual Health training which highlighted the following:
Patients who have not disclosed everything they wish to could utilise telephone interpreting to do so
Patients should be made aware that if an interpreter breaches confidentiality they can make a complaint
Interpreters should get more information about the appointment type
Some patients do not understand how counselling and other mental health services work
Training should be offered to reception staff regarding the role of the interpreters
Considerable work has been done to improve the experience of BSL users in mental health services including developing a series of BSL
signed DVDs, engagement with Deaf patients and training for staff on Deaf awareness.
Interpreting Service
a) Spoken Language
The NHSGGC Interpreting Service continues to provide an essential service to our patients who do not speak English.
Between April 2018 and February 2019 they provided interpreters in 103,493 face to face appointments which is an 5.57% decrease on last
year in the same period. Additionally, in the same time period, calls to NHSGGC’s telephone interpreting service increased by 15,059, to 27%
of all interpreting supported appointments on last year’s figures. These figures reflect a change from face to face interpreting to telephone
interpreting for many NHSGGC appointment types creating efficiencies in the service. Overall demand for spoken languages is up from
131,084 in 2017-18 to 140,032 2018-19, an increase of 8,948.
Figures show that 98% of requests for spoken language interpreters are filled. This means that approximately 6 appointments per day are
unfilled. In some languages this will be higher as there are fewer interpreters for some rarer languages. We have recently re-tendered all of our
interpreting provision which will improve language access and also recruited sessional staff with an emphasis on rarer languages.
b) British Sign Language (BSL)
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For 2018-19 4,567 face to face appointments received BSL interpreter support. This is a 3.6% decrease since 2017 - 18. Additionally 25 hours
of online interpreting were used; 78 of these minutes were in out of hours services.
Figures show that 95% of requests for BSL are filled. This means approximately 2 appointments per day are unfilled. We will continue to
make improvements to staff and patient awareness of the interpreting service to ensure all requests are met.
c) Deafblind communicators
Deafblind people’s communication needs are supported in NHSGGC services by Deafblind Scotland’s Guide Communicators. Last year they
supported 247 clinical appointments and a range of health improvement interventions. This amounted to just over 800 hours of Guide
Communicator support across NHSGGC.
Interpreting Service Review
The provision of interpreting across NHSGGC was reviewed in 2018-19. The aims of the review were to promote greater consistency of good
practice across the Interpreting Service, maximise the potential for efficient and effective working and ensure that the service is adequately
resourced and sustainable in order to meet future demand. The main changes in service provision were to change all appointments under 26
minutes to telephone interpreting unless the patient was particularly vulnerable; to create permanent employment for 12 full time interpreters
and to pilot an Arabic telephone interpreting system specific to NHSGGC. As a result of the review all of NHSGGC’s interpreting and
translation provision has been re-commissioned. This is now complete the new suppliers will come on line in April 2019.
Face to face training was delivered to 191 staff on how to use telephone interpreting across Acute and Primary Care. Staff who took part in the
training were surprised at how simple it was to use. To facilitate the use of telephone interpreting across services we addressed issues with
areas where phone lines or cordless phones were unavailable. One hundred and nine new telephones were bought across Acute to enable
staff to more easily use telephone interpreting.
A further 301 staff received face to face training on interpreting generally; including the policy and legal context, how to book interpreters both
spoken language and BSL, how to use telephone interpreting, the on line interpreting for BSL users and how to use Contact Scotland and
telephone interpreting to call out to patients at home. This number includes 108 doctors trained as part of the FY2 Clinical Simulation Training.
Action: Include the Disability Access Group in assessing action plans for new buildings and existing estate improvements.
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The Equality and Human Rights Team utilised existing contacts in the third sector disability organisations to recruit members to a Disability
Access Group. Interested people were invited to information and training sessions on equalities and the audit process. Those who attended
the sessions are all now members of the Access Group. The group will be asked to participate in other audit and access related work as it
emerges over the year. Growth of the membership will be encouraged over time as our audit process develops.
Action: Promote opportunities for voluntary organisations to feed back directly to services on the experiences of those with a
shared protected characteristic The Equality and Human Rights Team have actively promoted the online patient feedback system to third sector organisations to ensure
that people with protected characteristics utilise the feedback methods provided by NHSGGC (see Section 2.3).
2.4 Working towards fairer health outcomes and tackling the underlying causes of ill-health
Action: Promote inequalities sensitive practice to Acute staff, including routine enquiry on gender based violence and money worries,
using existing service improvement methods such as person centred care.
Gender Based Violence (GBV)
Staff in NHSGGC are encouraged to carry out Routine Enquiry (RE) on Domestic Abuse (DA) and Female Genital Mutilation (FGM) to support
their patients and prevent harm. Related areas such as Human Trafficking come under the umbrella of preventing harm and are covered in this
section.
a) Maternity Services
RE on DA and FGM is standard practice. The move to Badgernet electronic data system has taken place but the system is not yet able to
provide data on the numbers of enquiries made and disclosures to evidence routine enquiry practice. Work will take place with Business
Intelligence during 2019-20 to progress a solution to effective data capture and reporting.
b) Health Visiting (HV) Services
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RE on DA is standard practice. In 2018-19 all HVs across NHSGGC received training in using a multi –agency Domestic Abuse Stalking and
Honour- based Violence Risk Assessment Checklist (DASH – RIC). The DASH-RIC enables practitioners who work with adult victims of DA to
identify those at high risk of harm and make referrals to a multi-agency risk assessment conference in order to manage their risk.
Between March 2018 and February 2019 routine enquiry on domestic abuse by HVs took place on 18,013 occasions across NHSGGC area.
This means 52.1% of service users were asked about abuse.
c) Emergency Department Services
GBV leads within ED services have trained colleagues on domestic abuse enquiry.
d)
Health and Social Care Partnerships
Renfrewshire HSCP has led on introducing routine enquiry within primary care mental health services.
Following the higher than average levels of DA reported in the 2017 DPH report
West Dunbartonshire introduced a zero tolerance policy on
domestic abuse within its social housing properties. The No Home for Domestic Abuse initiative introduces measures aimed at reducing
homelessness and increasing protection and rights of victims by:
ensuring victims have immediate access to practical help and specialist legal assistance
introducing a presumption that all tenancies for couples are in joint names to ensure the victim is legally entitled to remain in the home
whilst the perpetrator is legally removed, and prevented from returning.
offering tenants found guilty of committing domestic abuse only short-term tenancies and ensuring the property is at a distance from the
victim.
This work was supported by Public Health who carried out a comprehensive literature review on prevention interventions.
e) Human Trafficking
Identifying and supporting victims of Human Trafficking is a feature of NHS services where victims may present. Medical and nursing staff
within GRI have received training on Human Trafficking. NHSGGC provided training to GPs and primary care service staff within Glasgow’s
Govanhill area. Staff guidance has been updated to incorporate recent changes in legislation. Training was developed and delivered within
Primary Care and Emergency Services. RCM colleagues planned and delivered a Human Trafficking staff conference.
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f) Rape and Sexual Assault (RSA)
Following publication in December 2017 of national standards and indicators for
Improving Healthcare and Forensic Medical Services (HIS
Standards) for People who have experienced Rape, Sexual Assault or Child Sexual Abuse: Children, Young People and Adults it has been
agreed to develop a cost-effective regional model for rape and sexual assault services based on hub and spoke model in conjunction with the
West of Scotland regional planning process.
g) National Consultations
NHSGGC contributed to numerous Scottish Government consultations on proposals to legislation, policy and service standard proposals on
different forms of GBV in relation to NHSGGC’s role. These consultations covered:
Provision of indicators for Clinical Pathways and Guidance for Healthcare Professionals Support Adults Experienced Rape or Sexual
Assault in Scotland;
Strengthening legislation on FGM;
Scottish Psychological Trauma and Adversity Training Plan;
Protective Orders for people at risk of Domestic Abuse;
Improving Multi-Agency Risk Assessment and interventions for victims of domestic abuse;
h) Infrastructure
In 2018-19 the GBV agenda has been linked strategically to new NHSGGC Public Protection Forum and represented on the Child Protection
Forum. A GBV Network has been established and met twice to share information across the Board and HSCPs on best practice.
Money Worries
NHSGGC has action plans in place for child poverty, welfare reform, fuel poverty & food poverty. Mental Health Services and Alcohol and Drug
Services have referrals to money advice as key priorities and have improvement plans in place.
In 2018/19 we are improved our approach to reviews of electronic routine enquiry money worries data for the children and families settings.
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Through increased local efforts we have seen an increase in referrals for children and families.
Table 2. Healthier Wealthier Children referrals and financial gain Jan-Dec 2017 & 2018
Year
Midwifery referrals
Health visiting referrals
Other referrals*
2017
293
1581
708
2018
304 (4% ↑)
1965 (24% ↑)
767 (8% ↑)
*GPs and health care assistants
**Approximately 46% of those referred take up the referral.
The table below shows financial gain and referrals between April and December 2018 for GGC’s tracked money advice programmes (Healthier
Wealthier Children).
Area (Apr - Dec 2018)
Financial gain
Referrals
Average gain p.a. per family
Healthier Wealthier
£4,330,235
3182
£3,000
Children
Children’s Hospital
£2,664,077
332
£8,024
329 emergency grants have been obtained for families in the Children’s Hospital amounting to £14, 969.
Adult hospital services have made 2886 referrals for financial support for patients with long term conditions between April 2018 and December
2019.
An innovation has been money advice workers in GP ‘Deep End’ practices, which has resulted in more targeting to meet unmet need. In
addition, we have seen a 41% increase in referrals to Healthier Wealthier Children and financial gain (18/19 3182 referrals, 17/18 1852
referrals). Part of this is due to an innovative approach on money advice and advocacy within our midwifery Special Needs in Pregnancy
Service and developmental work to increase referrals as part of Child Poverty Act work.
NHSGGC continues to review its welfare reform, fuel poverty and mental health services financial inclusion plans on a 6 monthly basis and
reports on the initiatives on a quarterly basis. GGC’s materials on unclaimed social security benefits are being used in Acute Services and
have been distributed for use by HSCPs as required.
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GGC continues to work with national leads on the national roll out of the Healthier Wealthier Children initiative. NHSGGC has developed a
range of actions in 2018-19 around the Child Poverty Act (Scotland) 2017 and has also set out actions for 2019-20. Healthier Wealthier
Children is a key service delivery element of the work. In 2018-19, a governance structure was identified for NHSGGC child poverty work and
a range of activity was undertaken including:-
presentations to CPPs which included information on support available from NHSGGC;
programme of staff awareness sessions alongside 2 NHSGGC wide events;
new Healthier Wealthier Children staff and public materials;
funding bid for the Hunter Foundation with a money advice partner was submitted;
analysis of Healthy Start uptake was undertaken and distributed to HSCPs to use;
cost of the pregnancy pathway proposal was developed;
research on staff with money worries was conducted which has resulted in a range of actions around attendance management, wage
arrestment and nursing registration processes.
56 health visitors attended the training session. Comments included:
“Very helpful session and lots of useful information. This reinforced that income maximisation has a significant impact on poverty”
“I will ensure finances are discussed with all families – employed and unemployed”.
Action: Mainstream patients’ access support needs into data systems and review practice in primary care and at ward level. Additional Support Needs
NHSGGC used the national improvement plan for additional needs to develop an additional needs SBAR. National guidance on the use of
streamlined national codes for additional needs were issued and SBAR actions in relation to SCI Gateway and Trakcare are being
implemented. A new SCI gateway additional needs approach has been developed with the support of the Local Medical Council and a
streamlined approach to feed new data into Trakcare is being identified.
Once the new system is live, we will re-issue Client Additional Support Needs cards and posters as part of this development. SCI gateway
additional needs data flow from primary care remains very low although we expect the new national system to vastly improve this and will
disseminate knowledge about this development widely.
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Secondary care alerts continue to be added to Trakcare as appropriate. In addition, we tested an ‘additional needs’ audit in primary care which
resulted in improvements such as staff training and use of 3rd sector providers on equalities issue.
2.5 Creating a diverse workforce, supporting staff to tackle inequalities and acting as a fair employer
Action: Deliver the Workforce Equality Action Plan which covers a wide range of activity on workforce planning and analytics,
recruitment and resourcing, learning and education and organisational development.
Workforce Equality Group (WEG)
Workforce equality documents - including the Workforce Equality Action Plan and Equal Pay Statement and workforce equality statistics,
are presented in the Equalities in Health website
http://www.equalitiesinhealth.org/public_html/workforce-accessible-documents.html
Recruitment data is presented at the Staff Governance Committee and published on the Equalities in Heath website. Our most recent
data shows that:-
Disclosure of disability by our staff is still low at 1.13% although this is a slight improvement since the introduction of employee self-
service
Success at recruitment is slightly lower for all non-white groups apart from Caribbean and Any Mixed Background.
The Workforce Equality Group is working towards the inclusion of further measures and improvement plans to tackle gaps. The introduction of
employee self-service will mean that we have an opportunity to improve equalities data capture for our existing staff.
The WEG has undertaken a wide range of work in 2018-19 including: submitting the Stonewall Workplace Equality Index for assessment;
supporting the Staff Disability Forum including an event in December to celebrate World Disabilities Day; establishing a Black and Minority
Ethnic Network following a series of focus groups; supporting the LGBT+ forum; developing actions on equal pay; and reviewing and analysing
workforce equality data.
Staff Money Wellbeing programme – As part of the Staff Health Strategy a post funded from endowments has been working to address
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financial issues of staff in the workplace. This included commissioning research and implementing the findings. The work has taken a whole
system approach and identified key trigger points which may result in financial worries for example absence from work, diagnosis of a long
term condition etc. This has enabled NHS GGC to take a preventative and early intervention approach which will support staff wellbeing.
Training staff on equalities issues
a) Mandatory Equalities Training
There has been significant increase in the uptake of the mandatory equalities e-learning module: 71% of the workforce has successfully
completed the e-learning module equating to around 28,400 employees. The module covers core Equality Act (2010) considerations together
with broader issues including hate crime, human rights in health and social care and promotion of staff engagement groups e.g. Staff Disability
Forum. Additionally topic specific e-learning modules have been completed by a number of staff wishing to increase their knowledge (April
2018 – Feb 2019):-
Accessible Information
140
Addictions
136
Age
133
Deaf Awareness
95
Disability
128
Ethnicity
115
Gender Based Violence
132
Inequality Sensitive Practice
114
Literacy
94
Marginalised Groups
98
Sex and Gender
96
Sexual Orientation
94
Social Class
95
Transgender
84
Visual Impairment
91
Welfare Reform
98
Working with Interpreters
96
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b) Sensory Impairment
Sensory impairment training was delivered to168 staff in 2018-19
. The training is delivered by people with a lived experience of being visually
impaired or hard of hearing. The training also covers issues relating to BSL users. Staff who participated in the training were from emergency
services, midwifery, nuclear medicine, speech and language therapy, occupational therapy and surgical recovery.
c) BSL classes for staff
A new series of BSL classes for staff started in QEUH and the Beatson West of Scotland Cancer Service with 87 staff in total attending. To
date more than 200 staff have participated and benefitted from this course. By the end of 2019-20 we aim to have a further 200 to 250
NHSGGC and HSCP staff completing the course.
d) Face to Face Training
The Equality and Human Rights Team carry out bespoke training for NHS staff and external organisations on a wide range of equality issues.
In 2018-19 this included:-
Nursing Induction (419 staff)
Hidden Bias Training (160)
Foundation Managers equalities element (98 staff)
Junior Dentists (80)
EQIA and Equality Act (2010) (60)
Junior doctors general awareness (67 staff)
Health Care Support Workers (82 staff)
West of Scotland Psychiatrists (52 staff)
SPSP ward managers (31 staff)
Specialist Work & Health service (4 staff)
Glasgow Association for Mental Health (GAMH) (Training for Trainers10 staff x 2 sessions)
Woodside Health Centre Equalities & Human Rights (18 staff)
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GAMH human rights review (14 service users and 10 staff)
Turning Point Human Rights Training (6 service users)
Langlands Older People’s Wards Human Rights (10 x 2 sessions)
Other training e.g. on money worries and gender based violence can be found in Mainstreaming section 2.4
Disability Confident (previously two tick symbol)
NHSGGC is formally recognised as a Disability Confident Employer based on self assessment against the following themes:-
getting the right people for our business;
keeping and developing our people.
NHSGGC is committed to the provision of equal opportunities, a safe environment for our staff and recruiting and retaining the best people,
regardless of disability. These commitments are demonstrated through actions such as:
the Disability Confident standard is embedded in our recruitment practice
we provide supporting guidance for managers and staff on HR Connect and in our recruitment training for managers
our Staff Health Strategy 2017 – 2020 outlines our exemplary approach to staff health in areas such as improving working culture
and conditions and tackling inequalities in the workplace
continued support to the established Staff Disability Forum with a focus on achieving and maintaining a positive culture towards
disability in NHSGGC. The Forum provides a platform for consultation and influence on issues impacting on the health, well being
and work of those with a disability
We are working towards the renewal of our commitment to Disability Confident in 2019.
Action: Develop future staff fora on other protected characteristics where a need is identified.
LGBT+ staff forum
The NHSGGC LGBT+ Staff Forum uses a closed Facebook page to facilitate communication between members though the group has also
met on several occasions. The Forum currently has 80+ members from across NHSGGC. Developments are underway to link the Forum into
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a wider national NHS Scotland LGBT+ forum leading to greater benefit from scale of membership including event management and social
activities. The forum supported a successful lanyard campaign which distributed rainbow lanyards to 10,000 staff. Lanyards are accompanied
by a Flyer entitled ‘Why go Rainbow?’ explaining the levels of discrimination faced by LGBT+ staff and service users.
BME Employee Network
NHSGGC set up a Black and Minority Ethnic staff engagement group after feedback from staff focus groups organised in different hospitals.
The network currently has 32 members from across the NHSGGC. After the initial meeting a survey was conducted to find out what steps
those present would like us to take to establish ongoing engagement. A wide range of suggestions were made on areas such as
representation, recruitment, progression and access to training for BME staff. A development session for the group was recently organised by
Corporate Organisational Development to establish the agenda for the upcoming year for the forum and agree terms of reference.
Staff Disability Forum
The Staff Disability Forum (SDF) continues to meet and take an active role in supporting disability issues in the workplace. In 2018-19 the
forum were involved in a number of events:-
Long Term Conditions Event: The event was organised by Healthy Working Lives and was aimed at managers. SDF’s stall included the
manager’s guides to supporting staff at work who have impairments which proved very popular.
Disability, Employment and the Workplace Congress: The event was organised by the Scottish Government and NHSGGC were represented
by the Human Resources and the forum.
NHSGGC World Disabilities Day Event: The event was held in December 2018 to celebrate World Disabilities Day and was supported by
Human Resources and the Staff Governance Committee. It was attended by 39 senior managers and disabled staff members.
Action: Produce and distribute a Transitioning Workplace Guide on how to support staff reassigning their gender
A transitioning guide for Trans members of staff was approved April 2017 by the Area Partnership Forum. The document is now
available via NHSGGC’s HR Connect site. The guide has also been Equality Impact Assessed which is available here:
http://www.nhsggc.org.uk/media/244423/nhsggc-transitioning-in-the-workplace-protocol.htm
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2.6 Measuring performance and improving data collection
Action: Ensure new data systems or migrated systems will always include fields to collect equality data and undertake an
improvement programme to update existing systems. In 2017-18 we have made improvement in our data recording systems as follows:-
Mental Health Services are developing EMIS as the new electronic assessment. This has been reviewed to ensure that all equality
fields are included.
In Health Visiting, EMIS is being reviewed to ensure money and debt worries items are streamlined.
The Live Active system was lacking on information on sexual orientation. This is now included and a review of use by protected
characteristics is planned.
Action: Include in the performance framework measures based on identified gaps in health outcomes for people with
protected characteristics and by deprivation and seek to show improved health outcomes through related measures. Disaggregated data (age, sex, deprivation and ethnicity) in relation to Did Not Attends was last reviewed in 2017 using 2016-17 data. It
showed that:-
men are more likely to DNA than women
the highest DNA rates are reported amongst the younger age group categories particularly the 16 - 44 years age group
the risk of DNA for both men and women is greater with increasing deprivation
DNAs were higher for all ethnic groups who were not White Scottish (although the numbers were small)
The data will be reviewed in 2019 to see if there has been any change.
The NHS is currently unable to provide appointment letters in different languages due to the national Trakcare system. To mitigate this
the Equality and Human Rights Team distribute guides to using the NHS in over 20 languages at a wide range of community events.
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Action: Put in place data collection and performance measures to track progress on the mainstreaming and equality outcomes
for the Board for 2016-10
Within Acute services the Acute Health Improvement and Inequalities Group (AHIIG) includes the following measures in the scorecard in
relation to the ‘Meeting the requirements of Equality Legislation: A Fairer NHSGGC 2016-20’ -
Number of financial inclusion referrals
Number of support and information brief interventions
Number of completed EQIAs
Number of disability access audits
Equality training
Support and Information Service development
These are regularly reviewed within each area and reported to the Senior Management Team. The AHIIG is currently being reviewed to ensure
that it is effective and meets the needs of the system.
Action: Follow up actions to target differentials in screening uptake and health outcomes to ensure action has taken place Public Health has recently published a report “Widening access and addressing inequalities in adult screening programmes: Action plan for
2019-21”. The following marginalised groups are identified as priorities for providing support to access screening services:
Adults involved in the justice system
Adults with severe and enduring mental illness
Adults from travelling communities
Adults in the armed forces.
Adults with a learning disability
The report, which has a comprehensive action plan to address inequalities in screening uptake across all protected characteristics can be
found he
re https://www.nhsggc.org.uk/your-health/public-health/public-health-screening-unit/reports/
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Action: Seek to influence national systems to include equalities data
Gender Reassignment
NHSGGC has worked to sensitise mainstream patient information systems to be inclusive of the Trans identity of patients. The organisation
has informed the development of national screening programmes in order to adapt inclusion to Trans patients who otherwise would be at risk
of being removed from potentially lifesaving interventions. In addition NHSGGC has amended core fields in TrakCare locally to remove
gendered titles and in so doing remove risk of inadvertently outing Trans patients through misgendered correspondence. A locally agreed
protocol for the recording, storage and sharing of information relating to Trans identities of patients will go to a regional records meeting for
discussion and a resolution to create a national protocol.
British Sign Language Act notification of additional need
NHSGGC
will improve the individual electronic patient health records so that they clearly show when the first or preferred language is BSL and
a BSL Interpreter is needed.
2.7 Resource allocation, fair financial decisions and procurement
Action: Continue to refine the process of rapid impact assessments in our commitment to making fair financial decisions Equality Impact Assessment (EqIA)
All EqIAs have been published on NHSGGC’s website and can be found at:
http://www.nhsggc.org.uk/your-health/equalities-in-health/equality-impact-assessments/2016-2017/
Fairer Scotland Duty
In April 2018 the Government introduced a new duty on socio-economic inequalities as part of the Public Sector Equality Duties. The duty
requires public bodies to demonstrate how our strategic plans will help to reduce poverty. This means being able to explicitly show that we
have considered health gaps caused by socio-economic inequality in our decision making processes.
NHSGGC has a long history of considering socio-economic inequalities as part of service delivery and the prevention of ill-health. Some
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examples of previous activity include:-
Creating hundreds of training places for young people in the building of the Queen Elizabeth and our modern apprenticeship programme
The support service for parents in the children’s hospital which, among other outcomes, has increased family incomes by an average
£6k per year at a financially challenging time
A wide range of referrals to money advice, housing advice, fuel poverty and debt advice which has generated the equivalent of £245m
for cancer patients, children and their families and many other people in our care.
We will continue to have examples of this type of work however the duty specifically requires us to show how strategic decisions will help to
reduce poverty. The Child Poverty Act is another piece of legislation which requires us to take action on tackling socio-economic inequalities to
improve health.
In 2018-19 we have:-
Included the Fairer Scotland Duty in our EQIA template and in EQIA training
Added information to the FIP guidance for Directors on assessing risk in relation to inequalities including socio-economic
Action: Explore wider social benefits through our procurement processes
Better Health through Employment Group
In line with the Procurement Reform (Scotland) Act 2014, work is underway to ensure procurement policy supports fair work practices,
sustainability, community benefits and ethical supply chains.
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3. Equality Outcomes
NHSGGC’s equality outcomes are bases on evidence gathered prior to publishing our equality outcomes for 2016-20 and highlights
where we need to make a significant difference for patients with protected characteristics. This section provides an updake of progress
made on the outcomes in 2018-19.
Equality Outcome 1: Disabled people and people experiencing poverty can access NHSGGC services without barriers and in
ways which meet their needs
Measure: 3 DDA audits per year carried out in priority areas
Three audits were carried out to assess any potential barriers to our services for disabled people. These were in: the Acute
Assessment Unit; Glasgow Royal Infirmary Plastics (Outpatients); and the West of Scotland Cancer service.
The audits in GRI highlighted some common issues: access from public transport to both services was problematic due to the terrain
and length of journey; the signage to both services could have been clearer; the buzzers to enter ward areas were too high for
wheelchair users to utilise; staff did not utilise the dropped counter for wheelchair users at reception desks and did not respond to
patients at this area. There were some differences in the specific services, examples including the use of peddle bins in the
accessible toilets and lack of induction loops. A priority action plan has been drawn up to address and mitigate these barriers.
The audit at the West of Scotland Cancer Centre is a three part assessment of both the physical building as well as the service’s
website for patients. An initial audit focusing on the route from the main entrance to the Outpatient’s Clinic and waiting areas has
been completed. A second stage will ask members of NHSGGC Disability Access Group (including people who may use assistive
technology) to conduct a website audit. Finally a short staff questionnaire on their view of access and equalities issues will be carried
out. The results will be utilised along-side the audit information to produce an overall report which will highlight any issues and inform
other potential areas of work.
Measure: Disabled people are involved in audit process
As part of NHSGGC commitment to working with disabled people the Equality and Human Rights Team utilised existing contacts in
the third sector disability organisations to recruit members to a Disability Access Group. A process is in place to continually recruit for
a virtual DDA audit group made up of disabled patients. This group will be supported with training and be asked to participate in
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various audits throughout the year. Some members of this group were involved on the three audits above.
Measure: Numbers of people with protected characteristics who use Cashiers Office and make enquiries at Support and
Information Services and an increase in appropriate claims by all people with protected characteristics.
A snap shot audit was undertaken across 5 cashiers’ offices in the following sites- Victoria ACH, Stobhill ACH, QEUH, Royal Hospital
for Children and Glasgow Royal Infirmary. Five hundred questionnaires were distributed to patients to collect data on their experience
of using the cashiers’ service for claiming fares and asking them to fill in an equalities monitoring form so that we can identify issues
for particular groups.
Analysis of the questionnaires will be carried out in 2019. A number of focus groups are planned to augment the questionnaires to
ascertain if there are differences in knowledge or experience of people with specific protected characteristics.
Measure: Numbers of patients engaged on access issues
We have engaged with over 673 people throughout the year on a wide range of access issues. Details can be found throughout the
report and cover British Sign Language users, asylum seekers and refugees, disabled people (learning disability, physical disability
and visual impairment), Lesbian Gay and Bi people, Trans people, women and men and people who have experienced poverty.
Actions for this work and how it has been fed back to services can be found throughout the report.
Measure: Increased money advice referrals
See Mainstreaming Section 2.4
Measure: Increase recording of patients’ access support needs
See Mainstreaming Section 2.4
Measure: Patient feedback on access support needs being met.
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The EHRT facilitated health discussions at 12 meetings for people with learning disabilities. This was in partnership with People First,
The Life I Want Group, Mainstay Trust and Enable. Much of this work is about ensuring people with learning disabilities have an
opportunity to feedback on their experience of using NHSGGC services. Areas raised include: how to increase staff knowledge of
learning disability and how to support people in our services better; how to make cancer information more accessible for those with
learning disabilities and how to improve access to dental services.
The Learning Disabilities Patient Group have also produced a staff training resource to inform NHS about how to provide more
supportive engagement and care for patients who have a learning disability- see Appendix II. The group have made plans to run
awareness and education events with staff in NHSGGC hospitals over the next 12 month period from April 2019.
Feedback was also sought form Glasgow Disability Alliance to understand how disabled people use NHS services and barriers they
may experience. This found three areas of concern:-
appointment letters which indicate you need to call to confirm or that come too late for disabled people to plan a hospital visit
travel to hospital which involves travelling to any hospital in NHSGGC area e.g. a disabled woman in chronic pain had to travel
form Glasgow East End to the RAH for a pain management appointment
scheduling of appointments in the morning when disabled people express a need for later appointments. Hospitals need to
recognise the mobility and support needs of many disabled people which rely on social care workers when scheduling
appointments.
Equality Outcome 2: People who require communication support in British Sign Language (BSL) receive it
Measure: Number of staff trained in using the BSL interpreting service and a year on year increase in BSL supported appointments.
Two hundred and forty staff watched the DVD on how to book BSL interpreters. Nineteen wards were trained on how to use on line
BSL interpreting. 95 staff completed the Deaf Awareness e-learning module and 96 completed the How to Work with an Interpreter
e-learning module.
Two hundred and eighty staff attended classroom sessions on Deaf Awareness training. This included Acute Ward staff, mental
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health staff and HSCP staff. Across Acute 168 staff attended ward sessions on sensory impairment awareness including content
around BSL.
Training was delivered on interpreting to communicate changes brought about by the Interpreting Service review. This was delivered
to 23 sites to 153 staff across Acute and Primary Care. This training included information on how to book BSL interpreters and the
legislative imperative to do so.
Additionally, with the revision of the mandatory Equality and Diversity e-learning module and associated performance plan, 70% of all
NHSGGC staff have completed the course which includes a section covering British Sign Language users. This equates to
approximately 28,400 employees answering a question on the requirement to provide a BSL interpreter for a patient who is Deaf.
Measure: Number of complaints from BSL users.
The BSL Mediator works directly with Deaf people to ensure they can feedback on their experiences of NHSGGC services and to
ensure they have no barriers to making a complaint. The mediator had contact with 77 Deaf people whose issues were as follows; 29
had no interpreter at their appointment; 19 contacted to query if an interpreter had been booked; 12 fed back about poor quality or
poor attitudes of interpreters at appointments; 7 fed back about poor staff attitudes in relation to their Deafness; 4 fed back about not
getting a reply for the Interpreting Service text phone; three feedback they were not happy with their choice of interpreters and three
fed back about poor care from NHSGGC.
The mediator is able to problem solve the issues that were raised, often in real time.
Measure: Patient feedback on British Sign Language user’s communication needs being met.
Online BSL interpreting
Over the past year we have increased the number of mini lap tops in our services to 33 which means that in emergency situations an
online interpreter can be made available. These are placed in all Accident and Emergency Departments, all Minor Injury Units, Mental
Health Services in patient services and Patient Support Services.
An evaluation has been carried out with staff. Results show that it works very well and staff felt that patients benefited from the
service.
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Another development in 2018-19 is our patient hand held online interpreting for BSL users. BSL using patients can now download
specific software to their own mobile phones to dial up an interpreter at a GP appointment. A protocol is in place to ensure that staff
know how and when to use this service instead of a face to face interpreter. So far 10 patients have registered to use the service. A
review will be carried out in June to understand how it is meeting people’s needs.
Equality Outcome 3: People who have migrated to our area, asylum seekers and refugees, know how to access Acute
services
Measure: Number of translated patient publications disseminated via services and voluntary sector organisations.
We have a range of resources to assist patients in getting the communication support they require and to understand how the health
service works. These include information and guidelines on BSL and spoken language interpreting services, advice on accessible
formats and easy read guides on using the health service (Pathways to Health) and patients’ rights. We distributed over 2000 of these
resources to staff and patients through training and engagement events. Many more were distributed on demand to voluntary sector
organisations working with equality groups. For example, specific translations of our Pathway to Health document were requested by
organisations such as the Scottish Refugee Council and the Red Cross to assist in their advocacy work with asylum seekers and
refugees.
Measure: Improved patient satisfaction.
A number of targeted engagement work with Refugees and Asylum seekers has been delivered to promote NHS services. Thirteen
events have been run with asylum seekers and refuges in partnership with a number of third sector support organisations including
the Integration Networks and the Red Cross. Two hundred and sixty two people attended these sessions across many language
groups. The dissemination of information about how the NHS works was highly valued. Concerns about how difficult mental health
services are to navigate was raised and how referral on to other services would be helpful. This included money and welfare advice
services. Further action will be taken to address these concerns.
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Equality Outcome 4: People who have reassigned their gender are not discriminated against in our services
Measure: Improved patient satisfaction
Trans people speaking to NHSGGC representatives at Pride Glasgow reported high levels of confidence in the being ‘out’ with service
providers though there remains a small but significant cohort of responders who continue to experience negative attitudes from some
service areas. Shared experiences emerging included being misgendered or being outed. The Go Rainbow Campaign has circulated
more than 10,000 rainbow lanyards accompanied by staff fact sheets relating to gay, bi and trans phobia within health and social
care. A repeat of the engagement activity at Mardi Gla in July 2019 will ask if attitudes have changed in light of the campaign and
associated learning and education activity.
Measure: Numbers of staff trained on gender reassignment issues
With the revision of the statutory and mandatory Equality and Diversity e-learning module and associated performance plan, 71% of
all NHSGGC staff have completed the course which includes a section covering gender identity as one of the 9 protected
characteristics. This equates to approximately 28,400 employees.
Importantly, the induction programme for new nursing intakes now sets aside a day for completion of statutory and mandatory learning
modules, meaning that all new nursing staff complete the equality and diversity module (including awareness of gender reassignment)
before talking up post.
Equality Outcome 5: Disabled young people receive support and information to enable them to successfully transition to
Acute adult services from Acute children’s’ services
Measure: Patient and carer satisfaction
NHSGGC Draft Transition Guidance is currently going through governance process to obtain sign off.
Young people’s service experience of Cerebral Palsies is being used as proxy for ensuring effective transition pathways in place for
children with complex needs, long term conditions or disabilities. A clinician led Cerebral Palsies Transition Group is leading on health
service actions and carer/ patient engagement to establish a patient centred pathway and ensure effective support and information
provided during transition process.
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Equality Outcome 6: People whose health is affected by their social circumstances as a result of inequality have their
needs identified and addressed through routine sensitive enquiry as part of person centred care.
Measure: Number of routine sensitive enquiry for gender based violence and money worries
Gender Based Violence (GBV)
See Mainstreaming section 2.4 Page
Money worries
See Mainstreaming section 2.4
Measure: Number of staff trained in priority areas on equalities sensitive conversations.
Inequalities Sensitive Practice is a way of working which responds to the life circumstances that affect people's health. Evidence
shows that if these issues are not taken into account by the health service, opportunities are missed to improve health and to reduce
health inequalities. Work in NHSGGC has focussed on gender based violence (GBV) and poverty however training on all of the
protected characteristics can improve practice.
The Equality and Human Rights Team undertake a wide range of bespoke training which covers equalities sensitive conversations.
Training has been delivered to junior doctors, new nursing staff and new managers. For more details see Mainstreaming section 2.5
Measure: Staff undertaking hate crime training
96 members of staff have completed the online Hate Crime module. However the revised NHSGGC mandatory Equality and Human
Rights e-learning module contains a section on Hate Crime and this has been completed by 71% of the workforce, equating to
approximately 28,400 employees.
Measure: Staff deliver healthcare which meets the needs and understands the experience of Black / Minority Ethnic communities.
During 2018 – 2019 (to February 2019) NHSGGC produced 408
resources in other languages or formats to meet the needs of our
patients. This compares to 239 in 2017-18. These translations include clinical reports, treatment instructions for patients, consent
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forms, public health information, speech language therapy reports for parents of children who do not speak English and NHSGGC
clinical information required for patient care. Our translation service provider has just been re-commissioned as part of the interpreting
service review to ensure we have the most cost-effective service.
The Clear to All Policy is being reviewed and a short life working group comprising representation from Public Health, Medical
Illustrations, Patient Experience and the Public Involvement team with links to Clinical Effectiveness colleagues is taking this forward.
This group has recommended the development of a Quality Assurance process for the development of health information; both clinical
and prevention information. This group will manage the co-ordination of this information in other formats to ensure equitable patient
pathways.
Equality Outcome 7: Patients who require augmented support in Acute care as a result of their protected characteristics
are linked to appropriate voluntary sector support
Partnership links between the third sector and NHSGGC Acute have been mapped showing active links with 104 third sector
organisations. Of these organisations 11 are cancer related charities, 7 are Deaf organisations and 6 are related to money advice
and/or poverty related issues. Learning disability and pan-disability organisations account for 5 organisations each.
Further analysis will be done to establish what type of working relationship services have with the voluntary sector to ensure that
patients can access specialist community support.
A partnership event is planned to provide opportunity for all partners to promote their work with Support and Information Service and
the Family Support and Information Service and to review current service referral pathways and identify opportunities for increased
partnership working in 2019 - 2020.
Equality Outcome 8: Older people receive services based on their needs
Measure: Review impact of frailty assessment tool on people’s health and care and increased patient satisfaction.
A Board wide group is overseeing delivery of a pathway in acute hospitals to deliver a high quality fast track frailty service that is
accessible to patients irrespective of arrival route. NHSGGC is actively participating in the national HIS Frailty Collaborative which
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continues to inform the Board wide improvement group.
IT changes will be introduced after April 2019 to make the new standard frailty screening tool available on TrakCare. This will create
system wide visibility of frailty positive patients, target resources and improve access to specialists for patients’ out-with the dedicated
areas and extend their liaison service across the hospital.
All six HSCP’s have collaborated over the introduction of a single frailty screening tool throughout GGC. The tool will ensure patients
who present with frailty receive the support they need within their own home.
Equality Outcome 9: Disabled staff receive appropriate reasonable adjustments and young disabled people are supported to
access modern apprenticeships in NHSGGC
Measure: Deliver Double Tick Action (now Disability Confident) Plan in consultation with Staff Disability Forum.
See Mainstreaming section 2.5
Measure: Produce and disseminate a manager’s guide to reasonable adjustment.
The manager’s guidance was been published in 2017and can be accessed on HR Connect.
Attendance Managemen
t http://www.nhsggc.org.uk/working-with-us/hr-connect/policies-and-staff-governance/policies/attendance-
management-policy-procedure-overview/supporting-disabled-members-of-staff/ Release Potentia
l http://www.nhsggc.org.uk/working-with-us/hr-connect/policies-and-staff-governance/release-potential/resources-for-
managers/
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Measure: Ensure young disabled people access NHSGGC modern apprenticeships.
Human Resources staff took a series of measures to increase the diversity of applications to NHSGGC’s modern apprenticeship
scheme. This included the following actions:-
Inclusion of the statement “We welcome applications from disabled people, minority ethnic groups, those who are care
experienced and the LGBTI community”
Creation of promotional flier to promote inclusive recruitment processes
Information sessions hosted tailored to each vacancy to provide information, advice and guidance on recruitment stages
Interview preparation sessions offered to every short-listed candidate
Opening up of vacancies to applicants aged up to 29 with a disability (generally up to 24 for non-disabled applicants) in line
with Skills Development Scotland strategy to increase the number of young people with disabilities being supported into
employment
Advert in Enable magazine
Circulation of vacancies to disability organisations
Interview confirmation email amended to include general statement reminding all applicants requiring adjustments to advise
team of requirements so that appropriate arrangements can be provided in a supportive manner
In 2018-19 We appointed 10 apprentices who disclosed a disability.
The Equalities and Human Rights Team and Human Resources have supported a Glasgow Centre for Independent Living graduate
trainee placement. The trainee has delivered a high standard of work on access audits, research on pregnancy and maternity and in
audiology.
Equality Outcome 10: Lesbian, Gay and Bisexual patients and staff are not subject to discrimination, including assumptions
of heterosexuality.
Measure: Number of staff trained on sexual orientation in priority areas.
With the revision of the statutory and mandatory equalities e-learning module and associated performance plan, 71% of all NHSGGC
staff have completed the course which includes a section covering Sexual Orientation as one of the 9 protected characteristics. This
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equates to approximately 28,400 employees.
NHSGGC has support the Rainbow Lanyard campaign, distributing more than 10,000 lanyards to staff across NHSGGC accompanied
by a Flyer entitled ‘Why go Rainbow?’ explaining the levels of discrimination faced by LGBT+ staff and service users.
Measure: Improved patient and staff satisfaction in how the organisation includes Lesbian, Gay and Bisexual people.
NHSGGC had a stall at Pride Glasgow 2018, talking to a large number of LGBT people across the weekend about their experience of
using our services. Three hundred and seventy five people completed feedback questionnaires – the largest return achieved in 6
years supporting the event.
Of those completing questionnaires, 19% described themselves as gay, 23% as lesbian, 25% as bi and 22% as straight. 10% defined
their sexual orientation in another way and 1% declined to answer the question.
As with previous years, the majority of people completing the questionnaire described very positive health care experiences including
praise for LGBT+ awareness amongst NHSGGC staff. However, 10% of respondents recorded less positive experiences, citing
issues such as stereotyping and patronising attitudes as impacting on overall quality of service. The NHSGGC stall at Mardi Gla in
July 2019 will re-visit attitudinal feedback and ask if visibility of NHSGGC’s ‘Go rainbow’ Rainbow Lanyard Campaign has further
improved service user experience.
Equality Outcome 11: Patients and staff have an increased understanding of discrimination and unconscious bias
Measure: Feedback from Human Library events and unconscious bias events.
The Equality and Human Rights Team have delivered 6 Unconscious Bias training sessions to a mix of integrated NHS and local
authority staff and community representatives totalling approximately 160 people. The sessions have evaluated extremely well and
developments are underway to develop an associated e-learning module. It is important to clarify that NHSGGC’s interpretation of
unconscious or hidden bias brings a focus to structural discrimination and how this plays out in the behaviours of individuals rather
than locating the challenge solely with the individual. NHSGGC will be delivering a joint learning event on unconscious bias with the
Commission for Race and Equality in April 2019 to NHSGGC’s top management cohort.
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Measure: Feedback from staff and patients of perceived cultural change e.g. Fairer NHS Survey, patient engagement.
The 2016 survey will form a baseline for the follow up survey in 2019-20.
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Appendix 1
Young people aged 12-25 were given an opportunity to explore ACEs (Adverse
Childhood Experiences). They were then asked how a young person who was
struggling or in distress should be treated by responsible adults. This was their
response:
SHOULD
SHOULDN’T
DO
DO
Be Positive
Be on time
Be Fun /
Use Jargon
Give UP
Funny
Raise your
Lis
voice
ten
Give
Be Kind
Be
Patronising
Options
Be
Be
Aggressive
Positive
Offer
Be Patient
negative
Body
Snacks
La
nguage
Talk about
Have long
Build Positive
Let them
Build Trust
waiting
Relationship
in groups
talk
time
Mention
Appendix II
Names
Be Unkind
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43
44