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Public Sector Equality Duty Annual Report 2016

This report was produced by:

Lenny St Jean, Equality and Diversity Lead

Dorota Scott, Business Intelligence Analyst

Natalie Cooper, Workforce Transformation Analyst

Please direct any enquiries to Lenny St Jean on lenny.stjean@boltonft.nhs.uk

or 01204 390390 extension 4713

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Annual Equality Report

Overview

Bolton NHS Foundation trust has a diverse community of patients, visitors and staff that come from Bolton and the surrounding areas. Building effective partnerships between and across these communities is a key driver behind our Equality, Diversity and Inclusion Strategy (EDI) 2015-2018. Our strategy outlines our long term goals to improve the health outcomes of patients from vulnerable and protected groups; reduce health inequalities; and ensure a safe and equitable environment for our workforce. This report outlines our achievements in the last year; the challenges that we face; and recommends actions that need to be taken to help us reach our long term goals.

Governance of Equality Diversity and Inclusion

The Executive Lead for Equality, Diversity and Inclusion is the Executive Director of Nursing and Patient safety. As chair of the Patient Experience and Inclusion Partnership Committee, the Director of Nursing and Patient Safety provides senior leadership and scrutiny for EDI activity across the Trust

The strategic direction for Equality, Diversity and Inclusion is set by the EDI Steering Group. This group is chaired by the head of Governance. Membership is drawn from all clinical divisions and corporate areas. Members of the EDI Steering Group are responsible for cascading information and initiating action within their division or corporate areas. As well as reporting to the PEIPC, the EDISG also reports to the Workforce Committee

There are a number of patient groups that contribute to the EDI agenda, such as the Learning Disability Sub group; the Dementia Carers Support Programme; and the Child and Adolescent Mental Health Service (CAMHS) Patient groups. Action logs for these groups indicate that these groups make a significant contribution to service delivery and improvement.

Recommendations

• Develop a team of EDI champions to further support implementing EDI activities within Divisions

• Develop a range of EDI staff networks/forums to further support staff engagement, ownership and integration of the EDI agenda

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Equality Objectives 2014 - 2016

The Public Sector Equality duty requires that the Trust publishes Equality Objectives at least every four years. Progress on our current Equality Objectives is set out below. Work will continue on any actions that have not yet been achieved. New Equality Objectives for 2016 onwards will be developed with reference to any recommendations made within this report, along with the findings of the Equality Delivery System (EDS2) audit which will take place in the summer of 2016

EDS2 Goal/outcomeEDS2 Goal2.1People cares and communities can readily access hospital, community health care services and should not be denied access on unreasonable grounds

Trust Equality ObjectiveImprove access and experience for patients with Dementia

Actions

Collect and analyse data including feedback from Dementia Carers

Review the information available to patients and their families on the external Trust Website

Develop an engagement strategy and user reference group to ensure that when changes are made to services we have a process of consultation and involvement

Identify training needs for staff

Progress

Dementia Training CQUIN 14/15 report Highlights good evidence to suggest that patients and their carers are involved in decisions about their care, treatment and involvement in plans for their discharge

A general review of information has taken place and a number of actions placed on the Dementia Steering Group (DSG) Work Plan accordingly. A specific review of the Website has not yet been conducted.

Engagement activity is delivered through the DSG. Membership of the DSG includes representatives from Public Health, the voluntary sector and professional carers. The Terms of Reference for the DSG are aimed at inclusivity and aid in any consultation and involvement

The development of a 10 week carer support programme has improved engagement and consultation with carers. In addition the carers questionnaire has been reviewed to ensure feedback of themes are cascaded to divisions. These questionnaires will be adopted by the Meridian patient feedback system going forward.

The Dementia Lead is developing stronger links with Bolton Dementia Support Group and aims to implement at least fortnightly drop ins for carers and patients

Dementia Training needs analysis complete, 98% compliance with training, monitored on a monthly basis

RAG

Achieved

In Progress

Achieved

Achieved

Achieved

Achieved

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EDS2 Goal/outcomeEDS2 Goal 2.4People’s complaints about services are handled respectfully and efficiently

Trust Equality ObjectiveAnalyse the handling of complaints/concerns from patients and carers from protected groups, to ensure that they are handled respect

Actions

Collect and analyse feedback from complainants following the handing of complaints and subsequent redress

Review the complaints process and identify any gaps/actions to improve patient experience in handling complaints for protected groups

Hold engagement activities with disadvantaged groups

Review complaints training and retarget at Ward Managers/Mangers and Matrons to ensure that issues are addressed and prevented ‘in the moment’

Progress

Analyses of feedback is provide through a 6 monthly report to the PEIPC

A review of the process highlighted an inconsistency in diversity data being recorded. This has implications to meaningful analysis of data. Improvements to this will be addressed as part of the EDI Strategy 2015-2018

Policy for the management of complaints reviewed and ratified in April 2015. This included changes to response times; introduced the requirement to record meetings; and the requirement to have final approval for all complaint responses from the CEO

Engagement with disadvantaged groups occurs locally by individual teams. The EDI Steering group is investigating how information from these events is shared across the Trust

External forums such at the Health and well-being forum and the Equality Target Action Groups are used as mechanisms to engage with a range of patient groups representing disadvantaged and vulnerable groups

As a result of the review Investigation training will be delivered on a regular basis throughout the year

Patient Experience Team delivery regular training on complaints as part of the HCA development programme

Poster are displayed in wards and departments to encourage patients to raise concerns with clinicians as soon as possible and advised to contact PAL’s if they did not receive a satisfactory outcome

RAG

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

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EDS2 Goal/outcomeEDS2 Goal4.1Boards and senior Leaders routinely demonstrate their commitment to promoting equality within and beyond the organisation

Trust Equality ObjectiveImprove the promotion of Equality, Diversity and Inclusion by Board Members and Senior Leaders

Actions

Analyse available information

Engagement exercise with the Board, disadvantaged groups and the workforce

Develop an action plan

Identify Training needs

Progress

As part of the Board Development session, the Board reviewed opportunities for them to strengthen EDI Leadership, with particular emphasis on Unconscious Bias and recruiting a more diverse Board

On-going Review of the Equality Analysis process highlighted opportunities to increase evidence of data and engagement

Review of the positioning of EDI in policy led to increased visibility of EDI outcomes in the people Strategy

A review of the staff award programme is in place to ensure that the diversity of the Trust is reflected in shortlisting

The Board and members of the EDI steering group have engaged in an EDI development session

A new initiative of monthly listening Lunches hosted by the Trust CEO provide an opportunity for staff to give their opinions on how it feels to work at the Trust

Diverse patient stories are routinely part of Patient Experience and Inclusion Partnership Committee and Board

Work undertaken to refresh the Trust Values will support managers and staff to reflect upon the practical application of fairness and respect

EDI Leadership is an integral part of the EDI Strategy 2015-2018 and a number of leadership activities have been included in the EDI work plan, inc improving the Equality Analysis process; increasing mandatory training rates; and a number of actions as part of the Workforce Race Equality Standard

Training needs are being identified and incorporated into a wider EDI Training Strategy

RAG

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

Achieved

In progress

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Equality delivery System (EDS2)

EDS2 is a framework by which the Trust, in partnership with external stakeholders can assess its equality performance and make improvements to service delivery; improve health outcomes for patients, as well as improving equality outcomes for our workforce. Whilst the Trust has in the past used the EDS2 framework to conduct a self-assessment, 2016 will be the first time that the Trust implements the process with the full engagement of wider stakeholders, including patient groups.

The EDS2 process has four Goals, which are:

1. Better health outcomes 2. Improved patient access and experience 3. A representative and supported workforce 4. Inclusive Leadership

Services that are assessed will receive one of the following grades:

People from all protected or vulnerable groups fare as well Excelling as people overall

People from most protected and vulnerable groups fare as Achieving well as people overall

People from only some protected or vulnerable groups fare Developing as well as people overall

People from all protected and vulnerable groups fare poorly Undeveloped compared to people overall OR evidence is not available

A full report on the EDS2 process, including grading and any associated action plans will be available on the Trust website in Autumn 2016

If you would like to be involved in the EDS2 grading event, please contact Lenny St Jean, Equality and Diversity Lead via email at:

Lenny.stjean@boltonft.nhs.uk

or by telephone on: 01204 390390 ext 4173

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Equality, Diversity and Inclusion – Service Delivery

Interpretation and Translation

The trust provides a range of services for people who speak little or no English. The Trust has two Link Workers based in the hospital who provide interpretation services for people who speak the following South Asian languages.

• Hindi • Gujarati • Urdu • Punjabi

As well as providing an interpretation service the Link workers deliver a number of community engagement activities

Interpretation and translation services for other languages are provided either through a 24 hour telephone service, or through booked external face to face interpreters, including British Sign Language (BSL) interpreters.

Between January 2014 and December 2014 the Trust provided a BSL interpreter on 242 occasions and a language interpreter on 6750 occasions

The Top 5 languages requested in this period were:

1. Hungarian 2. Arabic 3. Polish 4. Slovak 5. Czech

The Trust is currently reviewing its interpretation and translation services to make sure that it can meet the needs of emerging communities and their language needs.

Equality Monitoring

An analysis of the diversity of the patients using the Trust enables us to assess how accessible our services are, and develop evidenced based targeted activities that improve services. This section provides an overview of patients using services, analysed by

• Age • Ethnicity • Gender • Religion

The data is the section refers to the 12 months between November 2014 and October 2015. Within this period the Trust saw a total of 364,379 unique patients. Most of these were treated as outpatients

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• The Trust sees a range of patients across all age ranges. People over 71 are over represented compared to the age profile of Bolton. This is to be expected as health often deteriorates with age

• People under 15 are the largest groups of patients and account for21.74% of patients

• People under 15 are the largest users of community services (31.6%) and A&E (24.59%) • People over 71 are the largest users of Inpatient services (22.38%) and Outpatient Services (18.71%)

Analysis of data by age

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Recommendations

• Support Divisions to analyse DNA data by age and develop targeted appropriate activity to reduce DNA rates in identified areas

An analysis of DNA/missed appointment rates by age indicates that people aged 31-40 are marginally more likely to miss appointments when compared against overall trust activity. People aged between 61-70 are the least likely to miss an appointment

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• 63.25% of patients identify as White British. 0.41% Identify as White Irish and 1.35% identifying as Other White.

• People who identify as Other White are predominantly from EU Accession Countries.

• The percentage of people identifying as White British is lower than to be expected given the demographics of Bolton. However in over 20% of patient profiles, ethnicity is listed as either ‘unknown’ or ‘not stated.’ This increases to over 30% for patients treated within the community division. This could account for some of the discrepancy

A detailed breakdown of the ethnic profile of none White British service users indicate that Indian (Asian or Asian British) and Pakistani (Asian or Asian British) people are the largest minority ethnic group that use our services. This is consistent with the demographics of Bolton.

Analysis of data by ethnicity

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• 55.40% of patients were female with 44.60% of patients being male • Women are more likely to be treated as inpatients, outpatients and within the community. However men are more likely to be treated in A&E • Slightly more men failed to attend their appointments when compared to the overall patient profile (15.52 for men and 14.84 for women

Recommendations

• Improve the return rate for ethnicity across all divisions

• Explore recording more specific details rather than Other White in order to highlight any access issues faced by specific groups

Analysis of data by Gender

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Analysis of data by religion

• Data indicates that we do not hold information on religion for approximately 50% of patients. Where religion is recorded, the vast majority of patients identify as Christian

Recommendations

• Increase return rate for religion

• Increase awareness of religious festivals and implications for booking inpatient and outpatient appointments

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PALS and complaints

When anyone has a concern they wish to raise, whether it be a patient, carer relative or member of the public we encourage their feedback, as we acknowledge that as a result improvements can be made to our services. Through the use of posters and our ‘Compliments, Concerns and Complaints’ leaflet, we encourage patients to try and speak to staff as early as possible. However if this is not feasible, concerns can be brought to the attention of the Patient, Advice and Liaison Service (PALS) based on the ground floor, in the main entrance foyer of the hospital. Complainants can visit the office, send an email, telephone or write a letter. The PALS officers will also attend clinical areas to speak to staff if requested.

There were 431 complaints and 836 PALS concerns raised in 14/15. The data reflects a wide variation in source of complaints, enabling many patients to use an advocate to raise their individual concerns when they are not able to do so themselves. Consent to investigate concerns raised by an advocate is always sought in line with government guidelines. Equal numbers of men and women have raised concerns either as a PALS concern or as a formal complaint.

The data referring to age of complainants, relates to the service user rather than the actual person making the complaint on their behalf. A large proportion are a reflection of our elderly population who receive care.

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Ethnicity is not recorded or available for 70%-80% of our complainants/patients via the complaints data base and therefore it is difficult to provide any analysis on this aspect

Recommendations

• Improve the recording of ethnicity across all patient administration systems to support a better analysis of PALS and complaints data

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The overall age profile since 2014 is shown on next page.

Equality Diversity and Inclusion – Workforce data

This section provides an overview of the workforce analysed by

• Age • Disability • Gender • Race • Religion and belief • Sexual orientation

The data in this section refers to the 12 months between April 2014 – March 2015

AgeThe age profile of the Trust is important in terms of workforce planning. A balanced workforce at different stages of their career allows an appropriate re-invigoration of skills and ideas where turnover is at a sustainable level.

The data is showing what we might expect in that staff in their early stages of their career have not reached the higher pay bands. From a perspective of retaining staff the band 1-4 is relatively over-represented in the over 60s, showing that many professionally qualified staff are choosing to retire at 60 or earlier.

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It shows that in 2015 (2014 in brackets) the age profile was split as follows;

- 16.2% (15.5% in 2014) of our workforce are 30 or under - 53.4% (54.9% in 2014) of our workforce are between 31-50 - 30.2% (29.6% in 2014) of our workforce are 51 or over

Disability

Since 2013 the Trust has recorded a slight increase from 127 staff who considered themselves to have a disability to 157 in 2015. As this is reliant on self-reporting of information from staff, this is encouraging that this figure has increased.

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Recommendations

• Fully implement the TRAC system to ensure that demographic data is complete for all staff

• Reduce the number of “Do not want to answer” by education and raising awareness

Gender

The analysis shows a predominately female workforce (85.3%). This is a very similar ratio to 2012 with the Estates and Facilities and Medical staff groups being the only male-dominated professions.

The following chart demonstrates the workforce by pay band. It shows that the highest relative numbers of disabled staff are in the higher bands of 8b and 8c.

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The analysis by banding shows the higher bands become increasingly populated by male employees, despite the overall preponderance of female employees across the range of pay bands as a whole.

Recommendations

• Consider using good practice from the Workforce Race Equality Standard as a mechanism to monitor and improve representation and progression of staff by Gender

• Develop training opportunities to link to succession planning

Race

9.7% of our staff are from Black or Minority Ethnic (BME) groups. This compares with Bolton’s population of 18.1% - although the working age (over 16s) BME population in Bolton is 15.5%.

Approximately 25% of the Trust’s patient activity is from outside Bolton, mainly for residents of Salford, Wigan and Bury. The location of Royal Bolton Hospital close to the boundary of both Salford and Wigan also means the population from these areas bordering Bolton will know the Trust as ‘their local hospital’ and it will attract job applicants from these areas. The BME population of Salford is 9.8% and Wigan 2.8%.

The chart on next page shows we have a relatively high number of ‘Not Stated’ at 5.3%.

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By payband it shows the BME group to be under-represented in the Band 8s and above group and over-represented in the Medical staff group. Although the medical career path is popular amongst BME groups, the other professions show under-representation. This is especially a concern where recruitment is more difficult such as in nursing & midwifery, where there may be potential do some work to encourage more interest from certain population groups.

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Recommendations

• Monitor and improve the representation and progression of BME staff using the Workforce Race Equality Standard

Religion or Belief

The most common religion is Christianity (46.7%). The numbers of staff who do not wish to disclose their religion/belief has reduced from 47% in 2012 to 39% in 2015, showing a greater awareness of the importance of collecting this data.

The report shows we are still under-represented in the group that identifies Islam as their religion (2.9%) but this increased from 2013 where it stood at 2.3%.

Recommendations

• Fully implement the TRAC system to ensure that demographic data is complete for all staff

• Reduce the number of “Do not want to answer” by raising awareness

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Recommendations

• Fully implement the TRAC system to ensure that demographic data is complete for all staff

• Reduce the number of “Do not want to answer” by raising awareness

Sexual Orientation

The chart below shows those who have identified sexual orientation showing that there is under-rep-resentation in the non-heterosexual groups, but this may in part be due to staff who identify as lesbi-an, gay or bisexual not declaring this in the monitoring data.

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Key Findings For Applicants And Recruits

The analysis below shows the likelihood of each respective group being appointed over another.

Likelihood of appointment * The metric is based on the likelihood of shortlisted candidates being appointed by group for 2014/15.

Recommendations

• Focus on disability and sexual orientation, where statistically it is less likely staff who possess the protected characteristics are appointed.

Characteristic

Age

Disability

Race

Religion or belief

Sex

Sexual Orientation

Metric*

1.17 times more likely for the under 50s to be appointed than over 50s

2.71 times more likely for non-disabled candidates be appointed than disabled candidates

1.08 times more likely for White candidates to be appointed when compared with BME candidates

1.09 times more likely to appoint Christian candidates than non-Christian candidates

1.15 times more likely for female candidates to be appointed than male candidates

1.35 times more likely to appoint heterosexual candidates than non-heterosexual candidates

Number

1.17

2.71

1.08

1.09

1.15

1.35

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Recommendations

This report makes the following high level recommendations. SMART actions will be developed and added to the EDI work plan

1. Improve staff engagement and ownership of the EDI agenda by establishing a range of EDI champions and staff networks/forums

2. Support Divisional analysis of DNAs by protected groups and develop targeted activities to reduce DNA’s

3. Improve the recording of equality monitoring data for staff and patients

4. Increase awareness of how equality monitoring data is used to design and develop services

5. Monitor the representation and progression of BME staff using the Workforce Race Equality Standard (WRES)

6. Explore how the WRES might be used to improve representation and progression of staff holding other protected Characteristics

7. Further analyse likelihood of appointment for candidates who have a disability and those who identify as LGBT

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