Creating a fairer Britain
In 2005, the Mental Health Act Commission (MHAC) looked at the gender balance of its commissioners. Whilst the overall balance was even, there was a higher proportion of men as area (better paid) commissioners and a higher number of women as local (lower paid) commissioners. The MHAC undertook an equality impact assessment of the recruitment process and as a result, changes have been made to job descriptions. This has been to encourage more women to apply for area commissioner positions.
Human resources and equality staff reviewed the job description and person specification with an eye to gender bias both in terms of language and content. This included discussing with commissioners what had attracted them to, or put them off, applying for the different roles. As a result of feedback, job descriptions and person specifications were simplified, removing content that was not essential. This was to ensure that people with the ability to fulfil the role should not be discouraged from applying because of lack of experience, and this was likely to affect women more than men.
Commissioners to the MHAC are appointed by the national Appointments Commission. Previously, all appointments had been based on open competition. In order to rectify the imbalance the MHAC gained agreement for a process of internal recruitment.
This allowed transfers between the roles, which saw several women move from being local to area commissioners. This was followed by open recruitment in late 2007 for vacancies in both roles. Monitoring shows that progress is being made with regard to gender equality.
The duty to involve disabled people has created a real cultural change in the Mental Health Act Commission. In the programme Acting Together, Commissioners and service users undertake joint visits to health facilities. These have enabled commissioners to see the service from the users perspective. Furthermore, users with physical disabilities have highlighted access issues such as suitable bathing facilities and the provision of appropriate chairs on wards.
The Wales NHS Centre for Equality and Human Rights undertook a patient equality monitoring project. This has:
Pilots were undertaken before services were obliged to collect the data. It is anticipated that the data will be fundamentally important to the assessment of policy impact on different groups. The next challenge for the organisation involved will be to ensure that the data is analysed and used to inform service design and delivery.
Access to hospital paediatric and maternity wards relied on verbal communication via an intercom which was identified as a barrier for deaf service users. There was no way to alert ward staff that a visitor or service user may be deaf or require assistance. To find a solution the equalities department at the Trust brought together deaf users, ward and estates staff and the intercom design company.
Deaf users were fully supportive of the need for ward security and worked to enable staff and designers to understand the barriers to communication. The designers were able to test a number of ideas and they came up with a range of solutions to improve communication. For example, illuminated assistance buttons and a text box with access instructions. In addition, the users commented on the poor general signage for the intercoms and advised on better pictorial signage.
The intercom will be piloted in the hospital and it is expected that recommendations will be made to roll out the new design further. Feedback from the design company indicated that this was the first time they had been asked to look at accessibility of intercoms. To build on this knowledge and understanding of communication issues and the barriers faced by users accessing services, a programme of deaf awareness training is under way, including staff on wards where the new intercom is being piloted.
NHS North East has worked together across all of its 23 organisations to develop a single equality scheme framework. A working group from an equality network developed a framework and priorities which have been used by individual trusts to guide local actions. Huge benefits have accrued including avoiding duplication through sharing data, skills and expertise, and undertaking joint consultation and involvement activities.
A performance framework of high level actions has been developed as part of the scheme. This will be monitored across all trusts by NHS North East. Progress on equality data collection is one of the actions and all trusts in the region are encouraged to report on progress on equality issues annually to their Boards. This helps to raise the profile of equality to secure resources for the work. An equality impact assessment toolkit is available for all trusts to use.
The Trust held a conference for staff across the region and commissioned a third sector group to provide feedback from the community on the single equality scheme.
As part of a review of its catering service, a north of England mental health trust proposed to reduce the hours of catering across all sites. Initial screening indicated that some users of learning disability and neuro-rehab services might have difficulty accessing the alternatives, which were vending machines. A full equality impact assessment was carried out, drawing in service users for their views and advice. This led to a significant change in the original proposal. Fewer catering hours would be cut and there was a firm commitment to make the vending machines fully accessible. All involved considered this to be a positive outcome.
NHS Norfolk has been a key player in developing the Interpretation and Translation service in Norfolk (INTRAN), a partnership between the Trust, the County Council and 30 other agencies across the region.
This approach provides economies of scale, an ability to respond quickly to specific needs as well as a speedy barometer of key emerging community issues. INTRAN trains community-based interpreters which provides local employment. This includes regular interpreting sessions at two GP surgeries. INTRAN has been recognised as an example of social cohesion good practice by the Department for Communities and Local Government and it has received two national awards for procurement.
Action points in the Lewisham Primary Care Trust's (PCT) single equality scheme are directly linked to achieving real improvements in the health and well-being of the local population. The aim is to reduce health inequalities based on national and local data and the views and involvement of local people.
The scheme's action plan focuses on five service areas: mental health, learning disability services, cancer, immunisation and cardio-vascular services.
Over the three years of the scheme, the trust will identify and take action on the specific healthcare needs of lesbians, gay men and members of faith communities. The actions within the scheme are underpinned by outcomes through which the trust will measure its progress. These objectives will help to ensure that equality is mainstreamed across the organisation, and that staff at all levels understand and are supported in their role to deliver good health outcomes for all.
Islington PCT set up a disability group with staff providing adult and childrens services as well as with representatives from Islington Disability Network, Islington Age Concern and Islington Borough Users Group (mental health).
The Group worked together to identify the priorities for disabled people. They developed initiatives to address any gaps and to improve services for disabled people. These included providing and disseminating information in alternative formats such as ‘easy read’. This included information about the Patient Advice and Liaison Service, about making a complaint, and about how to find a dentist locally. The PCT also provided a list of Pharmacies and information about their accessibility on their website.
The group reviewed a number of services and policies to ensure that they promoted disability equality. They took a number of actions as a result, including: steps to improve co-ordination amongst services for children with a disability and advice to all GPs, dentists, pharmacists and opticians in Islington about improving their services for disabled people, including about using British Sign Language (BSL) Services. They implemented a new BSL service for opticians in the area to carry out NHS eye checks and to screen people with diabetes for early signs of diabetic eye disease.
In 2007 Islington PCTs disability group focussed on improving childrens services and introduced targets to improve co-ordination and integration of services for children with a disability. Over 60 families have a new, named, lead professional to act as a single point of contact for them. The lead professional co-ordinates single multiagency plans for every disabled child.
A new recruitment process for staff working in the children with a disability service was set up. Staff are interviewed by a panel which includes either parents or young people with a disability.
Together with the Islington Borough Council, the PCT links up with a local disability organisation for parents and carers and has introduced a new 8 weekly, talk shop for young people with a disability and parents who have a child with a disability. The talk shops focus on new service developments and agree actions to improve services.
Staff at Somerset PCT were invited to attend a one one-day course on Communication Tactics with Deaf People, run by Hampshire Deaf Association. This promoted deaf awareness and advised on basic communication skills, particularly for those who rely on lip-reading. The day included a short test which gave staff the opportunity to demonstrate their knowledge in a practical way.
The PCT also held mandatory Equality and Diversity training courses which included a session run by two volunteers with hearing impairments. They communicated through British Sign Language and spent time talking about their experiences of using local healthcare services. Time was spent discussing with staff the improvements that could be made to improve the patient experience for those with hearing impairments.
Following a review in 2006, it was established that the process of using volunteer Appropriate Adults was not giving sufficient service provision which meant that there were incidences when people with mental disorders were interviewed without an Appropriate Adult present. Additionally, There were reported occasions when Appropriate Adults took too long to arrive at the Police Station. The service was altered and voluntary Appropriate Adults have now been replaced with paid for contracted Appropriate Adults.
The revised Service has been reviewed and showed that every request for an Appropriate Adult has been fulfilled; the average attendance time from call to arrival at Police station is 53 minutes, and that there has been an average 12% increase in requests from police officers.
More information on Appropriate Adult: http://www.appropriateadult.org.uk/
The Health Development Service in Coventry runs drop-in services and weekly advice sessions targeted at women in Asian communities in the most deprived parts of the city. The involvement of women from the community in identifying the barriers they experience in accessing health services, and proposing ways to improve services to overcome these, is integrated into work to raise health awareness and improve take-up of services through information, advice and support.
To encourage women to become involved, the service made it a priority to identify and overcome the barriers that prevented Asian women from getting involved with, and using, health services. For example, rather than asking women to come into the Health Development Unit offices, those involved in the work now go to where the women they want to reach are.
Regular womens health sessions now take place in community centres, GP surgeries, temples and schools or centres near Mosques.
The benefits for participants include improved health outcomes, more opportunities to socialise and increased confidence and well being.
Benefits of the involvement include: