Single Equality Scheme 2008/11
Action Plan Report
May 2009
1
Introduction
In June 2008 Central and North West London NHS Foundation Trust published its first Single Equality Scheme. The Trust had previously
published a Race Equality Scheme 2006-8 which the Single Equality Scheme 2008/11 built on and replaced. The Trust also had in place a
Disability Equality Scheme 2006-9 and Gender Equality Scheme 2007-10. The Single Equality Scheme 2008/11 drew from and combined
both of these Schemes. The Trust also went further by including sections addressing Sexual Orientation Equality, Age Equality and
Religion or Belief Equality.
This report has been written to show progress against the specific Action Points identified within the Scheme. Most of the actions have
been achieved within the anticipated timescale, some remain in progress. We deliberately set ourselves an ambitious agenda, believing
that the essence and spirit of an Equality Schemes was to challenge and to extend ourselves.
As we write this report we are also updating the Single Equality Scheme Action Plan, and in particular looking at ways of embedding
recommendations from the Trust’s Delivery Race Equality Focussed Implementation Site Project within the Action Planning process.
The Trust structure for addressing Equalities and Diversity is through a central Equalities and Diversity Group, made up of representatives
from the service directorates and Human Resources. Local Equalities and Diversity structures, often taking the form of local groups, then
co-ordinate actions in response to the Trustwide and local agendas. Progress is monitored quarterly with the Action Plan being updated
with further actions taken.
2
CNWL Single Equality Scheme Action Plan 2008/2011
Note that many of the disability and gender standards below are adapted from national race/ethnicity standards – this means that in a number of areas
CNWL is targeting standards above those nationally set in relation to disability and gender
Progress to date is measured via a traffic light system:
Achieved
No. Measurable CNWL Outcome
Partly
achieved/
in process
Relates to
HCC Core
Standard
Not
achieved
Lead / involves
Time-scale
Progress to
date
Director of Human
Resources
March 2009
Achieved
A. Corporate Trust (HQ based) Actions
Employment / workforce issues
A1
The profile of the workforce is analysed by ethnicity, gender and disability annually to
identify areas of under- and over-representation.
C8b
Ethnic Monitoring Reports for staffing are produced and analysed annually. A staff disability survey was completed in 2007, staff data updated and a Report produced
from this data. Gender reports to show seniority by gender are being produced annually. Ethnicity, Gender and Disability data is now captured routinely for all new staff.
The Trust’s new Data Warehouse System is currently under development and during 2009/10 reports by ethnicity, gender and disability will be produced more efficiently
than in the past.
A2
The HR Directorate has an action plan to address areas of under-representation (and overC8b
Director of Human
March 2009
Achieved
representation where this is occurring in some areas). e.g. Targeted recruitment initiatives;
Resources
Targeted management development and skills development programmes
Difficulties noted in relation to how much influence CNWL has over the ethnicity of professionals within, for instance, nursing and medical staff. Discussions have taken
place with TVU, CNWL’s main training provider for nursing. New recruitment process has been initiated. Recruitment Strategy is being developed along with an
Organisational Development Strategy which will include targeted management development programmes building on current initiatives: Women in Management,
Springboard
A3
Establish a staff profile by sexual orientation by undertaking a census of staff and recording
C8b
Director of Human
December
Achieved
upon HR systems.
Resources
2008
Sexual orientation is being recorded at recruitment. Census has been undertaken in autumn 2008 to request data from staff already in post. New Data Warehouse system
will enable regular reporting.
3
A4
Establishing of BME staff professional development processes as part of Corporate
Organisational Development initiative, and in response to feedback from the Single Equality
Scheme Consultations
C8b
Director of Human
Resources
Director of Operations
March
2009
Partly
achieved/
in process
Organisational Development Programme drafted. More co-ordinated and targeted approach to staff professional development to be instigated, to include targetting
initiatives towards BME staff.
A5
Development of other CNWL-wide staff networks where need is expressed - to support
against disenfranchisement and discrimination.
C8b
Director of Human
Resources
Director of Operations
On-going
A Trust-wide Staff Disability Equality Group is established, meeting quarterly for support and to feedback on disability related issues.
Many staff within the Trust can attend local BME staff networks organised through the local councils, however, this is not available for all staff.
BME staff are attending an Inaugural National BME Network Conference and it is planned to develop a BME staff network following this.
LGBT staff are to be asked through the Trust’s Equalities Newsletter whether they are interested in a staff network
A6
Establish a profile of staff by religion by undertaking a census of staff religion and recording
C8b
Director of Human
December
upon HR systems.
Resources
2008
Partly
achieved/
in process
Achieved
Religion or belief is being recorded at recruitment and a census of all staff was undertaken in autumn 2008. The new Data Warehouse system will enable regular
reporting.
A7
Review and update the Trust’s Equal Opportunity Policy
C7e
C8b
C11
C13a
C16
C17
C18
Director of Human
Resources
Equalities and Diversity
Manager
December
2008
C8b
Director of Human
Resources
On-going
Achieved
Equality, Diversity and Human Rights Policy (Employment) in place
Equality, Diversity and Human Rights Policy (Service Delivery) in place.
A8
There is continued mentoring of BME staff by senior members of CNWL management.
Achieved
Mentoring continues to be available. The Trust’s new Organisational Development Framework includes a focus on further development in this area, with clearer systems
for accessing coaching, more publicity, co-ordinated training of coaches. There will be specific targetting of coaching towards BME staff.
A9
There is mentoring of staff having a disability by senior members of CNWL management.
4
C8b
Director of Human
Resources
Executive Board
December
2008
Partly
achieved/
in process
The Trust’s new Organisational Development Framework includes a focus on development in this area, with clearer systems for accessing coaching, more publicity, coordinated training of coaches. There will be specific mention of encouraging disabled staff in accessing coaching.
A10
The Trust will establish a mentoring system for female employees who have undertaken the
‘Women in Management’ process.
C8b
Director of Human
Resources
December
2008
Partly
achieved/
in process
The Trust’s new Organisational Development Framework includes a focus on this development. A system for ensuring that all female staff accessing the Women in
Management programme are offered on-going mentoring/coaching is being instigated during 2009.
Training
A11
Cultural Competency Training for Managers continues. Establish Cultural Competency
Training for Doctors. Further develop culturally-related training and learning processes,
including training in community engagement/PPI activities with BME groups.
Clinical staff receive training in incorporating the needs of different BME groups into care
planning, needs assessment & discharge planning.
C7e
C8b
C11
C13a
C16
C17
C18
FIS Project Manager
Equalities & Diversity
Manager
Equalities and Diversity
Group
December
2009
Partly
achieved/
in process
Cultural Competency for Managers and Cultural Competency for Doctors training is being provided. Local cultural competency training for staff being provided in some
areas of the Trust. Cultural factors are included within training in relation to care planning, needs assessment & discharge planning.
Community Engagement Guidance has been drafted.
A12
The Trust formulates a Community Engagement Strategy as defined by the Pacesetters
programme ‘A dialogue of equals’. Material produced to promote community engagement.
C17
C18
FIS Project Manager
Head of PPI
Equalities & Diversity
Group
March
2009
Achieved
Community Engagement Strategy is being embedded within the Trust’s wider Patients and Public Involvement Strategy. Community Engagement Guidance has been
drafted and will shortly be publicised.
A13
Formulate and implement methodology for assessing impact of Equalities and Diversityrelated training
C8b
C11a
Director of Partnerships
and Commercial
Development
Equalities & Diversity
Manager
FIS Project Manager
December
2009
Partly
achieved/
in process
Reviewed impact of current ‘Cultural Competence Training for Manager’ with a number of managers who have completed the course on 30th June 2008. Report produced.
Further processes need to be devised, linking to Organisational Development monitoring processes.
5
A14
A corporate (Trust-wide) programme of Disability awareness / disability equality training is
developed / commissioned in line with the requirements of the DDA 2005.
C7e
C8b
C11a
C13a
Director of Partnerships
and Commercial
Development
Equalities & Diversity
Manager
December
2008
Achieved
The Trust has developed its own ‘Understanding Disability’ e-learning package which has been made available for all staff to access w.e.f February 2009.
Disability awareness including legislation is included in the ‘Diversity in the Workplace’ e-learning package that all staff are required to complete.
‘Understanding Disability’, a powerpoint based e-learning package has been developed, publicised and is now available for staff.
Awareness raising is provided on Induction and the Induction handbook includes a section on Disability Discrimination legislation.
Reasonable Adjustment Training for Managers is being provided, and training in disability awareness and is embedded within Human resources-related training.
Disability Discrimination
A ‘Disability Confident’ Training DVD has been purchased and is available for managers to use locally for staff.
Deaf Awareness Training has been commissioned for PALs link-workers. Mandatory training for all new PALS link-workers
Deafness and Disability Awareness training sessions have been organised locally in different areas of the Trust.
Disability Equality included within Trust Induction.
A15 A corporate (Trust-wide) programme of Gender awareness / gender equality training is
C7e
Director of Partnerships
March
Partly
developed / commissioned in line with the requirements of the EA 2006. To also address
C8b
and Commercial
2009
achieved/
transgender issues.
C11a
Development
in process
C13a
Equalities & Diversity
Manager
A Gender Awareness Skillbooster training DVDs has been purchased and is available for managers to use locally for training staff.
Gender awareness including legislation is included in the ‘Diversity in the Workplace’ e-learning package that all staff are required to complete.
Training and education forum for front-line and management staff by Better Services for Women (BSFW) co-ordinator on issues pertaining to women: awareness raising
of issues such as ‘forced marriage’, ‘honour killings’, domestic violence and suicide and self-harm in Asian female population.
Further training to be considered within 2009/11 Action Plan.
Gender Equality included within Trust Induction.
A16 A corporate (Trust-wide) programme of Sexual orientation awareness / Sexual orientation
C7e
Director of Partnerships December
equality training is developed / commissioned.
Partly
C8b
and Commercial
2009
achieved/
C11a
Development
in process
C13a
Equalities & Diversity
Manager
A Sexual Orientation Awareness Skillbooster training DVDs have been purchased and is available for managers to use locally for training staff.
Sexual orientation awareness including legislation is included in the ‘Diversity in the Workplace’ e-learning package that all staff are required to complete.
Further training to be considered within 2009/11 Action Plan.
A17 A corporate (Trust-wide) programme of Age Equality awareness training is developed /
C7e
Director of Partnerships December
commissioned.
C8b
and Commercial
2009
C11a
Development
C13a
Equalities & Diversity
6
Partly
achieved/
in process
Manager
An Age Awareness Skillbooster training DVDs have been purchased and is available for managers to use locally for training staff.
Age awareness including legislation is included in the ‘Diversity in the Workplace’ e-learning package that all staff are required to complete.
Further training to be considered within 2009/11 Action Plan.
A18 A corporate (Trust-wide) programme of Religion or Belief Equality awareness training is
C7e
Director of Partnerships December
developed / commissioned.
C8b
and Commercial
2009
C11a
Development
C13a
Equalities & Diversity
Manager
A Religion or Belief Awareness Skillbooster training DVDs have been purchased and is available for managers to use locally for training staff.
Religion or Belief Awareness including legislation is included in the ‘Diversity in the Workplace’ e-learning package that all staff are required to complete.
Further training to be considered within 2009/11 Action Plan.
A19 Equality Impact Assessment training sessions continue to be held regularly.
C7e
Senior Nurse Advisor
On-going
C11a
Equalities & Diversity
C13a
Manager
C16
C17
C18
Equality Impact Assessment training sessions are provided quarterly, and additionally where there is a request from local managers.
Partly
achieved/
in process
Achieved
Corporate leadership and Commitment
A20
A monitoring system is formulated and implemented Trust wide to record progress in
embedding the Delivering Race Equality ‘key characteristics of a reformed service’ within
CWNL. This is updated and publicised Trustwide.
A21
A Spiritual Co-ordinator Post is established and recruited to.
C7e
Equalities & Diversity
July
C8b
Manager
2008 and on- Achieved
C11a
FIS Project Manager
going
C13a
C17
C18
A monitoring system has been in place since January 2007 to record actions against each of the DRE characteristics, by Borough/Directorate. This had been updated
every 6 months. However, the system of reporting has been reviewed and is currently being revised, with greater emphasis on specific targeted action and reporting
measurable outcomes. This new system is being established w.e.f. April 2009.
C13a
C18
7
Director of Partnerships
and Commercial
Development
Equalities & Diversity
September
2008
Partly
achieved/
in process
Manager
Funding for the post has been obtained, job description finalised and will be advertised shortly. To be carried over into 2009/11 Action Plan.
Corporate Information (Data) Issues
A22
Trust information systems collect religion using the national 19 categories from the ‘Count
Me In Census’. A target is set for collection of this data.
C18
Head of IT&M
Local E&D Leads
December
2008
Achieved
Religion of belief data is being collected for service users. 50% recording rate for known data as at December 2009. Quarterly Reports being produced and circulated to
encourage improved data entry rates. Target is to achieve 100% recording. Recording rate will be a specific action point in 2009/11 Action Planning.
Brent have established a system of monthly file auditing via the Mental Health Minimum Data Set has been established to monitor the recording of service user religion
A23
The systematic electronic recording of disability data is established Trust-wide with a target
of 95%
Brent
Brent: Monthly file auditing via the Mental Health Minimum Data Set has been established to
monitors the recording of service user disability
C18
Head of IT&M
Local E&D Leads.
December
2008
Partly
achieved/
in process
Very low recording rates for disability of service users (less than 1%) as at December 2008.
System has been established of quarterly reports to be produced and circulated to E&D leads to encourage higher recording rates.
Guidance for recording data currently being written. To be carried over to 2009/11 Action Plan.
A24
Data Warehouse System established so that service user diversity data is available and
accessible locally and corporately with live reports available.
C18
Head of IT&M
Local E&D Leads.
Performance Managers
March
2009
Partly
achieved/
in process
Details of Equalities and Diversity data needs submitted to Data Warehouse Project lead. Expected to be in operation by mid 2009. To be carried over to 2009/11 Action
Plan.
A25
Actions are formulated in response to any evidence of under- or over-representation
identified through the new Data Warehouse
8
C18
Heads of Service
Local E&D Leads
September
2009
Partly
achieved/
in process
Actions are already being taken to address under and over-representation of staff from particular ethnic groups in terms of recruitment and staff development. To be
carried over to 2009/11 Action Plan.
Communication issues
A26
Local information leaflets are produced in the top 5 languages for each borough, and in other
languages and specific formats on request (to include Braille, easy-read format and
audiotape).
C16
Communications
Manager
Local E&D Leads.
March
2009
Partly
achieved/
in process
The following patient information leaflets have been translated into the Trust's identified 9 key languages: Inpatient Information; Complaints; Care Programme Approach;
Carers’ Information, A Guide to Your Meetings. MHA Commission information leaflets available in 14 languages. PALS handouts translated into 17 languages. CNWL
produced information leaflets on 32 medications available electronically in 13 languages. Leaflets in Braille and easy read formats are available on request. Database of
translated patient information available for printing from the internet compiled and available on Trustnet. Some Directorates have local leaflets translated into top 5
langauges, however this is not consistent across the Trust and is to be carried over to the 2009/11 Action Plan
A27
A system is established for publishing all Equality Impact Assessments on the Trust website
so that the results of Equality Impact Assessments are available to the public and other
stakeholders
C7e
C16
C17
C18
Communications
Manager
Senior Nurse Advisor
E&D Manager
March
2009
Achieved
Equality Impact Assessments are being published on the Trust public website as of August 2008. Annual Eualitiy Impact Assessment Report produced and published.
A28
Progress against the Single Equality Scheme Action Plan is reported on and a report is
produced annually providing details of achievements against actions.
C7e
C8b
C11
C13a
C16
C17
C18
Annual Report for progress 2008/9 has been produced and published. This Action will be included for 2009/10.
9
Equalities and Diversity March 2009
Manager
and on-going
Achieved
A29
The content of the Single Equality Scheme Action Plan will be reviewed annually with a view
to adding new actions where identified as necessary.
C7e
C8b
C11
C13a
C16
C17
C18
Director of Partnerships March 2009
and Commercial
and on-going
Development
Equalities and Diversity
Manager
Achieved
Annual Review has been undertaken with a revised Action Plan developed for 2009/11, includes actions in progress from current Action Plan, recommendations of
Focussed Implementation Site Project, and further developments related to each of the Equalities strands to build on progress so far. This Action will be included for
2009/10.
Corporate PPI issues
A30
The Trust develops actions to improve PPI and sets objectives and actions to widen
participation of BME, disability and gender groups
C17
FIS Project Manager
Head of PPI
March
2009
Partly
achieved/
in process
Corporate
 Foundation Trust membership broadly representative of all ethnic groups although more work needed with voluntary organisations to increase membership levels.
 All Foundation Trust members contacted to indicate their interests and method of involvement to include all areas – information sent to services to encourage
participation.
 Focus groups being run to address formulating actions
 Plans to contact relevant voluntary organisations regarding effective methods of engagement, particularly targeting under-represented groups of FT members
 Review of PPI in terms of involvement of BME communities, disabled people and gender representation has been instigated.
Audit of PPI from BME, disability and gender groups has been undertaken. Inconsistent across the Trust. Links to BME community groups established in all local areas.
Will continue to be an action point at corporate and local level into the 2009/11 Action Plan.
We are procuring a new membership database which will enable us to track the levels of engagement of members of the FT (and others) and link that to the data we have
on their ethnicity, gender, age, and disability.
10
A31
Undertake a scoping exercise and report on to clarify the extent to which BME
communities, disabled people and gender groups (not just formal user groups) are
involved in:• Service planning & development groups• Design & deliver of training• Design of
audits• Baseline assessments• Policy development• Action planning• Progress review•
Recruitment processes.
C17
Head of PPI
Director of Human
Resources
Equalities and Diversity
Manager
September
2008
Achieved
Scoping exercise has been undertaken. Initial findings suggest involvement is occurring however it is Inconsistent across Trust and needs to be improved. Further
summary audit being undertaken.
A32
User involvement in Trust activities involves users from a broad spectrum of the community.
Progress on engagement and involvement of BME communities, disabled people and
gender groups is monitored by the Executive Board.
C17
Head of PPI
Equalities and Diversity
Manager
March
2009
Partly
achieved/
in process
Summary audit currently being finalised for E&D Group. To be submitted to Executive Board when complete. To be carried over to next Action Plan in order to develop
more consistent levels of involvement across the Trust.
We are procuring a new membership database which will enable us to track the levels of engagement of members of the FT (and others) and link that to the data we have
on their ethnicity, gender, age, and disability.
Will continue to be an action point at corporate and local level into the 2009/11 Action Plan.
A33
Centrally led service user satisfaction surveys are analysed by ethnicity, disability, gender,
age, sexual orientation and religion and show no significant difference in dissatisfaction
with services from different community groups. If dissatisfaction shown, remedial actions are
formulated and put into effect.
C13a
C18
Director of Partnerships
and Commercial
Development
Head of PPI
Equalities and Diversity
manager
March
2009
Partly
achieved/
in process
Data from HCC community survey available for ethnicity, gender and age.
Ethnicity – Trust initiated own follow up audit as disparities had been shown within central audit. Follow up audit showed little evidence of disparity. Annual audits will
continue and will be analysed.
Gender and Age – data has been obtained and currently being analysed.
In-patient audit in 2008 included specific questions regarding service user satisfaction in relation to ethnicity, disability, gender, sexual orientation, age and religion or
belief. Concerns reported on to Trust Acute Care Forum, referenced in report to Trust Board, and detailed feedback passed to wards. Further audit then undertaken
which showed consistent reduction in concerns across all Equalities strands. This was cautiously encouraging, however, the action point will be carried over to 2009/11
Action Planning to develop further.
11
B. Directorate based (local) actions
Local management issues
B1
All operational directorates have local equality action plans connected into the Trust-wide
E&D strategy though the E&D Group. These make reference to all Equalities strands.
C7e
C8b
C11a
C13a
C16
C17
C18
Heads of Service
Local E&D Leads
October
2008
Partly
achieved/
in process
Local Equality Action Plans developed in some areas, but not all. Audit currently being undertaken. To be carried over to 2009/11 Action Planning to develop further.
B2
All Trust Business Plans make specific reference to Equalities and Diversity
C7e
C8b
C11a
C13a
C16
C17
C18
Heads of Service
July
2008
Partly
achieved /
achieved
The need to undertake Equality Impact Assessments and to ensure reference is made within Business Plans to Equalities and Diversity issues has been embedded within
the 2009 Business Planning process
To be carried over to 2009/11 Action Planning to develop further.
B3
Responsible managers and senior managers are carrying out generic equality impact
assessments (inclusive of race/ethnicity, disability, gender, age, religion or belief and sexual
orientation) upon new services, policies, protocols and procedures, or when they come up
for review or where there is an identified priority need.
C7e
C13a
C16
C17
C18
Director of Nursing
Practice
Director of Human
Resources
Heads of Service
Professional Leads
On-going
Partly
achieved/
in process
Corporate Policies should not now be ratified unless they have an accompanying Equality Impact Assessment.
Completion of EIAs on local services and policies/protocols is inconsistent across the Trust. Over 150 managers have been trained but low numbers of EIAs are being
completed. More Guidance and examples of EIAs have been published for staff to access.
Action point will be carried over into 2009/11 Action Plan.
12
B4
Directorates have identified potential barriers faced by refugees and asylum seekers
accessing and using mental health services and have actions in place to address these.
C18
Heads of Service
Local E&D Leads
December
2008
Achieved
A range of responses are being made across the Trust which include training, the development of CDW roles, the continued provision of a Refugee Support
Service, representatives of refugee and asylum seeker groups attending local E&D group, specific targetting, partnership working with local voluntary sector
organisations.
B5
Locally led service user satisfaction surveys are analysed by ethnicity, disability, gender,
age, sexual orientation and religion and show no significant difference in dissatisfaction
with services from different community groups. If dissatisfaction shown, remedial actions to
be formulated and put into effect.
C13a
C18
Heads of Service
Local E&D Reps
Local Performance
Managers
March
2009
Partly
achieved/in
process
In-patient audit in 2008 included specific questions regarding service user satisfaction in relation to ethnicity, disability, gender, sexual orientation, age and religion or
belief Concerns reported on to Trust Acute Care Forum, referenced in report to Trust Board, and detailed feedback passed to wards. Further audit then undertaken which
showed consistent reduction in concerns across all Equalities strands. This was cautiously encouraging, however, the action point will be carried over to 2009/11 Action
Planning to develop further. More work also needs to be undertaken in this area to ensure Equalities and Diversity is addressed within local surveys
B6
Patients’ gender needs are recorded in patients’ notes
B7
Directorates report on local initiatives and outcomes against all Delivering Race Equality
twelve characteristics of a reformed mental health service relevant to their service areas.
Progress is monitored.
B8
A Trustwide Protocol for service user transition between CAMHS and Adult Services is
implemented, addressing Age Equality issues
C13a
C18
Service Heads
Local E&D Leads
December
2008
Partly
achieved/in
process
The recording of gender needs has been encouraged across the Trust, however, an audit is needed to ensure compliance. Audit to be carried over to 2009/11 Action
Plan.
C7e
Heads of Service
December
Achieved
C8b
Local E&D Leads
2008
C11a
C13a
C17
C18
Reporting system established within Directorates reporting every 6 months on local initiatives. New reporting system now developed (see being developed early 2009.
C13a
C16
C17
C18
Trustwide Protocol is in place. Currently being further reviewed in line with implementation of new Trust CA Policy.
13
CAMHS and Adult
Heads of Service
March
2009
Achieved
B9
Protocols and processes for service user transition between Adult and Older Adult Services
are reviewed, addressing Age Equality issues
C13a
C16
C17
C18
Older Adult and Adult
Heads of Service
March
2009
C17
Senior Nurse Advisor
Heads of Service
September
2008
Partly
achieved/
in process
Older Adult Community Mental Health Service developed n Westminster.
Further work required in this area Trustwide, to be informed during 2009./10 by the new Equality Bill.
Carried over to 2009/11 Action Plan.
Local public and user involvement
B10
Trust–wide guidance is developed regarding the involvement of volunteers from BME, and
faith communities, and volunteers with disabilities with our patients particularly
regarding payment, induction on mental health issues and CRB checks. CRB checked and
suitably inducted volunteers are involved in offering support to patients within in-patient and
other residential facilities.
Partly
achieved/
in process
Volunteer Policy written (which includes a section on Faith Visiting). Not yet ratified as systems for CRB, Health and reference checks to be agreed on specific to Faith
Visiting. To be carried over to 2009/11 Action Planning to develop further.
B11
Each directorate evidences partnership working with local BME voluntary organisations.
C17
Heads of Service
FIS Project Manager
March
2009
C17
Heads of Service
Local E&D Leads
Head of PPI
March
2009
Achieved
All directorates have evidence of working with local BME voluntary organisations – networks.
B12
Patient and Public Involvement arrangements are in place by which BME communities,
disabled groups, groups representing gender specific issues and other local
populations (not just formal user groups) are involved locally in: • Service planning &
development groups• Design & deliver of training• Design of audits• Baseline assessments•
Policy development• Action planning• Progress review• Recruitment processes Where
there is existing user involvement in local activities, that this involves users from a broad
spectrum of the community.
Partly
achieved/
in process
Scoping exercise undertaken. Further audit in process. Inconsistent involvement across the Trust. More work to be undertaken in this area. To be carried forward to
2009/11 Action Plan.
Local Partnerships
B13
Processes are developed to ensure that all work undertaken through each Local
14
C7e
Heads of Service
March
Partly
Implementation Team (LIT) and Drug Action Team (DAT) is subject to:
2009
achieved/
 Race Equality Impact Assessment
in process
 Ethnic monitoring
 Disability Equality Impact Assessment
 Disability monitoring.
 Gender Equality Impact Assessment
 Gender monitoring
Actions are being undertaken, for instance:
Hillingdon
 The Key local group have been invited to be part of the local E&D group so that we develop a shared understanding of equality duties. Local partners have been
able to access relevant equality training setting out equality duties
Addictions and Offender Care Services
 These are National Treatment Agency (NTA) requirements and undertaken through DAAT monitoring reporting system
Brent
 Brent Head of Service is a member of the LIT and where is a LIT Steering group for service developments activities or review of protocols in Brent the necessary
EI Assessment has been undertaken.
B14
The Trust actively promotes race, disability and gender equality within its multi-agency
initiatives and shared action plans through the:
• Local Strategic Partnership (LSP)
• Local Implementation Teams (LIT)
• Drug Action Teams (DAT).
Each borough LIT, DAT and LSP can show an example of addressing race, disability and
gender equality issues within its work .
C7e
Heads of Service
Local E&D Leads
March
2009
Partly
achieved/
in process
Borough-wide EIA processes established in some areas. To be carried forward to 2009/11 Action Plan as more work required in this area.
Inpatient and residential unit-specific issues
B15
Age-related activities and resources are available on wards and in-patient facilities
C17
C18
Head of OT
September
2009
Partly
achieved/
in process
The following from Brent is an example of developments within the Trust,
 PRCMH Seacole Older Adults ward activities include; Exercise Groups, Music & Movement, Reminiscence, Relaxation, Quizzes, Word Games, Bingo and Art
Therapy.
All other wards provide similar activities, working in partnership with the Tamarind Therapy Centre including Playstation and WII computer groups.
To be carried forward to 2009/11 Action Plan.
15
B16
Faith and Spirituality Action Plan formulated and in process of being implemented Trustwide, addressing faith visiting, chaplaincy, faith rooms, access to faith services, faith related
training, spiritual needs assessment.
C7e
C11a
C13a
Chair, Faith and
Spirituality
Implementation Group
E&D Manager
Local Faith Leads
Heads of Service
Local E&D Leads
March
2009
and
on-going
Heads of Service
Local E&D Leads
March
2009
Achieved
Action Plan has been formulated and being updated with actions taken.
Trustwide Faith and Spirituality Implementation Group is established to take forward the agenda.
Local Faith and Spirituality Implementation groups being formed within the Trust to take forward the agenda locally.
Further work needed to promote establishing of local Faith and Spirituality Implementation Groups and agenda.
Will be carried forward to 2009/11 Action Plan as work is on-going.
B17
Information packs will be produced and made available distributed to those providing care to
Black and minority ethnic patients. The packs should be drawn up in conjunction with the
local community, taking into account any issues relating to patient catchment areas, and
updated regularly to reflect the changing population.
C16
Partly
achieved/
in process
Actions have been taken and packs developed in many areas of the Trust, but further development work required. To be carried over to 2009/11 Action Plan.
B18
Reduction in reported incidents of sex-related harassment/assault at in-patient facilities
C7e
Heads of Service
September
2009
Partly
achieved/
in process
Systems established for recording and monitoring. To be targeted within 2009/11 Action Plan.
Additional Service Delivery initiatives
B19
Better Services for Women Action Plan formulated, updated and implemented with relevant
local management and treatment issues addressed
Action Plan in place, actions being taken and monitored quarterly.
16
C7e
C8b
C11a
C13a
C16
C17
C18
Better Services for
Women Co-ordinator
Heads of Service
On-going
Achieved
B20
Further develop the Trust’s Men’s Health Forum as a vehicle for publicising men’s health
issues and co-ordinating responses to men’s health and social care needs within CNWL
C7e
C11a
C17
C18
Equalities and Diversity
Manager
Men’s Health Forum
On-going
Achieved
Men’s Health Forum has been established, is attracting membership and promoting men’s groups and men’s health agenda. Scoping exercise of men-specific
services/groups being undertaken. To be carried forward to 2009/11 Action Plan as this is an on-going development.
B21
Undertake a scoping exercise of all services to ascertain where sexual orientation-specific
support groups are currently functioning or planned, and in what ways they have proved to
be particularly helpful. Publish and publicise findings Trustwide.
C7e
C18
Equalities & Diversity
Manager
Service Managers
C7e
C18
Service Managers
Equalities and Diversity
Leads
December
2008
Partly
achieved / in
process
Scoping exercise initiated March 2009. To be carried over to 2009/11 Action Plan.
B22
Develop sexual-orientation specific services where need/demand indicated
March 2009
Partly
achieved / in
process
On-going
Achieved
Some services exist, for instance a Gay Men’s Alcohol Support Group in Westminster. To be carried over to 2009/11 Action Plan.
B23
Publicise information in relation to lesbian, gay and bi-sexual difficulties and inequalities in
relation to accessing services and receiving treatment
C11a
C13a
A set of NHS Briefing papers has been distributed to all sites/services and is available electronically on Trustnet
Information by way of reports, papers etc are being publicised and cascaded.
LGBT and Mental health National Conference Report included in November 2008 Inclusion News
17
Equalities and Diversity
Manager
Conclusions
As you will have noted, many of the targeted actions have been achieved within the time-frames we set ourselves. Others remain in process and we are committed to
ensuring that they are achieved at the earliest opportunity.
We note, in particular, the need to continue to place a focus on user involvement and feedback. Action points relating to service user questionnaires and PPI
arrangements will be areas of particular priority in the coming year.
Additionally, we are developing resources for E&D-related training, seeking to provide a range of media through which staff can develop their understanding of
equalities and diversity in the context of the workplace and service delivery.
We are pleased to have updated and developed a number of Equalities and Diversity-related policies during the past year, providing a basis from which to build and
develop further the Trust’s responses in this area.
We note that further work needs to be undertaken in relation to service user satisfaction and the use of surveys. Feedback from Trustwide surveys is passed back to
local services and it is cautiously encouraging that follow up audits are indicating reductions of concerns from Equalities perspectives.
For 2009/11 we will be adding an extra set of action points, which have been developed from the recommendations of the Trust’s Focussed Implementation Site
Project for Delivering Race Equality. This will cover a range of areas including community engagement and involvement, policy review, training, and further
development of Equalities roles within the Trust.
We will also be ensuring that we respond to the requirements of the Equality Bill, with expected changes in relation to public sector duties, extension of pay reporting
and the extension of legislation to outlaw age discrimination in the provision of services. Once the Equality Bill has been enacted we will be in a position to develop
further action points, however, we believe we are moving towards meeting expected further legislative requirements with, for instance, our actions regarding transition
arrangements between age-based services, age-related activities and resources and having included Religion or Belief, Sexual Orientation and Age within our current
Single Equality Scheme.
Finally, we are also establishing a greater focus on Human Rights which is closely linked to Equalities issues. Policies have been implemented both in relation to
Employment and Service Delivery with Guidance currently being drafted. Information is routinely published and publicised within the Trust’s electronic information
system, along with access to e-learning in this area. A Department of Health pamphlet including a CD-Rom with the Human Rights in Healthcare e-learning module is
soon to be distributed to all sites and services within CNWL.
18