Equality, Diversity & Human Rights Patient Equalities Data Report 2014-15
Wirral Community NHS Trust Patient Equality Data Annual Report 2014-15 1.0 Overview Wirral Community NHS Trust (WCT) has a legal duty under the Equality Act 2010 - to promote equality of opportunity, foster good relations, and to eliminate harassment and discrimination. The Equality Act protects the same groups of individuals that were protected by previous legislation. However, the headings of age disability, gender reassignment, race, religion or belief, sex (previously termed gender), sexual orientation, marriage and civil partnership, and pregnancy and maternity are now known as protected characteristics. As part of the Trust’s legal duty we must prepare and publish annually an equality profile of our patients to better understand the equality issues in service delivery. In particular, the aim is to identify any under-representation of access to key services.
2.0 Methodology and report structure The report uses patient data available at this time (June 2015) and should be considered as work in progress. The Trust, in accordance with its Equality Duty, will update this information annually. Further analysis will be undertaken as part of publishing progress on the Trust’s Equality objectives in July 2016.
3.0 The Patient Survey 2014-15 The Patient Experience Questionnaire has been utilised by Wirral Community NHS Trust as the standard survey tool within all clinical services since 2011. In 2014 8 of the 9 the protected characteristic groups were added to the Patient Experience Form. It is aimed at patients, family members, parents, carers and other patient advocates. The questionnaire is available in all clinical services and is usually distributed by staff at the point of care to foster real time feedback. There has been a significant year on year increase in the number of surveys returned, see graph 1. Graph 1
Equality & Diversity Patient Equalities Data Report 2014/15
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Patient data has been highlighted from some key service areas. Each clinical service is set an annual target of completed patient experience questionnaires. Graph 2
This target reflects the unique patient contacts for the service and the service speciality. Since 2010 this target has increased annually by 10%. For 2014/15 all services were set a stretch target of up to 200% increase. 13 clinical services achieved 75% of their annual target, 14 services achieved 100% or more of the annual target set (see Graph 2).
4.0 Services for specific patient groups There are some of our services which, by their very nature, are specifically targeted at meeting the needs of individuals from specific characteristics. These include: Protected Characteristic - Sexual Orientation - Sexual Health Advisory services Protected Characteristic - Age - Health Visiting Protected Characteristic - Age - Disability - Community Nursing and Therapies Protected Characteristic - Sexual Orientation Sexual Health Service Which best describes your sexual orientation?
Data
Heterosexual
265
Gay man
9
Lesbian/gay woman
1
Bisexual
6
Not stated
3
Equality & Diversity Patient Equalities Data Report 2014/15
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Protected Characteristic - Age Health Visiting Please tell us your age
Data
0 - 14
3
15- 19
51
20 - 24
261
25 - 34
68
35 - 44
1
45 - 54
1
55 - 64
1
Protected Characteristic - Age Community Nursing and Therapies Please tell us your age
Data
0 - 14
31
15- 19
14
20 - 24
26
25 - 34
105
35 - 44
102
45 - 54
141
55 - 64
221
65 - 74
305
75 - 84
328
Over 85
156
Not stated
5
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Protected Characteristic - Disability Community Nursing and Therapies Do you consider yourself to have a disability?
Data
Yes
607
No
584
Not stated
32
Community Nursing and Therapies - Type of impairment Type of impairment
Data
Physical
503
Learning disability
14
Sensory impairment
21
Mental health condition
27
Other
52
Not stated
121
5.0 Patient Data Patient data has been provided from across key trust services. Patients by age Age group
%
0 - 14
13
15- 19
2
20 - 24
4
25 - 34
10
35 - 44
10
45 - 54
12
55 - 64
13
65 - 74
15
75 - 84
22
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Patients by gender Male = 39% Female = 61%
Ethnicity of Community Patients Ethnicity Description
%
Ethnicity Description
%
African
0.06%
Other Asian ethnic group
0.01%
Any other group
0.01%
Other Black backgrounds
0.02%
Arab
0.01%
Other ethnic group
0.01%
Asian
0.04%
Other ethnic, other mixed orig
0.01%
Baltic Estonian/Latvian/Lithuanian
0.03%
Other Mixed backgrounds
0.23%
Bangladeshi
0.02%
Other mixed White
0.02%
Bangladeshi or British Bangladeshi
0.17%
Other White backgrounds
0.86%
Black - other African country
0.01%
Other white British ethnic group
0.02%
Black - other, mixed
0.01%
Other white ethnic group
0.02%
Black African
0.01%
Other White or White unspecified ethnic category 2
0.02%
Black British
0.02%
Pakistani
0.01%
British
0.02%
Pakistani or British Pakistani
0.04%
British or mixed British
43.71%
Polish
0.09%
Caribbean
0.02%
Romanian
0.01%
Chinese
0.35%
Scottish
0.01%
Chinese and White
0.01%
South and Central American
0.01%
English
0.11%
Sri Lankan
0.02%
Indian
0.02%
Turkish
0.02%
Indian or British Indian
0.35%
Unknown
0.22%
Irish
0.40%
Vietnamese
0.01%
Italian
0.02%
Welsh
0.02%
Kurdish
0.02%
White
0.12%
Latin American
0.01%
White and Asian
0.18%
Mixed
0.01%
White and Black African
0.17%
Muslim
0.01%
White and Black Caribbean
0.10%
Northern Irish
0.01%
White British
51.46%
Oth White European/European unsp/Mixed European
0.05%
White Irish
0.36%
Other
0.17%
White Scottish
0.01%
Other Asian backgrounds
0.27%
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6.0 Patient Experience Summary • equality monitoring data is shown from 2 data sources for comparison (Compliments and Concerns) • overall response rates are good • causes in variations in feedback across the characteristics is difficult to establish as protected characteristics are not fully collected across the clinical services to make comparison • total response rate from ethnic minorities is 3.5 % , this is 1.5% lower than that of the BME population in Wirral • 28% of respondents state they have caring responsibilities • 30% of respondents describe themselves as having a disability Equality and Diversity monitoring - by age Response rate = 99%
Response rate = 82%
Equality and Diversity monitoring - by gender Response rate = 97%
Equality & Diversity Patient Equalities Data Report 2014/15
Response rate = 84%
6
Equality and Diversity monitoring - by gender assignment Response rate = 88%
Response rate = 67%
Equality and Diversity monitoring - by sexual orientation Response rate = 86%
Equality & Diversity Patient Equalities Data Report 2014/15
Response rate = 72%
7
Equality and Diversity monitoring - by ethnicity Response rate = 94%
Response rate = 82%
Equality and Diversity monitoring - by religion Response rate = 81%
Equality & Diversity Patient Equalities Data Report 2014/15
Response rate = 71%
8
Equality and Diversity monitoring - by disability Response rate = 82%
Response rate = 66%
Equality and Diversity monitoring - by impairment Response rate = 41%
Equality & Diversity Patient Equalities Data Report 2014/15
Response rate = 46%
9
Equality and Diversity monitoring - caring responsibilities Compliment
Data
Concern
Data
None
2852
None
71
Primary carer of a child (under 5)
393
Primary carer of a child (under 5)
18
Primary carer of an older person
106
Primary carer of an older person
6
Primary carer of a disabled adult
150
Primary carer of a disabled adult
4
Primary carer of a child (with a complex condition)
79
Primary carer of a child (with a complex condition)
3
Secondary carer
86
Not stated
3
Not stated
117
Equality and Diversity monitoring - breastfeeding Compliment
Data
Concern
Data
Yes
74
Yes
1
N/A
2957
N/A
94
Not stated
199
Not stated
4
Equality and Diversity monitoring - changing facilities available? Compliment
Data
Concern
Data
Yes
116
Yes
6
N/A
1722
N/A
44
Not stated
503
Not stated
16
Equality and Diversity monitoring - working pattern Compliment
Data
Concern
No
1228
No
31
Yes (part time)
540
Yes (part time)
25
Yes (full time)
988
Yes (full time)
27
Retired
1145
Retired
21
Not stated
3
Not stated
68
Equality & Diversity Patient Equalities Data Report 2014/15
Data
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7.0 Patient complaints Patient complaints are currently collected against two of the protected characteristics, gender and ethnicity. The breakdown of complaints through 2014/15 is shown below. A total of 79 complaints were registered with the Trust throughout 2014/15.
There are no observable trends in the data. In terms of addressing the gaps in patient data in respect of complaints against the nine protected characteristics, training for the concerns and complaints team is underway to ensure staff are confident in requesting the data/information from patients in an accurate and sensitive way, as well as ensuring that patients understand the reasons for collecting these additional equality data characteristics. The following are objectives in relation to the management of Concerns and Complaints across Wirral Community NHS Trust for 2015/16: • development of effective contingency plans for concerns/complaints team including team succession planning • improve the number of complaints responded to within timescales agreed with complainant • 80% of complaint information to be collated in the format of the 9 protected characteristics • produce an easy read leaflet and poster advising patients/carers on how to make a complaint for display in all clinic areas • broader collaboration with colleagues within the Quality and Governance Service and Communications team to address the issue of providing an online complaint and feedback form for service users/carers with learning difficulties • monitoring and recording the number of concerns received, by division, relating to appointment times to access any of the trust’s services, and extract key themes
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8.0 Gaps in data During 2014/15 Wirral Community NHS Trust utilised a number of IT systems to capture its clinical activity, including: • SystmOne for Community Nursing Services, Health Visiting and Public Health • Adastra for Sexual Health, GP Out of Hours and Walk in Centres • SOEL for Community Dental • BEST for Wheelchair Services • EMIS Web for Community Therapy Services • Cerner Millennium for Community Heart Services A consequence of having a large number of community systems is that the capture of data is not all standardised across the Trust and in some instances, such as SystmOne, not standardised within the different services using the system. During 15/16 the Trust will be moving away from EMIS Web with the majority of Therapy Services on a trajectory to implement SystmOne. The following action plan is therefore based on improving E&D reporting in the remaining systems. 1. Standardise the collection of Ethnicity Categories across all units (Services) within SystmOne This action is partially complete, with a standardised template based around the 2001 census available now to all services as shown in the screenshot below. Use of this template will be supported by training materials for all users during Q1 & Q2 of 15/16.
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2. Development & Implementation of an “Equalities Monitoring Template” within SystmOne There is currently no mandated provision within national NHS data standards that requires suppliers to ensure that all elements of the protected characteristics are captured for patients. As a result individual Trusts must develop a local solution. With SystmOne viewed as the Trust’s long-term clinical IT solution work is being undertaken and will be completed by Q2 to develop, test and implement an Equalities Monitoring Template within all modules of SystmOne. Whilst this is not something it is possible to enforce every user to complete for every patient staff will be supported with appropriate training material to capture Equalities Monitoring information at the initial assessment state/referral point for new patients. 3. Equalities Reporting During 2014/15 the Information Team established a number of E&D reports which electronically reported on data recording within each system. Further work on these reports is required for all IT systems but when completed by end of Q2 will enable all staff to view data recorded on our patients and provide further evidence for decision makers when re-designing services around the needs of our patients. 4. Master Patient Index Having one master index of all an organisation’s patients in common practice in many NHS Trusts, particularly where there are a limited number of Patient Administration Systems (PAS). During 2015/16 the Information Team will undertake further work within the Trust’s Data Warehouse to create a Master Patient Index combining demographic data from all PAS systems. A number of our patients make use of different services, which are captured in different systems. Currently a protected characteristic might be captured in one system but not another. Combining all our data into a single repository will generate a more robust dataset and ensure we are leverage all possible information about our patients to better understand the patients we care for. 5. Organisation Wide E&D Reporting With establishment of a Master Patient Index the Information Team will produce a unified set of E&D reports. This will improve information for analysis, decision-making and service redesign. 6. Missing Protected Characteristics Whilst data collection of characteristics such as Age and Gender are 100% complete and ethnicity and sexual orientation is much improved there are still challenges in recording Religion/Belief, Transgender Status and Disability. This is further complicated by the lack of a national requirement, in terms of mandated NHS Data items, to record these items in standard datasets. Effectively until a data item is mandated by the NHS Health and Social Care Information Centre (HSCIC) suppliers are not required to ensure that the IT systems they supply to NHS capture these items. The development of a local SystmOne Equalities Template should help this and Information will be reported from this template by the end of Q2. IT and Information will work with the Trust’s E&D manager to understand how missing protected characteristics can reasonably be recorded in other systems such as Cerner Millennium and Adastra. 7. Summary of Actions The above plan sets out to provide a degree of background information surrounding the Trust’s Data Quality & Completeness challenges. However for the avoidance of doubt all actions referred to in the above plan are summarised succinctly below: • Data Completeness Review – Information Team to work with 2 services per quarter, starting October 2015 to assess data completeness of records held on the clinical IT system used. First data completeness review findings to be presented to the January 2016 Data Quality Improvement Group
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• Compulsory Recording of Data Items – Information Team and SystmOne configuration lead to review all items as defined in section 4.1 and make compulsory in SystmOne where possible by end of November 2015. Compulsory data items to be confirmed at December’s Data Quality Improvement Group • Data Quality Reports – A number of additional data quality and completeness reports will be developed, specifically: o All Data Items (as per section 4.2) to be reported by end of January 2016 for review by the Data Quality Improvement Group and rolled out to all services during February 2016 o E&D protected characteristics report – continuing provision of existing reports on ethnicity, age and gender during Q3 and adding the additional characteristics during Q4 following the release of the Equalities Template in SystmOne o Data Entry Timeliness Report – To monitor % of data entered with 5 days of the activity event a report building on information currently available will be provided through the Data Quality Improvement Group in December 2015 • Equalities Monitoring Template – This monitoring template will be tested and piloted in the Livewell Services during September 2015, barring any further developments required the template will be available for all services from January 2016 onwards • Service Specific Data Sets – Agreement of data items by end of September 2015 in the Children & Wellbeing Division, with Monitoring available for all services in the Division by January 2016. By end of January 2016 the Information Team will agree the specific data items for monitoring in the Urgent Care Division with reports examining data collection to be available by April 2016. By end of April 2016 the Information Team will agree data items relevant to Adults & Community Division in line with 2016/17 contractual requirements. • KPI Performance Reports – Every KPI fed by a clinical IT system will have a weekly automated report available via the Intranet through which service leads and Divisional Managers can check and validate performance by end of October 2015 • Master Patient Index (MPI) – The MPI will continue development throughout Q2 and Q3 with testing during Q4 for live use from April 2016 at the latest
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