NHS Greater Glasgow and ClydeEquality Impact Assessment Tool for Frontline Patient ServicesEquality Impact Assessment is a legal requirement and may be used as evidence for cases referred for further investigation for legislative compliance issues.Please refer to the EQIA Guidance Document while completing this form. Please note that prior to starting an EQIA all Lead Reviewers are required to attend aLead Reviewer training session. Please contact [email protected] for further details or call 0141 2014560/4967Name of Current Service/Service Development/Service Redesign:Brownlee Outpatient Service, Gartnavel General Hospital, Emergency Care DirectoratePlease tick box to indicate if this is a:Current Service Service DevelopmentService RedesignDescription of the service & rationale for selection for EQIA: (Please state if this is part of a Board-wide service or is locally determined).What does the service do?The Brownlee unit was built 16 years ago to replace the previous infectious diseases facility in Ruchill Hospital. The usage today far exceedsthe original number of patients it was designed to treat and the facilities have been modified to ensure rooms are utilised to their maximumwhilst considering the patient pathway, i.e. keeping consulting rooms for this use solely and utilising another room for phlebotomy/treatment. Inthe most recent reconfiguration, as a result of consulting the patients, the small waiting room has been refurbished. This is used by vulnerablepatients to provide more confidentiality than the large main waiting area.The Brownlee Outpatient service provides a specialist medical service that includes tropical and infections medicine, travel medicine, HIV,Hepatitis B and Hepatitis C information, testing, support and treatment, counselling and outpatient antibiotic therapy services. The service hasclose links with the Sandyford Initiative.Approximately 70% of the weekly work is associated with the general clinics that deal with infectious diseases including holiday diarrhoeas,cellulites and pneumonia’s.There are approximately 1,400 HIV patients using the service (HIV cohort of patients expected to increase by approximately 100 annually). Inaddition to the HIV patients there are all the other infectious disease patients that attend the outpatient service.The travel clinic is seeing more young people attending who are working abroad for a variety of timescales. This includes those going onschool trips and other trips to ‘see the world’ before they settle down for additional studies/fulltime occupation.There is an Outpatients Home Antibiotic service which takes referrals from all hospitals in NHS Greater Glasgow and Clyde. This reduces the
inpatient stay and this is where patients are taught how to self administer antibiotics or attend this area on a daily basis for treatment.There are good links between the inpatient ward upstairs and the outpatient department. That is the outpatient department can refer straight tothe ward as necessary and vice versa.The counselling team also receive self referrals from those who are undergoing blood borne virus testing. If a blood borne virus is diagnosedthen the patient will see a consultant within 2 weeks of this diagnosis. Those being treated for a blood borne virus will attend the clinic regularly,i.e. every 4/6months or more frequently when first diagnosed. This means that there can be 200 – 250 blood borne virus patients per week.The service is provided to all those over 14 years of age. (Before this age patients will be treated in the Royal Hospitals for SickChildren,Yorkhill).Referrals come from, self, inpatient services, GP’s, other hospitals, schools and the Sandyford Initiative.There is a Multi-Disciplinary Team which consists of 11 Consultants within the medical team, Blood Borne Virus Specialist Nurses; OutpatientNurses; specialist HIV pharmacists; Dietician; Occupational Therapist; Psychiatrist; Counsellors; Sexual Health Advisers, physiotherapistAlthough there are other infection disease units in Scotland the Brownlee is the West of Scotland speciality with the Western General inEdinburgh being the equivalent in the east of Scotland. This means that if there is more specialised advice required then referrals can comefrom other units.Why was this service selected for EQIA? Where does it link to Development Plan priorities? (if no link, please provide evidence of proportionality, relevance,potential legal risk etc.)Identified by the Directorate Management Team for the EQIA since there are a wide range of equality groups attend this service. .Who is the lead reviewer and when did they attend Lead reviewer Training? (Please note the lead reviewer must be someone in a position to authorise anyactions identified as a result of the EQIA)Name:Date of Lead Reviewer Training:Con Gillespie, Lead NursePlease list the staff involved in carrying out this EQIA(where non-NHS staff are involved e.g. third sector reps or patients, please record their organisation or reason for inclusion):Lead Nurse; Senior Charge Nurse (Out-patients); Ward Manager; Practice Development Nurse; Sexual Health Advisor; Blood Borne Virus
Nurse Specialist; Peer Support Manager; Occupational Therapist; Consultant; Counsellor; Quality Co-ordinator; Equality and DiversityAssistant.1.2.Lead Reviewer QuestionsExample of Evidence RequiredWhat equalities information isroutinely collected from peopleusing the service? Are there anybarriers to collecting this data?Age, Sex, Race, Sexual Orientation,Disability, Gender Reassignment,Faith, Socio-economic status datacollected on service users to. Canbe used to analyse DNAs, accessissues etc.Can you provide evidence of howthe equalities information youcollect is used and give details ofany changes that have taken placeas a result?A Smoke Free service reviewedservice user data and realised thatthere was limited participation ofmen. Further engagement wasundertaken and a gender-focusedpromotion designed.Service Evidence Provided(please use additional sheet whererequired)The unit only transferred ontorecording patient information on theTrak Care system at the end of May2013. Previous to this they wererecording patient data on thePassweb and Portal systems. TrakCare can record age, gender,ethnicity, religion, any interpretingrequirements, preferred language,etc.Data capture for HIV patients atpresent includes, sex, sexualorientation, age, postcode andethnicity. See protectedcharacteristic sections for breakdownof data.Not applicable.Additional RequirementsOnce the team are familiarwith Trak Care then they areto plan a review of all patientsto ensure the Trak Caresystem is up to date with allthe relevant fields captured.Once the above is undertakenthen a review should beplanned to sample allprotected characteristics datato ensure there are no gaps inservice provision.
3.Have you applied any learning fromresearch about the experience ofequality groups with regard toremoving potential barriers? Thismay be work previously carried outin the service.Cancer services used informationfrom patient experience researchand a cancer literature review toimprove access and removepotential barriers from the patientpathway.The Brownlee Centre regularlyconducts audits.With the arrival of asylum seekers inGlasgow, advice/training was soughtfrom the Compass Team (whoprovide mental health services forasylum seekers and refugees).Staff found the information sessionprovided by the Society for theVictims of Torture very helpful andinteresting. This session alsoincluded tips for working withinterpreters.Using advice from Waverley Care, astaff member developed and anasylum seeker/African/foreignlanguage folder which includes usefulinformation and contact details.There is also a Waverly Carerepresentative here in the outpatientswaiting area twice a week to talk toour patients and discuss anyproblems that may arise. They thenfeedback to the staffThere is a monthly HIV Peer forum,facilitated by Brownlee patients whomeet to discuss issues, changes andput forward any ideas they haveabout our service.
4.Can you give details of how youhave engaged with equality groupsto get a better understanding ofneeds?Patient satisfaction surveys withequality and diversity monitoringforms have been used to makechanges to service provision.Informal surveys have beenconducted as well as operating asuggestions box. The surveys areconducted annually.The unit regularly displays posters tofeed back on the basis of ‘you saidwe did’. From this involvement thestaff have been able to makechanges e.g.: Arrange for improvements insome of the signage. Remodel the waiting area tobe information free and tocreate more space by havingless bulky chairs Create information zoneswithin the corridor Refurbish the smaller waitingroom for vulnerable patientsThere is a patient forum specificallyfor HIV patients which creates formallinks and communication with theBoard’s HIV programme and servicedelivery groups. Representativefrom this forum will be involved in thedevelopment of an appropriatewebsite for the service.5.Is your service physicallyaccessible to everyone? Are therepotential barriers that need to beAn outpatient clinic has installedloop systems and trained staff ontheir use. In addition, a review ofThere is a ramp to the main entrancefrom the main driveway that runsbetween the main hospital and theThere are some accessissues in that there is nodisabled car parking adjacent
addressed?signage has been undertaken withclearer directional information nowprovided.hotel across the road. Some patientswill opt to pay to park their car in thehotel car park for ease of access tothe unit.There is a lift available from the wardarea above the clinic. The upperlevel connects to the main hospital.to the building. This can onlybe located in the mainhospital car park and patientsthen have a long route toaccess the out patient areavia the corridor upstairs andarrive in the department viathe lift.Review the entrance doors asthese are manual and can bedifficult to open.Review the signage for theBrownlee Centre bothinternally and externally.6.How does the service ensure theway it communicates with serviceusers removes any potentialbarriers?A podiatry service has reviewed allwritten information and includedprompts for receiving information inother languages or formats. Theservice has reviewed its process forbooking interpreters and hasbriefed all staff on NHSGGC’sInterpreting Protocol.Staff are aware of NHS GreaterGlasgow and Clyde’s InterpretingPolicy and Procedures. There is arobust system in place to ensure thatinterpreters are booked for allappointments.It can be difficult for patientsto telephone the Centre. Asuggestion was made to haveautomated options to directpatients to the correctdepartment.The ‘information zone’ displays theAccessible Information Posters whichstates that if patients needinformation in another format orlanguage to ask the staff.Review patient letters toensure they comply with NHSGreater Glasgow and Clyde’sAccessible Information Policy.The Centre distributes a newsletter toHIV patients about the Peer SupportProject.Investigate the possibility oftelephone interpreting foremergency situations e.g. aninterpreter does not turn up.
The Centre has established a ‘twitter’account.An external website is currently beingdeveloped for patients.Patients can contact the staff in avariety of ways including emails.7.Equality groups may experiencebarriers when trying to accessservices. The Equality Act 2010places a legal duty on Public bodiesto evidence how these barriers areremoved. What specifically hashappened to ensure the needs ofequality groups have been takeninto consideration in relation to:(a)SexA sexual health hub reviewed sexdisaggregated data and realisedvery few young men were attendingclinics. They have launched a localpromotion targeting young men andwill be analysing data to test ifsuccessful.71% of HIV patients are male and29% female.Staff will try to accommodaterequests for same sex healthprofessionals. If this isn’t possiblepatients could be offered anotherappointment at Sandyford.Staff are aware of NHS GreaterGlasgow and Clyde’s Gender BasedViolence Policy.In the ‘Information Zones’ there areleaflets about domestic violence.
(b)Gender ReassignmentAn inpatient receiving ward heldsessions with staff using theNHSGGC Transgender Policy. Staffare now aware of legal protectionand appropriate ways to deliveringinpatient care including use oflanguage and technical aspects ofrecording patient information.For HIV patients - 0.1% of the malesdescribe themselves as transgender0.5% of the females describethemselves as transgender.Staff are aware of NHS GreaterGlasgow and Clyde’s TransgenderPolicy.Staff will respect the patient’s chosengender and will use appropriatepronouns.When staff are undertaking screeningtests (e.g. cervical smear tests) theywill ensure that the patient iscomfortable and be sensitive to thepatient’s needs.Staff can signpost patients to thetransgender support groups atSandyford.(c)AgeA urology clinic analysed their sexspecific data and realised thatyoung men represented asignificant number of DNAs. Textmessage reminders were used toprompt attendance andappointment letters highlightedpotential clinical complications ofnon-attendance.The age group for patients ispredominantly 30’s – 40’s. Althoughthere is an aging patient group.There are transition clinics forpatients who are transferring frompaediatric services to adult services.Staff have undertaken ChildProtection Training.
(d)RaceAn outpatient clinic reviewed itsethnicity data capture and realisedthat it was not providinginformation in other languages. Itprovided a prompt on allinformation for patients to requestcopies in other languages. Theclinic also realised that it wasdependant on friends and familyinterpreting and reviewed use ofinterpreting services to ensure thiswas provided for all appropriateappointment