1. health and fitness

Annual Equality Report 2014 - 15
Berkshire Healthcare NHS Foundation Trust
January 2015
Contents
Section
Page
Context
2
Executive summary
3
Leadership, accountability and monitoring
4
NHS Equality Delivery System
5
NHS Equality Delivery System Priorities and Action Plan
6
Progress on public sector Equality objectives 2012-16
7
Progress on Equality Strategy supporting objectives
8
Promoting Equality: Benchmarks
9
Promoting Equality: Good practice spotlight
10
Mental Health Services
11
Good practice spotlight: IAPT
12
Good practice spotlight: Memory Clinics
13
Community Health Services
14
Community Health ethnicity monitoring improvements
15
Access, privacy and dignity
16
Patient satisfaction, incidents and complaints
17
Workforce profile and recruitment
18
Workforce spotlight – BME staff
19
Staff by grade and career development
20
Turnover, sickness absence, grievances, disciplinary, harassment
21
Equality training
22
Senior leadership, Board, Governors, Members
23
Context
Context
The aim of this report is to provide an overview of the progress
made by Berkshire Healthcare NHS Foundation Trust on equality,
diversity and inclusion.
Our legal duties are specified by the Equality Act 2010’s public sector
duty. The general duty has three elements, which are to:
• Eliminate unlawful discrimination, harassment and
victimisation
• Advance equality of opportunity between those who share a
characteristic and those who do not
• Foster good relations between people who share a protected
characteristic and those who do not.
The Act prohibits individuals from being discriminated and victimised
on the grounds of their protected characteristics: age, disability,
gender, race, marriage and civil partnership, pregnancy and
maternity, religion and belief, sexual orientation and transgender.
This report outlines our performance on the public sector equality
duty objectives and equality, diversity and inclusion strategy during
2013/14. It also includes an analysis of workforce data and service
related data relating to the period 1 Sept 2013 to 30 October 2014.
Detailed data tables will be published alongside this report on our
website www.berkshirehealthcare.nhs.uk to comply with the specific
duties of the Equality Act.
The Trust and its services
Berkshire Healthcare NHS Foundation Trust is a provider of both
community health and mental health services to the population of
Berkshire. We employ around 4,100 staff working from more than 100
sites as well as visiting people at home. We cover the local authority
areas of Slough, Windsor and Maidenhead, Bracknell, Wokingham,
Reading and West Berkshire. We provide a range of services used by the
public such as health visiting, community nursing, school nursing,
physiotherapy, walk-in services and all mental health NHS services.
Demographics and deprivation
Berkshire is a county of approximately 860,000 people, living in six local
authority areas. In the East – Bracknell, Windsor and Maidenhead and
Slough; in the West – Reading, Wokingham and West Berkshire.
According to the 2011 census, the population distribution is:
• 50% women and 50% men
• 25% of the population aged 0 -19 years
• 61% aged 20-64 years
• 12% aged 65-84 years
• 2% aged 85 years and over
• 27% from an ethnic minority background., with 7% of these from a
non-British white background
• 56% Christian
• 6.5% Muslim
• 2.7% Hindu
• 28% other religion
Although Berkshire is one of the most affluent counties in England there
are some striking local variations with hotspots of deprivation across the
county, particularly wards in Slough and Reading.
2
Executive Summary
Our achievements
Areas for improvements
This year we have achieved seven Greens and nine Ambers in the NHS
Equality Delivery System tool-kit areas. Overall our performance is
‘developing’.
• Ethnic minority usage of primary and secondary mental health
services
Highlights of our equality and inclusion performance are:
• Minority ethnic staff in senior leadership positions and
management positions Agenda for Change band 7 and above
• Improvements in staff equality monitoring declaration rates. For
example, 78% of our staff now declare their sexual orientation, a
10% improvement on 2011
• Improved ethnicity monitoring in community health services –
with 77% of community health data collected, compared with
66% in 2013
• Men and older people using talking therapy services
• Women in senior non-clinical leadership positions
• Minority ethnic staff access to continuing professional
development
• Equality monitoring in community health services and in any new
databases (e.g. sexual health services)
• Improved equality training compliance up by 8% this year to 89%
overall
• Dissemination of learning from specialist courses and activities
that promote equality and inclusion
• Improving Access to Psychological Therapy stands out as good
practice in community engagement, innovation in improving
access and equality monitoring
• Improvement of equality data quality from patient experience
and complaints
• Successful interventions to reduce health inequality e.g.:
securing funding for the Gypsy and Traveller health visitor in
Wokingham; the launch of a corporate health inequality
objective – the diabetes education project
• Equality analysis of strategic initiatives (eg: Talent management)
• Growth of staff equality and inclusion networks/champions
• Improvement in BME (Black Minority Ethnicity) rates of
disciplinary and grievance.
• Engaging with/capturing feedback from diverse communities
Proposed next steps:
• Review our Equality and Inclusion Strategy to strengthen
directorate and service level accountability for equality/inclusion
• Developing stronger systems for supporting local accountability
for equality both in terms of human resource management, and
operational and clinical service delivery.
3
Leadership, accountability and monitoring
Diversity Steering Group
• The Diversity Steering Group (DSG) monitors progress on the Equality
and Inclusion Strategy on a quarterly basis on behalf of the Trust
Board. The group reports to the Board via the Quality Executive Group
twice yearly (May 2014 and January 2015).
• The DSG is chaired by the Director of Corporate Affairs, Bev Searle,
who is the Board Lead for Equality and Diversity. Representation
includes the Director of Strategic Planning and Business Development,
Director of Human Resources, Deputy Director of Governance, the
Chairs of staff equality and inclusion networks, the Head of Marketing
and Communications, the Chaplain and the Equality Manager. The
group met four times this year.
Equality Team
NHS Equality Delivery System
• The Trust uses NHS England’s Equality Delivery System (EDS2) to
benchmark performance and assist in demonstrating compliance
with the public sector equality duty
• Built into EDS is an assessment of the level of evidence and equity
for each protected characteristic
• Equality panels have been set up to provide independent
assessment of the Trust’s performance
• Our results are published overleaf.
The team responsible for the implementation of the Equality and
Inclusion Strategy comprises the Director of Corporate Affairs, the
Director of Strategic Planning and Business Development, the Director of
HR and the Equality Manager. A number of champions also implement
aspects of the strategy.
Equality panels
Staff inclusion network chairs
• Our Staff Equality Panel also met in March and represents the staff
inclusion networks, the Joint Staff Consultative Committee and staff
across the Trust. 14 staff participated on the staff equality panel.
Staff inclusion network chairs lead the following groups:
• Lesbian, Gay, Bisexual and Transgender (LGBT) network
• Black and Ethnic Minority Advisory Group
• Time to Change Taskforce
• Our Community Equality Panels met in March 2014 to jointly agree
EDS grades with the Trust. This year we established two panels –
one for the East of Berkshire and one for the West. Around 20
people participated on the community equality panels
Chairs submitted progress reports of their group’s work to the DSG each
quarter. Each had an agreed action plan.
4
Goal 1
Services are commissioned, procured, designed and
1.1
delivered to meet the health needs of local communities
Better Health
Outcomes
1.2
Individual people’s health needs are assessment and met
in appropriate and effective ways
Transitions from one service to another, for people on
1.3
care pathways, are made smoothly with everyone wellWhen people use NHS services their safety is prioritised
1.4
and they are free from mistakes, mistreatment and
Screening, vaccination and other health promotion
services reach and benefit all communities
People, carers and communities can readily access
2.1 hospital, community health or primary care services and
should not be denied access on unreasonable grounds.
1.5
Goal 2
Improved Patient
Access and
Experience
2.2
People are informed and supported to be as involved as
they wish to be in decisions about their care
People’s complaints about services are handled
respectfully and efficiently.
Goal 3
3.1
Fair NHS recruitment and selection processes lead to a
more representative workforce at all levels
A represent-ative
and supported
workforce
The NHS is committed to equal pay for work of equal
3.2 value and expects employers to use equal pay audits to
fulfil their legal obligations
Goal 4
Inclusive
Leadership
3.3
Training and development opportunities are taken up
and positively evaluated by staff
3.4
When at work, staff are free from abuse, harassment,
bullying and violence from any source
Flexible working options are available to all staff
3.5 consistent with the needs of the service and the way
people lead their lives
Staff report positive experiences of their membership of
3.6
the workforce/health and wellbeing
Boards and senior leaders routinely demonstrate their
4.1 commitment to promoting equality within and beyond
their organisations
Papers that come before the Board and other major
4.2 committee identify equality-related impacts including
risks, and say how these risks are to be managed
Middle managers and other line manager support their
4.3 staff to work in culturally competent ways within a work
environment free from discrimination.
To be graded in
2015
2.4
New
outcome
2.3 People report positive experiences of the NHS
Priority
2014
To be graded in 2015
Goals and Outcomes of the EDS2 Toolkit
2013
NHS Equality Delivery System 2014 results
Background
• The Trust has been using EDS to support
compliance with the public sector equality duty
since 2011
• In 2014 we used NHS England’s Equality Delivery
System (EDS2) to assess Goals 1 and 2 and EDS1 to
assess Goal 3 (employment) and part of Goal 4.
Panel grading
• Based on evidence presented, panels agree
performance grades with the Trust. These indicate
levels of equity for people with protected
characteristics across the EDS outcome areas
• 36 people sat on panels and were drawn from a
range of people with protected characteristics or
their representatives
• Panels included representatives from local
Healthwatch organisations, Reading Voluntary
Action, Slough Council for Voluntary Services,
Empowering West Berkshire, Rethink, Berkshire
Mental Health Users Group, Hearing Link,
Wokingham Council Deaf Services, Mencap,
Windsor Older People’s Partnership Board,
Arthritis Care, West Berks Independent Living and
a range of other voluntary sector organisations
• 3 Trust governors were panel members this year
• Staff panels included representatives from the
Joint Staff Consultative Committee, the BME
Advisory Group and the Trust’s LGBT staff network
• Pregnant women or transgender people (or their
representatives) were not represented on the
panels this year.
5
Equality Delivery System Priorities and Action
Plan 2014/15
Priorities agreed by panels and the Board this year:
•
•
•
•
•
EDS 2.2 People are informed and supported to be as involved as they wish to be in decisions about their care (by 2016)
EDS 2.3 People report positive experiences of using NHS services (by 2016)
EDS 3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source (by 2015)
EDS 3.6 Staff report positive experiences of their membership of the workforce – in particular their health and wellbeing (by 2015)
EDS 4.2 Papers that come before the Board and other major committees identify equality-related impacts including risks, and say how these risks
are to be managed.
Patient Experience Actions
EDS 2.3 People report positive experiences of using NHS services (by
2016
Agreed actions:
• Design an Easy Read ‘Family and Friends’ feedback survey
• Collect service user feedback using a range of methods suitable for
those who are vulnerable and marginalised
• Identify and link up with other service user engagement initiatives from
our Listening into Action (LiA) patient experience project.
In addition we committed to:
• Demonstrate improvement in patient experience at the Slough Walk
In Centre.
EDS 2.2 People are informed and supported to be as involved as they
wish to be in decisions about their care (by 2016)
Agreed actions:
• Disabled service users and people from minority ethnic backgrounds
will be invited to take part in the Trust’s ‘15 Steps’ reviews in 2015.
In addition we committed to:
•
Review our Information for Patients policy
•
Investigate how services communicate with disabled people and show-case
good practice
Workforce Actions
EDS 3.4 When at work, staff are free from abuse, harassment, bullying
and violence from any source (by 2015)
• Introduce a resolution process that staff see as effective and fair
• Obtain confidential focus group feedback from BME and disabled
staff about support they receive when raising concerns
• Develop and evaluate the business case for introducing an
independent investigation process for bullying
• Review the Dignity at Work policy and procedure, including how it is
communicated widely with staff and JSCC members
• Implement and monitor the impact of changes in specific
units/groups.
EDS 3.6 Staff report positive experiences of their membership of the
workforce – in particular their health and wellbeing (by 2015)
• Investigate the root causes of work-related stress experienced by
disabled staff, including the quality of support received from their
line managers to enable a positive experience of work
• Share analysis, prioritise and develop action plans; identify any
impact of exceptional turnover on staff experience of work; identify
if any protected groups are disproportionately affected
• Investigate the take-up of health and wellbeing services by staff and
if it is proportionate. Where take-up is significantly above or below
average for any protected group, identify the reasons and develop
recommendations for healthy initiatives.
6
Progress on Public Sector Equality Objectives 2012-16
• Seven locality health inequality objectives were completed in March 2014 and endorsed by our
commissioners
• A single corporate objective to reduce health inequality was agreed in July 2014 focusing on increasing
awareness of diabetes in the workforce and in the community
• A roadshow was delivered by our Specialist Diabetes Nursing team on World Diabetes Day, together
with a staff awareness survey.
Objective 1
Reduce inequities in
service usage
• Patient experience surveys collect information on six protected characteristics
• The EDS Community Equality Panels graded this area as ‘developing’ based on a sample of patient
experience survey results
• An equality action plan is in place to collect regular evidence from vulnerable and marginalised groups to
improve performance, in particular via the ‘Friends and Family’ test.
Objective 2
Service users with
protected characteristics
have positive experiences
• The EDS Staff Panel graded Objective 3 as ‘developing’ based on evidence presented in March 2014
• Cultural competence embedded in Staff Induction programme; new leaflet on cultures and religions
promoted
• Unconscious bias integrated into our training programmes for staff recruitment and middle managers
• Mother Tongue, the specialist multi-ethnic counselling service, provided specialist clinical supervision to
our psychological therapy team
• Internal South Asian Mental Health conference held on 30 September 2014.
Objective 3
Strengthen cultural
competencies, particularly
of middle managers
Objective 4
Research and remove
potential barriers to
diversity in senior
leadership
•
•
•
Following our research in this area, we ensured that our new performance appraisal system picked up
training needs effectively (compliance improved to 80%); coaching and mentoring were promoted
Black and minority staff were featured on our intranet as role models for Black History Month
In light of the proposed Race Equality Standard for the NHS, we are reviewing opportunities to improve
leadership development for our BME staff Talent Management Programme (the current senior
leadership cohort included 11% BME staff) as well as reviewing good practice from other NHS providers
7
Progress on Equality Strategy Supporting Objectives
Ensure key policies and service transformation
projects are subject to equality analysis
• The Trust Board agreed that all major strategy and business plans would include an
equality impact analysis from November 2014.
Maintain a rolling programme of training to
promote equality and inclusive approaches in
service
• 89% of staff have undertaken equality training (30 Sept 2014)
• Equality training is integrated into our key training programmes: Essential Knowledge
for Managers, the Excellent Manager Programme; and into our mental health risk
assessment.
Embed an inclusive, holistic and spiritual
approach into health assessment/planning
communication and customer care
Design and implement robust data capture and
business systems to collect evidence of protected
characteristics
Promote opportunities for dialogue and
partnership with diverse local communities and
key stakeholders working to reduce health
inequality
Ensure our staff engagement and OD
programmes promote inclusion and make the
most of the diverse contributions of staff in terms
of knowledge and talent development
•
•
•
•
Spiritual needs assessment piloted for an adult mental health inpatient ward
Internal conference on spirituality and psychosis held in January 2014.
Faith information available as drop down menus on mental health patient database
Sanctuary space at Prospect Park Hospital now includes onsite washing facilities.
• Community health services ethnicity data recording added to our Trust Board’s
Performance Assurance Framework
• Regular performance tracking sent to all teams requiring data improvement
• Sexual orientation and long term chronic conditions data collected routinely by our
Talking Therapies service.
•
•
Slough BME community engagement event held in February 2014 jointly hosted with
Slough Community Voluntary Service.
A number of people with protected characteristics participated in our Listening Into
Action patient experience events.
• Three staff inclusion networks meetings held every two months (BME Advisory
Group; LGBT Group; Time to Change Taskforce)
• 67 inclusion champions from all the staff networks
• LGBT virtual network awarded the Trust’s Non-Clinical Staff Network of the Year
2014.
8
Promoting Equality: Benchmarks
As a Stonewall Diversity Champion, the
Trust is proud to support sexual orientation
equality at work and in the community.
• In January 2015 we were ranked at position 79 in the
Stonewall Workplace Equality Index of Gay friendly employers
• Our LGBT virtual network was awarded Non-Clinical Team of
the Year at our Staff Awards in March 2014
• We were invited to attend, and presented at, the Stonewall
conference in Leeds in December 2014, to share our
employment and community engagement good practice.
Highlight of the year
Our LGBT staff network has had a stall at Reading Pride for a
number of years. This year we were an official Pride sponsor
enabling us to promote our services from the stage to a
community which generally does not engage well with health
services. Our vibrant stand attracted record numbers, and30
members of staff volunteered on the stand during the day.
Since our work with Stonewall began in
2010 the Trust has:
• Improved its record on sexual
orientation declaration rates at work
(see graph on right). We attracted
389 LGBT job applicants this year,
and sexual orientation declaration
rates were 91%
• Improved staff engagement through
the use of computer screen savers
and pop-up banners
• Supported the LGBT staff network of
23 staff members
• Nominated dedicated champions.
% LGB workforce
Not declared
33%
0.80%
Year
2011
32%
24%
22%
0.90% 1.10% 1.40%
Year
2012
Year
2013
Year
2014
Results
• 300 people talked about their mental health with our
therapists and were signposted to services
• 135 people took mini-health checks including blood pressure
tests
• 200 had respiratory lung-age checks
• 85 chlamydia testing kits were given away
• 175 Pride goers were recruited as Trust members
• 250 people took our light-hearted health quiz
“It gives us a great opportunity to understand all the people we
serve as well as helping them access our services.” – Trust
Community Matron
9
Promoting Equality: Good practice spotlights
The Trust pledged its support to the mental
health anti-stigma campaign Time to Change in
2012.
As part of our action plan this year, we asked Time to Change to
conduct an independent healthcheck of the organisation. This
involved a desk audit of policies, staff-wide survey and 12
confidential interviews.
26% of staff responded to the staff survey. An action plan was
agreed in July 2014 and the Time to Change steering group drew
up an action plan to take forward recommendations.
Our Time to Change 2014/15 Action Plan
1) To improve communication of our policies around mental health
at work.
2) Support managers to increase recognition of mental health
problems.
3) Support staff wellbeing and promote healthy workplaces.
4) Work with the wider community to reduce stigma.
Highlights
• An internal podcast featuring one of our own staff talking about
her experience of disclosing mental illness at work
• World Mental Health Day promotional activity in each local
authority area
• Resilience workshops for managers and staff
• Promotion of the Trust’s confidential staff counselling service
• Four anti-stigma workshops scheduled for Jan-April 2015.
The Trust’s Black and Minority Ethnic (BME) Advisory
Group was set up in 2011/12 and met every two
months this year.
Chaired by the Deputy Locality Director for Slough, the group has:
• Reviewed service and employment ethnicity data
• Received good practice presentations from the Mary Seacole Day
Nursery and Alafiya (BME voluntary sector organisations) as well
as our own efforts to improve our Complex Needs Service
• Attended the National Health and Social Care BME Network and
Black History Month conferences.
Locality Good Practice – Slough services
Community Engagement
• In April 2014 Slough Locality together with Slough Council for
Voluntary Services invited 46 members of local minority ethnic
communities and health professionals to contribute to discussions
on their experiences of using Trust services.
Priorities identified were:
Language barriers, lack of knowledge of
services, lack of time at primary care
consultations.
Solutions identified were:
More health professionals attending BME
events, better cultural competence,
identification and training of minority ethnic
community health activists, better profiling
of services/preventative approaches with
the BME community.
Staff engagement
In June 2014 as part of its Road Show events, Slough locality
promoted the Trust’s staff inclusion networks (Time to Change,
LGB&T and BME Advisory) to interested locality staff.
10
Mental Health Services
Context: The Trust provides secondary community mental health services for children, adults and older people provided in local outpatient clinics and
in people’s homes across Berkshire. We also provide the Crisis Resolution and Home Treatment Team (CRHTT ) and hospital services for people who are
acutely mentally ill who require hospital treatment at Prospect Park Hospital (adults and older people) and at Wokingham Community Hospital
(Berkshire Adolescent Unit).
Overall : The gender balance of our services has remained the same as in previous years, with a slightly higher proportion of men using hospital
services (+5%) and higher proportions of women using crisis or community mental health services (+5%). The overall age profiles are in line with
previous years. There has been an increase in the proportion of patients identifying as ‘any other ethnic group’ and a decrease in patients from a ‘white
other’ background.
Inpatients
• The profile of inpatients was 71.86% white, 23.66 % minority ethnic and
4.48% not stating ethnicity
• Patients from a black background comprised 4.67% of the total inpatient
population this year, an increase (+1.12%) on 2012/13 (actual difference 7
patients). Patients from an Asian background decreased (-0.72%) to 6.72%,
patients from a ‘White Other’ background decreased (-1.07%); there was a
slight increase in patients identifying as those from ‘other ethnic backgrounds
(+ 1.58%). There were 24 patients aged 65 years and over from an ethnic
minority background this year (+6 patients compared with 2012/13).
Crisis Response and Home Treatment
• The profile of service users was 72.1% white, 21.67% minority ethnic and
6.2% not stating ethnicity
• Patients from a black background comprised 2.8% (197) of the caseload,
patients from an Asian background formed 7% (494), and service users from
any other ethnic background were 5.6% of the case load.
Community Mental Health (CMHT)
• The profile of service users was 74.15% white, 18.9 % minority ethnic and
6.93% not stating ethnicity
• Service users from a black background comprised 2.3% (529) of the caseload,
Asians formed 5.65% (1,299) and 5.91% (1,358) are from any other ethnic
backgrounds. The number of people from ‘other ethnic’ backgrounds has
more than doubled compared with 2013
• The profile of people aged 65 years and above receiving CMHT services was
3.89% Asian, 1.26% black, and 4% from other ethnic groups.
Trends
4.67% of psychiatric inpatients from a black background
(+1.17%) above the population average of 3.5%
Asian service users overall fall short of the population average
of 13%:
• 6.72 % of psychiatric inpatients (-6.28%)
• 7 % of Crisis team service users (-6%)
• 5.65 % of Community mental health service users (-7.35%)
% of CRHTT service users identifying as ‘any other ethnic
background’ compared to the population (+4.6%).
Progress this year
• Crisis Response – saw 35 more black patients and 33 more Asian
patients in 2014 compared to 2013
• CMHT services for working age adults saw 30 more clients from an
Asian background and 45 more clients from a black background in
2014 compared to 2013
• CMHT services for people aged 65 years and above (including
elderly services and memory clinics) saw 56 more Asian clients,
183 more clients from any other ethnic background and 4 more
clients from a black background compared to 2013.
11
Good practice spotlight: Talking Therapies
IAPT is a primary care talking therapy service for common mental health problems related to depression, anxiety, phobia, panic, stress and
Obsessive Compulsive Disorder. The IAPT service can be provided over the telephone, face-to-face or in groups at a range of locations across
Berkshire. The service can be accessed through self-referral on the phone, website or via GP.
The IAPT service has made significant efforts to
enable easy access to the service. The profile of the
case-load from 1.10.13 – 30.09.14 is as follows:
• 67% of clients were female and 23% male.
Men were under-represented by 17%
compared with the population as a whole
• In the 20 – 64 age category 28% were male
• 17% of clients were from ethnic minority
backgrounds (including non-British white
ethnic groups) compared to the ethnic
minority population of 27%
• 8% of the case-load identified themselves as
disabled people
• 29% had long-term conditions such as
asthma, diabetes, heart disease.
Inclusive service design for people with protected characteristics:
• Clinics are held during the evenings and Saturdays
• The diverse team includes staff who are multilingual/mixed gender
Interpretation is available and multi-lingual posters displayed.
• Group sessions are provided for patients with long-term physical
health problems (also presented in non-English languages)
• Promotion of the service at community events to address unmet need
(e.g. Reading Pride , Slough Mela, and retirement fairs)
• Service poster campaign “Help us put a smile back on granddad’s face”
• ‘Silver Cloud’ on-line treatment aimed at newly retired people, people
under 40 years of age, and men
• Referral to psychologist service for people with hearing impairment
• In Slough, maternity liaison for women with post-natal depression
• In Bracknell, services tailored to the needs of the Nepalese community.
Staff expertise in meeting individual health needs:
• Professional ethos of being open-minded and non-judgemental,
welcoming, friendly, informal
• Equality training covering all 9 protected characteristics for staff
• Specialist clinical supervision of staff in cultural competence
delivered by Mother Tongue, the award winning multi-ethnic
counselling service
• A number of staff interest groups exist within the service to
promote specialist knowledge and cascade training: cultural
competence expert supervision; physical health supervision;
domestic violence; learning disability; and neurological problems
• Good practice shared through internal newsletter/team meetings
• Routine monitoring questions on special needs/long term physical
health problems; sexual orientation ; ethnicity; age and gender;
12
ante-natal and post-natal provision.
10
Good practice spotlight: Memory Clinics
Memory clinics are part of Older People’s Mental Health Teams. There are six clinics across Berkshire offering assessment and treatment of
memory (neurodegenerative conditions) at the early to moderate stages of dementia. Support is offered so that carers are able to manage and
care for their relatives at home. If required, the service offers home visits. The memory clinic is staffed by a multi-professional team of
psychologists, neurologists, a consultant psychiatrist, dedicated memory clinic nurses, speech dieticians, speech and language therapists, and
physiotherapists).
Client Profile
Our data shows that the gender and ethnicity
of people referred to memory clinics reflects
the population mix; the proportion of people
in each age band treated with anti-dementia
medication reflects the ages of people
referred.
Graphics
The pie charts opposite (on the left) show the
caseloads by ethnicity of the memory clinics in
Slough and Reading. The pie charts to the right
show the census populations by ethnicity for
people over the age of 70 years living in Slough
and Reading. 95% of people using memory
clinics are aged 65 years and over.
Features of inclusive service design:
• Younger person’s forum (Berkshire West)
established for people aged 40-60 years
• Six week course for carers
• Home visits can be arranged for people with
mobility issues
• Five week dementia information course in
Punjabi (Slough) and Cognitive Stimulation
Therapy in Punjabi.
13
Community Health Services
The Trust provides a range of community health services including community nursing services, health visiting, school nursing, physiotherapy, and
diabetes specialist nursing. We provide rehabilitation wards at West Berkshire Community Hospital, St Marks Hospital, and Upton Hospital; the Slough
Walk-In services; Sexual Health Services in Berkshire East; Minor Injuries Unit in West Berkshire; and Westcall, the GP out of hours service in Berkshire
West.
Rehabilitation Wards
• In line with previous years there were a greater number of women using
the service than men
• 88% of patients were aged 65 years and over
• 79% of patients on wards in Berkshire West were white, 17% of data was
not captured and 4% were from minority ethnic backgrounds; in Berkshire
East 76% of patients on wards were white, 12% of data was not captured
and 12% of patients were from minority ethnic backgrounds – just under
half of these were from ‘white other’ backgrounds.
Community Health Services
• In line with previous years, 54% of service users were female and 46%
were male
• 49% of service users were white, 18% were ethnic minority and 33% of
ethnicity data was not captured. 9% were Asian, 2.3% were from mixed
backgrounds, and 5% were from white other backgrounds.
Walk-In Services
• As with previous years our Minor Injuries Unit (at West Berkshire
Community Hospital) was used more by men than women with 55% male
service users. In terms of ethnicity, 65% of service users classified
themselves as white, 29% ‘white other’ and 31% of the data was not
captured.
Trends
• In line with previous years, men were under-represented on the
caseload with the exception of the Minor Injuries Unit
• Despite improvements, ethnicity data capture remains an issue
preventing accurate analysis
• In community services generally there appears to be underrepresentation of Asian service users (-4%), white other (-2%),
and black (-1.5%) compared to the population average
• No equality data was available from West Call (GP out of hours),
Audiology Services or the Sexual Health Services this year.
14
Community health ethnicity monitoring
improvements
In April 2014, a new indicator on ethnicity reporting in community health services was added to the Trust Board’s monthly Performance Assurance
Report (PAF). Rates of reporting have been significantly lower compared to our mental health services where the Trust is 97% compliant - above the
England average. The Performance and Informatics team assigned a phased target to each team and operates a countdown process every month.
The March 2015 target is 90% with a 5% per month improvement target for community health services.
The ethnicity data capture level in community health services was
66% in May 2013 when inclusion in the PAF was agreed by the
Executive.
Much work has been undertaken by Data Quality Analysts in
conjunction with community health teams to collect valid ethnic
codes for patients and enter them onto the patient database. Staff
were issued with check-lists and guidance.
Data compliance rose by 11% to 77% in October 2014. The chart
below shows data capture by locality.
Individual services have had varying levels of success in improving ethnicity
data capture. Overall there has been an upward trend. Two service
examples are included below:
School Nursing % improvement in ethnicity data capture
30/10/13 – 30/10/14
80.00
60.00
40.00
20.00
Ethnicity data
capture 2013
Ethnicity data
capture 2014
0.00
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Overall Community Health ethnicity data
collection rates by locality Oct 2014
Community Nursing % ethnicity data capture
13/11/13 - 13/11/14
120
100
80
60
40
20
0
2013 data
capture
2014 data
capture
15
Access, privacy and dignity
Interpretation and Translation
Clinical environments
The Trust ensures that people with mobility needs and those in
wheelchairs can access our premises independently. As a minimum
there is full disabled access to waiting and consultation areas and
disabled toilets. Our strategy is to reduce our dependence on estate in
the future by enabling more workers to work in the community.
Results of the Patient Led Assessments of 10% of our Clinical
Environments (PLACE) are presented below with an example from
Prospect Park Hospital:
PLACE Assessment domain 2014
Trust
England
Average
Cleanliness
99%
97%
Food and hydration
95%
89%
Privacy, dignity and wellbeing
92%
88%
Condition/maintenance
97%
92%
During the period 1 October 2013 to 30 September 2014, we provided
£121,988 of interpretation and translation services for non-English speakers
and British Sign Language speakers accessing our services. This is an increase
in expenditure of £27,351 compared with last year (£94,637). Most of this
expenditure was for face-to-face interpretation. A range of multi-lingual
posters were also designed to promote our Talking Therapies Service.
Following a formal competitive tender process, from 20 October 2014 Pearl
Linguistics has provided our interpretation and translation services, and the
deaf-led service Remark! has provided British Sign Language. We continue to
work with Mother Tongue for the provision of specialist mental health
interpretation in 7 local languages.
A number of briefing sessions were held to promote the new services to staff.
One training session was held to improve staff skills in working with hearing
impaired patients; a further three are planned for 2015.
Examples of reasonable adjustments in clinic practice
• Adapted assessment tools for Memory Clinic (dementia) patients with
sensory impairment
• Speech and language therapists available
• Detailed hospital needs assessments include mobility, nutritional, long
term chronic illness, mental capacity and risk assessments
• Twice weekly GP visits for mental health inpatients with long-term chronic
conditions
• Longer or double appointments for people with sensory or learning
disability e.g. audiology, podiatry, diabetic eye-screening and dentistry
• Advocacy services for patients with mental ill-health and learning
disability
• Talking glucose meter and large print glucose diaries for people with visual
impairment.
16
Patient satisfaction, complaints, incidents
Patient satisfaction by protected characteristic
Our patient experience trackers collect patient satisfaction data by
protected characteristic to monitor whether there is equity in patient
satisfaction across protected groups. This is one of our public sector
equality objective outcomes. A sample of responses by gender and age
is shown below for our dementia ward in Prospect Park Hospital for two
questions: ‘Do you feel safe on the ward?’ and ‘How would rate the
overall service?’ The sample of responses relates to the period 1 April
2014 to 30 June 2014.
100.00%
Do you feel safe on the ward?
Verbal abuse by type
Male
Female
50.00%
0.00%
Strongly
agree
100%
Agree
Neither
Disagree
Patient rating of overall care by age
65 - 74yrs
75 - 84yrs
85 plus yrs
0%
Excellent
Good
Fair
Racial abuse
Sexual Harassment
Harassment
Bullying
Other
Total
Number
Number
experienced by experienced
patients
by staff
8
43
3
7
2
7
2
1
74
677
89
735
Complaints
17 - 64yrs
50%
Incidents
We record all clinical incidents on our Patient Incident Database, Datix
with robust follow-up procedures. This year 89 instances of verbal
abuse experienced by patients from other patients were recorded, 90%
in mental health services. Staff recorded 735 instances where they had
experienced verbal abuse, 80% in mental health settings. This is an
increase of 390 recorded incidents compared with the same period last
year. 836 incidents of physical assault took place against staff.
Poor
Results show generally high levels of satisfaction. However, the
protected characteristic data is poorly completed for religion and belief,
disability and sexual orientation. Numbers of ethnic minority
respondents are too small to compare.
We record complaints on Datix. There were 263 complaints in the period 1
October 2013 to 30 September 2014. Of these, 118 complainants were
female, 70 were male and 81 were not stated. The collection of complaints
data by protected characteristic started formally in September 2014.
• 8 complaints were made by disabled people or their carers about delays in
wheelchair provision/maintenance by the mobility service – this is being
pursued with the contractor
• 11 complaints were from the carers of children with mental health
problems, in particular those with ADHD or Autism about waiting times –
this has been raised with our commissioners
• One complaint about sloped access to the Parkinson’s clinic at St Marks
hospital – way-finding signage has subsequently been improved
• One complaint alleging lack of disabled access and awareness among
nursing staff on an acute ward at Prospect Park Hospital – additional
training has been given to staff (disabled access was available)
• One allegation of racism by a member of staff which was not upheld.
Workforce profile and recruitment
Workforce Profile
Recruitment
The Trust employed 4,139 staff at 30 September 2014. The demographic profile of the workforce
has remained relatively stable this year. There has been a slight increase (+0.6%) in the proportion
of women in the workforce and a decrease (-1.3%) in the proportion of part-timers. Asians remain
under-represented in the workforce (-5%) and staff over the age of 45 years over-represented. The
proportion of LGBT staff has increased (+0.3%) to 1.4% and disabled staff decreased (-0.3%) to
5.2%.
Job applicants:
Key Protected
characteristic
Female
Ethnic Minority
Disabled
45 plus
60 plus
LGB&T
Christian
Muslim
Other religion
Civil partnership
Married
2014 2013
84.2% 83.6%
18.5% 18.7%
5.2%
5.5%
42.8% 43.5%
7.9%
8.2%
1.4%
1.1%
53.1% 53.3%
2.4%
2.2%
8.0%
7.2%
0.7%
0.9%
39.1% 43.9%
Population
Estimate
50.0%
20.0%
7.5%*
19.3%
18.7%
6.0%
56.2%
6.5%
27.7%
0.2%
Mixed
1% Other
2%
Asian
Not
stated
4%
8%
White
78%
2014 Workforce Ethnic diversity
• Decrease in male job applicants (-2.8%)
• Decrease in job applicants from ethnic
minority backgrounds from 42% in 2012/13
to 38.7%.
Success rates of short-listed applicants:
Success rates at interview:
• Lower for men, those from an Asian
background, a black background, mixed
and other ethnic backgrounds, some
religious backgrounds, disabled and LGB
candidates.
• Compared with 2012/13 there was an
increase in Asian appointees (+1.5%).
Disabled candidates: Two Ticks Scheme
LGB job applicants
BME job applicants
The scheme guarantees job interviews
for disabled candidates who meet the
essential criteria for the job:
• 389 LGB job
applicants (2.4%)
• 6,835 BME job
applicants (42%)
• 684 disabled job applicants (4.2%)
• 91 shortlisted (2.1%)
•
• 13 appointed (1.8%)
1,417 shortlisted
(33%)
•
142 appointed (19%)
• 23 appointed (3.1%)
• Total applicants was 16,276 – a decrease of
4,058 compared with 2012/13.
• Lower for men, those from an Asian
background, some religious backgrounds,
and age groups <25 – 43 years.
Black
7%
* % of disabled workers in the South East labour force
• 194 short-listed (4.5%)
• 736 jobs were advertised in 2014/13
compared with 703 in 2012/13.
2014 New starters’ ethnic diversity
Not Mixed
stated 2%
11%
Other
1%
Asian
10%
Black
7%
White
69%
18
Workforce spotlight – BME staff
The Trust’s pay bands range from Agenda for Change Band 1 to Band 9. Executive Directors’
salaries are outside of this structure and are classed as ‘Other’. The category ‘Other’ also
contains medical doctors employed by the Trust.
In line with many NHS organisations, minority ethnic staff are clustered at Bands 1-6 in the
pay-scales and are under-represented from Band 7 upwards, with the exception of Band 8c
and medical doctors in the ‘Other’ category. The black line in the graph below represents the
proportion of BME staff in the workforce (18.5%).
Internal job applicants
Successful BME internal job applicants dropped from
18.5% to 15.6% this year:
Ethnic profile of successful internal job
30/09/2014
applicants
30/09/2013
100.0%
80.0%
Minority ethnic staff by pay band
% of Clinical Staff (BME)
% of Non Clinical Staff (BME)
60.0%
40.0%
40.0%
30.0%
20.0%
0.0%
20.0%
White
10.0%
BME
Not declared
Access to Continuing Professional Development
0.0%
Band 1 Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band 8aBand 8bBand 8cBand 8d Other *
BME in management - progress in 2014:
Performance Appraisal 2014
Compared with 30 September 2013, this year’s analysis of
pay bands show the following increases and decreases in
black and minority ethnic staff in each pay band:
• At 30 September, 80% of
our staff had undertaken
their annual performance
appraisal.
• Of these, 17.7% were from
an ethnic minority
background which
compares well with the
workforce profile of 18.5%.
The Trust funds a number of courses which are geared
towards career development. This year approximately
24% or 621 staff in Bands 5-9 accessed such courses, of
these 14% were from minority ethnic backgrounds.
19% of the workforce at bands 5 – 9 are minority
ethnic.
Proportion of staff in bands
5 - 9 accessing CPD
BME
14%
White
86%
19
Staff by grade and career development
The Trust’s pay bands range from Agenda for Change Band 1 to Band 9. Executive Directors’
salaries are outside of this structure and are classed as ‘Other’. The category ‘Other’ also
contains medical doctors employed by the Trust.
In line with previous years female staff are under-represented in managerial non-clinical posts
compared to their overall presence in the labour force (84%).
2014 Female staff by grade
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
% of Clinical Staff (Female)
% of Non-Clinical Staff (Female)
Internal job applicants
All permanent posts are advertised and 314 staff
successfully achieved a promotion this year. There was
a proportionate spread across age bands and religions,
and with the exception of ethnic minority staff, they
were in line with the workforce profile :
• 83.4% were female
• 16.6% were male
• 15.6% were ethnic minority
• 4.1% were disabled
• 1.3% were LGB.
Access to Continuing Professional Development
Band 1 Band 2 Band 3 Band 4 Band 5 Band 6 Band 7 Band Band Band Band Other
8a
8b
8c
8d
*
Gender Pay Gap
• Based on the hourly rates of all basic salaries, the gender pay gap for the Trust on 30 Sept
2014 was 23.16% in favour of men i.e. the average male salary was 23.16% higher than
the average female salary. This was a 3% increase on Sept 2013
• If only salaries on the Agenda for Change pay-scales are analysed, the gender pay gap
reduces to 10.14% in favour of men i.e. the average male salary is 10.14% higher than
the average female salary. This is a 1.92% increase on Sept 2013. The UK gender pay gap
widened in 2014 to 15.7%
• Around 94% of salaries are on Agenda for Change, the equality proofed pay system used
by the NHS. Differences are due to the higher proportions of men employed in higher pay
bands.
The Trust funds a number of courses designed to
support career development. 621 people on bands 5-9
were analysed to assess equity:
• The gender balance reflects the staff profile
• The following groups were under-represented,
though numbers may not be statistically significant:
o Ethnic minority staff (-4.5%)
o LGB staff (-1.5%)
o Muslim staff (-1.4%)
o <25 and 35-44 years
Family friendly/flexible working
• The return to work rate from maternity leave
dropped to 73.8% this year, a 12.2% decrease
compared to 2013
• 41.7% of the workforce work part-time, 93.4% of
part-timers are female, a drop of 2.3%
• 110 staff work term-time hours, 2.7% in line with
2013.
20
Turnover, sickness, grievances, disciplinary, dignity
Turnover
• The annual staff turnover for the Trust from October 2013 to
September 2014 was 16.3% (706 leavers overall) an increase of 2.2%
compared to the same period last year
• The turnover for women (16.4%) and men (16.1%) was broadly in line
with the average
• There was an increase in ethnic minority turnover rates. Ethnic
minority staff accounted for 156 or 22% of all leavers.
Staff turnover 2013/14 by ethnicity
40.0%
30.0%
20.0%
10.0%
0.0%
Sickness absence
• The average number of sickness days per employee was 6.86 in the
six month period April 2014 – September 2014
• In line with a similar period last year, on average, staff from a mixed
ethnic background appeared to have higher sickness rate, however
numbers are small and not statistically significant
• Disabled staff had higher than average sickness rates (nearly twice as
much as the Trust average)
• Muslims had slightly higher than average sickness rates
• LGBT staff had significantly lower than average sickness rates.
Grievances
30-Sep-14
30-Sep-13
White Black Asian Mixed Other Not
Stated
• Turnover was highest in the <25 years (35.6%) and 60 plus years
category (35.2%).
• Turnover among disabled staff increased by (+4.7%) to 17.8%.
• Turnover among LGBT staff reduced to 7.9% (-4.5%).
• Turnover among Muslim staff increased by 5.7%.
Dignity at Work (harassment and bullying)
The Trust investigated 10 allegations of harassment and bullying this year
(an increase of 1 case compared with 2012/13):
• Less than 5 were from ethnic minority staff
• Less than 5 were from disabled staff
• 80% were female
• Less than five were in the 25 – 34 years age group
• 60% were in the 45 – 54 years age group
• No other protected characteristics were disclosed.
There were 15 grievances this year, a decrease of 9 cases compared with
2012/13:
• 66% were from white staff
• 34% were from BME staff (a decrease of 11%)
• 87% were from female staff
• 53% were in the 45-54 years age category
• Less than 5 related to staff aged 60 years and over
• Less than 5 were from disabled staff
• 53% involved staff with religious beliefs – either Christian or ‘other’
beliefs
• There were no grievances lodged by LGBT staff.
Disciplinaries
There were 88 disciplinaries this year (a decrease of 15 cases compared
with 2012/13):
• 24% involved ethnic minority staff (a 5% reduction)
• 31% involved male staff (a reduction of 2%)
• All age groups were represented though the highest proportion,
45%, involved staff aged 45-54 years
• 4.5% were Muslim, 41% Christian, 3.4% Hindu
• 6.1% involved disabled staff
12
• There were no disciplinaries involving LGBT staff.
21
Equality training
Our core Equality Training course is part of the mandatory induction
training. An online refresher is required every 3 years for all staff – both
clinical and non-clinical.
Training compliance rates
We achieved 89% compliance with our Equality and Diversity core training
target. In addition:
• 2.5% staff attended in-house dementia training
• 8.3% staff attended Autism training
• 4% attended ‘Excellence in Communication’
• 14% attended Learning Disability training
• 0.3% attended Promoting Equality and Cultural Competence training
• 1% Post-Natal Depression training
• We held stress workshops for staff and managers.
Mainstream training integrating equality
Our mainstream training programmes which include relevant aspects of
equality and diversity include:
• Essential Knowledge for Managers (1.5 hours)
• Excellent Manager Programme (1 hour)
• Recruitment and Selection
• Mental Capacity Act
• Deprivation of Liberty Safeguards
• Care Programme Approach training (mental health)
• Mental Health risk training
Other relevant internal equality courses and conferences
South Asian Mental Health
Our second South Asian Mental Health full day conference took place in
Reading on 30 September 2014. Organised by Rajay Herkanaidu and
the Crisis and Home Treatment Team, keynote speakers were Professor
Dinesh Bhugra, Dr Waquas Waheed and Southall Black Sisters.
Gypsy and Romany cultural competence
A half day course was held in June 2014 ‘It was some of the best cultural
awareness training I have ever had…another great outcome of multiagency working in Wokingham around our Gypsy and Romany Traveller
community’ (Head of Children and Families Wokingham).
Deaf Awareness
Four half-day courses running 2014/15 ‘Very enjoyable, made me think
about how I communicate with both hearing impaired and deaf people’
‘Overcoming Stigma – working with dignity and respect’ will run in
January-April 2015. This is part of our Time to Change Action plan.
Spiritual care
A conference was organised by our chaplain in January 2014 on
spirituality and psychosis, exploring our assessment process, and was
well attended by a range of professional staff.
Transgender awareness
A transgender awareness course was held this year.
12
22
Senior Leaders, Board, Governors, Members
Senior
Leadership
As at 30th
September
2014
Non-Executive
Directors (6)
Executive
Directors (6)
Directors
Heads of
service
Other Senior
managers (8c
upwards not
counted above)
Total staff
(headcount)
Gender
Male Female
Ethnicity
White
Non-White Undisclosed
Minority
ethnic
66.7%
33.3%
100%
0%
0%
66.7%
33.3%
100%
0%
0%
50%
33.3%
50%
66.7%
72.2%
87.9%
16.7%
9.1%
11.1%
3.0%
35.3%
64.7%
100%
0%
0%
15.8%
84.2%
77.7%
18.5%
3.8%
By comparison with September 2013, women and ethnic minorities remain
under-represented at Board level.
Compared to 2013, there have been some increases this year in the
following areas:
• +4% increase in women at Director level
• +9% increase in women at Head of Service level
• +7% increase in ethnic minorities at Director level
There has been a 4% decrease in ethnic minority Heads of Service.
Governors
Our Governor profile is in line with the Berkshire demographic with
the exception of governors under the age of 45 years.
We currently have 28 Governors in post:
• 53% are men, 42% women, 3.5% not stated
• Under 5 are less than 45 years of age, 36% are 45-64 years of
age and 46% are 65 plus
• 75% are from white backgrounds and 25% are from ethnic
minority backgrounds
• 57% are disabled (mental health, sensory or physical
impairment)
• 46% are Christian and 18% are non-Christian
• Under 5 are lesbian, gay or bisexual. Under 5 are carers
Members
As of December 2014, we have 10,604 Trust members. Our
demographic data is limited on our membership forms. Men,
younger people and ethnic minorities are under-represented.
Overall the profile is as follows:
• 64% are female, 26% are male, 10% no data
• 1% are 10-19 years, 15% 20-29 years, 18% 30-49 years, 28%
50-69 years, 8% are 70 plus; with no age data for 20%
• 1.9% tell us they are disabled people
• 1.1% are lesbian, gay, bisexual or other
• 14% are from non-white ethnic backgrounds
Member Ethnicity
No data
18%
White Other
5%
Asian
8%
Black
4% Mixed
2%
Other Ethnic
group
0%
White
British
63%
23