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Equalities in Health

NHSGGC Staff Guidance – Money Worries

Asking and responding to patients’ money worries is part of Inequalities Sensitive Practice, which is about taking into account each patient’s social circumstances and how they are affecting their health. It also relates to person centred care.

Advice On Money Worries – Who is it for?

Money advice support is for patients, parents/carers or staff of all ages, regardless of their working status.

Why is it important?

With the recession and changes to the benefits system, many of our patients are experiencing money difficulties and mounting debts. The COVID-19 pandemic has also created additional financial worries for many people.

This is important to health services as in addition to being a cause of poor health, money worries can also be a barrier to engaging fully with our services.

“I observe this again and again – that I cannot address medical issues as I have to deal with the patients’ agenda first, which is getting money to feed and heat.”  GP

By asking a simple question and providing assistance on where to get help, we can do a lot to prevent unnecessary worry and anxiety.

Click here to view Money Worries: In Sickness & In Health – a short film aimed at healthcare professionals outlining the link between poor health and money worries.

What kind of advice available?

If your patients are facing financial difficulties, they should not pay for advice.   You can help your patients to use the free, high quality services available across NHSGGC which offer help with:

  • Maximising Income      
  • Debt Advice
  • Benefits
  • Savings
  • Banking
  • Budgeting

Evidence shows that referring patients to these services can result in improved mental health, increased income, debt reduction, increased financial planning and reduced stress.

How Do I Ask About Money Worries?

If your patients are facing financial difficulties, they should not pay for advice.   You can help your patients to use the free, high quality services available across NHSGGC which offer help with:

  • Maximising Income      
  • Debt Advice
  • Benefits
  • Savings
  • Banking
  • Budgeting

Evidence shows that referring patients to these services can result in improved mental health, increased income, debt reduction, increased financial planning and reduced stress.

How Do I Ask About Money Worries?

If done sensitively, patients value being asked about money problems and referred to Money Advice Services.  It only takes a few minutes to do and can be incorporated easily into patient assessment as part of a person centred approach. Most NHSGGC assessment forms cover money worries.

  • “Do you have any money or debt worries?
  • “Would you like to speak with an advisor to discuss money worries or help you to claim any benefits that you may be entitled to?”
  • “Is having a baby adding financial pressure?”

These type of standard questions for introducing the topic of money worries are used in the community setting. Similar questions are used in hospitals, where staff need to establish whether the patients has any immediate work/money related concerns as a result of their health condition.

If you are working with groups of people it is good practice to discuss people’s health in the context of their life circumstances.  Money and debt worries are a major issue for many people and should always be covered in these discussions.

How Do I Make A Referral?

Where patients have issues relating to money worries and debt, the role of staff is to:

  • reassure that support is available
  • gain consent for referral
  • refer to the service

In Hospital settings – complete a referral by contacting the Support and Information Service at sis@ggc.scot.nhs.uk

In community settings, use the link below to locate Money Advice services in local settings: http://infodir.nhsggc.org.uk/Home/Directory

Training & Resources

In NHSGGC, tackling inequalities is a priority.  Responding to money and debt worries is part of this.

If you would like a training session on raising the issue, why it’s important and on referral pathways, please get in touch with:
Lesley.Nish@ggc.acot.nhs.uk or Jane.Beresford@ggc.scot.nhs.uk

Poverty and financial inclusion and employability e-modules are also available via Staffnet alongside a range of other e-modules on equalities issues.

Posters and flyers can help promote a discussion around money advice services for patients, parents/carers and staff. They are available at this link – simply enter ‘Money Advice’ in the search facility:
http://www.phrd.scot.nhs.uk/HPAC/Search

The Money Advice Service website offers information and advice on budget planning and improving your finances, including tools and calculators to help you plan ahead.





Gender-Based Violence (National Guidelines)

What Health Workers Need to Know

This guidance is intended for use by service managers and staff members who, in the course of their work, are involved in identifying and responding to gender-based violence.

Gender-based Violence National Guidelines – What health workers need to know

If you require this or any other NHS information in another format, such as large print or braille, or in another language, please use the contact details on your patient leaflet or letter or contact us.

Face to Face or Telephone Interpreting

You are entitled to an interpreter for all NHS services, including hospital and GP appointments, dentists, opticians, chiropodists, pharmacists etc. A member of staff must provide the interpreter for you. 

During COVID restrictions, face to face interpreting using PPE equipment is still permitted in some circumstances. However, telephone interpreting will be used unless this is not appropriate for the particular patient or appointment. Attend Anywhere / Near me video interpreting is also available for spoken language interpreting.

The following leaflet states your right to an interpreter and explains to staff how they should go about this if they are unsure. You can print it off, or contact us for a copy to carry with you when attending appointments.

British Sign Language Online Interpreting Service

The NHS has a responsibility to make sure that a BSL interpreter is provided for you when you use our services. If you have an appointment then staff should book an interpreter in advance. Please ensure that your Clinician/GP is aware that you require an interpreter so that they can do this with as much notice as possible.

For emergency hospital visits, you can still ask for a face to face interpreter. You can then use the BSL Online Interpreting service until your interpreter arrives.

During COVID restrictions, face to face BSL interpreting using PPE equipment is still permitted. However, on some occasions we may suggest the use of video interpreting to facilitate the appointment if this is considered a safer option.

BSL Online interpreting – information in BSL

NHSGGC’s BSL interpreting service – information in BSL is currently being updated and will be available soon.

ISPI was active from April 2006 to March 2009. It was established to test out and hone ways of developing practice that is sensitive to the impact of inequalities.

Funded by the Scottish Government, the initiative has resulted in key learning which can help NHSGGC improve ‘frontline’ practice and how these changes can be brought about and sustained.

ISPI has been able to demonstrate how a sustainable change in practice can be achieved across four settings:

  • addictions
  • maternity
  • children’s services, and
  • primary care mental health.

ISPI has also been able to make clear recommendation as to how the learning from the initiative can inform the development of inequalities sensitive practice across NHSGGC’s system.

An independent evaluation of the initiative together with a suite of reports and other useful documents from each of the practice settings can be accessed using the following links:

Some of the key documents relating to the initiative are listed below:

Evidence Briefing

The theory that inequalities sensitive practice is an effective approach that can impact positively on health inequalities, draws on literature that describes practice that has been undertaken within NHSGGC, the UK and across wider European and international settings. ISPI commissioned the production of a briefing paper that reviews and highlights this literature. This ISPI Evidence Briefing provides useful information for those involved in efforts to develop and support an inequalities sensitive practice approach at individual and organisational levels. Click here to see report.

ISPI Evaluation Report

An independent evaluation of ISPI was commissioned from Avante Consulting. An action research, dynamic methodology was used in evaluating the initiative, with the evaluators working closely with the initiative throughout its period of activity.

This document details the approach taken within ISPI and describes key learning, messages and recommendations for future development of inequalities sensitive practice.

Case Studies

Case Study 1: Identifying and responding to the needs of adult survivors’ of sexual abuse within addiction services.

Mary’s story

Mary is a thirty four year old female. She has been addicted to drugs for many years and has a history of self harm, homelessness and prostitution. As part of a reassessment Mary was asked sensitively but directly about her experience of past or current abuse. Mary disclosed that she had been abused as a child. No one had ever directly asked before. The addiction worker engaged in discussion about how the abuse has affected her life and current circumstances. The worker recognised symptoms of related trauma and discussed how she could help support her now with these issues.

With agreement from Mary the worker arranged a multi disciplinary review and all agencies invited agreed that together they would provide appropriate interventions and coordinate, monitor and review Mary’s treatment and care.

Mary is currently

  • Stable with drug use through substitute prescribing.
  • Illicit drug free
  • Exited from prostitution
  • Maintaining tenancy
  • Refraining from self harm or suicide attempts
  • Engaging with appointments
  • Attending appointments with a trauma specialist
  • Talking positively about her future.

By proactively asking about abuse issues, the worker was able to identify trauma related issues and work with Mary to address the underlying cause of her addiction.

Case Study 2: Identifying and responding to the needs of people who have worries about money.

The Taylor Family

The Taylors are young couple with 3 children, the youngest 2 are under 5 and each has a disability. Dad works full time in fairly low paid employment with mum at home full time caring for the children. The couple are owner occupiers. Mum finds it very difficult to go out with the children as she is unable to use public transport and taxis are too expensive. Due to the children’s mobility difficulties, Mum and the children spend most of their time at home which means heating the home for most of the day and night. Due to the children’s disabilities mum has to do lots of laundry. These factors are having a big impact on the family’s energy bills. Debt has been accrued with Brighthouse, a high street weekly payment household goods store, totaling £6000 for a suite and a TV. Weekly payments to Brighthouse are £33 with 2 payments remaining on the suite. 

The family Health Visitor suggested a referral to the Healthier Wealthier Children(HWC) project following a diagnosis of significant disability of youngest child. Mum commented she did not think that a child of 2 and half years would be entitled to DLA but was happy for the referrals to be made.

Following referral to HWC the Income Maximiser assisted the family in applying for additional benefits. The family were awarded Middle Rate Disability Living Allowance (DLA) and disabled child element of tax credits. This amounted to an additional £47.80 and £52.21 extra per week respectively. Mum stated that the extra money will help with taxi costs, she can now afford hackney style taxis to get out and about to hospital appointments; this had been a problem in the past with the larger style pram. Mum can also afford taxis to go to clubs and support groups in her area. The extra money will also go towards utilities bills and mum will not have to worry as much about times when she has to heat the house for days at a time, i.e. winter 10/11 was a very worrying time. A benefit check also revealed that the couple were entitled to Council Tax Benefit, they assumed they wouldn’t be as they were owner occupiers, this saved the family £943.44 per year.

The couple were also supported to apply for a mentored loan of £500 from their local credit union and Money Matters, the income maximiser also negotiated the return of the TV to Brighthouse. A TV was purchased from a local supermarket for under £500 with repayments on the mentored loan £12 per week, £2 of which is savings with the credit union.

Engagement with the service has clearly brought about significant improvement for this couple and while this may not be the case for everyone it highlights the potential contribution Health Visitors and other key health staff groups can make to reducing child poverty.

The Healthier Wealthier Children (HWC) project continues to provide evidence of financial gain, debt reduction and reduced stress for NHS patients.

Since its launch in 2010, this NHS led child poverty initiative has resulted in over £52 million pounds going back into the pockets of local families with over 32,000 referrals to money advice services from NHS Greater Glasgow and Clyde staff.

The initiative has meant that many people are now receiving welfare benefits they were unaware they were entitled to. Debts have been written off and sanctions appealed successfully. Families have had access to grants and assistance with dealing with food and fuel poverty.

All NHSGGC midwives, health visitors, family nurses and specialist children’s service are now asking about money and debt worries routinely and referring to money advice services as part of day to day care. 

The project has now been mainstreamed across all NHSGGC areas:

  • maintaining Children & Families referral pathways to money advice services
  • awareness sessions on money worries, child poverty and welfare reform for NHS staff
  • monitoring outcomes of the Healthier Wealthier Children approach
  • mainstreaming group work programmes

In addition, from October 2021 there is a national roll-out of primary care money advice for areas of highest deprivation. Some patients with children will access this service. NHSGGC has five Health & Social Care Partnerships involved: East Renfrewshire, Glasgow, Inverclyde, Renfrewshire and West Dunbartonshire.

The Healthier Wealthier Children model is cited as a requirement of Scotland’s Child Poverty action plan and similar models have been developed in London as as far afield as Sweden and Australia.

Statement 

Statistics

10 Goals for Inequalities Sensitive Health Service

Understanding, identifying and tackling inequalities is at the heart of NHSGGC’s approach to providing effective health care. To help the organisation achieve this, the 10 Goals for an Inequalities Sensitive Health Service have been developed.

The Goals are split into 3 sections:

  1. Engaging with Populations and Patients
  2. Developing the Workforce
  3. The Health Service’s Role in Society

The 10 Goals across the three sections were used as the basis for NHSGGC’s Equality Scheme Action Plan 2010-2013.

Engaging with Populations and Patients (The Health Service)

Goal 1 – Knows and understands the inequalities & discrimination faced by its patients and population

Historically, health services have largely been planned without taking into account patients’ needs relating to inequality and discrimination. In order to properly understand the population we serve and develop better health services, we need to collect and use a wider range of evidence to help us build up a more complete picture.

Currently, NHSGGC is building up a more comprehensive picture through the following:

  • Population data analysed in relation to protected characteristics and socio-economic status.
  • Patient monitoring by  protected characteristics e.g. ethnicity monitoring and socio-economic status
  • Patient profiling to understand the needs of individual patients in relation to their protected characteristics
  • Information on patient experience by  protected characteristics and social economic status
  • Differences in the health status and health outcomes for people  with different protected characteristics
  • Impact on health of discrimination and social inequality
  • General information about inequality and discrimination

Evidence of good practice across NHSGGC

The COMPASS service

The COMPASS team is a city–wide mental health service which exists to provide mental health care and treatment for asylum seekers and refugees with moderate to severe mental health problems stemming from trauma.

Data is collected through the referral form or at assessment.  The referral form captures information on: general demographics and family, including dependants; language spoken; need for interpreter; religious affiliation; level of educational attainment; Asylum Status, physical disability and trauma history. Alert systems are used to notify staff of additional needs at appointments.

Further information is then collected at assessment including: nature of financial pressures; importance of faith and religion; family composition and needs in relation to adults and children; history of gender-based violence, sexual orientation and preferred language and interpreter.

The service completed an Equality Impact Assessment and identified a number of actions to further improve collection of equalities data, such as using non-gender-based enquiry in relation to sexual orientation and including questions around socio-economic status, physical disability and sensory impairment.

Equalities data has been used to directly enhance patient care.  For example, information collected on language is used to inform the selection of translated appointment letters and the booking of an appropriate interpreter. Socio-economic status of clients is used to assess eligibility for support with travel to appointments and to guide clients to further support. Information on a client’s religious beliefs is used to inform the timing of appointments and is taken into consideration during psychological therapy.

Collection of equalities data has also informed service planning and review. For example, awareness of the asylum status of clients has lead to the service routinely sending out maps with first appointment letters which include photos of our department. Socio-economic data was used to inform the decision to provide clients with information on services for destitute people. Information on client demographics was used when planning to meet the needs of groups under-represented in the service.

The Sandyford Initiative

The Sandyford Initiative provides NHSGGC’s specialist sexual, reproductive health services. 

At registration, age, postcode, ethnic origin, disability status and gender are collected.  Alert systems are used to notify staff of additional needs at appointments. 

The collection of Ethnic origin has significantly improved in the last few years due to staff training and revision of the registration form.  

Sexual orientation is not asked about at registration.  The service considered this but do not feel that such a sensitive subject should be enquired about by clerical staff or that our patients should be required to label themselves at this initial use of the clinic. It is covered in routine sexual history taking, where sexual preference, experience and desire is enquired about.

Activity at all Sandyford locations is closely monitored and a range of reports have demonstrated good use of equalities monitoring data to ensure access to local services and appropriate targeting of particular groups. 

For example, a report for Sandyford Renfrewshire shows that the local service is:

  • used by local people, with 80% of activity by people living in the CHP area
  • successfully targeting young people
  • increasing the proportion of men seen overall
  • increasing the proportion of men who have sex with men seen,
  • seeing a more deprived population than the local average, with 38% attendees from the most deprived quintile

Information about ethnicity has been used to plan specific interventions, for example a series of events aimed at involving local African communities. 

In Inverclyde CHP, data analysis drew attention to high sexually transmitted infection rates in young people, sexual health needs in Greenock prison, and unprotected sex amongst men who have sex with men as key local priorities.

 Due to locally identified need, Sandyford South East has some male-only and female-only clinic appointments and a weekly appointment clinic for women staffed by an Urdu and Punjabi speaking female doctor.

Useful Sources of Information

Goal 2 – Engages with those experiencing inequality and discrimination

The NHS in Scotland aims to work more in partnership with patients. Learning from patient experience and service user engagement initiatives is key to Goal 2. However, initiatives that ignore inequalities issues are discriminatory. Service user engagement should specifically involve people representing the protected characteristics.

People’s experience of inequalities relates to why they develop health problems, do not engage with health services and find it difficult to manage their health problems. Service user engagement and patient experience programmes that recognise inequalities issues will:

  • identify barriers to patient attendance
  • improve equal access to services
  • improve patient experience of services
  • improve the experience of taking part in service user engagement activities

In the long term, these inequalities sensitive programmes will lead to a better understanding of:

  • which patients access health services and why
  • the type of inequalities patients have experienced
  • how this affects their health and the way they use health services

In NHS Greater Glasgow and Clyde some areas have carried out Equality Impact Assessments of user engagement activity. In addition, support is being provided for a strategic approach to:

  • recognising equalities issues within user engagement induction and development
  • equalities monitoring of service user engagement groups

NHS Greater Glasgow and Clyde has also completed inpatient and primary care pilots as part of the national Patient Experience Learning Programme [BROKEN LINK] which includes equalities monitoring.

Evidence of good practice across NHSGGC

Engagement and Mental Health

Glasgow Anti-Stigma Partnership has carried out a range of activities to engage with service users, carers and communities on mental health and equalities related stigma. For example:

  • the Mental Health Arts and Film Festival was started by GGC, now Scotland wide. 40,000 participants – interactive events which cover a wide range of equalities, anti-stigma and anti-discrimination issues
  • BME and equalities Community Engagement Programme (Mosaics of Meaning) recognised in UK National Mental Improvement Frameworks and internationally as good practice. Wide dissemination of tools
  • Mindwaves programme commissioned: service users, carers and local communities working as ‘journalist’ identifying, developing and publishing mental health and wellbeing good news stories

Local areas have engaged with patients and staff as follows:

  • Forensics Services stigma research with staff & patients, patient ward atmosphere scale, carers conference of over 50 people, DVD of patient & carers journey
  • Asylum seekers and refugees & mental health users group – developed Women’s Charter, user conference of 100 people in March
  • Engagement with BME communities and Imams in South East Glasgow – psychological perspectives on race and faith – conference of over 150 people in October; mental health staff involved in setting up of Roma Practitioners and service users Group and participate in Glasgow Homelessness Network user engagement work
  • Carers survey piloted in South Glasgow. Renfrewshire Intensive Home Treatment Team patient satisfaction questionnaires for each client

View our Patient Engagement web pages

Useful links

Equality and Human Rights Commission – The Equality Act Codes of Practice post consultation report

Scottish Community Development Centre – National Standards for Community engagement

Scottish Health Council – Participation Standard – Participation Standard

Goal 3 – Know that people’s experiences of inequality affects the health choices they make

People’s health choices are shaped by their experience of discrimination and feeling excluded and Goal 3 requires health workers to understand this.

How much people adopt a healthy lifestyle is influenced by how valued people feel by society or how much investment they have in their future.

An approach to health improvement based on making choices now which will benefit you in the future is unlikely to benefit people who lack power, who feel their future looks bleak or who are dealing with immediate concerns like debt or unemployment.

Equally Well, the Ministerial Task Force on health inequalities identified the following key health inequalities facing people in Scotland;

In Scotland in 2006, healthy life expectancy at birth was 67.9 years for men and 69 years for women. In the most deprived 15% of areas in Scotland in 2005-2006, healthy life expectancy at birth was considerably lower at 57.3 years for men and 59 years for women.

A higher proportion of babies born to mothers living in the most deprived fifth of the population have a low birth weight than those born to mothers living in the most affluent areas (9% compared to 5% in 2004 – 2005).

In Scotland in 2006, people who had a low household income, or reported finding it difficult to manage on their household income, had poorer mental wellbeing than those with a high household income or who reported finding it easy to manage on their income.

There are large and increasing relative inequalities in deaths amongst young adults due to drugs, alcohol, assault and suicide.

In Scotland in 2006, more than two thirds of the total alcohol-related deaths were in the most deprived two fifths of area.

Those living in the most deprived 10% of areas of Scotland have a suicide risk double that of the Scottish average.

Adult smoking rates increase with increasing deprivation. In Scotland in 2005-2006, smoking rates ranged from 11% in the least deprived 10% of areas to 44% in the most deprived 10%.

Compared with the non-South Asian population, the incidence of heart attacks in Scottish South Asians is 45% higher in men and 80% higher in women.

Lesbian / gay / bisexual and transgender people experience lower self esteem and higher rates of mental health problems and these have an impact on health behaviours, including higher reported rates of smoking, alcohol and drug use.

Just under a quarter (24%) of all individuals in households with at least one disabled adult or disabled child are living in relative low income, compared to 16% of those in households with no disabled adults or disabled children.

Equally Well (2008) Click here to download PDF.

Equalities in Health in Scotland

Evidence of good practice across NHSGGC

Smoking Cessation Needs Assessment of BME population living in South East Glasgow HSCP

This research programme aims to better understand barriers to accessing cessation services for BME people and make appropriate changes to service delivery models.

Thrive Counselling Service for Male Survivors of Childhood Sexual Abuse

Understanding gender and in particular the impact of masculine norms and values helped the counselling service establish itself. Thrive, like many inequality sensitive services, has helped dispel the perception of ‘hard to reach groups’ and replaced it with a more positive understanding of potential preventative barriers in current service designs.

Keepwell Anticipatory Care Programme

At the Heart of the Keepwell model is an understanding that health gain can be achieved if the cause of ill health is treated from an inequalities perspective. Asking people to make health choices as part of a health check without understanding the context of lived experience would fail to make sustained and generational improvements. To this end, Keepwell has included a number of additional, non-clinical elements to support patients make investment in future personal health planning.

Goal 4 – Removed obstacles to services and health information caused by inequality

Goal 4 describes the need to remove barriers to services for those with protected characteristics. Barriers can be physical, about attitudes or about how we plan services to meet the needs of one group and not another. These barriers to services can cause direct discrimination e.g. not having an interpreter available to meet someone’s language needs or indirect discrimination e.g. always having appointment times at a time when a particular group can’t make it.

There are a range of programmes underway to remove barriers for patients:

Equality Impact Assessment

Goal 4. requires that all services address unlawful discrimination. In order to do this we have developed an Equality Impact Assessment process which can help services identify areas of risk and take action to improve services for people with protected characteristics.

Accessible Information

Effective communication is vital to provide high-quality services and care. Many of those who access services have difficulty understanding the information provided. This may be because they are blind, deaf, have a learning difficulty, or because English is not their first language. It may be because they need support in terms of reading (literacy problems) or they have a condition which limits their ability to communicate (e.g. following a brain injury or a stroke). Children and young people have specific communication requirements.

Goal 4 requires that information for NHS Greater Glasgow and Clyde patients is presented in an accessible way, in a range of languages and formats that are easily used and understood by the intended audience. This does not mean watering down the content or creating a summary.

This means taking information in a form that is not accessible to an individual, and changing, translating or interpreting it into a form the individual can understand.

Disability Access

Goal 4 requires NHS Greater Glasgow and Clyde to ensure that all its building and sites are accessible for disabled people. We have an annual programme of Disability Discrimination Act audits where we work in conjunction with a disabled peoples’ network to assess the accessibility of our buildings and grounds. In addition, NHSGGC invests in innovative solutions to overcome barriers for disabled people using our services.

These include:

  • Good practice guidelines for those with sensory impairment.
  • a British Sign Language online interpreting pilot, aiming to improve access to interpreting for Deaf people.

Evidence of good practice across NHSGGC

The Sandyford Initiative is an NHSGGC wide sexual and emotional health service.  It provides a comprehensive range of services at a central location in Glasgow and within ‘Hubs’ across NHSGGC.    

The initiative completed an EQIA as part of a redesign of its services.  The EQIA indicated a range of good practice on equalities exists within this services. This included good use of equalities monitoring data, routine enquiry on social issues and  adapting the service to meet the needs of specific communities.  The EQIA allowed reflection on gaps and subsequently areas for improvements were identified such as sensitive enquiry and recording of sexual orientation.

Goal 5 – Uses an understanding of inequality and discrimination when devising treatment and care

‘Inequalities Sensitive Practice’ is central to Goal 5. This kind of practice involves taking into account underlying issues of social inequality, such as money worries or gender-based violence, in order to improve the health of individual people. Evidence shows that if these issues are not taken into account by the health service, opportunities are missed to improve health and to reduce health inequalities.

An Inequalities Sensitive health practitioner:

  • understands the impact that inequality has on a patient’s experience of life and health
  • doesn’t judge and understands power within the practitioner/patient relationship
  • is sympathetic and has good listening skills which enables the patient to tell their story, thus making it ‘real’
  • challenges in a sensitive way, providing alternative options
  • takes a person centred approach

From 2006 to 2009, NHS Greater Glasgow and Clyde delivered an Inequalities Sensitive Practice Initiative which produced evidence and resources for staff.

The organisation now has a number of programmes of work aimed at ensuring our services know and understand their responsibilities in identifying and responding to experiences of social inequalities.

Evidence of good practice across NHSGGC

Healthier Wealthier Children

Working in partnership to tackle child poverty and inequality can produce meaningful and far-reaching results. The Scottish Government-funded Healthier, Wealthier Children project has been operating in the NHS Greater Glasgow and Clyde area since October 2010 and has succeeded in embedding financial inclusion referrals into care for pregnant women and families that are experiencing or are at risk of poverty.

Key to the project is the ethos that tackling child poverty is everyone’s business, and that money and debt worries need to be routinely discussed as part of assessments. It brings together maternal and early years health and social care professionals with voluntary sector providers of money advice, debt advice, and income maximisation services which explore benefit and tax credit entitlement. Onward referrals from advice services are also made to address related issues such as fuel poverty, homelessness, addiction, mental health and immigration advice.

At the end of March 2012, 3853 referrals had been made to advice services which resulted in 54% uptake among pregnant women and families. Six out of 10 people accessing the advice services received some type of intervention with a total annual recorded gain of just over £2.7 million (for 644 referrals) and £328,000 in one-off lump sums (for 370 referrals). The majority of referrals – 80% – were made by midwives and health visitors.

The project achieved its aims of increasing access to money advice services for equality groups. Women are more at risk of poverty due to the gender pay gap, occupational segregation, part time working and caring roles. Evidence also shows that women are more likely than men to go without food and clothes in families experiencing poverty with a female and male composition. 94% of referrals in this project were women This is particularly encouraging as pregnancy & childbirth can be risk times for increased financial hardship.

The majority of referrals were single parents. 17% of referrals were from BME communities (83% White Scottish / British / Irish; 6% Pakistani; 3% Polish; with a range of other ethnic groups referred also).

A NHSGGC wide Equality Impact Assessment (EQIA) was carried out early on in the project with some areas carrying out local EQIAs, which supported marketing to equalities groups.

Within the health board area 10 community health (and care) partnerships and 6 local authorities are involved in the delivery of the project, which is being evaluated by the Glasgow Centre for Population Health. A learning network has been established to share information and support emerging good practice across the partnership.

For more information and detailed case studies visit the HWC web site.

Gender based violence

Gender Based Violence (GBV) is recognised as being a major public health issue causing pain, injury and suffering, particularly to women and children and as such is an important contributing factor to poor health outcomes for individuals attending NHSGGC services. It is known that all health staff have a unique and crucial role in identifying and supporting all those affected by it.

GBV and Maternity Services

In NHSGGC, routine enquiry about domestic abuse was introduced at the maternal history taking visit prior to the issuing of CEL_41 (2008). However, it wasn’t a uniform roll-out as it occurred prior to the amalgamation of NHS Argyll & Clyde and Greater Glasgow NHS.

Early on in maternity services, the work to embed routine enquiry about domestic abuse was supported by 3 midwives, who received intensive training around gender based violence (GBV). These staff now co-ordinate a strategic response to GBV in all of the Women’s and Children’s Directorate.

The approaches have been different for Greater Glasgow and Argyll & Clyde areas with a wide range of work carried out over the years including:

  • Assessing midwives training needs and what they perceived were the barriers to routine enquiry
  • Ensuring that service issues were addressed for all areas (e.g. ensuring that all staff were introducing private time)
  • Development of a rolling programme of basic awareness and skills based training (the latter provided by the Women’s Support Project)
  • Standards of care were written (based on the All Wales Pathway but following the incremental stages of establishing a pathway for routine enquiry) and a set of competencies
  • Mentoring for staff who lacked confidence after initial training in how to ask the question sensitively and responding to disclosures. (e.g. the mentor sits in through two booking visits feeding back after each one so that the midwife is aware of the improvements (if any needed) in her approach, & developed a range of practical case studies to work with mentees on how to deal with disclosures)
  • Evaluation and monitoring of routine enquiry and mentoring

GBV and Sexual Health Services

The Sandyford Initiative provides all specialist sexual health services within NHS Greater Glasgow and Clyde. A GBV Policy was developed in January 2011. It sets out procedures for supporting staff to identify and respond appropriately to clients who have experienced gender-based violence, or who are perpetrators of gender-based violence. It also provides up to date information about all forms of GBV and appropriate support services available for referral.

Given the significant levels of gender-based violence within the population and its consequences for health and well-being it is important for staff working in sexual health services to have the competence and confidence to ask about GBV including domestic abuse. Sandyford staff already regularly deal with people who have experienced abuse, whether or not the abuse is a direct or indirect cause of their presenting condition, including self harm or suicide attempts.

In house education sessions have been provided and clinical supervision sessions and appropriate support from line managers provide additional opportunities for staff to discuss their experiences of sensitive routine enquiry and other GBV related issues.

GBV work in Renfrewshire HSCP

Renfrewshire HSCP has led work across NHSGGC to ensure Sensitive Enquiry on GBV becomes part of routine practice.

A GBV lead was identified by the CHP Director to drive delivery of NHSGGC GBV Plan. The GBV lead was able to garner support for this programme at an early stage by having an extended management team session. This resulted in a whole systems approach being taken across primary care services.

Renfrewshire CHP is in the process of extending the national programme to include Health and Community Care Settings and have provided short training sessions for admin staff. They have also utilised local Multi-Agency Partnership relationships and resources to ensure that all key staff access Basic Awareness Domestic Abuse Training.

A programme of support for staff has been agreed, covering Peer Support, Clinical Supervision, Line Manager Support and Complex case discussion/review. The involvement of a specialist local women’s organisation (Women & Children First) has been secured to support complex case discussion. Extensive internal communication and promotion of the GBV plan has included NHSGGC’s team brief system as well as team meetings.

Goal 6 – Uses its core budget and staff resources differently to tackle inequality

NHS Greater Glasgow and Clyde has an annual budget of 2.6 billion and employs 38,000 staff. Goal 6 requires these resources to be used innovatively to tackle inequality. Work to tackle inequality is part of NHS Greater Glasgow and Clyde’s core business rather than an additional service. This means that financial and service planning needs to have tackling inequality at its centre.

While acknowledging the difficult economic environment in which public authorities are now operating, the Equality and Human Rights Commission is emphasising the compulsory nature of the equality duties, and the importance of public authorities meeting their duties when making significant decisions.

NHS Greater Glasgow and Clyde has carried out rapid impact assessments of cost savings programmes to ensure that there is not an unfair effect on those with protected characteristics.

The Public Sector Duties and Financial Decisions (PDF)

Developing the Workforce

Goal 7 – Has a workforce which represent our diverse population

Goal 7 requires NHS Greater Glasgow and Clyde to remove barriers to recruitment for people with protected characteristics.

Discrimination and prejudice can impact on people’s employment opportunities and it is unlawful to discriminate against people when recruiting or in the workplace. A more diverse workforce is important to patients because it means we are representative of the communities we serve. In order to monitor diversity, Human Resources produces Equal Opportunity Reports on applicants and employees.

All Human Resources policies are subject to Equality Impact Assessment to ensure that they support the recruitment and retention of a diverse workforce. NHS Greater Glasgow and Clyde have a range of guidance and policies which support this. Human Resources can support managers to ensure they are delivering best practice and our Recruitment Guidance Manual includes advice on equal opportunities interviewing.

Goal 8 – Created a non-discriminatory working environment and a workforce which has the skills to tackle inequality

Goal 8 requires that staff have access to a range of learning opportunities to ensure that they are aware of the equalities legislation and have the skills to deliver health services that are fair to all.

The Equality Act 2010 contains nine protected characteristics (areas where we must not discriminate) and by law the NHS must actively promote equality.

We need to ensure that our staff are able to:

  • Challenge discrimination,
  • Promote equality of opportunity and
  • Meet the needs of those with protected characteristics.

Equality is a complex subject area and we have developed a range of short e learning modules to promote better awareness of each protected characteristic. These modules describe the needs of those with protected characteristics and their protection in the law.

Staff training and resources uptake is analysed by protected characteristic which will help ensure that staff have equal opportunities to access training and development opportunities.

A Manager’s Guide to the Equality Act 2010 is available so that senior personnel can support their staff to meet the legislation’s requirements.

The Health Service’s Role in Society

Goal 9 – Spends the money being invested in buildings, goods and services in a way which tackles poverty and inequality

Goal 9 requires NHS Greater Glasgow and Clyde to ensure that the procurement of goods and services is not discriminatory. For example, making it clear how smaller organisations who specialise in equalities work can bid for NHS contracts.

‘Social benefits’ clauses can be used to ensure contractors make a positive impact in the local community. For example, the New South Glasgow Hospital which is being built in Govan has provided training places to give people access to construction jobs.

Evidence of good practice across NHSGGC

New South Glasgow Hospitals

The New South Glasgow Hospital campus project will be the largest single NHS hospital build project ever undertaken in Scotland. The campus will include a new children’s hospital, new adult hospital and laboratory development.

NHS Greater Glasgow and Clyde (NHSGGC) recognises the important role the NHS plays in local communities beyond the provision of healthcare facilities and services. The strategy adopted in relation to the campus not only seeks to engage patients in the design of the new hospitals but also engages communities in the broader campus development, maximising the opportunities from NHSGGC’s investment.

The impact of the new South Glasgow Hospitals Campus will only be realised through effective collaboration between partner organisations, building on existing partnership structures in South West Glasgow and Glasgow.

Community Benefit

NHSGGC sought to maximise training and employment opportunities, business start up and business growth through a targeted approach to securing benefit for communities in Greater Glasgow and Clyde in the procurement process for the new hospitals.

In doing so, the board included specific community benefit considerations requiring bidders to demonstrate how they would meet the following objectives:

  • Target 10% of total labour required to deliver the project to be delivered by New Entrants
  • Assess and develop the capacity of Small/ Medium Enterprises
  • Assess and develop the capacity of Social Enterprises

Targeted Training and Recruitment

Brookfield Construction Ltd (BCL) has committed to deliver a target of 10% of total labour required to deliver the project (including those works delivered by specialists, or sub-contractors) to be delivered by New Entrants. In addition, BCL has also committed to deliver additional targets in relation to training and learning (see below).

IndicatorTotal
Total number of people employed in delivery of contract.2505
New Entrants250
Qualifications to be achieved by new entrants315
No. of Apprentices88
Work Experience Places184
Lifelong Learning Opportunities1060
  

BCL has entered into a partnership with Glasgow South West Regeneration Agency (GSWRA) to deliver training and recruitment targets. In furthering the traing and recruitment targets, GSWRA working with Brookfield will:

  • Devise a Local Labour Action Plan and establish requirements with Sub-Contractor/s to recruit and source supplies locally where these exist.
  • Establish an operational team to deliver services including: vacancy promotion, skills assessment and matching, general and vocational training and business development.
  • Establish a “Recruitment & Training Centre” in close proximity to the New South Glasgow Hospitals Project.
  • Share relevant data and management information to ensure collaborative working.
  • Identify and source funding from various agencies, development programmes, charities to ensure that aims and objectives are achieved.
  • Engage effectively with the community and other stakeholders on the work of the Partnership.
  • Recruit relevant partners to enable effective delivery of these aims.

In addition to the above, BCL has adopted a recruitment protocol were all vacancies resulting from the construction project will be notified to GSWRA to support mainstream recruitment form communities in South West Glasgow.

Developing the Supply Chain

In assessing and developing the capacity of Small Medium Enterprises (SMEs) BCL have entered into partnership with Glasgow City Councils Supplier Development programme (SDP) to support and develop the capacity of Small Medium Enterprises by undertaking:

  • Activities to identify Small Medium Enterprises (SME’s) and assess their capacity.
  • Actions to assist Small Medium Enterprises (SME’s) to obtain contracts
  • Actions to ensure that the sub-contractors make work packages available to Small Medium Enterprises (SME’s)
  • Measurement of the social and economic impact of the engagement with the Small Medium Enterprises (SME’s)
  • To provide support for the Small Medium Enterprises (SME’s) to assist them to work in Partnership.

In assessing and developing the capacity of social enterprises, BCL have entered into partnership with Community Enterprise in Scotland. Community Enterprise in Scotland under the “Ready for Business” programme will support and develop the capacity of Social Enterprises by undertaking:

  • Activities to identify Social Enterprises and assess their capacity.
  • Actions to assist Social Enterprises to obtain contracts
  • Actions to ensure that the sub-contractors make work packages available to Social Enterprises
  • Measurement of the social and economic impact of the engagement with the Social Enterprises
  • To provide support for Social Enterprises to assist them to work in Partnership.

BCL will work with Glasgow City Council and Community Enterprise in Scotland to provide training and support to equip SMEs and social enterprises with the relevant expertise and policies to enable them to bid for potential sub-contracting opportunities.

Recognising that the scale of opportunities available may be prohibitive for smaller SMEs and social enterprises, the BCL has committed to identify construction and non-construction related ‘work packages’, which are accessible to SMEs and social enterprises who otherwise would have found it difficult to secure a contract.

BCL have agreed a protocol for SMEs and SEs wishing to engage in the project .This has been supported by the establishment of a portal for individuals and businesses to register for future opportunities.

Goal 10 – Works with partners to reduce health inequality by addressing issues such as income, inequality, social class, inequality, gender inequality, racism, disability discrimination and homophobia

Reducing the health inequality gap and shifting resources from treatment to prevention requires action from organisations other than the NHS.. This includes education, employment, housing, transport and other public services which impact on the underlying causes of poor health.

Goal 10 requires NHS Greater Glasgow and Clyde to work with other partners to address inequality and discrimination. For example, Glasgow Community Planning Partnership recently carried out research on protected characteristic groups to enable all partners, including NHSGGC, to improve services.

NHS works with partners on a range of projects to tackle health inequality.

Healthier Wealthier Children is an example of partnership working to ensure families with money worries are referred to financial inclusion services to reduce child poverty.

Equality Groups in Glasgow ODS Report

Evidence of good practice across NHSGGC

Working with the Local Authorities and the Voluntary Sector is crucial in addressing the effects of poverty.  Within Glasgow City, NHSGGC is a key partner in the development of an Anti-Poverty Strategy.  As part of that, a strategic plan to address the effects of child poverty has been developed. This includes consolidating our NHS approach to child poverty, which includes ensuring families have appropriate support e.g. through Universal and Vulnerable Care Pathways and ensuring social interventions such as parenting support and money advice are widely available.

Public Sector Equality Duty, April 2011

Specific Equalities Duties for Public Sector Organisations

A set of requirements came into force on 27 May 2012 which will bring about some important changes in how we tackle inequality in NHSGGC.

The purpose of these ‘Specific Duties’ in Scotland is to help public sector organisations to deliver the Equality Duties laid out in the Equality Act 2010. These require that public authorities, in the exercise of their functions, give due regard to the need to:

  • Eliminate unlawful discrimination, harassment and victimisation and other prohibited conduct
  • Advance equality of opportunity between people who share a relevant protected characteristic and those who do not
  • Foster good relations between people who share a protected characteristic and those who do not.

The Specific Duties require NHSGGC to:

  • Report on how we are putting equality at the heart of all our services
  • Publish equality outcomes and report progress
  • An equality outcomes should further one or more of the following needs: eliminate discrimination, advance equality of opportunity or foster good relations. An outcome has been described as measuring -“Not how many worms the bird feeds its young, but how well the fledgling flies”
  • Assess and review our policies and practices
  • NHSGGC already has a process in place to carry out Equality Impact Assessments
  • Gather and use employee information to ensure our workforce represents the communities we serve
  • Publish gender pay gap information
  • There is a 11% gap between men’s and women’s full-time hourly rates, and a 32% gap when you compare women’s part time hourly rate to men’s full time hourly rate
  • Publish statements on equal pay to say how we will close any gaps in relation to ethnicity and disability
  • Ensure that our procurement processes to buy goods and services consider equality issues
  • Publish information in a manner that is accessible, for example translated into different languages and accessible

Contact person: Jac Ross, Corporate Inequalities Team
Email: jac.ross@ggc.scot.nhs.uk
Telephone: 0141 201 4560 or 0141 201 4967

You can also read more information on the Public Sector Equality Duties and the Specific Duties using the link below:

https://www.equalityhumanrights.com/en/public-sector-equality-duty-scotland