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Equality Impact Assessment and Consultation Document
Proposal to Co-locate Children and Adolescents Mental Health Out-Patient Services for Belfast at
refurbished accommodation at Forster Green and to develop an outreach service within local communities
Section 75 and Schedule 9 The Northern Ireland Act 1998
CONSULTATION PERIOD 9th MARCH 2010 – 4th MAY 2010
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CONTENTS
Page
EXECUTIVE SUMMARY 4
1 INTRODUCTION 8
1.1 Introduction 8
1.2 Statutory Context Section 75 N.I. Act 1998 9
1.3 The Equality Impact Assessment Process 10
1.3.1 Equality Screening Outcomes 10
1.3.2 Scope 10
1.4 Human Rights 11
1.5 Trust‟s Background, Purpose, Values & Strategic Objectives
11
1.5.1 Background to the Trust 11
1.5.2 Trust‟s Purpose, Values & Objectives 12
1.6 Management Structure and Descriptions 13
2 BACKGROUND TO SERVICE PROVISION 17
2.1 Current Service Profile 18
2.2 Key Drivers for Change 19
2.3 Future Proposed Model 20
3 OPTION APPRAISAL 25
3.1 List of Options 25
3.2 Benefit Criteria 26
3.3 Option benefit scoring 27
3.4 Preferred Option 28
4 CONSIDERATION OF AVAILABLE DATA AND RESEARCH
30
4.1 Strategic Data Sources 30
4.2 Local Data Sources 31
4.3 Children & Adolescent Mental Health Data 31
4.4 B.H.S.C.T. Population Profile 34
4.5 B.H.S.C.T. Staff Profile 37
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5 ASSESSMENT OF IMPACT 43
5.1 Assessment of impact on Section 75 Groups - Patients & Clients
43
5.2 Assessment of impact on Section 75 Groups - Staff
45
6 CONSIDERATION OF MEASURES TO MITIGATE ADVERSE IMPACTS
48
6.1 Mitigating measures for Patients & Clients 48
6.2 Mitigation Measures for staff 50
7 FORMAL CONSULTATION, PUBLICATION AND MONITORING
54
7.1 Formal Consultation 54
7.2 Publication 55
7.3 Decision of the Public Authority 55
7.4 Monitoring 55
TABLES:
Table 1 Activity Information 18
Table 2 Option Benefit Scoring 27
Table 3 Male & Female Referrals 31
Table 4 The Mental Health of Children & Young People 32
Table 5 Population Profile - B.H.S.C.T. (Belfast & Castlereagh Area Population by Section 75 Group)
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Table 6 B.H.S.C.T.: Staff Profile by Section 75 Group (Jan 2010 figures)
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Table 7 Postcodes of Staff (Travel to Work) 46
APPENDICES DESCRIPTION
Appendix 1: Glossary of Abbreviations 56
Appendix 2: Consultation Questionnaire 57
Appendix 3: Freedom of Information Act (2000) Confidentiality of Consultations
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This document is available on request in alternative formats (including braile, disc and audio cassette, and in minority languages to meet the needs of those who are not fluent in English). Please contact Orla Barron, Acting Health & Social Inequalities Manager by telephone 028 90 960069 by textphone: 028 90565330 or by email: [email protected]
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Executive Summary The Belfast Health & Social Care Trust (The Trust) strives to provide the highest quality of care and treatment to the population it serves. The Trust has set out in “New Directions” – a conversation with the citizens of Belfast its guiding principles and direction of travel for future service delivery. Children and Adolescence Mental Health Services (CAMHS) within the Trust have been considering the most appropriate model of service delivery for its Child and Adolescent Mental Health (Tier 3) Out-Patient Services. (Tier 3 services are those services usually provided by a multi disciplinary team or service, working in a community mental health clinic, child psychiatry Out-Patient service or community settings. They offer a specialist service for those with more severe, complex or persistent disorders.) The Trust is now embarking on a consultation process regarding the proposed relocation of its CAMHS Tier 3 services from three existing sites to a centralised site with outreach clinics provided at Health & Wellbeing Clinics across Belfast. The Trust wishes to provide a model of best practice for CAMHS Users and Staff. The Trust believes this would be achieved by localising services where possible and bringing together its two Out-Patient teams based at three sites, to a single team based at one site. This document is an Equality Impact Assessment (EQIA) through which The Trust seeks to consult openly and transparently in regard to any equality and human rights implications with its internal and external stakeholders on the proposed relocation of services. An Equality Impact Assessment is an in-depth study of a policy or proposal to assess the content of the impact on the equality of opportunity for the nine categories identified in Section 75 of the Northern Ireland Act 1998. It requires the analysis and consideration of both quantitative and qualitative data. Currently, Out-Patient Services in Belfast have been organised into one service area in a managed clinical network. There are two specific teams at three sites across the city:
The Child and Family Clinic located at The Royal Belfast Hospital for Sick Children
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The Adolescent Team based at The Young People‟s Centre in 10 College Gardens and 88 Lisburn Road.
Therefore, services provided to children, young people and their families are mainly provided at locations where the teams are located. None of the existing buildings, where the services are currently delivered, are purpose built for the provision of a modern CAMH Community based Out-Patient Service. There are significant drawbacks with regard to space, environment and accessibility in the offices used in providing Therapeutic Services. The Trust has undertaken an Option Appraisal process in determining how best to deliver CAMH services. This is set out in more detail in Section Three of the document. The outcome of this process and the preferred option which the Trust is now consulting on would provide a central location on the Forster Green site with outreach service delivery at Health and Well Being Centres across Belfast. The proposed pattern of service provision across the city for the outreach model will include provision of services at:
Grove Health and Well-being centre in North Belfast
Royal Belfast Hospital for Sick Children (temporarily whilst awaiting the Commissioning of new Health and Well-being centres in Andersonstown and Shankill early in 2011) in the West of the City
Knockbreda and Holywood Arches Health and Well-being centres in the East and south east of the City
In addition to dedicated therapeutic space and purposely designed office space for CAMHS - available at Forster Green
Wellington Park, The Family Trauma Centre.
The Trust is conducting this Equality Impact Assessment to ensure that service users, parents, guardians, carers, staff and the public at large have an opportunity to provide their views before any final decisions are taken. The Trust is statutory bound to consider the implications for equality of opportunity and good relations. Human Rights and disability considerations are also integral to this process.
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This Equality Impact Assessment will set out:
Organisational and strategic context
Background to the service provision, the current proposed service model and key drivers for change
Option appraisal process - The assessment of the three options, together with the rationale of how the preferred option was identified
Consideration of available data across the nine Section 75 categories – both service users and staff
Assessment of Impact
Mitigation Measures To conclude, Section 7 looks at the formal consultation process the Trust will undertake to ensure that stakeholders are informed and consulted on the proposed change.
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SECTION 1 1 INTRODUCTION 1.1 Introduction 1.2 Statutory Context Section 75 N.I. Act 1998
1.3 The Equality Impact Assessment Process
1.3.1 Equality Screening Outcomes 1.3.2 Scope 1.4 Human Rights 1.5 Trust‟s Background, Purpose, Values and Strategic
1.5.1 Background to the Trust 1.5.2 Trust‟s Purpose, Values and Objectives 1.6 Management Structure and Descriptions
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1 Introduction
1.1 Under the statutory duties contained within Section 75 of the Northern Ireland Act 1998, the Belfast Health and Social Care Trust („The Trust‟) gave an undertaking to carry out an equality impact assessment (EQIA) on each policy or group of co-joined policies where screening had indicated that there may be significant implications in relation to one or more of the nine equality dimensions.
The Trust welcomes any comments which you may have in terms of
the EQIA. A copy of this EQIA report is available on the Trust‟s website at
http://www.belfasttrust.hscni.net
If you have any queries about this document, and its availability in alternative formats (including Braille, disk and audio cassette, and in minority languages to meet the needs of those who are not fluent in English) then please contact:-
Orla Barron Acting Health & Social Inequalities Manager Graham House Knockbracken Healthcare Park Saintfield Road Belfast BT8 8BH
Tel: 028 9096 0069
Fax: 028 9056 6701
Text phone: 028 9056 5330
E-mail: [email protected]
Deadline for comments will be: Tuesday 4th May 2010
To facilitate comments please see Appendix Two – Consultation Pro-forma. Following consultation a summary report will be made available.
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1.2 Statutory Context Section 75 NI Act 1998
Section 75 of the Northern Ireland Act 1998 requires each public authority, when carrying out its functions in relation to Northern Ireland, to have due regard to the need to promote equality of opportunity between nine categories of persons, namely :-
Between persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation
Between men and women generally
Between persons with a disability and persons without; and
Between persons with dependants and persons without. Without prejudice to its obligations above, the public authority must also have regard to the desirability of promoting good relations between persons of different religious belief, political opinion or racial group. The Trust submitted its adopted Equality Scheme to the Equality Commission for Northern Ireland (ECNI) in June 2007. The Scheme outlines how the Trust proposes to fulfil its statutory duties under Section 75. Following approval of the Scheme, existing policies were screened to assess impact on the promotion of equality of opportunity or the duty to promote good relations using the following criteria:
Is there any evidence of higher or lower participation or uptake by different groups?
Is there any evidence that different groups have different needs, experiences, issues and priorities in relation to the particular policy issue?
Is there an opportunity to promote equality of opportunity between the relevant different groups, either by altering the policy, or by working with others in government or in the larger community, in the context of the policy?
Have consultations with relevant groups, organisations or individuals indicated that policies of that type create problems specific to any relevant group?
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Consideration was also given to the health and social Inequality, disability discrimination and human right implications.
Further, the Trust gave a commitment to apply the above screening methodology to all new policies as an integral part of the development process and where necessary and appropriate to subject new policies to further equality impact assessment.
1.3 The Equality Impact Assessment Process
An Equality Impact Assessment is a thorough and systematic analysis of a policy, whether that policy is written or unwritten, formal or informal and is carried out in accordance with the section in the Guide to the Statutory Duties (Annex 1 – Procedure for conduct of equality impact assessment). Whilst an EQIA must address all 9 Section 75 categories, it does not need afford equal emphasis to each throughout the process – rather the EQIA must be responsive to emerging issues and concentrate on priorities accordingly.
An EQIA should determine the extent of differential impact upon the relevant groups and in turn establish if the impact is adverse. If so, then the public authority must consider alternative policies to better achieve equality of opportunity or measures to mitigate the adverse impact.
1.3.1 Equality Screening Outcomes During the Equality Screening process, the Belfast HSC Trust screened this proposal in – meaning that it should undergo a full equality impact assessment.
1.3.2 Scope The scope of the Equality Impact Assessment on the relocation of Tier 3 CAMHS considers the affect of the proposal on children, young people , their parents and carers and the staff who will provide this service. This current EQIA shall follow seven separate elements as outlined in the Equality Commission‟s guide to Statutory Duties:
1. Consideration of available data and research 2. Assessment of Impacts
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3. Consideration of measures which might mitigate any adverse
impact or alternatives which might better achieve the promotion of equality of opportunity
4. Formal Consultation
5. Decision by public authority
6. Publication of results of EQIA
7. Monitor for Adverse impact in the future and publication of
results of such Monitoring. 1.4 Human Rights
The Trust deems it essential that all of its Children‟s Services; policies and practices accords with the Children‟s Act and the Human Rights Act and therefore due consideration is given to this legislation and principles when changes to services are proposed.
1.5 Trust’s Background, Purpose, Values and Strategic Objectives
1.5.1 Background to the Trust
The Belfast Health and Social Care Trust (the Trust) was established on
1st April 2007 under the Belfast Health and Social Services Trust
(Establishment) Order (Northern Ireland) 2006. The Belfast Health and
Social Care Trust has been formed from the following six Legacy Trusts
:-
Belfast City Hospital Trust
Green Park Healthcare Trust
Mater Hospital Trust
Royal Hospitals Trust
North & West Belfast H&SS Trust
South & East Belfast H&SS Trust
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The Trust serves the population, not only of Belfast and Castlereagh but
all of Northern Ireland with its Regional Services providing the full range
of hospital community and social care services for older people, for
children and for people with mental health, learning disability, physical
disability as well as acute and rehabilitative care for patients and clients.
Health and Social Services Trusts (HSS) are provided for under Article
10(1) of the Health and Personal Social Services (NI) Order 1991 and
the functions of the Trusts are conferred by this legislation.
The Belfast Health and Social Care Trust :-
Employs approximately 20,000 staff
Covers a population of 345,000
Has an annual income of approximately £1,000 million.
1.5.2 Trust’s Purpose, Values and Objectives
Purpose: The purpose of the Belfast Health and Social Care Trust is “to improve
health and wellbeing and reduce health inequalities” Values: The Trust undertook an engagement process asking a range of people
what matters most as we carry out our work. Through dialogue and engagement with Service Users, Carers, Staff, Staff Side and others, four key values were identified :-
Respect and Dignity Treating all with respect and dignity. Respect embodies equality
and equity, maintain fairness in policy and practice.
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Accountability Having a personal and professional accountability for the
provision of high quality care and services by competent staff in a safe environment. Being accountable for achieving clear standards in service delivery, care and service outcomes and experience. Securing the best use of resources and ensuring services are planned, delivered and evaluated to make the most of financial and other available resources.
Openness and Trust
Have a clear process with two-way communication with Users, Staff and the Public with transparency, openness and trust in decision making and communication and providing timely and appropriate information to service users.
Learning and Development
Building capacity and empowering people through appropriate development and support.
Strategic Objectives:
On the firm base of the organisational values, five strategic objectives have been developed. These five objectives support the purpose and shape the strategic direction over the next three to five years :-
To provide safe, high quality and effective care
To modernise and reform our services To improve health and wellbeing through engagement with our
service users, local communities and partner organisations To show leadership and excellence through organisational and
workforce developments To make the best use of our resources to improve performance
and productivity.
1.6 Management Structure and Descriptions
The Management Structure of the Belfast Trust is as follows :-
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The Trust‟s Headquarters is situated at :
Roe Centre Knockbracken Healthcare Park Saintfield Road BELFAST BT8 8BH
Telephone number: 028 9056 5555 Minicom number: 028 9056 5406 The Trust also has a freephone enquiry line. This provides information about Trust services: Telephone number: 0800 228844. Social Services, Family, Childcare, Mental Health and Learning Disability Responsible for a comprehensive range of acute and community, health and social services based around the needs of the child, the mother and the family, which will deliver better outcomes for them all.
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Children’s
Services Manager
Community Child
Health
Co-Director
Women‟s & Maternity
Children‟s Services Manager Children
with Disability
Children‟s Services Manager CAMHS
Children‟s Services Manager Children‟s Hospital
Maternity Services Manager
Children‟s Services Manager
Child Protection/Gateway
Children‟s Services Manager
Looked After Children & Leaving
& Aftercare
Children‟s Services Manager
Fostering, Adoption, Early Years
Children‟s Services Manager
Residential Care
Children‟s Services Manager
Safeguarding/Family Support
Gynae/Family Planning Manager
Co-Director, Family & Child
Care
Co-Director, CAMHS
Children’s
Disability
Co-Director Child Health
Clinical Director
Clinical Director
DIRECTOR
Associate Medical Director
Co-Director Social Work
Care
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SECTION 2
2 BACKGROUND TO SERVICE PROVISION
2.1 Current Service Profile
2.2 Key Drivers For Change
2.3 Future Proposed Model
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2 Background to Service Provision
The amalgamation of six legacy Health and Personal Social Services Trusts into the Belfast Health and Social Care Trust provided the opportunity to consider the most appropriate model of service delivery for the Child and Adolescent Mental Health Tier 3 Out-patient service taking into account the identified key requirements:
To support and deliver on organisational and Regional objectives as they relate to good CAMHS practice
To support and deliver on key result areas e.g. Priorities for Action (PfA), Access Targets and the Trust‟s MORE programme (Maximising Outcomes, Resources and Efficiency)
To provide a model of care that maximises local delivery of services as set out in the „Belfast Way‟ – a conversation with the citizens of Belfast
To modernise the delivery of high quality CAMH services and the buildings we use bringing together teams across the city into one team and base.
Children and Adolescent Mental Health Services (CAMHS)
There are four tiers within CAMHS which are described below: Tier 1: Service provided by practitioners working in universal services (such as GPS, health visitors, teachers and youth workers)‟ who are not necessarily mental health specialists. They offer general advice and treatment for less severe problems and refer to more specialist services. Tier 2: Services provided by specialists working in community and primary care settings in a uni-disciplinary way (such as primary mental health workers, psychologists and paediatric clinics). They offer consultation to families and other practitioners, outreach to identify severe/complex needs, and assessments and training to practitioners at Tier 1 to support service delivery. Tier 3: Services usually provided by a multi disciplinary team or service working in a community mental health clinic, child psychiatry Out-Patient service or community settings. They offer a specialised service for those with more severe, complex and persistent disorders.
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Tier 4: Services for children and young people with the most serious problems. These include day units, highly specialised Out-Patient teams and inpatient units, which usually serve more than one area.
2.1 Current Service Profile
Tier 3 CAMH Out-patient services in Belfast have been organised into one service area in a managed clinical network. Currently there are two specific teams at three sites across the city:
The Child and Family Clinic located in the Royal Belfast Hospital for Sick Children
The adolescent team based at the Young People‟s Centre in 10 College Gardens and 88 Lisburn Rd.
Table 1 - Activity Information
Year Referral to
Out-Patient Services
1st Appointments
Review Appointments
Total
07/08 2,249 1,548 12,215 13,763
08/09 2,650 1,780 16,283 18,063
% increase
18 15 33 31
Services provided at CAMHS Out-Patient services are specialist child psychiatric and theraputic care for Children and adolescents with complex, severe and persistant mental health disorders.
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Information for the first nine months of 2009/10 suggests this increase in activity has levelled off with both sub-specialist teams (such as the Eating Disorder Team or the Crisis, Assessment and Treatment Team (CAIT) appropriately diverting referrals away from out-patient services and the referral pattern stabilising to a total estimated activity level of between 14,000 and 15,000 patient contacts per year.
Pre-consultation
The Trust has undertaken a pre-consultation exercise with representatives of staff likely to be affected by the proposed changes to accommodation base of the Out-Patient teams in order to inform them of the proposals and to learn their views on the impact of the proposals.
2.2 Key Drivers for Change
Bamford Review - A Vision of a Comprehensive Child & Adolescent Mental Health Service
Assertive Outreach The Bamford Review states that improvement in provision for children and young people at specialist Tier 2/3 CAMHS will impact positively and decrease the number of those requiring Tier 4 service. In other cases improved Tier 2/3 provision and closer links between Tier 3 and 4 will ensure that an interagency working approach and increased flexibility of service. This could help to facilitate movement of the young person through the tiers of CAMHS service.
Assertive outreach provides frequent contact and co-ordinated intensive treatment with the young person and/or their carers by a multidisciplinary team. It could be delivered by collaboration between Tier 4 and Tier 3 services in conjunction with other agencies. It can take place in an inpatient setting or exclusively as an Out-Patient assertive outreach model, or in conjunction with day unit provision but day units are more readily applicable to urban populations than to scattered rural populations because of distances of travel involved in the latter case.
It is also acknowledged that, community based CAMH services should not solely be delivered on an acute hospital site. Currently services provided to children, young people and their families are mainly provided at the locations where the teams currently are located. Child and Family Clinic on the Royal Belfast Hospital for Sick Children The Young People‟s centre at 10 College Gardens and 88 Lisburn Road. None of the existing buildings are purpose built for the provision of a modern CAMH community based out-patient service and there are significant
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drawbacks with regard to space, environment and accessibility in the offices used in providing therapeutic services.
Strategic Fit
In addition to the accommodation options considered a number of service delivery options were identified to meet the requirements of “New Directions” to deliver services „locally where possible and centralised only where necessary‟. Following consultation within CAMHS it was acknowledged that a fully centralised model i.e. bringing existing teams together to deliver services at only one site, would not be sufficient to meet the requirement to maximise the local delivery of services nor meet PfA and other targets.
Consideration of accommodation options
It was also acknowledged that there had been dissatisfaction regarding the “fitness for purpose” of the existing accommodation expressed over the years and therefore any proposed accommodation option should also bring both the Child and Family Clinic team from the RBHSC and the Adolescent Out-patient team based at College Gardens and 88 Lisburn Road together on one site and provide on an outreach basis, the maximum number of patient contacts in local settings across Belfast.
Existing accommodation is based in one wing of the older part of RBHSC and does not allow for sufficient, dedicated therapeutic space, the offices are old and overcrowded.
Existing accommodation for the Young People‟s Centre is spread over two sites in College Gardens and the Lisburn Road; both sites were originally houses which have been converted to a mix of therapeutic spaces and office accommodation. Both are old and the accommodation is spread over a number of floors causing issues concerning accessibility and suitability for children, young people and their families. Therefore one key driver for change is to provide modern, new built and newly refurbished with dedicated, therapeutic space in addition to modern office accommodation for the team.
2.3 Future Proposed Model
The proposed model would provide a central location, on the Forster Green site with outreach service delivery at Health and Wellbeing Centres and other CAMHS clinics across Belfast, a central location for the CAMHS team and a number of outreach services in local communities.
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Royal Belfast Hospital for Sick Children 88 Lisburn Road 10 College Gardens
Grove Health
and Well-being centre North
Belfast
Current locations
Proposed new Health and Well-being centre in Andersonstown
Proposed new Health and Well-being centre in Shankill Knockbreda
& Arches Health & Wellbeing Centres
Therapeutic Space for CAHMS at Forster Green
Proposed Locations
Royal Belfast Hospital for Sick Children
Wellington Park Family Trauma Centre
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The benefits of which would include:
Creation of a single 0 -18 service
Improved access for children and families within local communities
Single Point of Access to Belfast CAMHS
Improved interface between the out-patient service and in- patient services
Harmonisation of referral pathway
Improve transition between the child and adolescent service
Shared learning and cross fertilisation in a single multidisciplinary team – wealth of experience
Ability to provide an outreach service into communities
Rationalisation of the administration structures to provide a more effective and efficient service.
In considering the proposed accommodation options it was acknowledged that the development of an outreach model for CAMHS across the city was an essential pre-requisite of any future service delivery model. Based on the availability of suitable outreach accommodation in the Belfast Trust‟s portfolio of Health and Wellbeing Centres and other CAMHS clinics, and other possible outreach venues for CAMHS, it is anticipated that the weekly provision of patient contacts on an outreach basis should be between 80 and 120. The remainder of patient contacts will be provided in the centralised accommodation option equivalent to approximately 200 patient contacts per week. It is envisaged that 8 – 10 small clinical teams comprising 2-3 staff members will provide the outreach service on a rolling basis. Each team would provide one day outreach per week which would equate to 8 – 10 days outreach service per week across the Belfast Trust. Each team should be multi-disciplinary, have access to a psychiatrist (at least on call) and will have appropriate administrative support.
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The proposed pattern of service provision across the city for the outreach model will include provision of services at:
Grove Health and Well-being Centre in North Belfast
Royal Belfast Hospital for Sick Children (temporarily whilst awaiting the commissioning of new Health and Well-being centres in Andersonstown and Shankill early in 2011) in the West of the City
Knockbreda and Holywood Arches Health and Well-being centres in the east and south east of the City
In addition to dedicated therapeutic space and purposely designed office space for CAMHS - available at Forster Green
Wellington Park, The Family Trauma Centre.
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SECTION 3
3 OPTION APPRAISAL 3.1 List of Options 3.2 Benefit Criteria 3.3 Option Benefit Scoring 3.4 Preferred Option
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3 Option Appraisal
This section sets out the list of options considered by the Trust to meet the needs of the service. The list of options was developed based on an analysis of the strategic context, vision and objectives for the service set out earlier in this report and on the options available to the Trust to meet these objectives. The Trust mindful of its Section 75 considerations identified and consulted on the need to complete a full Equality Impact assessment on the proposed outcome of the appraisal process.
3.1 List of Options
The list of options considered by the Trust is set out below.
Option 1 – do nothing This option (the “Do nothing” option) involves the continued provision of CAMHS Tier 3 Out-patient services for children at the Royal Belfast Hospital for Sick Children - Child and Family Unit, for adolescents at the Adolescent Teams based at 10 College Gardens and 88 Lisburn Rd. Although this option results in no change to the current service provision, it has been carried through for further analysis as a baseline for comparison purposes.
Option 2 – provide Tier 3 CAMH Services at Mc Kinney House on the Musgrave Park Hospital site in south Belfast. This option involves bringing together the teams based at the Royal Belfast Hospital for Sick Children, 10 College Gardens and 88 Lisburn Rd to 1 refurbished floor in Mc Kinney House. In addition this option provides for the delivery of community based out-patient treatment services in a range of heath and well-being centres and other Trust premises across the city. This option has been selected for further appraisal on the basis that it contributes to the Trust‟s vision and objectives for the service area.
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Option 3 - provide Tier 3 CAMH Services at refurbished premises on the Forster Green site in South Belfast This option involves bringing together the teams based at the Royal Belfast Hospital for Sick Children, 10 College Gardens and 88 Lisburn Rd to a refurbished free standing building on the Forster Green Hospital site in close proximity to the new Tier 4 In-patient Unit, to be known as Beechcroft. In addition this option provides for the delivery of community based out-patient treatment services in a range of heath and well-being centres and other Trust premises across the city. This option has been selected for further appraisal on the basis that it contributes to the Trust‟s vision and objectives for the service area.
3.2 Benefit Criteria
Each current location was considered in terms of its overall suitability. Various factors were considered and these included:
Quality of Accommodation This criterion assesses the environment in which staff are housed and (some) patients are treated. The Trust seeks to provide modern office facilities in a pleasant environment with adequate space and access to good quality facilities for one to one and family therapy provision.
Capacity of Accommodation to house combined team This criterion assesses the options to ensure staff in the combined Children‟s and Adolescent Teams can be comfortably housed together in single accommodation
Capacity of option to deliver required level of service This criterion assesses the ability of options to provide high quality care through both centre and community based provision of CAMHS Out-Patient services. This is estimated at current levels of activity to equate to 175 - 200 patient contacts per week. This criterion also considers how well the provision of additional services in close proximity to the inpatient units will to facilitate integration and increased interaction between complementary services in order to deliver a more seamless service to clients.
ICT Links Options will be assessed against the ability to provide excellent Information and Communication Technology to allow for the development of modern communications to free administrative staff from call handling and to maximise the use of combined databases for the management of activity information.
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Minimum initial disruption to service & staff This criterion relates to the requirement to minimise disruption in terms of continuity of service to users and minimal disruption in respect of staff redeployment.
Accessibility Ease and equity of access are key determinants in providing a service that must be accessible to all clients throughout the Trust. The location of the facilities is extremely important in terms of the service being easily accessible to service users both at the facilities outlined in each option, for example in respect of public transport and parking and at each outreach facility.
3.3 Option benefit scoring
The performance of each option against the benefit criteria has been scored using a scale of 0 to 10. In each case a score of 0 signifies that the option delivers no discernible benefit for that criterion and a score of 10 signifies that the option results in full realisation of the benefit criterion.
Table 2
Option Option 1 Existing
base
Option 2 Musgrave Park Site
Option 3 Forster
Green site Criteria
Quality of Accommodation
3 4 8
Capacity of Accommodation to house combined team
0 6 8
Capacity of option to deliver required level of service
6 5 8
ICT Links 5 7 7
Minimum initial disruption to service & staff
8 3 3
Accessibility 3 3 3
Total 25 25 37
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3.4 Preferred Option
Option 3 is the preferred option as it best meets the Trust‟s aim to improve and enhance social care services by providing them locally where possible‟ and accords with the recommendations of the Bamford report. CAMHS are required to bring together its two disparate Out-Patient Teams based at three sites as a single team at one base. Consideration was given to each of the factors outlined above, in the appraisal of available options. Weighing up the various factors contributing to the scoring, Option 3; the relocation of Belfast CAMHS Teams to a single site with outreach clinics, scored highest.
This preferred option is in keeping with the Trust‟s commitment to staff who will benefit from working together as a coherent CAMHS Out-Patient team with appropriate therapeutic space and is in close proximity to Beechcroft the newly built.CAMHS In-Patient Unit at Forster Green Hospital. This will allow for a significant synergy to develop between these two parts of the CAMH service and continue to build upon important links between the Tier 3 Out-Patient Service and Tier 4 teams especially the Crisis, Assessment and Intervention Team.
In addition, the Forster Green Site is adjacent to the Knockbreda Health and Well Being Centre which provides convenient services in:
Dentistry
Speech and Language
Podiatry
Physiotherapy
Citizens Advice
Social Work
Nursing.
Castlereagh Borough Council is located nearby as are the Jobs and Benefits Office, Forestside Shopping Centre, Hydebank Playing Fields, Belvoir Park and a number of schools and Churches
Option 3 is therefore the preferred option and it is proposed that subject to the outcome of consultation the Trust will implement this option as soon as possible.
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SECTION 4 4 CONSIDERATION OF AVAILABLE DATA AND RESEARCH 4.1 Strategic Data Sources 4.2 Local Data Sources 4.3 Children & Adolescent Mental Health Data 4.4 Population Profile – B.H.S.C.T. 4.5 Staff Profile - B.H.S.C.T.
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4 Consideration of available data and research
In keeping with the Equality Commission for Northern Ireland Guide to the Statutory Duties and EQIA Guidelines, quantitative and qualitative data has been drawn from a number of sources. The following data sources were used to inform this Equality Impact Assessment.
4.1 Strategic Data Sources
The strategic direction for the provision of health and social care is laid down in a number of key strategic documents notably:
Regional Strategy „A Healthier Future (2005–2025)‟
DHSSPS - Equality, Good Relations and Human Rights Strategy and Action Plan
DHSSPS Priorities for Action 2008-09
Investing for Health Strategy 2002
Bamford Review
SSI Child Protection Overview Report 2006
10-year Strategy for Children and Young Persons
Children‟s Matters Task Force – DHSSPS
Specific data collected by Information and Analysis Directorate in DHSSPS
2001 Census of Population (Northern Ireland)
QIN MAC Standards.
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4.2 Local Data Sources
This document is also shaped by a number of Trust documents as follows: -
“The Belfast Way”: A vision of excellence in Health and Social Care
“New Directions”: A conversation on the future delivery of Health and Social Care Services in Belfast.
The Belfast HSC Trust Delivery Plan
The Belfast HSC Trust Corporate Plan
The Belfast HSC Trust Health and Wellbeing Investment Plan (HWIP).
4.3 Children and Adolescent Mental Health Data
The Trust does not have recorded data for its CAMHS Out-Patient user under all of the nine categories. Information is detailed below on age, gender and the relevant general data. Based on activity information for 2006/07 and 2007/08 there has been a significant increase in referrals to the CAMHS service. It is therefore anticipated that total activity for the service should be able to provide for 14500 new and review appointments in the future.
Table 3
Male Referrals Female Referrals
58.5% 41.5%
0-4 5-10 11-15 16-18
43 206 398 203
0-4 5-10 11-15 16-18
31 146 282 144
Male Referrals
Female Referrals
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Table 4. The Mental Health of Children & Young People
Great Britain Percentages
boys girls
5-10 11-15 All 5-10 11-15 All
Emotional disorders
3.3 5.1 4.1 3.3 6.1 4.5
Conduct disorders 6.5 8.6 7.4 2.7 3.8 3.2
Hyperkinetic disorder
2.6 2.3 2.4 0.4 0.5 0.4
Less common disorders
0.8 0.5 0.7 0.2 0.7 0.4
Any disorder 10.4 12.8 11.4 5.9 9.6 7.6 Prevalence of psychiatric disorders by sex and age, 1999
Demographics and Epidemiology NI has a population of approximately 1.7 million cited in the Census 2001
of which:
451,514 are less than 18 years (27%); and
398,056 are less than 16 years (23%) (OFMDFM 2004).
Very little epidemiological study of child mental health problems has been carried out in Northern Ireland and the rates of many problems and disorders have to be extrapolated from British and international studies. The influential study of 10,000 children aged 5-15 published by the Office of National Statistics (ONS) was only carried out in England, Wales and Scotland and did not extend to NI.
In Great Britain (GB) it has been shown that 30 to 40% of young people may at some time experience a mental health „problem‟. Up to 20% (depending on environment and circumstances) will have a diagnosable mental health disorder.
The prevalence of CAMH problems and disorders is clearly linked to deprivation. Vulnerable children include those exposed to a wide range of problems including social and educational disadvantage. Looked After Children (LAC), abused children, asylum seekers, refugees and homeless children may be particularly vulnerable and in need of protection and intervention. In 1999, the rates of mental disorder in Great Britain varied by sex and age. Overall, boys were more likely to have a mental disorder than girls, and this was evident in both the 5 to 10 year age group (10 per cent of boys compared with six per cent of girls) and the 11 to 15 year age group
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(13 per cent of boys compared with 10 per cent of girls). More specifically, the prevalence of conduct and hyperkinetic disorders were greater among boys than girls.
The prevalence of emotional disorders – anxiety and depression was similar in boys and girls of school age. With the exception of hyperkinetic disorders, rates for the other main disorder categories increased from childhood to adolescence.
Research has shown that the population of Northern Ireland are at greater risk of mental health illness than those of England, Scotland and Wales; due to factors such as poverty and community conflict.
According to the Bamford Report mental health needs are 25% higher in Northern Ireland than in England, with more than 25% of young people estimated to suffer „significant mental health problems‟ by their 18th birthday.
According to the Investing for Health report (2003) between 10% and 20% of teenagers will suffer depression.
The Bamford Report concludes that out of 45,000 young people aged 5-15 will have a moderate to severe mental health illness and will require intervention from a specialist CAMH service in Northern Ireland (Health Promotion Agency 2006)
Suicide, although not classified as a mental disorder, has strong associations with mental health. Reporting to the UN Committee on the Rights of the Child all four UK Children‟s Commissioners identified mental ill health and higher rates of suicide and self harm among children and young people as key issues of concern
Many risk factors for youth crime are shared with risks for psychiatric disorders. Looked after children, young people who are homeless and young offenders are among the groups most at risk for Mental Ill Health.
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4.4 Population Profile - Belfast Health and Social Care Trust
Table 5: Belfast & Castlereagh Area Population by S. 75 Group
Section 75 Group Area Belfast Health and Social Care Trust Population - Approximately 340,000
Gender Male Female
47.4% 52.6%
Age * The Age profile for the service equates to 14% - 48,960
0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 and Over
11.8% 14.4% 15.9% 13.0% 14.0% 10.6% 8.9% 7.2% 4.3%
Religion Roman Catholic Protestant Other Religion No Religion or None Stated
37.4% 44.7% 0.6% 17.3%
Political Opinion (Based on council seats on Belfast City and Castlereagh Borough Councils)
DUP UUP Alliance SDLP Sinn Fein PUP Traditional Unionist Voice Independent
26 seats 12 seats 8 seats 10 seats 14 seats 2 seats 1 seat 1 seat
Marital Status (based on over 16s)
Single (never married) Married Re-married Separated Divorced Widowed
38.9% 39.5% 2.4% 5.1% 4.8% 9.2%
Dependent Status (based on households with children between 0 and 15 or a person between 16 and 18 in full-time education)
Dependent Children No Dependent Children
30.4% 69.6%
Disability (based on households with one or more person with a limiting long-term illness)
Disabled Not Disabled
43.6% 56.4%
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Section 75 Group Area Belfast Health and Social Care Trust Population
Ethnic Group White Irish Traveller Mixed Indian Pakistani Bangladeshi Other Asian Black Caribbean Black African Other Black Chinese Other Ethnic Group
98.63% 0.07% 0.26% 0.15% 0.06% 0.02% 0.03% 0.02% 0.06% 0.03% 0.51% 0.16%
Sexual Orientation Research indicates that 10% of a population is LGB. (Source: Rainbow Project July 2008)
**The Age section is particularly relevant to the CAMHS service. Source: Northern Ireland Census 2001 Key statistics The Trust recognises that the Census figures do not provide a truely accurate and up-to-date reflection of the Northern Ireland population, given that it is was conducted in 2001. There have been significant demographic changes since then and the Trust does not rely solely on these census figures but rather looks to complement the statistics with other relevant quantitative and qualitative information sources. NB: This list is not definitive and illustrates some examples of information sources.
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Ethnicity
Ethnicity of patients is not routinely gathered, but using requests for Northern Ireland Health and Social Services Interpreting Services gives an indication of the language needs of foreign nationals and ethnic minorities. The statistics represent the hospital site as a whole and in the case of Knockbracken the South and East Belfast area.
Belfast HSC Trust Languages Top Ten 1 July - 31 December 2009
Polish 1589 Chinese - Mandarin 1260 Chinese - Cantonese 787 Lithuanian 258 Slovak 256 Arabic 234 Chinese - Hakka 218 Romanian 137 Portuguese 120 Russian 107
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4.5 Staff Profile
Belfast Health and Social Care Trust: Staff profile A key objective of the Trust‟s Employment Equality and Diversity Plan is to further develop and expand its current monitoring arrangements. Following regional discussion with Trust Equality Managers, the Equality Commission for NI and Trade Union Side, a revised monitoring form has been developed to capture information relating to all nine equality categories. The Trust is currently resurveying its existing workforce and is also using this form for all new job applicants, thus enhancing and updating its database. However the information detailed below is based on the current monitoring information held by the Belfast Health and Social Care Trust, as the survey is ongoing and the database is in the process of being updated. The Trust‟s Human Resources Management System lists a total of 29 people, employed in the service under review based at three locations - 10 College Gardens, 88 Lisburn Road and Royal Belfast Hospital for Sick Children. This represents a Whole Time Equivalent of 25.53 posts. Due to the low number of staff involved they cannot be identified by location in accordance with Fair Employment Monitoring Guidelines. The staff include administrative, nursing, medical, psychologists and social work staff. The profile of staff for the service is compared below with the profile of all Trust staff to identify any potential adverse impacts on particular groups. As there are only 29 staff involved each member of staff equates to a high percentage of the total.
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Table 6: Belfast Health and Social Care Trust: Staff profile by Section 75 Group (Jan 2010 figures)
Category Grouping Family Childcare Staff
Belfast Trust
Gender Male 24% 21%
Female 76% 79%
Age
16-24 0% 7%
25-34 7% 26%
35-44 31% 28%
45-54 45% 27%
55-64 17% 11%
65+ 0% 1%
Religion
Protestant 34% 45%
Roman Catholic 48% 48%
Unknown/Other 18% 7%
Marital status
Married 69% 55%
Single 28% 39%
Other 3% 6%
Disability
Disabled 7% 2%
Not disabled 59% 60%
Unknown 34% 38%
Ethnic origin
White 72% 72%
Other 4% 4%
Unknown 24% 24%
Gender There is a higher proportion of female than male staff working within Family and Childcare 76% Female to 24% male. This is reflective of the Trust as a whole, (79% Female and 21% Male)
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Figure 1: Staff by gender
Age Figure 2 shows staff by age band. In Family and Childcare 38% of staff are under 45 and 62% over 45. Opposed of the Trust as a whole with 61% of staff are under 45 and 39% 45 and over.
Figure 2: Staff by age band
Religion Figure 3 shows the community background of staff. Overall, there are 34% Protestants, 48% Roman Catholics and 18% Other or Unknown. In the Trust as a whole 45% of staff are Protestant 48% Roman Catholic, and 7% Other or Unknown.
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Figure 3: Staff by community background
Marital/Civil Partnership Status Figure 4 shows the marital status of staff. Overall in family and Childcare, 69% are Married, 28% Single and 3% Other or Unknown. This marital status profile is higher than that of the Trust, where 55% of staff are recorded as married, 39% as single and 6% other or unknown.
Figure 4: Staff by marital status
Disability 7% of staff have stated that they have a disability compared to the Trust figure of 2%.
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Ethnic Origin Within Family and Childcare Ethnic origin is not recorded for 24% of staff 72% are White and 4% Other Races. In the Trust as a whole 72% stated that they were White, 4% Other Races and 24% provided no information.
Figure 5: Staff by Ethnic Origin
Political Opinion The Trust is currently collecting details of the political opinion of its staff. Sexual Orientation The Trust is currently collecting information on the sexual orientation of its staff. It is considered reasonable to assume that up to 10% of the population is lesbian, gay, bisexual or transgender. Dependent Status The Trust is currently collecting details of staff members‟ dependents.
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SECTION 5
5 ASSESSMENT OF IMPACT 5.1 Assessment of impact on Section 75 Groups – Patients & Clients 5.2 Assessment of impact on Section 75 Groups - Staff
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5 Assessment of impact 5.1 Assessment of impact on Section 75 Groups - Patients & Clients
Gender
The proportion of males and females using the Trust‟s Tier 3 CAMHS is approximately equal to that in the baseline population. The proposed reconfiguration of services would continue to provide Tier 3 CAMHS. The proposal seeks to enhance the care of children and young people, their families and carers by the development of a single team of dedicated CAMHS professionals based at a central site and delivering care at Health and Wellbeing Centres and other CAMHS clinics across the City. The change in service model will create a single 0 - 18 service and improve access to service users in their own communities. Part of this change will be the development of a single point of access to CAMHS Tier 3 in Belfast by harmonising the existing referral pathways.
Age The majority of patients attending the service are aged between 6 -18. The Trust does not anticipate any adverse impact as the existing service, and that which is proposed, will be the same except that the patients will be served by one integrated team, within an outreach model of care.
Religion The Trust do not currently collect information on the religion of service users. As outreach services will be provided locally - the Trust does not anticipate any adverse impact on service users. Political Opinion The Trust does not currently collect information on patient‟s political opinion. However, the Trust does not anticipate any adverse impact on service users as a result of this proposal.
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Marital status People using CAMHS services are more likely to be single. The Trust considers that the reconfiguration of CAMHS will not impact adversely on marital status.
Dependent Status Any adverse impact of change on people with dependents is likely to be on carers in terms of relocation of the proximity to their work, home and service location
Disability A provision of CAMHS from one site with outreach across the City will mean that some of the population may not have to travel as far to access services. Those who require access to services at Forster Green site with a reduced mobility may encounter difficulties with access to the building via stairs. These users can be accommodated at Knockbreda Health and Wellbeing Centre, which is fully accessible and in close proximity.
Ethnicity The Trust is aware of the low uptake of CAMHS services by ethnic minorities. The current monitoring system used in mental health services were inherited from three different legacy Trusts; therefore there is disparity in information collected and major gaps in terms of ethnicity. The Belfast Trust will work to streamline monitoring systems across all sites. Sexual Orientation While the Trust does not gather information on the sexual orientation of its users, population trends of 10% are assumed for gay, lesbian and bisexual community (Source: Rainbow Project)
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5.2 Assessment of impact on Section 75 Groups – Staff
Gender The workforce on all three locations is predominately female (76%). This is reflective of the Trust workforce as a whole, where the female to male ratio is 79%: 21%. The proportion of women in all sites is similar. Age In the Trust as a whole 61% of staff are under 45 and 39% are 45 and over. In the locations under review 38% are under 45 and 62% are 45 and over. The age profile of staff means that any staffing reorganisations will have more of an impact on older staff from the three locations Religion The staff profile for the Trust is 45% Protestant, 48% Roman Catholic, and 7% Other/Not Known. Overall within the three locations there are 34% Protestants, 48% Roman Catholics and 18% Other or Unknown. Marital/Civil Partnership Status In the Trust 55% of staff are married 39% Single and 6% Other or Unknown. In the locations under review 69% are married, 28% are Single 4% are classed as Other. Disability The proportion of staff in the Trust stating that they have a disability is 2%. In the locations under review there are 7% of staff stating they have a disability. There is therefore potential for impact on people with disabilities.
Ethnic Origin
In the Trust 72% staff stated that they were White, 4% Other Races and 24% have not provided information on their Ethnic Origin This is reflective in the locations under review as 72% are White, 4% Other, 24% Unknown.
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Political Opinion As stated previously the Trust is currently collecting information on the political opinion of its staff. Sexual Orientation As stated previously the Trust is currently collecting information on the sexual orientation of its staff. Dependent Status As stated previously the Trust is currently collecting information on the caring responsibilities of staff. Statistics provided by Carers Northern Ireland show that 17.6% of adults in Northern Ireland reported some caring responsibilities and that 62% of carers are female and 38% male. Any relocation for female staff is more likely to impact on their caring responsibilities, particularly in respect of the proximity of their work base to their home. Travel to Work The Table below is based on the Postcodes of the staff based at each location. Table 7: Postcodes of Staff
HOME LOCATION FAMILY CHILDCARE STAFF
NORTH BELFAST 3%
SOUTH BELFAST 14%
EAST BELFAST 14%
WEST BELFAST 14%
LISBURN 14%
DUNMURRAY 17%
NORTH DOWN 4%
CO DOWN 10%
CO ANTRIM 7%
OTHER 3%
TOTAL 100%
The majority of staff live in the Greater Belfast area (76%) though the remaining staff (24%) travel from outside Belfast.
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SECTION 6
6 CONSIDERATION OF MEASURES TO MITIGATE ADVERSE IMPACTS 6.1 Mitigating Measures for Patients and Clients 6.2 Mitigation Measures for Staff
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6 Consideration of Measures to Mitigate Adverse Impacts
6.1 Mitigating measures for patients and clients
Gender
The proportion of males and females using the Trust‟s CAMHS is approximately equal to that in the baseline population the Trust does not anticipate any adverse impact in terms of gender on service users. The Trust will continue to monitor uptake of the services post-configuration.
Age
The age of patients using the service are between 0 -18. The proposed changes will not have an adverse impact on the age of the users.
Religion
The Trust does not currently collect data on the religious profile CAMHS users. However as CAMHS outreach services are to be provided at local Health and Wellbeing Centres and other CAMHS clinics, the Trust does not anticipate any adverse impact in terms of access to Users religious observance.
Political Opinion
There has been no differential impact identified that would adversely impact on those with different political opinions. Marital Status
A differential percentage has been identified, as people using CAMHS services are more likely to be single. The Trust considers that the reconfiguration of CAMHS will not impact adversely on marital status. Dependent Status
As the nature of any impact on carers will vary depending on the person being cared for, CAMHS will provide mitigation based on individual need. In addition to this the Trust will engage with carers‟ representatives during the consultation process to access their perception of any differential impact.
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Disability
Given the relative proximity of the Knockbreda Health and Wellbeing Centre to Forster Green the proposal should not have a major impact on those with physical disability. The Trust will nevertheless engage with relevant advocacy groups, umbrella organisations and other interested parties as part of its public consultation.
Ethnicity
In order to mitigate the potential impact on access to CAMHS, the Trust will work with ethnic minority groups to increase awareness of CAMHS, with a view to increasing uptake of services among the ethnic minority population. Externally the Social Services, Family, Childcare, Mental health and Learning Disability Service will continue to work with community groups and representatives and also to conduct more outreach initiatives to ensure that more individuals from ethnic minorities avail of these services. CAMHS Services will also work in partnership with the Health and Social Inequalities Team, Community Development and Health Improvement internally; to look at ways of overcoming any barriers to accessing mental health services.
Sexual Orientation
In order to explore the impact of the proposed changes on this section of the population, the Trust will engage with gay, lesbian and bisexual advocacy groups as part of its public consultation.
Multiple Identity
The Trust recognises that people - service users or staff - do not neatly fit into one Section 75 category and that pure statistical information does not capture these multi-faceted complexities. The Belfast Trust will not rely solely on quantitative data but rather engage on a one-to-one basis with the service user, carer and family and patient advocate, ensuring that they receive a sensitive and responsive service.
The Social Services, Family, Childcare, Mental Health and Learning Disability Service within the Belfast HSC Trust are committed to monitoring service uptake, service user satisfaction surveys, staff satisfaction surveys, (supervision and regular review meetings for staff), CAMHS users needs will be provided on a person-centred, person-led basis and tailored according to the individual's needs.
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6.2 Mitigation measures for Staff
The proposed reorganisation will impact on those staff currently working in 10 College Gardens, 88 Lisburn Road and the Royal Belfast Hospital for Sick Children. The post code information shows that the majority of staff already travel to work from across all areas of Belfast.
The Trust is committed to improving the productivity and utilisation of all its staff over the next number of years. In so doing, this reorganisation process will be characterised by openness, transparency, involvement, recognition and engagement with our staff and Trade Union Side colleagues. The Trust will comply with all relevant employment and equal opportunities legislation when implementing any proposed changes. The Trust has developed a Good Practice Guide on Consultation and Communication in relation to its Strategic Reform and Modernisation Programme. This Guidance sets out the consultation and communication framework, the essentials of public consultation by the Trust and details the staff and equality considerations to be undertaken by Managers. The general guiding principles which will be applied are:
Staff will be kept fully informed and will be supported during this process
The principles of fairness, dignity and equity of treatment will be applied in the management of people undergoing these changes.
It should be noted that at the time of issuing this consultation document the Trust is in the process of developing and agreeing a Framework on the Management of Staff affected by Organisational Change with its Trade Union representatives. This framework will be supplemented with a number of agreed detailed protocols relating to issues such as arrangements for vacancy control, redeployment, relocation, pay protection, retraining, redundancy, etc.
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The main impacts anticipated for staff in this reorganisation is:
Relocation
New ways of working/retraining and/or re-skilling.
Relocation The proposed re-organisation will require staff to move from their current work location to Forster Green Hospital Site. The proposed reorganisation of the service will impact on those staff currently based at College Gardens, Lisburn Road and the Royal Belfast Hospital for Sick Children, as staff will be expected to move from one site to another if they want to remain within their chosen specialism. The Post code analysis shows that staff are already travelling from across Belfast and beyond. The Trust‟s agreed guidance with Trade Union Side on the protocol/process of staff movement within the Belfast Trust will be applied. The Protocol on Staff Movement within the Belfast Trust has been developed in consultation between Management and Staff representatives to ensure the smooth and effective transfer of staff with respect to change in workforce location. It takes account of the statutory obligations, including those arising out of Section 75 of the Northern Ireland Act, Equality Laws and their specific significances in relation to employment and location issues. The protocol has been developed in recognition of the fact that location of work is of major importance to staff, and to provide assurance, guidance and a process incorporating best practice, and the provision for regional agreements on excess mileage and the application of the Trust‟s flexible working arrangements. A redeployment protocol is currently being developed as part of the organisational management framework. New ways of working/retraining and/or re-skilling The Trust will give consideration to the provision for different work patterns and/or arrangements to facilitate employees‟ personal circumstances whenever possible, whilst ensuring efficient and effective service delivery. This will be facilitated through the Trust‟s range of work/life balance policies and flexible working arrangements developed in partnership with Trade Union Side.
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Staff Support The Trust will put in place a range of support mechanisms for individual staff as appropriate:
Staff support
Retraining/re-skilling for new roles if appropriate
Advice and guidance on Human Resource policies and procedures. Partnerships
The Trust in partnership with Trade Union Side will consider how it will minimise any adverse impact on the workforce resulting from the proposed changes. Change and the management of change will be taken forward through partnership approaches and consultation and negotiation with Trade Unions. The measures outlined above are intended to mitigate any significant adverse impact on staff.
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SECTION 7
7 FORMAL CONSULTATION, PUBLICATION AND MONITORING 7.1 Formal Consultation 7.2 Publication 7.3 Decision of the Public Authority 7.4 Monitoring
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7 Formal Consultation, Publication and Monitoring
The public consultation on the Relocation of the Child and Adolescent Mental Health Out-Patients Service proposal to relocate Children and Adolescent Mental Health Out-Patient Services from the Family & Child Clinic at The Royal Belfast Hospital for Sick Children, and the Adolescent Team based at the Young People‟s Centre in 10 College Gardens and 88 Lisburn Road to Forster Green Hospital site and with outreach provision at Health & Wellbeing Centres across Belfast - opens on Tuesday 9TH March, 2010 and will close on Tuesday 4th May 2010. Any group or individual wishing to participate is invited to obtain a copy of the consultation document from the Trust website, http://www.belfasttrust.hscni.net Responses to this EQIA can be made using the questionnaire to be found at the end of this document. Before you submit your response, please read Appendix 4 regarding the Freedom of Information Act 2000 and the confidentiality of responses to public consultation exercises. In the interests of accessibility this document can be made available in a range of alternative formats. For further information please contact:
Orla Barron Health & Social Inequalities 1st Floor Graham House Knockbracken Healthcare Park Saintfield Road Belfast BT8 8BH Tel 028 9096 0069 E-mail: [email protected]
7.1 Formal Consultation
The Trust wishes to consult as widely as possible on the findings included in this equality impact assessment. With this in mind the Trust proposes to take the following actions:-
An advertisement inviting the public to comment on this matter will be placed in the main newspapers in Northern Ireland, in accordance with normal practice
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A letter will be issued to relevant Consultees listed in the Trust‟s Equality Scheme
A copy of this report will be posted on the website
Individual consultation meetings will be arranged with representatives of particular interest groups if requested
Face to Face meetings with be arranged with relevant stakeholders and representative groups
The report will be made available, on request, in alternative formats including Braille, disk and audio-cassette and in minority languages for those who are not fluent in English.
The closing date for responses is Tuesday 4th May 2010.
7.2 Publication
The outcomes of this EQIA will be posted on the Trust‟s website and/or made available on request. The Trust will issue the outcome of this EQIA to those who have submitted to its consultation on this issue.
7.3 Decision of the Public Authority
The Trust will take into account the consultation carried out in relation to this EQIA before a final decision is made.
7.4 Monitoring
In keeping with the Equality Commission‟s guidelines governing EQIA the Trust will put in place a monitoring strategy to monitor the impact of the reconfiguration of CAMHS on the relevant groups and sub-groups within the equality categories. The Trust will publish the results of this monitoring and include same in its annual progress report to the Equality Commission for Northern Ireland.
If the monitoring and analysis of results over a three year period show that the impact of the change results in greater adverse impact than predicted, or if opportunities arise which would allow for greater equality of opportunity to be promoted, the Trust will ensure that measures are taken to achieve better outcomes for the relevant equality groups.
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APPENDIX 1
GLOSSARY OF ABBREVIATIONS
BHSCT Belfast Health and Social Care Trust CAMHS Children and Adolescents Mental Health Service CSR Comprehensive Spending Review DBS Developing Better Services DHSSPS Department of Health Social Services & Public Safety ECNI Equality Commission for Northern Ireland EQIA Equality Impact Assessment HPSS Health and Personal Social Services HSC Health and Social Care M.O.R.E. Maximising outcomes resources and efficiency NISRA Northern Ireland Statistics and Research Agency PFI Private Finance Initiative PFG Programme for Government PSA Public Service Agreement Public Services Commission RBHSC Royal Belfast Hospital for Sick Children RPA Review of Public Administration
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APPENDIX 2
Proposal to Co-locate Children and Adolescents Mental Health Out-Patient Services for Belfast at
refurbished accommodation at Forster Green and to develop an outreach service within local communities
Section 75 and Schedule 9 The Northern Ireland Act 1998
CONSULTATION QUESTIONNAIRE
The aim of this consultation is to obtain views from stakeholders in Northern Ireland and the Trust would be most grateful if you would respond by completing this questionnaire. Please answer each question by writing (preferably typed) your comments in the space provided. The closing date for this consultation Tuesday 4th May, 2010 and we need to receive your completed questionnaire on or before that date. You can respond to the consultation document by e-mail, letter or fax as follows:
Mrs Orla Barron, Acting Health & Social Inequalities Manager, Health & Social Inequalities, 1st Floor,
Graham House, Knockbracken Healthcare Park, Saintfield Road, Belfast, BT8 8BH
Tel: 028 90960069 Fax: 028 90566701 Textphone: 028 90902863
E-mail: [email protected]
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Before you submit your response, please read Appendix A at the end of this questionnaire regarding the Freedom of Information Act 2000 and the confidentiality of responses to public consultation exercises. So that we can acknowledge receipt of your comments please fill in your name and address or that of your organisation if relevant. You may withhold this information if you wish but we will not then be able to acknowledge receipt of your comments.
Name:
Position:
Organisation:
Address:
I am responding: as an individual on behalf on an organisation (please tick)
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Can you identify any additional relevant evidence or information which the Trust should have considered in assessing the equality impacts of these proposals.
Can you identify any other potential adverse impacts with supporting evidence which might occur as a result of these proposals being implemented.
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Can you suggest any other mitigating measures to eliminate or minimise any potential adverse impact on the staff concerned?
The Trust is seeking your views on the human rights implications of the proposals and any issues you think relevant.
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General comments
THANK YOU FOR YOUR INPUT TO THIS CONSULTATION EXERCISE.
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APPENDIX 3
Freedom of Information Act (2000) – Confidentiality of
Consultations
The Belfast Trust will publish an anonymised summary of responses following completion of the consultation process; however your response, and all other responses to the consultation, may be disclosed on request. We can only refuse to disclose information in limited circumstances. Before you submit your response, please read the paragraphs below on the confidentiality of consultations and they will give you guidance on the legal position about any information given by you in response to this consultation.
The Freedom of Information Act gives the public a general right of access to any information held by a public authority, namely, Belfast Trust in this case. This right of access to information includes information provided in response to a consultation. We cannot automatically consider information supplied to us in response to a consultation as information that can be withheld from disclosure. However, we do have the responsibility to decide whether any information provided by you in response to this consultation, including information about your identity, should be made public or withheld.
Any information provided by you in response to this consultation is, if requested, likely to be released. Only in limited circumstances would information of this type be withheld.
