Patient Services Equality Monitoring Report

1.0 Accessible Information Standard (AIS)

The Trust continues to make reasonable adjustments for communication needs in response to individual requests for example provision of face to face/telephone interpreting service including British Sign Language (BSL), lip speaker, deafblind communicator, written translation of patient information in various languages including Braille and easy read leaflets.

The Trust has already made changes to its website which is now fully accessible through the ability to increase font size, change screen colours and the ability to use text-to-speech software. Additional work is being investigated to produce patient information leaflets online in a similar format.

The Trust is in the process of implementing a new Patient Administration System (PAS), across Good Hope Hospital, Heartlands Hospital, Solihull Hospital and Birmingham Chest Clinic. This is already in place at Queen Elizabeth Hospital Birmingham (QEHB). A common PAS used throughout the Trust will support the improvement of patient care by driving accurate and timely patient data through reducing errors and enabling best practice. The Accessible Information Standard (SCCI1605) will be used as a driver to implement equality monitoring throughout the Trust. We will be able to record all protected characteristics of all patients and service users.

The Trust has set up a 'care of people with learning disability' working group, one of the key priority identified by the group is to look at ways of implementing the learning disability improvement and the AIS. It is recognised that the Trust must have mechanisms to identify and flag patients with learning disabilities, autism or both from the point of admission through to discharge; and where appropriate, share this information as people move through departments and between services.

After the successful completion of the 'communication box' pilot at Good Hope, Heartlands and Solihull hospitals to support patients who have a communication need, funding has been identified to launch communication boxes at HGS to compliment what is already in place on every ward and department at QEHB.

In addition:

• Deaf/blind information has been allocated to many of the communication boxes at QEHB with more still to be distributed to the wards
• Hearing aid (pink boxes) are available for patients to ensure their hearing aids are kept safe and secure whilst they are not being worn
• See Me Care bundle for hearing and vision loss has been rolled out

Accessible Information Standard modules continue at QEHB. Total: 817 staff completed module one (information) and 778 staff completed module two (towards excellence). It is envisaged that this training will be launched at HGS sites.

1.1 Learning disabilities

Training continues at QEHB (Emergency department and various programmes such as NADP and advanced enhanced care).

Following on from the learning disability quality check in ED which took place in November 2017, an always event was held in January 2019 which was attended by senior sister from ED and named nurse for learning disabilities. The always event framework has created guidelines and a toolkit for implementing always events across the NHS and there are now 106 sites committed to the programme. Always events are those aspects of patient experience that are important to everyone and we must aim to perform them consistently for all of our patients.

Next steps for us the Trust are to see where we are going to start and what our project will be. The project may be something that patients/families/carers have identified that worked well and we need to ensure that happens for all patients and embed it into the organisation.

New proforma sheet for reviewing patients with learning disabilities to ensure the following are captured:

• Capacity assessments completed and documented
• Health Facilitation team involvement
• DOL’S insitu
• IMCA involvement
• Communication needs assessed and met

The Trust is looking at the learning from deaths of people with a learning disability (LeDeR) programme to improve the flagging/data collection for learning disabilities to expand the protected characteristics data collection

2.0 Engagement activity

2.1 Engagement

The Trust continues to work collaboratively with staff, stakeholders and the wider health economy. We have become active partners of the Local Health Economy group, working in collaboration to share equality data and promote and challenge inequalities.

Membership includes:

• West Midlands NHS Regional Equalities Network
• NHS Acute Liaison Learning Disabilities Network
• Birmingham & Black Country Chaplaincy Collaborative
• Pan Birmingham Faith Advocacy Group
• Stonewall Workplace Equality Index
• Birmingham LGBT Centre

During 2018/2019 the Trust undertook and participated in a series of internal and external engagement events. The internal events included:

• Monthly meetings of the Patient Experience Group
• Monthly meetings of the care of people with learning disability
• Bimonthly meetings of patient carer community councils
• Bimonthly meetings of the LGBT staff network
• Bimonthly meetings of the BAME staff network
• Bimonthly meetings of the Young Person’s Group for staff
• Bimonthly meetings of the staff Carers Group
• Bimonthly meetings of the staff Women’s Group
• Bimonthly meetings of the Mental Health and Wellbeing Group for staff
• Bimonthly meetings of the Pan Birmingham Faith Advocacy Group
• Trans awareness training
• Sexual orientation awareness training
• LGBTQ Conference
• Carer Conference
• Black History Month panel discussion event
• Eid celebration lunch

2.2 New staff networks

The Trust has launched four new staff networks:

• Carers
• Women’s
• Young Person’s
• Mental Health and Wellbeing

These networks were launched in March 2019 and the meetings are open to all staff to attend.

2.3 Mental Health and Wellbeing Network

The network provides a safe, welcoming and confidential space for staff who have lived experience of mental and emotional health conditions, or who are supporting others with poor mental health, or who want to learn how to promote mental wellbeing in themselves and others.

One in four people will experience a mental health issue each year, and one in seven experience mental health problems in the workplace. A mental illness is a condition that affects a person's thinking, feeling or mood.

The network will raise awareness and improve understanding (and dispel misunderstanding) around mental health conditions, and will ensure that the Trust is doing all that it can to support our staff and patients. It will offer a collective voice to promote mental wellbeing at work, helping to combat stigma and encouraging staff to feel more able to be open about mental health problems and to seek help earlier

2.4 Women and Allies Network

The Women’s Staff Network offers a safe and confidential forum for advice and support as well as an opportunity to share knowledge and experiences. It is open to female staff, anyone identifying as female and their allies.

The network will draw on the views and experiences of women to affect policy and procedures and to work in partnership with the Trust on agendas such as; the gender pay gap, #metoo and gender representation to positively impact matters concerning women.

2.5 Young Person’s and Allies Network

This network supports and motivates young staff members aged between 16 – 25 and their allies working within the Trust. It is a forum where issues facing our younger members of staff can be raised and discuss and to raise awareness of any barriers which young people may face.

The network will be used to draw on the views and experiences of young people, to affect relevant policy and procedures and be the voice of young people with the Trust.

2.6 External events

The external events includ:

• NHS Regional Equalities Network meetings
• NHS Equality and Diversity Council listening events
• Stonewall workplace equality index seminar
• WRES seminar
• Celebrating equality and diversity/human rights event hosted by Coventry and Warwickshire NHS Partnership Trust
• EDS2 refresh workshop provided by the NHS Equality and Diversity Council
• Trans Day of Remembrance provided by the Birmingham LGBT Centre

2.7 Patient Experience Group

The Trust Executive Chief Nurse has established an operational Patient Experience Group (PEG) and the first meeting was held in January 2019.

The purpose of the PEG is to provide an objective review of the Trust’s patient experience, to monitor the feedback received from patients via trends, themes and quantitative data and determine the strategies and measures required to improve or maintain consistently high patient experience across all sites.

The group membership includes Trust staff and vice chairs of the PCCCs, Young Persons’ Council and Faith Advocacy Group. The meetings are held monthly.

2.8 Healthwatch Project

Healthwatch Birmingham undertook a Birmingham-wide investigation around NHS hospitals waiting rooms and waiting times in A&E and outpatients areas (e.g. clinics running behind, people not being able to get a seat and standing for hours, with no access to food and drink).

The Trust Patient Experience team facilitated Healthwatch Birmingham to visit Outpatients and the Emergency Department at Good Hope, Heartlands, Queen Elizabeth and Solihull Hospitals, (one day each site) in December 2018 to talk to patients, families, carers who were attending appointments/services in these areas. The visits formed part of a city wide investigation with an overarching report plus individual site feedback.

2.9 Transgender Awareness Week

The Trust supported Transgender Awareness Week in November 2018 to help raise the visibility of transgender and gender non-conforming people, and address the issues the community faces through the Trust staff network groups. Also, on staff notice emails and In the Loop bulletin, useful resources were shared to help better understand gender issues to educate and advance advocacy around the issues of prejudice, discrimination, and violence that transgender people face. Social media like Twitter and Facebook were also used to show their support and made their pledges and shared with staff.

2.10 Breaking through despite the odds

The Trust Black Asian and Minority Ethnic (BAME) Staff Network hosted 'breaking through despite the odds', a talk with Professor Dame Elizabeth Anionwu. Elizabeth Anionwu is an inspirational speaker who has turned shame and prejudice into strength and service.

2.11 International Women’s Day - Leadership

To mark International Women’s Day in March 2019 an inspirational leadership lecture was delivered by guest speaker Francesca Martinez titled ‘finding your voice’, drawing on her own experience as a disabled woman, and leader, offering an insight into her own journey whilst encouraging leaders and women at University Hospitals Birmingham NHS Foundation Trust (UHB) to find their voices – and make it heard. The event was opened by Trust Chief Nurse, Lisa Stalley-Green, Lisa spoke about her own experiences as a leader in the NHS and why empowering women at UHB is vital.

2.12 LGBT conference

The Trust celebrated LGBT History Month on 25 February 2019 with a conference. It was held in partnership with the University of Birmingham and was well attended by Trust and University staff and as well as many external partners from neighbouring Trusts and private sector organisations.

The two keynote speakers, Chris Ives (Management Consultancy Partner) and Rikki Arundel (Motivational Speaker and Gender Coach) who by bravely sharing their personal stories gave the attendees an insight into their lived experiences. Chris spoke of the need for healthcare professionals to create an environment where LGBT+ patients feel safe and able to speak openly and without judgement. Rikki spoke about the difference between sex and gender and how gender identity and gender expression must be acknowledged and understood by healthcare professionals if we are to better support and care for patients who identify as trans.

The keynote speakers were joined by a panel of experts including Tara Stone (Stonewall), Matt Morgan (UHB), Davina Thomas (UHB), Khakan Qureshi (Finding a Voice), Dr Kate Nambiar (Brighton and Sussex Medical School) and Chloe Edwards (University of Birmingham) for a lively and informative panel discussion.

A number of important topics were debated including the need for visible signs of LGBT inclusion through the Trust and University in order to create a culture of acceptance. These can include rainbow lanyards, rainbow badges and pledges on the wall for all to see in patient and staff areas. Khakan spoke about LGBT and faith and the need for more BAME LGBT+ staff from across both organisations to feel safe and supported in the workplace if they are be their true selves. Chloe Edwards, a medical student at the University of Birmingham, spoke of the need for medical students to familiarise themselves with the unique needs of LGBT+ patients in order to address the health inequalities experienced by LGBT+ people.

The Trust has made significant progress with LGBT+ inclusion and have recently been ranked amongst Stonewall’s top 100 inclusive employers. However there is still more work to be done.

2.13 International Day of People with Disability

To mark the International Day of Persons with a Disability on 3December 2018, the Trust promoted the rights and wellbeing of people with disabilities in all spheres of society and development and supported the theme for this year to empower individuals with disabilities and ensuring inclusiveness and equality. Inspiring stories of UHB staff with a disability and how they have felt empowered to achieve success were shared on the intranet.

2.14 Support for younger patients

UHB in partnership with the Birmingham Liver Transition team launched a new group called Birmingham Liver Youth Support (BLYS) for 16 – 25 years old on 11 March 2019 at QEHB.

The group will provide a great opportunity for young people who have had or will have a liver transplant to ask informal questions, socialise with young people of their own age, who know exactly what they are going through and talk about their shared experiences.

2.15 Making Birmingham a great place to grow old in

The Trust is involved in an exciting Birmingham-wide project to improve care for older adults.

The early intervention work stream is part of the Birmingham Older People’s Programme, which reports into both the STP and the Birmingham Health and Wellbeing Board.

The work stream involves Birmingham City Council and NHS organisations who care for the city’s older people with the aim of improving their experience after a trigger (e.g. an illness or injury). This workstream will focus on the health and social care support offered to older people to help them make a quick recovery and return, or stay, at home where possible. Here at UHB, the OPAL service at QEHB, the QEHB Discharge Hub and the Norman Power Centre will be involved in testing new ways of working.

There are two other work streams in the Birmingham Older People’s Programme which are looking at Prevention and Ongoing Personalised Support.

2.16 Carers service

As part of the newly launched carers service, there are now two carer coordinators across all four UHB hospital sites. Their role focuses on ensuring carers receive all the support they need while in hospital.

An unpaid carer is someone who, due to illness, disability, or a mental health problem, is caring for someone that cannot cope without their support. They often find themselves having increased contact with hospital staff, when for example, the person they are caring for moves between health and social care services. Planned or unplanned hospital admissions may also mean someone becomes a carer for the first time, often in very difficult or distressing circumstances.

Our staff will want to make sure carers are offered the support they need and feel they are recognised as partners in care and their expertise to help deliver the best care to our patients is valued.

The care coordinators undertake the wards to meet staff to promote and support staff to access the carers service.

2.17 UHB rated 'good' by CQC inspectors

UHB has been rated 'good' overall by the Care Quality Commission – with an 'outstanding' rating for the 'well led' aspect of the inspection. The inspectors also gave a rating of 'good' for whether the Trust services are responsive, effective, caring and safe.

They found that there were consistently high levels of constructive engagement with staff and people who used our services, including all equality groups. The inspectors found the Trust engaged and involved patients to shape services and culture; safe innovation was celebrated, and there was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care.

3.0 Interpreting and translation service provision

The Trust continues to provide a full range of interpreting service prevision to meet the needs of non-English speaking patients or those who have a sensory impairment such as hearing. It is comprised of an in-house interpreting service and Word360 face to face, telephone interpreting and translation services, this service is used both in and out of hours for planned and short notice interventions. The interpreting service is well publicised and is easily accessible to patients and Trust staff when required.

The Trust Interpreting and Translation Service procedure was developed and implemented in June 2017, This procedure replaces the previous Interpreting and translation services operational policy. The procedure was well publicised within the Trust and is available for staff on Trust intranet.

The Trust inhouse interpreting service flyers are also circulated to all patient care areas and departments. In addition patient hospital appointment letters also have the Trust interpreting service contact details for patients to book in advance an interpreter for language and choice of interpreter gender they may require for their appointment.

The use of the interpreting service is monitored on an ongoing basis. Any significant increase in demand which will have an impact on service provision is reported to the relevant Trust committee with a view to identifying resources to meet the new demand.

The use of top ten languages for face to face and telephone interpreting across all UHB sites. Good Hope Hospital, Heartlands Hospital, Queen Elizabeth Hospital Birmingham, Solihull Hospital, Birmingham Chest Clinic and Community services reflect the local demographics, which has become increasingly diverse and requires a wide range of languages support to meet individual patient communication needs for a safe patient care.

4.0 Meeting religious and cultural needs of service users

4.1 Multi-faith chaplaincy service

Religion is one of the equality monitoring data characteristics the Trust has routinely collected from patients (see table below).

In 2018, 124 different religions were recorded for our service users. The most common religion was Christianity, with 31.6% of service users, and many different denominations.48.26% of our service users did not disclose their religion or belief.

The Chaplaincy team across UHB continues to serve patients, visitors and staff in providing spiritual, religious and pastoral care to all. The team, across Good Hope, Heartlands, Solihull and Queen Elizabeth Hospital Birmingham sites are aligning services and prioritising activities to maximise resources available and deliver the best possible care to patients, their visitors and staff.

During 2018 the Chaplaincy team had developed and delivered the following initiatives:

• Our Mindfulness project, delivered currently by two experienced Buddhist chaplaincy colleagues. The Mindfulness project seeks to enhance the health and wellbeing of staff. The initiative to offer mindfulness to our staff has developed significantly with financial support from various sources. It is offered as a tried and tested intervention in self-care and there is an ever-growing amount of empirical research that demonstrates its effectiveness. Mindfulness has been shown to be an effective way to manage stress and anxiety, and also improve work experience and quality of work. Throughout this financial year mindfulness support was offered to 1830 staff members
• Ongoing development of a teaching programme within the Trust offered by members of the Chaplaincy team in which we teach clinical teams equipping them to deliver patient-centred spiritual care in a variety of contexts and circumstances. In this financial year we have been asked to deliver a programme of teaching with End of Life/Bereavement, and Supportive and Palliative Care colleagues on the FY1, FY2 and CMT teaching programmes
• Ongoing development of our mentoring programme and CPD training for both chaplains and Chaplaincy volunteers
• Provision of supervision support for Palliative Care CNS staff by several of Chaplaincy team
• Ongoing development of a Chaplaincy database that enables us to respond to patient’s spiritual needs in a more timely manner. Several other local Trusts have made enquiries about purchasing this software
• Continuing close working with Chaplaincy/spiritual care teams in other local trusts and hospices to deliver high quality training for new Chaplaincy volunteers
• Continuing development of the QEHB Food and Clothing Bank, providing patients with essentials at the point of discharge. This project is run in partnership with the Trussell Trust and the Sparkhill Foodbank. We are currently exploring the development of this project on all hospital sites
• Funding secured for members of Chaplaincy team to receive clinical supervision
• Development of new publicity material describing the work of Chaplaincy to patients, visitors and staff across all four sites. Two team members participating in masters degrees with support from QEHB Charity
• Students and newly qualified Chaplains from other Trusts on placements with Chaplaincy team at UHB
• Patient experience surveys and engagement with representatives from local faith/belief communities to ensure that UHB can support our many patients in the most culturally sensitive and informed way
• Over the past year different team members on all four sites have been asked to support staff teams by conducting memorial services for colleagues who have died. Further the chaplains have conducted patient memorial services and occasional funerals. We are currently engaging in a Trustwide review of these aspects of our work

4.2 Cultural and multi-faith celebrations

Throughout the year the Chaplaincy team across UHB arranges a variety of cultural and faith celebrations that both reflect and honour the diversity amongst our patients and staff. In 2018 we celebrated the following across UHB sites:

• Eid
• Diwali
• Bhandi Chhor
• Guru Nanak Dev Ji’s Birthday
• Paranirvana Day
• Sangha Day
• Chanukah
• Christmas
• Easter

These occasions are all expressions of the ways in which as a Chaplaincy team and as a wider trust, we seek to be welcoming of all, committed to growing in understanding and respect and to build healthier lives.

The Trust provides multi-faith prayer facilities on all Trust hospital sites (i.e. Good Hope, Heartlands, Solihull and Queen Elizabeth Hospital Birmingham sites). A Chapel, Prayer Room and Quiet Room are available for all to use. Regular services of Prayer (Christian and Muslim) as well as Holy Communion and Roman Catholic Mass are offered.

5.0 End of life care

The Trust Bereavement Care Service continues to work closely with local and national key stakeholders to develop educational tools and end of life care pathways which are appropriate and sensitive to social, cultural and religious diversity of the communities the Trust serves. For example:

5.1 Pan Birmingham Faith Advocacy Group

The Faith Advocacy Group is a pan Birmingham group which meets four to six times a year. Membership consists of representation from Bereavement Services at the Birmingham acute NHS trusts, CCG, the HM Coroner’s office, Birmingham and Solihull Registry offices, Birmingham City Council Bereavement Services, in addition to representation from various faith communities.

The aim is for these key stakeholders to form a cooperative through which to explore existing and new ways of working across traditional boundaries and to work together with external agencies to act as advocates for community members to provide optimum service and best practice respecting both cultural/religious requirements and relevant legal implications. One of the actions of the group is to monitor progress of the early adopter implementation of the death certification reforms, considering the implications and effect on the local faith communities.

5.2 Rapid release procedure

Within Trust bereavement services there is a rapid release procedure which allows deceased patients to be released from hospital within an appropriate timeframe to meet religious and cultural requirements.

All bereaved families are offered the follow up support service which is provided through partnership working with local and external bereavement counselling organisations. This service has also been utilised by members of Muslim community.

6.0 Equality monitoring

6.1 Key trends

Under current practice, there continues to be gaps within the Trust’s information gathering and analysis of patient data. Only equality information in relation to a patient’s ethnicity, age, gender, marital status and religion is collected routinely.

For the purposes of this report, we have reviewed the data in terms of ethnicity, age, gender, religion and marital status access to hospital services for 2018, which is available to us and overall it is reflective of the local population the Trust serves.

6.2 Inpatient demographic

6.2.1 Ethnicity

In 2018, 63.23% of our service users were white British or Irish.10.89% of our service users did not declare their ethnicity.

25.88% of our service users were BAME. This is significantly lower than the population of Birmingham, and lower than that of our workforce.

The 2011 Census indicated that 53% of the Birmingham population is of a white British ethnic origin and 47% from BAME. This suggests our service users are under representative of the local BAME population.

6.2.2 Gender

In 2018, 50.94% of our service users were female and 49.06% of our service users were male. This is an even split between the two genders.

The 2011 Census indicated 51% of the Birmingham population was female and 49% male. This suggests our service users are representative of the local population.

From October 2019, we will be able to record all protected characteristic data of patients and service users into our Patient Administration System (PAS) using the accepted Stonewall criteria.

6.2.3 Age

In 2018, our largest age group was those of aged 65+, with over a third of patients falling into this age category. The rest of our service users were fairly evenly split across other age ranges.

The 2011 Census indicated that there were around 138,000 people aged 65 and over living in Birmingham. The number of people aged 90 and over had also increased by 18.5%, with very elderly men showing an increase of 54.5% since the last census.

With an ageing population, it is likely that this will be reflected in our service user data, particularly with elderly people living longer and with more complex health needs than previously seen.

6.2.4 Marital status

In 2018, 71.05% of service users did not specify their marital status. 16.24% were married and 9.94% single. 1.19% were divorced and 1.33% widowed.

6.3 Outpatient demographic

6.3.1 Ethnicity

In 2018, 62.51 % of our service users were white British or Irish. 15.43% of our service users did not declare their ethnicity.

22.06% of our service users were BAME. This is significantly lower than the population of Birmingham, and lower than that of our workforce.

The 2011 Census indicated that 53% of the Birmingham population is from a white British ethnic origin and 47% from BAME. This suggests our service users are under representative of the local BAME population.

6.3.2 Gender

In 2018, 59.25% of our service users were female, and 40.75% of our service users were male.

The 2011 Census indicated 51% of the Birmingham population was female and 49% male. This suggests our service users are representative of the local population.

From October 2019, we will be able to record all protected characteristic data of patients and service users into our PAS using the accepted Stonewall criteria.

6.3.3 Age

In 2018, our largest age group was those of aged 65+ , with over a third of patients falling into this age category. The rest of our service users were fairly evenly split across other age ranges.

The 2011 Census indicated that there were around 138,000 people aged 65 and over living in Birmingham. The number of people aged 90 and over had also increased by 18.5%, with very elderly men showing an increase of 54.5% since the last census.

With an ageing population, it is likely that this will be reflected in our service user data, particularly with elderly people living longer and with more complex health needs than previously seen.

6.3.4 Marital status

In 2018, 16.43% of service services did not specify their marital status. 45.63% were married and 30.65 % single. 3% were divorced and 4.23% widowed.

6.4 Maternity demographic

6.4.1 Ethnicity

In 2018, 50.32% were of white British or Irish descent and 43.95% were of BAME backgrounds. 5.73% of patient’s ethnicity is not known.

In 2018, white British or Irish patients continue to be the highest admitted group for maternity inpatient admissions, similar to previous years. The lowest admitted group continuing to be BAME origin (43.95%). Trends over the last few years, however, indicate an overall increase in the number of other ethnic origin (6.82%), other white origin (3.69%) and African origin (2.16%), other Asian origin (1.79%) maternity inpatients and outpatients. This data is in line with the growth in the migrant worker population and the numbers of refugee/asylum seekers in Birmingham.

6.5 Emergency Department demographic

6.5.1 Ethnicity

In 2018, 56.71% of our service users were white British or Irish. 13.85% of our service users did not declare their ethnicity.

29.55% of our service users were BAME. This is significantly lower than the population of Birmingham, and lower than that of our workforce.

6.5.2 Gender

In 2018, 49.71% of our service users were female, and 50.28% of our service users were male. This is an even split between the two genders.

The 2011 Census indicated 51% of the Birmingham population was female and 49% male. This suggests our service users are representative of the local population.

From October 2019, we recorded all protected characteristic data of patients and service users into our PAS using the accepted Stonewall criteria.

6.5.3 Age

In 2018, our largest age group was those of aged 60+, with over a third of patients falling into this age category. The rest of our service users were fairly evenly split across other age ranges.

The 2011 Census indicated that there were around 138,000 people aged 60 and over living in Birmingham. The number of people aged 90 and over had also increased by 18.5%, with very elderly men showing an increase of 54.5% since the last Census.

With an ageing population, it is likely that this will be reflected in our service user data, particularly with elderly people living longer and with more complex health needs than previously seen.

6.5.4 Marital status

In 2018, 17.68% of service services did not specify their marital status. 26.17% were married and 43.93% single. 1.83% were divorced and 3.32% widowed.

6.6 Community demographic

6.6.1 Ethnicity

In 2018, 65.35% of our service users were white British or Irish. 14.96% of our service users did not declare their ethnicity.

19.69% of our service users were BAME. This is significantly lower than the population of Birmingham, and lower than that of our workforce.

6.6.2 Gender

In 2018, 57.12% of our service users were female, and 42.88% of our service users were male.

The 2011 Census indicated 51% of the Birmingham population was female and 49% male. This suggests our service users are representative of the local population.

In 2018, patients of white British and Irish background continue to be the highest admitted group for community services patients. The lowest patient group continuing to be BAME origin. Trends indicate the number of patients of white British and Irish background remain similar to those recorded in last three years and black and minority ethnic origin and other white background patients remain similar to previous years.

6.6.3 Age

In 2018, our largest age group was those of aged 65+, with over a half of patients falling into this age category. The rest of our service users were fairly evenly split across other age ranges.

The 2011 Census indicated that there were around 138,000 people aged 60 and over living in Birmingham. The number of people aged 90 and over had also increased by 18.5%, with very elderly men showing an increase of 54.5% since the last Census.

With an ageing population, it is likely that this will be reflected in our service user data, particularly with elderly people living longer and with more complex health needs than previously seen.

7.0 Equality impact assessment

During 2018 the Trust continued to undertake equality impact analysis (equality impact assessments) on all policies and practices to ensure that our services do not directly, indirectly, intentionally or unintentionally discriminate against the users of our services or our staff. Where a negative impact is found, we mitigate the impact through the development and implementation of equality improvement plans.

The equality impact assessment face to face individual training/support sessions were provided to policy and service developers in 2018. The existing toolkit continues to be used to undertake equality impact assessments for new/review of policies and services.

During 2018, we undertook an equality impact analysis on the following four policies:

7.1 Information governance policy

It was anticipated the policy will have no differential impact on all equality characteristic groups. The equality impact assessment process also did not flag up potential differential issues when implementing the policy in following aspects.

Patient information is:

• held securely and confidentially, as appropriate
• obtained fairly, efficiently and lawfully
• recorded accurately and reliably
• used effectively and ethically
• shared and disclosed appropriately and lawfully

7.2 Patient information policy

It was anticipated the policy will have no differential impact on all equality characteristic groups. The equality impact assessment process flagged up following potential differential issues:

• Deaf and deaf blind/visually challenged patients may require different types of communication support
• Visually challenged may require information in appropriate format
• Non-English speaking may require interpreting/written translation services

The above issues are addressed by the Trust by providing appropriate communication support services to meet individual needs when required. For example, providing male or female interpreter in relevant languages and different type of sign languages, patient information available in large print or braille. In addition, staff awareness on current interpreting service arrangements within the Trust is raised through equality and diversity training programmes, interpreting policy best practice guidelines, staff meetings and interpreting service webpage on Trust intranet.

7.3 Missing patient policy

It was anticipated the policy will have no differential impact on all equality characteristic groups The equality impact assessment process flagged up possible adverse impact for those patients who may have impaired capacity due to a learning disability, mental health and dementia, however these areas of concerns have been addressed within the policy under 'mental capacity' and 'assessing capacity' guidelines, procedure and staff training.

7.4 Prevent violent extremism and radicalisation policy

It was anticipated the policy will have no differential impact on all equality characteristic groups.

The equality impact assessment process flagged up potential adverse impact on an individual due to their religion, ethnicity, age and gender. These potential areas of adverse impact have been mitigated in the monitoring and implementation of various Trust policies and procedures as follows:

• Adult safeguarding policy
• Consent to examination or treatment policy
• Data protection and confidentiality policy
• Information governance policy
• Mandatory and statutory training policy
• Person of trust procedure (HGS)
• Preventing violent extremism and radicalisation of patients and staff procedure
• Procedure for consent to examination or treatment
• Procedure for the management and safeguarding of patients less than 18 years of age
• Raising concerns in the public interest (whistleblowing) policy
• Risk management policy
• Safeguarding of adults at risk policy
• Security policy

8.0 Actions for 2019/20

8.1 Service users

• To record all protected characteristics of all patients and service users in our PAS system
• To ensure AIS module is rolled out across all Trust sites
• To develop and implement patient experience feedback for LGBTQ+ patients and partners
• To launch yellow communication boxes across all Trust sites to support patients with communication needs