(Risk level will be added by EQIA steering group)
3. Rapid Impact Assessment summary report
Each of the numbered sections below must be completed
Interim report Final report x (Tick as appropriate)
1. Title of plan, policy or strategy being assessed.
A Dynamic Quality Improvement framework for the management of Vulnerable Patients (Adults) in Hospitals across Lothian
2. What will change as a result of this proposal?
Build future requirements for both inpatients, out patient and community settings.
3. Briefly describe public involvement in this proposal
No direct involvement with public members in the development of the action plan, however members of the public/lay personnel will be involved in, at minimum, three of the sub-groups, discharge planning, volunteering and carer support.
4. Date of RIA
6th December 2012
5. Who was present at the RIA? Identify facilitator and any partnership representative present
Name Job Title Date of RIA
training Email Carol Crowther James Glover (Facilitator) Alison Jarvis Tracy Ryan Neil Muir Chief Nurse Head of Equality and Diversity Project Manager - Review of Nursing in the Community Consultant Clinical policy Advisor Nov 2008
6. Evidence available at the time of the RIA
Evidence Available? Comments: what does the evidence tell
you?
Data on populations in need Yes NHSL possesses significant data in terms of the number of patients over 65 years of age with a diagnosis of dementia, these will be one of the specific groups this action plan will support. Also data on patients with a learning disability. Data on service
uptake/access
Yes All patient movement within NHSL is available and can be called upon in relation to specific actions within the plan, in particular there will be an interest in patient movement and this is an area that requires further development.
Data on quality/outcomes Minimal Some data will be pulled from complaints and incident reporting.
Research/literature evidence Yes Significant literature review undertaken for the 5x5x5 improving patient experience for vulnerable adults.
Patient experience information
Minimal Some anecdotal, some from patient
experience picked up on through the Older People in Acute Care methodology HIS Inspection.
Consultation and involvement findings
No But will be included once draft passes through relevant groups (as referred to above).
Good practice guidelines Yes NHS Dementia Standards and Standards for Older People 2004
Other (please specify)
7. Population groups considered
Potential differential impacts
Older people, children and young people The framework is for adults only and not children. It is clear that staff must not focus wholly on older patients but must focus on all vulnerable adults. However as older patients make up a significant part of our inpatients this will have a
greater effect. This framework, at present, relates to in-patients only but will expand to include out-patients/primary care facilities in the future.
Women, men and transgender people (include issues relating to pregnancy and maternity)
There is a greater amount of older women in the population than men, but different services will have different clinical needs. For example there are more men with Traumatic/acquired brain injuries and men are more likely to abuse substances, e.g.
alcohol. Men are also less likely to engage with services. Maternity services are going to see women only, and provision is available for pregnant women who have learning difficulties. Transgender patients may have increased mental health needs however this group of patients is
significantly small. Disabled people (includes physical disability,
learning disability, sensory impairment, long term medical conditions, mental health problems)
This patient grouping, are the main focus of the framework and therefore this framework will have a positive impact on them. However, patients who have sensory impairment may score low on cognitive tests due to their physical rather than their cognitive ability.
Minority ethnic people (includes
Gypsy/Travellers, non-English speakers)
Communication is always important when interacting with this group. They may present late due to cultural differences and discharge planning should always include family members. Patients who have a cognitive impairment may revert to their original language and any learned languages may be lost, staff should be aware of this.
Refugees & asylum seekers It is possible that this group of individuals may seek healthcare and the framework will allow a positive approach.
People with different religions or beliefs Staff should respect individual beliefs and treat all patients with dignity especially when dealing with an end of life situation. Person centred care is paramount.
Lesbian, gay, bisexual and heterosexual people
Older men may feel a stigma towards their sexual orientation due to their previous experiences, staff should be aware of this and also patients with learning difficulties may have varied sexual preferences and staff should afford them the same respect as they would any other patient.
People who are unmarried, married or in a civil partnership
There may be an increased chance of patients who are unmarried living alone and having a reduced support network. Patient that are married or in a civil partnership may be at more risk of becoming financially abused and staff should be aware of this.
People living in poverty / people of low income
This is an increasing user group and discharge planning will be hugely important for the planning of related services. The framework should have a positive effect.
Homeless people Staff should not impose their own
personal beliefs on this group, and treat people’s lifestyle choices with dignity and respect.
People involved in the criminal justice system NHS Lothian is now responsible for the delivery of healthcare in prisons and staff should treat all patients with dignity and respect.
People with low literacy/numeracy ¼ of all adults in Lothian have literacy problems. Use of other tools, for example pictorial aids, is to be considered.
People in remote, rural and/or island locations
This may be affected by the council policy in the area the patient lives. Discharge should be considered when the patient is first admitted and the planned admission time should be sympathetic to those that live in rural areas. It may be difficult to get in for a 0730 appointment time if you have some distance to travel.
Carers (including parents, especially lone parents; and elderly carers)
Carers should be included throughout and treated as equal partners. Staff should also be aware of the need to see certain documents, e.g. power of attorney. There may also be difficulty when the vulnerable adult is also the carer, staff may have to consider the use of emergency respite care in these circumstances.
Staff (including people with different work patterns e.g. part/full time, short term, job share, seasonal)
The framework may be seen to increase workload and there will be additional training required. Support is available. OTHERS (PLEASE ADD): Patients who have
suffered sexual abuse
Patients who fall under this category may be those who have been abused and those who have been abusers. These individuals may as they become older become cognitively impaired and
consideration will need to be made as to how we keep these patients safe and how we protect those on the sex offenders register.
8. What positive impacts were identified and which groups will they affect?
Impacts Affected populations
Diet and Nutrition
Education, Learning and Skills Social Environment
Living Conditions
Accidental Injuries or Public Safety Health Care Social Services Education All Staff All All All All All All
9. What negative impacts were identified and which groups will they affect?
Impacts Affected populations
Nothing to note
10. What communications needs were identified? How will they be addressed?
There will be a need for the key stakeholders on the Vulnerable Peoples Steering Group to ensure that the actions required within this framework are properly and appropriately communicated to all staff to ensure that benefits are obvious.
11. Additional Information and Evidence Required
N/A
12. Recommendations
This is a dynamic evolving document based on a number of existing local and national policies and procedures. Many of the bi-products of the framework may well, in the future require to under go; a RIA in their own rights, i.e. further work on discharge planning, environmental dementia standards etc.
Future development of TRAK with patients with additional needs may require further input to this dynamic framework as it progresses.
There are some specific issues that require to be considered, in particular in relation to patient’s ethnicity relating to discharge planning. Religion and sexual orientation should be picked up through compassionate care work.
There are some issues in relation to Consent and Capacity/Power of Attorney in relation to patient admissions and also in relation to security of patients in certain areas of NHS Lothian and consideration needs to be given to the Human Rights aspect of this.
13. Specific to this RIA only, what actions have been, or will be, undertaken and by when? Please complete:
Specific actions (as a result of the RIA)
Who will take them forward (name and contact details)
Deadline for progressing
Review date
A number of areas within the framework require to have some reinforcement in terms of communication of actions.
These aspects will be taken forward by the workstream leads. These will be progressed at the April 2013
These are specifically in relation to discharge planning, pre-admission procedures, patients who may have low literacy, patients who may not have English as a first
language or may revert to their native tongue when confused and carer assessment. January / February meeting of the Vulnerable Patients Steering Group
14. How will you monitor how this policy, plan or strategy affects different groups, including people with protected characteristics?
This dynamic action plan will be progressively reviewed at each of the steering group meetings and will report back to Healthcare Governance & Risk Management of NHS Lothian at their March/April meeting and thereafter 6 monthly.
Manager’s Name: Carol Crowther, Chief Nurse Quality & Professional Standards Date: 17 December 2012
Please send a completed copy of the summary report to:
James Glover, Head of Equality and Diversity [email protected]
Note that you will be contacted by a member of NHS Lothian’s impact assessment group for quality control and/or monitoring purposes.
