Redesign of urgent care: equality impact assessment
Impact assessment (EQIA) for the redesign of urgent care to ensure patient safety during the winter period while the NHS continued to respond to the pandemic.
Stage 2: Table setting out data gaps, actions taken and possible mitigation, by each characteristic
Characteristic |
Evidence Gathered and Strength/Quality of Evidence |
Source |
Actions Taken / Mitigation |
|---|---|---|---|
Age |
Urgent Care Use The NHS NSS 'Who Attends Emergency Departments' report highlights that very young (0 to 4) and older people (65+) are more likely to attend an emergency department and more likely to be admitted to hospital following their attendance. Digital Age is the leading characteristic of low digital engagement, with digital engagement decreasing as age rises. Those over 70 are particularly less likely to engage digitally. Older people are less likely to have internet access, and even if they do they are less likely to use it. Over a third (36%) of households where all adults are over 65 do not have home internet access. This rises to three fifths (60%) of households where all adults are over 80. Two-thirds (65%) of adults aged 60+ used the internet in 2018 – compared to under one-third (29%) in 2007. Moreover, older Asian people are significantly less likely to have used the internet than white people belonging to the same age groups, suggesting that there may be particular digital barriers to the engagement of some older minority ethnic groups. While almost all young people use the internet, there are still many who lack good digital skills or access to resources such as home computing and broadband. Evidence relating to care-experienced young people has highlighted the inequalities they can experience when accessing health services. They are also a group of people more likely to experience socio-economic disadvantage. Ensuring that efforts are made to engage with this group of people to convey information around the changes is essential. |
NHS NSS (2015) Understanding Emergency Care in Scotland. Who Attends Emergency Departments. |
Working with Public Health Scotland we will undertake a population needs assessment to further identify the needs of the population and the ongoing improvement data required for monitoring purposes. Working with third sector organisations and Healthcare Improvement Scotland (HIS) Community Engagement we will co-produce the change needed to deliver urgent care which meets the needs of the Scottish population using local HIS engagement offices within Boards to undertake gathering views exercises, HIS citizen panel and jury. Potential mitigation strategies identified include:
By partnership working with local libraries to provide private space for remote consultations, this may increase access to video enabled care for those without access to video devices. Noted that further mitigation will need agreed to ensure 24 /7 access. Further mitigation strategies will be developed after the feedbackfrom public and professional engagement has been fully explored, particularly for those digitally excluded. Monitoring Impacts Data on the age of those using urgent care (attending A&E, contacting NHS 24 and contacting out of hours) are published by Public Health Scotland. Additional data or research may be needed over time to understand impacts. |
| Scottish household survey 2019: key findings - gov.scot (www.gov.scot) |
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Disability |
Urgent Care Use Some people with a disability have conditions which make them more prone to needing urgent care and more likely to present to A&E. Moreover, some disabled people may be experiencing gaps in social care provision as a result of Covid-19 and responses to the pandemic (e.g. this could mean they are in less regular contact with social care staff/a PA and may be more inclined to contact emergency services. Reduced availability of some therapies and treatment may mean people feel they can cope less well with existing conditions. They may then be more likely to request emergency care. Digital Disabled people are also more likely to live with socio-economic deprivation. Disabled people are more likely to be digitally excluded. For example, in 2018, 27% of adults in Scotland with a long-term physical or mental health condition reported not using the internet, compared with 8% of adults who do not have any such condition. Clear communication and access options at every stage will be important for people who rely on information in, for example, Easy Read, BSL, Braille, audio/visual formats. A range of access points for information will also be important for people who are more likely to be digitally excluded and/or without regular access to media. Separate accessible info/communication and language barriers. Disabled people whose conditions impact their verbal communication could be deterred from accessing urgent care further to the introduction of the requirement to call NHS 24. For example, a person with a stammer may be deterred from calling because of their anxiety around having telephone conversations. When promoting changes to the urgent care model and the new NHS 24 pathway, consideration should always be given to the provision of information in accessible formats, such as Easy Read, large print, colour contrasted backgrounds or audio. The need to make information accessible to British Sign Language Users and others with language barriers should also be met. Interactive voice recorded menus could be a barrier to some disabled people. People with hearing impairments may struggle to hear the options or people with cognitive impairments may find long questions, or multiple response options, difficult to remember. In 2019, NHS 24 staff undertook a number of engagement activities (Art of the Possible) with disabled people who can experience barriers to communication. This engagement highlighted a number of things for NHS 24 to consider when delivering telephone-based services. They include:
BSL (Scotland) Act 2015: promote and support the language, culture & identity of British Sign Language users. Augmentative and Alternative Communication (AAC) Duty In 2016, the Scottish Parliament passed legislation which entitles people with severe communication difficulties to be provided with communication equipment and support. Referred to as Augmentative and Alternative Communication (AAC), this equipment includes communication aids and accessories, as well as other non-electronic aids such as symbol communication books. The duty to fulfil the legislation lies with NHS Boards and Integration Joint Boards throughout Scotland. People who require AAC equipment may contact healthcare services, but it is more likely that a carer, a relative or a friend will call on their behalf, which means for those without a 24-hour care presence, it can be difficult to make the call when they might need it. It could be difficult for healthcare providers to meet the needs of people who use AAC equipment. However, an approach proposed to address this is to create a national communication hub similar to the service provided by Contact-Scotland-BSL. One UK study recorded that BSL/English interpreters were present at just 17% of GP and 7% of A&E consultations. Another study found that over three-quarters of Deaf patients had difficulty communicating with hospital staff. |
Scottish Government (2019) Scottish Household Survey 2018 Poverty and Inequality Commission THE HEALTH OF DEAF PEOPLE IN THE UK .pages (bridgewater.nhs.uk) |
Actions: as above Potential mitigation strategies identified include:
Mitigation already in place includes:
Monitoring Impacts There are no specific plans to routinely monitor the disability status of those using urgent care. Additional data or research may be needed over time to understand impacts. |
Sex |
Urgent Care Use Children and parents/care-givers are noted as more frequent attenders at A&E. Around 60% of unpaid carers are women. People who provide unpaid care for someone because of a long-term physical condition, mental ill-health or disability, or problems related to old age. Women do more unpaid caring than men in most age groups. 90% of single parents are women, with 45% of single parents living in poverty. Just over half (51%) of Scotland's population are women. There are a higher ratio of women to men in older age groups, reflecting women's longer life expectancy. Therefore it is possible that women may need to access unscheduled care more frequently. Women are disproportionately more likely to experience domestic abuse. In 82% of all incidents of domestic abuse recorded by the Police in 2018-19 the victim was a woman and the accused was a man (where gender information was recorded). Digital This could make a preliminary conversation/digital engagement with services more risky if it takes place in the home. However, further research would be beneficial here. Women are more likely to be the victim of controlling behaviours/ coercive control and this could impact on their access to healthcare or access to healthcare for their families. |
Poverty and Inequality Commission Scottish Health Survey 2017 Scottish Health Survey 2018 |
Actions: as above Understanding the impact on women, particularly those who are the primary care-givers for children or who are experiencing domestic abuse. Gaps in data relate to why people access urgent care and how the genders may be disadvantaged or advantaged by the change. Potential mitigation strategies may include:
Monitoring Impacts Data on the sex of those using urgent care are published by Public Health Scotland. Additional data or research may be needed over time to understand impacts. |
Pregnancy and Maternity |
Urgent Care Use Complications or health conditions associated in pregnancy may create a need for urgent care. People who are pregnant or who have recently had a baby are often offered a direct contact number for their labour unit ward so that they can speak directly to a midwife. Ensure clear messaging on the best route for urgent care is provided for people who are pregnant/recently had a baby. |
Actions: as above |
|
Gender Reassignment |
Urgent Care Use Past experience of discrimination or poor treatment can mean that LGBT people are less likely to access some key health services, like GP services and screening programmes, but are more likely to use A&E and minor injuries clinics. Digital Some trans people may experience mis-gendering over the phone depending on a number of factors. It may be that their CHI details do not recognise the gender they identify as or call handlers could mistakenly assume someone's gender based on the sound of their voice. |
Actions: as above To understand fully what would make a new urgent care system accessible to LGBT people. Gaps in data in relation to why people access urgent care and how the gender reassignment may be disadvantaged or advantaged by the change. Monitoring Impacts There are no specific plans to routinely monitor the gender reassignment status of those using urgent care. |
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Sexual Orientation |
Urgent Care Use Past experience of discrimination or poor treatment can mean that LGBT community are less likely to access some key health services, like GP services and screening programmes, but are more likely to use A&E and minor injuries clinics. Though there is evidence to suggest that LGBT people can experience poorer health outcomes than non-LGBT people, it is unclear if the redesign of urgent care would present any new issues/barriers. |
Actions: as above To understand fully what would make a new urgent care system accessible to LGBT community. Gaps in data relate to why people access urgent care and how people's sexual orientation may be disadvantaged or advantaged by the change. Potential mitigation strategies include:
Monitoring Impacts There are no specific plans to routinely monitor the sexual orientation of those using urgent care. Data or research may be needed in future to understand impacts. |
|
Race |
Urgent Care Use 35% of Minority Ethnic people are in poverty compared to 18% of White British people. A significant number of people speak English as a second language and this is more common among minority ethnic communities. Access issues such as the availability of interpreters, literacy issues and perception around short appointment times can impact early engagement with health services. For Gypsy Traveller communities, issues to consider include difficulties with GP registration, anticipated discrimination or poor treatment, digital exclusion, lower levels of literacy and the need for a tailored approach to communicating within communities, who may not be engaged with mainstream messaging or who may have concerns about a digital first approach. It is known that Gypsy travellers have poorer health than the general population. In 2017, it was reported by NHS Health Scotland that Gypsy/Travellers had low rates of outpatient appointments, hospital admissions, A&E attendances, cancer registrations and maternity hospital admissions. It was suggested that this may be due to the under-recording of Gypsy/Travellers compared with the proportions reported in the census, and issues with accessing services. Engagement with Gypsy/Travellers, undertaken in 2015 and 2016 by NHS 24, highlighted that Gypsy/Travellers can often use urgent care services as their primary healthcare access point due to barriers relating to registering with GP services. The EHRC's 'Is Scotland Fairer? 2018' report noted migrants were generally found to be low-level users of health services, possibly due to a lack of knowledge around how the healthcare system works in Scotland. Changes to the urgent care model may increase confusion for this group of people who are already reported to have a lack of understanding of the Scottish health system. Minority ethnic people whose first language is not English, may be unable to understand information about the changes to the urgent care model unless this information is communicated in their preferred languages. In 2018, NHS 24 undertook engagement with minority ethnic people and organisations that represent their interests to help understand what could be done to improve NHS 24 services for minority ethnic communities, refugees and asylum seekers. Findings from this engagement were as follows.
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Poverty and Inequality Commission Population level data See Scottish surveys Core Questions for detailed results by ethnicity for a number of questions: "White: Other British", "White: Other" and "All other ethnic groups" reported higher good/very good general health than the "White: Scottish" reference group. Since 2012, levels of good/very good general health have increased by 3.0 percentage points for the "White: Other British" group. The Scottish Government (2015) 'Which ethnic groups have the poorest health?' report, based on analysis of 2011 Census data. Key findings:
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Actions: as above To understand fully what would make a new urgent care system accessible to people who are black, Asian or from a minority ethnic community. Gaps in data relate to why people access urgent care and how race may be disadvantaged or advantaged by the change. Potential mitigation strategies may include:
Mitigation strategies already in place include:
Mitigation strategies will be developed after the feedbackfrom public and professional engagement has been fully explored Monitoring Impacts There are no specific plans to routinely monitor race of using urgent care. However, work is underway across health and social care to improve ethnicity data in health care and administrative records and Health Boards have been asked to address this as a priority. Covid has highlighted gaps in Scottish data on ethnicity. Additional data or research may be needed over time to understand impacts. Different BME groups are not evenly distributed across Scotland, so ensuring equality of treatment, and good quality monitoring will vary across boards. |
Religion or Belief |
We are not aware of any relevant existing evidence currently on religion or belief in relation to the Redesign of Urgent Care Programme. |
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Marriage and Civil Partnership |
Scottish Government does not require assessment against this protected characteristic unless the policy or practice relates to work, for example, HR policies and practices. Refer to Definitions of Protected Characteristics document for details |
Contact
Email: UnscheduledCareTeam@gov.scot
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