Redesign of urgent care: equality impact assessment

Stage 4: Decision making and monitoring

Identifying and establishing any required mitigating action

Have positive or negative impacts been identified for any of the equality groups?:

Emphasis on remote and digital creates choice for some may remove choice for others, two sides to the same coin: being better able to focus urgent care on those who really do need to see someone should be a pro, but if people feel they have no choice, this may put them off seeking care at the right time.

Is the policy directly or indirectly discriminatory under the Equality Act 2010?:

There is no evidence, so far within this EQIA that the policy is
directly or indirectly discriminatory under the Equality Act 2010.

If the policy is indirectly discriminatory, how is it justified under the relevant legislation?:

Not applicable

If not justified, what mitigating action will be undertaken?:

Not applicable

Ongoing Engagement and evidence gathering

In order to tackle the health inequalities that exist, we must ensure that our delivery of the new urgent care model meets the needs of everyone living in Scotland.

In order to meet the general equality duty, and comply with the obligations of the Human Rights Act, and taking into consideration the need to tackle health inequalities, the following points should be considered.

1. Evidence suggests that people experiencing socio-economic disadvantage are more likely to access urgent care than those people who are not. Groups of people noted as being more likely to experience poverty include:

• minority ethnic people (including Gypsy/Travellers, migrants, refugees and asylum seekers);
• people who are Muslim;
• disabled people;
• care-experienced young people;
• people experiencing homelessness;
• people living in the most deprived areas of Scotland according to the Scottish Index of Multiple Deprivation; and
• older adults.

As the redesign of urgent care evolves, we should seek to ensure that these groups of people, and organisations that represent their interests, are engaged with to better understand the impact of the changes.

2. Recommendations from the Discovery Project

The project was undertaken using a small number of participants and it is important that wider engagement is undertaken. To take this forward the unscheduled care team are working with colleagues from Healthcare Improvement Scotland (HIS) to develop a robust public engagement process. This will include two initial exercises.

Gathering Views

• HIS – Community Engagement's network of engagement offices are able to collate comments and experiences from across Scotland to give local, regional and national perspectives using focus groups, interviews, questionnaires and events. Additionally this approach works with local third sector organisations and community groups to reach people, especially those who are often excluded from consultations.
• The focus for Gathering Views is to run early 2021 to address equalities-related engagement gaps in the discovery phase work with particular regard to the protected characteristics and most marginalised communities. This work will also be informed by experience gained during the NHS A&A pathfinder exercise, with findings to be published on the HIS website and publicised through their social media platforms.^[6]

The timeframe for Gathering Views is to run and report during spring 2021.

Citizens' Panel

• HIS will run a Panel in in 2021 which will comprise a series of questions relating to the Redesign of Urgent Care and in particular the service configuration, barriers to access considerations, and ways to improve. This will be directly informed by the engagement activities undertaken from October 2020 with the discovery phase, through the practical experience of operating the new delivery model over the winter period, and the learning gained from the Gathering Views work.
• The timeframe for the Citizens' Panel will be agreed following the Gathering Views exercise.

We are also working with Care Opinion to determine how we can assess and shape the service model. This may lead to HIS developing an evaluation framework which can be used by NHS Boards and, potentially at national level, to determine the impact of this new model of care.

3. Communications, Language and Engagement

Scottish Government marketing team is currently working with the following organisations to identify specific challenges in effectively reaching seldom-heard or vulnerable groups with the Redesign of Urgent Care messaging; NHS and PHS colleagues, BEMIS (umbrella organisation for Ethnic Minority Voluntary Sector), CEMVO (national intermediary partner and strategic partner of the Scottish Government Equality Unit) , MEHIS (Minority Ethnic Health Inclusion Service) MECOPP (Minority Ethnic Carers of People Project) and the Scottish Public Health Network (Gypsy/Traveller Community). Insights gathered from these conversations will help shape marketing materials, and collaborations will help to ensure messaging reaches communities via trusted voices, such as community leaders.

4. Remote and Rural

Due regard for the need to engage with those who live in remote and rural areas (including islands) should also be considered. It should be noted that the Scottish Government are considering the development of a national islands assessment. The Scottish Government continues to work with Health Boards to consider how this model can be adapted to meet the needs of local communities.

5. LGBT

We should also consider the potential impact of the proposed changes on these LGBT communities as it is not clear from the evidence available. Any engagement undertaken with these groups should seek to improve understanding of any potential impact.

6. Removing Barriers

We should seek to ensure that the introduction of the option to contact NHS 24 prior to people being able to access urgent care is not an unintended barrier for any groups of people. Particular regard should be given to the groups of people identified within this impact assessment. For example:

• How to overcome common barriers to access for disabled people should always be considered. The evidence in this report relating to disabled people, highlights some of the barriers that should be considered.
• Lack of awareness of health services within minority ethnic communities and the barriers to access they can experience when seeking to access health services should be addressed. The provision of services and information about these services in other languages should always be available. In order to reduce the health inequalities gap that exists, we must provide appropriate access and service provision for minority ethnic communities living in Scotland. The evidence in this report under Race highlights some of the barriers we should address in relation minority ethnic people.
• In order to meet the needs of disabled people who may experience barriers to effective telephone communication, consideration should be given to creating a national communication hub similar to the service provided by Contact-Scotland-BSL.

Data Improvement

7. There is a lack of equality monitoring data for some characteristics in relation to who uses and who does not use NHS Scotland services/Urgent Care services. Consideration as to how we can monitor be proportionately, lawfully and purposefully which groups of people commonly access services will help establish which groups do not. This data will help NHS Scotland to understand where future engagement and promotion of services should be targeted.

It is not believed the changes recommended in this section will create any new, adverse, impacts in relation to a person's relevant protected characteristics.