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NHS GRAMPIAN RACE EQUALITY SCHEME

VIEWS: 6 PAGES: 36

									 Consultation Draft
      of the

 NHS Grampian

Race Equality
  Scheme
  2008 - 2011


    October 2008
NHS Grampian




Do you have difficulty understanding the English language?
If you have a problem reading or understanding the English language, this document is
available in a language of your choice. Please ask an English speaking friend or relative to
phone, write or email Nigel Firth, Equality and Diversity Manager, NHS Grampian. His
contact details are:-

Nigel Firth,
Equality and Diversity Manager,
Ground Floor Room 15, Ashgrove House,
Aberdeen Royal Infirmary,
Aberdeen
AB25 2ZA
Telephone Aberdeen (01224) 552245
Email :- Nigel.firth@arh.grampian.scot.nhs.uk




Czy masz trudności w zrozumieniu angielskiego?
Jeżeli masz kłopoty ze zrozumieniem języka angielskiego w mowie lub na
piśmie dokument ten jest przetłumaczony na język polski. Poproś znajomego lub kogoś z
rodziny, kto mówi po angielsku aby zatelefonował, napisał lub przesłał email do pana
Nigela Firth, Equality and Diversity Manager, NHS Grampian. Jego adres i telefon znajduje
się poniżej :-
Nigel Firth,
Equality and Diversity Manager,
Ground Floor Room 15, Ashgrove House,
Aberdeen Royal Infirmary,
Aberdeen
AB25 2ZA
Telefon Aberdeen (01224) 552245
Email :- Nigel.firth@arh.grampian.scot.nhs.uk




                                             2
NHS Grampian


你在对英语的理解方面是否存在着困难?
如果你在阅读或理解英语上存在着问题,本文件有你所选择语言的版本以供索取
。你可以请一位会说英语的朋友或者亲属致电、写信或发送电子邮件给Grampian
地区国民保健服务 (NHS Grampian) 的平等与多元化经理 (Equality and
Diversity Manager) Nigel Firth。他的联络详情是:
Nigel Firth,
Equality and Diversity Manager,
Ground Floor Room 15, Ashgrove House,
Aberdeen Royal Infirmary,
Aberdeen
AB25 2ZA
电话: Aberdeen (01224) 552245
电子邮件信箱: Nigel.firth@arh.grampian.scot.nhs.uk




Do you have a visual impairment?
This document is also available in large print, and
in other formats, upon request




                      Contents
                          3
NHS Grampian


1.   Foreword by the Chairman

2.   An introduction to NHS Grampian

3.   The NHS Grampian Race Equality Scheme 2008- 2011

4.   Involving the local ethnic communities in the production of the Race
      Equality Scheme

5.   Priority areas of work

6.   Improved access to dental services

7.   GP services

8.   Racial equality awareness training for NHS Grampian staff

9.   Information on specific health care services

10. The NHS Grampian 2008/09 Racial Equality Action Plan : implementing the
    Race Equality Scheme

11. Consultation on the Race Equality Scheme

12. The size and diversity of the local ethnic communities served

13. NHS Grampian racial equality policy statement

14. Roles and responsibilities

15. Equality and Diversity Impact Assessment

16. Monitoring, complaints and racist incidents

17. Procurement of goods and services

18. Maintaining progress in 2009/10 and 2010/11

Appendix I : NHS Grampian 2008/09 Racial Equality Action Plan

Appendix II : Demography in Grampian




1. Foreword by the Chairman

                                          4
NHS Grampian
Over the last three years, NHS Grampian has made excellent progress towards becoming
a culturally competent organisation.

NHS Grampian is already a leader in many areas of racial equality work within the
healthcare field in Scotland. Over the next three years, the NHS Grampian Board have set
the ambitious target of NHS Grampian becoming the leader in all aspects of racial equality
work. This target will only be achieved with the hard work and commitment of all NHS
Grampian staff, the support of our local ethnic communities and their representative
organisations, partner agencies and other interested parties.

There are many different ethnic communities in Grampian, spread out over a large
geographical area. We must also be aware of the rapidly changing demographic profile of
Grampian and the health care needs of the large number of recent migrant workers and
their families choosing to settle here. It is vital that NHS Grampian reaches out to all of
these communities, to identify their healthcare needs and address them. Involvement and
consultation will be at the heart of everything we do.

In terms of service provision, our emphasis must continue to be on practical, lasting,
measurable and sustainable improvements, that will directly benefit all members of the
communities we serve.

I am confident that we will achieve our goals and continue to set an example of excellence,
for others to follow.



David Cameron,
Chair
NHS Grampian
6.10.2008




2. An Introduction to NHS Grampian


                                             5
NHS Grampian
(i) What is NHS Grampian?
NHS Grampian is the fourth largest Health Board in Scotland. It comprises :-

       Three Local Community Health Partnerships (LCHPs). These are Aberdeen City,
        Aberdeenshire and Moray.
       An Acute Sector
       A Mental Health Service

All are supported by corporate services such as Finance. The work of NHS Grampian is
overseen by a Health Board. The Health Board comprises representatives from the local
Grampian community who oversee the provision of health care, assisted by a
management team. The Health Board headquarters are based in Summerfield House,
Eday Road, Aberdeen.


(ii) What does NHS Grampian do?
The purpose of NHS Grampian is to :-
   Improve the health of the people of Grampian (compared to the rest of Europe)
   Provide safe, high-quality treatment, based on clinical need in comfortable
    surroundings and within the available resources.

We can only achieve these goals by working closely with our staff, patients, partner
agencies, carers, the local community, Community Planning Partners and
organisations/groups in Grampian, in the North of Scotland, and nationally.


(iii) Where do the patients treated by NHS Grampian come from?
NHS Grampian provides a comprehensive Healthcare service to over half a million people
living in Grampian. It also provides specialist healthcare services to the Western Isles,
Highland, Orkney, Shetland and Tayside as well as other parts of Scotland. The specialist
services provided outwith Grampian account for around 6% of total activity.


(iv) Where are services provided?
The aim is to deliver services as close to patients’ homes as it is clinically safe to do so.
Services are provided in a range of community settings - workplaces, peoples’ homes, in
one of the 91 GP practices or 19 Community Hospitals within Grampian. Highly
specialised care is delivered in the acute hospitals of Dr Gray’s, Woodend and Aberdeen
Royal Infirmary. Royal Cornhill Hospital provides inpatient and community support for
mental health services. For women and children, specialist services are provided at
Aberdeen Maternity Hospital or the Royal Aberdeen Children’s Hospital.


(v) Resources used
The 2008/09 budget is £868 million. NHS Grampian employs 14,252 staff.


3. The NHS Grampian Race Equality Scheme 2008-2011

                                               6
NHS Grampian
The Race Relations (Amendment) Act 2000, requires NHS Grampian to produce a new
Race Equality Scheme every three years. This Race Equality Scheme covers the period
2008-2011.

The NHS Grampian Race Equality Scheme 2005-2008, was cited by the Commission for
Racial Equality as a “Model of Excellence”. Accordingly, we need to maintain the high
standards which we have set.



4. Involving the local ethnic communities in the production of the
   Race Equality Scheme
NHS Grampian has a legal duty to involve the local ethnic communities in the production
of the Race Equality Scheme, together with the wider community in Grampian. In addition
to the regular daily contact with members of our local ethnic communities, their
representative organisations and groups, the NHS Grampian Racial Equality Working
Group felt that there was a need to organise specific dedicated consultation events.
However, the Grampian Racial Equality Council (GREC), members of the local ethnic
communities and their representative organisations made it clear that the local ethnic
communities were clearly suffering “consultation fatigue”. Accordingly, in January 2008,
NHS Grampian joined with Aberdeen City Council, Aberdeenshire Council, the Grampian
Police and the Grampian Fire and Rescue Service and facilitating bodies such as GREC
and the Ethnic Minority Forum, to plan a joint public bodies consultation event in June
2008, to avoid a massive duplication of effort.


(i) One Day Ethnic Communities involvement and consultation Event 21st June 2008
On the 21st June 2008, a joint consultation event was held at the Waterside Hotel,
Peterhead. The Ethnic Community Forum were the co-ordinating body. There were
places for 150 participants from all over Grampian. All 150 places were taken and a
further 80 people on the waiting list could not be given places. Moray Council chose not to
participate.

Free buses were provided for participants. Morning refreshments, lunch and afternoon
refreshments were also provided free of charge. There were a number of displays from
different organisations and a wide range of information and materials made available in
English and the main local ethnic community languages.

The event was simultaneously interpreted into 5 languages since many of the participants
were non-English speaking. After the introductory session, the participants were split up
into groups, each with a facilitator and a scribe and a range of previously agreed topics
were discussed. The day ended with a Question and Answer Panel.

The groups discussed a wide range of topics under six headings, which had been
previously discussed and agreed with local ethnic community representatives. The six
heading were :-




      Community Safety
      Education

                                             7
NHS Grampian
      Employment
      Health and Social Care
      Housing
      Voluntary Sector

There was also the opportunity to discuss any other issues or topics. The general
discussion sessions generated a lot of extremely positive comments from members of our
local ethnic communities about the quality of health care provided in Grampian. It is
estimated that 90% of the comments were positive. In the group sessions, for each topic
heading, each group was asked “What would make your life in Aberdeen City and
Aberdeenshire better?” Accordingly, the focus tended to be on the areas for improvement.

The information from the group sessions and general discussions was collected together
and analysed.


(ii) “Dedicated” health orientated ethnic communities involvement and consultation
events
Following the joint involvement and consultation event, most public bodies in Grampian
advised that they did not intend to carry out any further involvement or consultation work
with the local ethnic communities, prior to the issue of their Race Equality Schemes. This
gave NHS Grampian a window of opportunity to carry out two smaller health orientated
involvement and consultation events, with approximately 35 members of our local ethnic
communities at each event. The Grampian Racial Equality Council were commissioned
and funded to facilitate these events. The Scottish Ambulance Service accepted an
invitation to participate in the two health orientated involvement events to obtain local
information to inform their own Race Equality Scheme.

All participants completed a questionnaire in the language of their choice, which sought
specific information under six headings. These were :-

      GP Services

      Community Services (e.g. Health Visitors, District Nurses, Community Midwives,
       Community Nurses)

      Dental, Optician and Pharmacy services

      Hospital services

      Contraception and Sexual health

      Ambulance Services

For each heading, the questions asked were :-

      How did you find out about this service?

      Was it easy to get information about the service?

      How easy was the service to access?

                                             8
NHS Grampian

      Are there any steps we can take to make the service better for you?

      Personal experiences of using this service?

      Availability of “Language Line” or “face to face” interpreters?

      Availability of information, either in English or in translation if required?

After the questionnaires were completed, discussions were held in small groups, these
then fed into a larger discussion session.

       a). Involvement and consultation event, Saturday 30th August 2008
       This event was held at the “Hot Spot” in Peterhead and was attended by members
       of the local ethnic communities from the Peterhead and Fraserburgh areas, split
       into three separate sessions. With one exception, all of the participants were none
       English speaking. The event was simultaneously interpreted into Polish, Russian,
       Latvian and Lithuanian.

       b). Involvement and consultation event, Saturday 13th September 2008.
       This event was held at the Forum in Aberdeen. There was good representation
       from the Asian community, the Muslim community, as well as the Polish and
       Russian communities. Interpretation was provided in Bengali, Urdu, Arabic, Polish
       and Russian. It was known in advance that a number of participants had young
       children, so a crèche was also provided free of charge.



5. Priority areas of work
The three involvement and consultation events provided a large volume of detailed
information on the health care needs of our local ethnic communities. This information has
directly informed the NHS Grampian Race Equality Scheme 2008-2011. It has been
supplemented by input from local ethnic community groups and from front line NHS
Grampian staff who provide services to the local ethnic communities.

The priority areas for service improvement identified by our local ethnic communities, are
shown in Sections 6- 9 below

The rapidly changing make up of the population of Grampian, makes health needs
assessment a dynamic area of change. Accordingly, it is important to regularly review
these priorities.

Information collected on ambulance services will be included in the Scottish Ambulance
Service Race Equality Scheme and is therefore not shown here.




6. Improved access to dental services

                                                9
NHS Grampian

a). The topics raised
(i). Few members of our local ethnic communities have access to an NHS dentist. This
problem is particularly acute for recent migrant workers and their families. A number of
recent migrant workers and their families, have made special visits to their countries of
origin such as Poland, Lithuanian or Latvia, to obtain dental treatment. In these countries,
they have access to a same day dental services, at a modest cost.

(ii). Many participants in the involvement and consultation events commented on the high
cost of private dental treatment in Grampian.

(iii). Few participants had heard of the Emergency Dental Service provided by NHS
Grampian.


b). The action required
(i). The shortage of NHS dentists has been a UK – wide problem for some time. Locally,
the shortage is a serious issue in all areas of Grampian and amongst all communities.
The NHS Grampian Health Board have responded to the problem by approving the NHS
Grampian Dental Plan 2008-2012, at their August 2008 Meeting. Work is now underway
to identify sources of funding.

The main features of the NHS Grampian Dental Plan are :-

      To increase the number of dental care professionals working in Grampian. The
       targets are an extra 30 dentists by 2010 and a further 50 dentists by 2012.

      The registration of 124,000 new patients by 2012.

      The opening of a new NHS Dental School in Grampian to train dentists locally.

      The opening of new dental centres and the updating of existing dental premises at a
       cost of £11.4 million.

      An increase in preventative care and oral health promotion.

All of the action required to improve the provision of NHS dental care in Grampian is
already being vigourously progressed by the NHS Grampian Dental Service.

(ii). There is nothing NHS Grampian can do with regard to reducing the cost of private
dental health care in Grampian. However, the NHS Grampian Dental Plan, when
implemented, will give most people the choice between an NHS dentist or a private
dentist.

(iii). More work needs to be done to promote the work of the Emergency Dental Service
amongst the local ethnic communities. Leaflets and posters need to be produced in the
main local ethnic community languages and widely distributed through libraries, ethnic
community organisations, schools, community staff, GP Practices, hospitals, the three
Local authorities, the Grampian Racial Equality Council, English as a Second/Alternative
Language Services and employers with a large ethnic community workforce. This work


                                             10
NHS Grampian
will be progressed by the NHS Grampian Racial Equality Working Group, in close co-
operation with NHS Grampian Dental Services.



7. GP services
When involvement and consultation events took place during 2006 and early 2007, it
quickly became clear that only half of the participants were registered with a GP. As a
result, a massive campaign was launched to encourage recent migrant workers and their
families to register with their local GP. A booklet was produced explaining why people
should register, how to register, the range of services on offer and explaining entitlement
to free NHS Health care. The booklet was produced in English, Polish, Latvian,
Lithuanian, Russian and Portuguese and given a massive distribution in both hard copy
and electronic formats. Over 4,000 booklets in hard copy have been distributed. The
booklet is also in use in five other Health Boards in Scotland.

Approximately 90% of the participants at the three 2008 involvement and consultation
events were registered with a GP. This would suggest that the campaign to encourage
recent migrant workers and their families to register with their local GP, has been
successful. The campaign is still ongoing. Feedback on GP services was extremely
positive, most commented favourably on the high quality of care provided. Naturally, the
discussions focussed on any areas where the service could be improved.


a). The topics raised
(i). Many participants said that it usually took 3-4 days to see their GP. This was of
particular concern to families with babies and small children. Many recent migrant workers
from Eastern Europe advised that in their country of origin, they were used to immediate
access to their GP. From the discussion groups, it became apparent that many people
thought that if they registered with a GP, they could only see that specific GP, not realising
that they could on many occasions ask to see any GP in the Practice and thereby receive
a quicker appointment. In addition, many people did not realise the importance of clearly
stating the seriousness of a problem when making an appointment.

(ii). Many recent migrant workers from the Peterhead and Fraserburgh areas who were
non-English speaking advised that they had problems communicating with the GP
reception staff and their GP. Some commented on the limited availability of the “Language
Line” telephone interpretation system and the non-availability of “face to face” interpreters.
As a result, a number had resorted to taking along a friend to interpret. Feedback from the
involvement and consultation events consistently referred to GP Reception and other
Practice staff not being aware of the needs of recent migrant workers and their families.


b). The action required
(i). The time taken to see a GP usually depends on the urgency of the problem, as stated
when making the appointment. A willingness to see another GP in the same Practice, can
also reduce the waiting time. This information needs to be widely disseminated to our
local ethnic communities. The production of this information will be taken forward by the
NHS Grampian Racial Equality Working Group, in close co-operation with GPs and the
Local Community Health Partnerships.

                                             11
NHS Grampian

The Scottish Government “HEAT” target (Health improvement Efficiency and Access to
Treatment) for access to GP services in 2008 is to ensure that anyone contacting their GP
surgery will have guaranteed access to a GP, nurse or other health care professional
within 48 hours. This will lead to reduced waiting times.


(ii). In the Fraserburgh and Peterhead areas, there is a need to :-

      Provide more racial equality awareness training for GP Reception and Practice
       staff.

      Increase the numbers of staff trained in the use of the “Language Line” telephone
       interpretation service.

      Increase the number of “Language Line” Access Points.

      Increase the number of trained “face to face” interpreters available in North
       Aberdeenshire.

This work will be taken forward by the Equality and Diversity Manager, in co-operation with
the Fraserburgh and Peterhead GPs, the North Aberdeenshire Local Community Health
Partnership and the Grampian Racial Equality Council.



8. Racial equality awareness training for NHS Grampian staff

a). The topics raised
Feedback from the involvement and consultation events referred to a small minority of
NHS Grampian staff, in different parts of Grampian, not being aware of the needs of the
recent migrant workers and their families.


b). The action required
A great deal of racial equality training has been undertaken by NHS Grampian over the
last three years. However, not all staff have received training and there are also new staff
who still need to be trained. Racial equality awareness training will be stepped up.
Training will be provided for 900 staff per year, for the next three years to overcome this
problem. The training will be provided by the NHS Grampian Equality and Diversity
Manager on a joint basis with the Grampian Racial Equality Council and in close co-
operation with the Local Community Healthcare Partnerships, Acute Sector and Mental
Health Service.




9. Information on specific health care services

                                             12
NHS Grampian

a). The topics raised
Many members of our local ethnic communities acknowledged that a great deal of
information has been produced by NHS Grampian, in the main local ethnic community
languages. However, the clear message was that more information is required. The health
care services for which more information is required are :-
          Maternity Services, including follow up care and information on postnatal checks
           carried out on babies

          Ophthalmic Services

          Pharmacists

          Community Services provided by Health Visitors, District Nurses, Community
           Midwives and Community Nurses.

          School Health, what the service provides.

          Contraception and sexual health services.

          Alcohol, drugs and smoking cessation.

          How to access emergency services.


b). The action required
The NHS Grampian Racial Equality Working Group will work closely with all of the services
concerned to produce the required information. Depending on the volume of material, it
may be possible to combine all of the information into one or more booklets. The drafts of
all material produced will go out to our local ethnic communities, for consultation, prior to
being finalised. The information will then be made very widely available, in both electronic
and hard copy formats, in all of the main local ethnic community languages.

NHS Grampian will also fund the expansion of the translation service provided by the
Grampian Racial Equality Council. This will increase capacity and reduce turnaround
times for the translation of material.




10. The NHS Grampian 2008/09 Racial Equality Action Plan :
  implementing the Race Equality Scheme
The main vehicle to implement the Race Equality Scheme will be Annual Action Plans.
The NHS Grampian Racial Equality Working Group have designed the 2008/09 Action
Plan to give a great deal of excellent progress in the identified key areas of need, in a cost
effective manner. A copy of the proposed 2008/09 Action Plan is attached at Appendix I.


The enthusiastic and committed support of the Health Board, Chair, Chief Executive,
Director of Corporate Communications and managers and staff for this work, is gratefully
                                              13
NHS Grampian
acknowledged. We are also grateful for the active engagement of our local ethnic
communities.



11. Consultation on the Race Equality Scheme
The NHS Grampian Race Equality Scheme 2008-2011 was issued as a consultation draft
on Wednesday 8th October 2008, for a three week period. The deadline for comments is
Wednesday 29th October 2008.

Copies have been sent out in either electronic and hard copy format to :- 18 local ethnic
community groups, the three Local Authorities, other partner organisations, interested
individuals, the NHS Grampian website, Community Websites, Community Forums,
Hi-Net, Patient Focus Public Involvement Groups, all 14,252 NHS Grampian Staff, the
NHS Grampian Area Partnership Forum, all Scottish Health Boards, the National
Resource Centre for Ethnic Minority Health, Health Scotland and the Equality and Human
Rights Commission. In addition, GREC have offered to use their extensive network to
ensure that that the consultation draft reaches the smaller and more geographically remote
ethnic communities. The consultation draft has also been made available to the wider
community in Grampian.



12. The size and diversity of the local ethnic communities served
Grampian is currently undergoing the biggest population change in its history. The 2001
Census showed that Grampian had a diverse range of local ethnic communities who
numbered 18,908 in total. However, these figures are now completely out of date. The
Census results do not reflect the substantial influx of mostly Eastern European migrant
workers and their families coming to Grampian since the expansion of the European
Economic Area on 1st May 2004.

In the period May 2004 to May 2006, it is estimated that approximately 800 migrant
workers and their families, came to Grampian every month. From May 2006 to June 2008,
this figure increased to approximately 1,200 per month. From July 2008 onwards, there is
clear evidence that this figure reduced to just over 800 per month.

As at September 2008, it is estimated that inward migration since 2004, has increased
the size of the local ethnic communities in Grampian to 71,308 or 12.4% of the population
of Grampian (total population of Grampian 571,136)

Grampian is an attractive destination for inward migration due to the availability of large
numbers of jobs and secondly, the availability of low cost accommodation in some areas.
More information on the way this estimate has been complied is shown at Appendix II.

The two main areas where recent migrant workers and their families have settled in
Grampian are Aberdeen City and the Buchan Coast around Fraserburgh and Peterhead.
There are smaller numbers in Moray, Central and South Aberdeenshire.

13. NHS Grampian racial equality policy statement


                                             14
NHS Grampian
      NHS Grampian is totally committed to the promotion of racial equality in all of the
       services it provides. It will comply fully with the Racial Equality Laws, Scottish
       Government Policies and Good Practice Guidelines. NHS Grampian will strive to
       be a model of good practice within Scotland and work towards cultural competence.

      Racial equality work within NHS Grampian will have two strands. Firstly, to improve
       and develop services in targeted areas of identified need. Secondly, to bring racial
       equality work into the mainstream.

      There will be full and regular consultation with members of the local ethnic
       communities, representative groups and the Grampian Racial Equality Council.

      Whenever possible, NHS Grampian will adopt a partnership approach, working
       closely with the Grampian Racial Equality Council, local ethnic community groups,
       local authorities and other Health Boards and interested parties.

      Annual Racial Equality Action Plans will be developed, implemented and monitored.
       The emphasis will be on practical and lasting improvements in the quality of
       services provided. Due to the rapidly changing make-up of the local ethnic
       population, NHS Grampian will keep under review the needs of the ethnic
       communities and respond flexibly to any changes required.

      The racial equality work of NHS Grampian will be implemented by the Equality and
       Diversity Manager, NHS Grampian, supported by the Racial Equality Working
       Group.

      NHS Grampian staff will receive full and appropriate training to help them meet the
       needs of the local ethnic communities. When proposals are being formulated to
       enhance existing healthcare services or to develop new services, the needs of the
       local ethnic communities will be taken fully into account.

      Any organisation undertaking work on behalf of NHS Grampian, or supplying any
       type of service, must fully meet the NHS Grampian standards of compliance with
       the Racial Equality Laws, Scottish Government Policies and Good Practice
       Guidelines. Failure to do so will result in the issue of a warning notice setting a
       reasonable period to effect the improvements required. If, after a reasonable
       period, the necessary improvements have not been made, NHS Grampian will
       terminate contracts and may refer the matter to the Equality and Human Rights
       Commission.


14. Roles and responsibilities
The Chief Executive of NHS Grampian is ultimately responsible to the NHS Grampian
Board for all matters related to racial equality. This responsibility has been assigned by
the Chief Executive, on a day to day basis to the Director of Corporate Communications.
Implementing the Race Equality Scheme is the responsibility of the NHS Grampian
Equality and Diversity Manager, supported by a Racial Equality Working Group.


15. Equality and Diversity Impact Assessment

                                             15
NHS Grampian
All new or updated NHS Grampian-wide policies are Equality and Diversity Impact
Assessed using the prescribed methodology. This process has been in place since May
2005. NHS Grampian has a trained Impact Assessor Trainer, who has trained 47
managers and staff to be Level One Impact Assessors. The next Training Seminar to train
additional Impact Assessors will be held in December 2008. At present, work is underway
to Impact Assess existing policies and strategies. Each area within NHS Grampian which
generates polices or strategies should ideally, have at least two trained Impact Assessors.

NHS Grampian has also trained Impact Assessors for other organisations, free of charge,
in a spirit of co-operation and joint working. These organisations include :-

      The Scottish Ambulance Service
      Grampian Police
      Grampian Fire and Rescue Service
      The Moray Council
      Aberdeen City Council
      Aberdeenshire Council
      The Scottish national blood Transfusion service
      Three local charities



16. Monitoring, complaints and racist incidents
There are many ways in which the progress made by NHS Grampian towards becoming a
culturally competent organisation is monitored. These are :-


a). Monitoring within NHS Grampian
(i) The NHS Grampian Senior Management Team and Board
 Have an overview of progress on an annual basis.

(ii) The Annual NHS Grampian Racial Equality Workforce Monitoring Report
NHS Grampian carefully monitors racial equality within its own workforce. Each year, an
NHS Grampian Racial Equality Workforce Monitoring Report is produced. The report is
discussed and agreed at a Health Board meeting, before it is widely distributed. The
2007/08 Report was approved at the August 2008 Health Board meeting. The Board noted
the overall satisfactory position of NHS Grampian in relation to racial equality within its
own workforce.

(iii) The NHS Grampian Racial Equality Working Group
This multi-disciplinary Group is responsible for producing the NHS Grampian Race
Equality Schemes and driving forward the work of the Annual Racial Equality Action Plans,
to ensure progress is maintained. The group has ethnic community representation and
meet monthly. Monitoring is one of its core functions.




(iv) Complaints

                                            16
NHS Grampian
Any complaint received by the NHS Grampian Complaints Service, from either a member
of an ethnic community or with a racial element or a discriminatory element, is immediately
copied to the NHS Grampian Equality and Diversity Manager, for follow up, as appropriate.
Follow up investigations may involve members of the Racial Equality Working Group, the
Grampian Racial Equality Council and other individuals

(v) Monitoring of racist incidents
NHS Grampian has in place a “Zero Tolerance Policy” for any kind of verbal abuse, racial
abuse or assault incidents. These are all recorded and followed up. Details of any
incident with a racist element are forwarded to the Equality and Diversity Manager and
considered by the Racial Equality Working Group. Follow up action is taken as
appropriate, often involving other agencies and the police, if they have not already been
involved.


b). Monitoring by other bodies within the Scottish Health Service
(i) The Scottish Government Annual Performance Review
The progress made by NHS Grampian in the field of racial equality is monitored as part of
the Annual Performance Review by the Health and Social Care Minister.

(ii) National Resource Centre For Ethnic Minority Health
This monitoring is done via bi-monthly meetings and questionnaires.

(iii) The Scottish Health Council
The Scottish Health Council have a formal monitoring role for racial equality and request
detailed information on a regular basis.

(iv) Quality Improvement Scotland (QIS)
QIS include racial equality as a key element in their monitoring and assessment of clinical
and non-clinical services.


c). Monitoring from outwith the NHS
(i) Equality and Human Rights Commission (EHRC)
The EHRC have a statutory monitoring and enforcement role. The EHRC have regular
contact with Health Boards and monitor statutory compliance and investigate any alleged
breaches.

(ii) Racist incident partnerships in Grampian
There are three racist incident partnerships in Grampian, each following the Local
Authority boundaries. Membership comprises the Grampian Police, Local Authority
representatives from areas such as Education and Social Work, NHS Grampian, local
ethnic community groups, the Grampian Racial Equality Council, the Procurator Fiscals
Office, Universities, colleges and victim support groups. Their role is to monitor trends in
racist incidents and agree an Action Plan to effect reductions in the number of incidents.
The Grampian Police have a lead role in each Racist Incident Partnership.




                                             17
NHS Grampian
d). General Point on monitoring
The monitoring of service provision is very important. However, the NHS Grampian Racial
Equality Working Group are very much aware that the key indicator of success must be
whether the local ethnic communities themselves feel that they have improved access to
the healthcare services we provide and that their needs are being met. Hence the
importance of regular involvement and consultation events and regular contact with
members of the local ethnic communities and their representative organisations.



17. Procurement of goods and services
NHS Grampian is responsible for meeting the requirements of all racial equality legislation
and the Scottish Government Policy “Fair for All”, when services are contracted out to
other agencies.

Since August 2005, NHS Grampian has :-

(i) Required any new supplier of services to state whether they have in place sound racial
equality procedures. If they do not, it is a condition of contract that they must introduce and
enforce racial equality policies.

(ii) As each NHS Grampian local contract comes up for renewal, the standard contract
documentation includes reference to the mandatory requirement for the supplier to have in
place and to enforce, an effective racial equality policy.

(iii) Any supplier found to be operating in a way inconsistent with the Racial Equality Laws
or in a way contrary to good practice, will be given a reasonable period of time to effect the
improvements required. Failure to do so may result in the contract being summarily
terminated and the matter being referred to the Equality and Human Rights Commission.



18. Maintaining progress in 2009/10 and 2010/2011
NHS Grampian will develop and implement Racial Equality Action Plans during 2009/10
and 2010/2011. These Action Plans will be ambitious and will take forward the area of
work identified as priorities by our local ethnic communities. The Action Plans will also be
updated to take on board information from further involvement and consultation events.




                                              18
NHS Grampian


                                   Race Equality Scheme Appendix I




               NHS Grampian
               Racial Equality
                Action Plan

                     2008/09


                Produced by the NHS Grampian
                 Racial Equality Working Group

                        October 2008




                              19
NHS Grampian


              NHS Grampian Racial Equality Action Plan 2008/09


1. Introduction
NHS Grampian as a Public Body has a legal duty to actively promote racial equality in all
aspects of the healthcare services it provides. It also has a duty under the Scottish
Executive Policy "Fair For All", to develop and implement Annual Racial Equality Action
Plans to continue to make progress towards cultural competence.

The Annual Racial Equality Action Plans are the main vehicle by which the objectives
identified in the NHS Grampian Race Equality Schemes are taken forward and achieved.

The three NHS Grampian Racial Equality Action Plans produced in the period 2005–2008,
have made excellent progress to implement the objectives of the NHS Grampian Race
Equality scheme 2005-2008. This Action Plan is the first to implement the objectives of
the new 2008-2011 NHS Grampian Race Equality Scheme.

As with previous Racial Equality Action Plans, the emphasis is on practical, lasting,
measurable and sustainable improvements, that will directly benefit all members of the
communities we serve. The 2008-2011 Race Equality Scheme, is an opportunity to set
our sights even higher.

As in previous years, financial resources within NHS Grampian are limited. Accordingly,
the 2008/09 Action Plan has been designed by the NHS Grampian Racial Equality
Working Group to achieve a great deal of excellent progress in the identified key areas of
need, for a very modest cost. Details of the costs are shown at Section 13 below. The
membership of the NHS Grampian Racial Equality Working Group who produced this
Action Plan is shown at Appendix I.

The vigorous support of the Chair, Board, Chief Executive, General Managers, the Director
of Corporate Communications and very large groups of managers and staff for this work is
gratefully acknowledged. We are also grateful for the active engagement of our local
ethnic communities.

The work to be undertaken during 2008/09 is summarised in tabular form at Appendix II.



2. Priority areas of work
The Action Plan has been directly informed by the priorities identified by the local ethnic
communities, as expressed in the three involvement and consultation events organised in
June, August and September 2008. This information has been supplemented by input from
local ethnic community groups and from front line NHS Grampian staff who provide
services to the local ethnic communities.

The four priority areas for improvement in the quality of the services provided, as identified
by our local ethnic communities, are shown in Sections 3- 6 below. These have been
supplemented by three items namely :- Racial Equality Monitoring within NHS Grampian,


                                              20
NHS Grampian
Equality and Diversity Impact Assessment and the need to further expand the availability
of the “Language Line” telephone interpretation system across NHS Grampian.



3. Improved access to dental services
a). The topics raised
(i). Few members of our local ethnic communities have access to an NHS dentist. This
problem is particularly acute for recent migrant workers and their families. A number of
recent migrant workers and their families, have made special visits to their countries of
origin such as Poland, Lithuanian or Latvia, to obtain dental treatment. In these countries,
they have access to a same day dental services, at a modest cost.

(ii). Many participants in the involvement and consultation events commented on the high
cost of private dental treatment in Grampian.

(iii). Few participants had heard of the Emergency Dental Service provided by NHS
Grampian.


b). The action required
(i). The shortage of NHS dentists has been a UK – wide problem for some time. Locally,
the shortage is a serious issue in all areas of Grampian and amongst all communities.
The NHS Grampian Health Board have responded to the problem by approving the NHS
Grampian Dental Plan 2008-2012, at their August 2008 Meeting. Work is now underway
to identify sources of funding.

The main features of the NHS Grampian Dental Plan are :-

      To increase the number of dental care professionals working in Grampian. The
       targets are an extra 30 dentists by 2010 and a further 50 dentists by 2012.

      The registration of 124,000 new patients by 2012.

      The opening of a new NHS Dental School in Grampian to train dentists locally.

      The opening of new dental centres and the updating of existing dental premises at a
       cost of £11.4 million.

      An increase in preventative care and oral health promotion.

All of the action required to improve the provision of NHS dental care in Grampian is
already being vigourously progressed by the NHS Grampian Dental Service.

(ii). There is nothing NHS Grampian can do with regard to reducing the cost of private
dental health care in Grampian. However, the NHS Grampian Dental Plan, when
implemented, will give most people the choice between an NHS dentist or a private
dentist.



                                             21
NHS Grampian
(iii). More work needs to be done to promote the work of the Emergency Dental Service
amongst the local ethnic communities. Leaflets and posters need to be produced in the

main local ethnic community languages and widely distributed through libraries, ethnic
community organisations, schools, community staff, GP Practices, hospitals, the three
Local authorities, the Grampian Racial Equality Council, English as a Second/Alternative
Language Services and employers with a large ethnic community workforce. This work
will be progressed by the NHS Grampian Racial Equality Working Group, in close co-
operation with NHS Grampian Dental Services.



4. GP services
When involvement and consultation events took place during 2006 and early 2007, it
quickly became clear that only half of the participants were registered with a GP. As a
result, a massive campaign was launched to encourage recent migrant workers and their
families to register with their local GP. A booklet was produced explaining why people
should register, how to register, the range of services on offer and explaining entitlement
to free NHS Health care. The booklet was produced in English, Polish, Latvian,
Lithuanian, Russian and Portuguese and given a massive distribution in both hard copy
and electronic formats. Over 4,000 booklets in hard copy have been distributed. The
booklet is also in use in five other Health Boards in Scotland.

Approximately 90% of the participants at the three 2008 involvement and consultation
events were registered with a GP. This would suggest that the campaign to encourage
recent migrant workers and their families to register with their local GP, has been
successful. The campaign is still ongoing. Feedback on GP services was extremely
positive, most commented favourably on the high quality of care provided. Naturally, the
discussions focussed on any areas where the service could be improved.


a). The topics raised
(i). Many participants said that it usually took 3-4 days to see their GP. This was of
particular concern to families with babies and small children. Many recent migrant workers
from Eastern Europe advised that in their country of origin, they were used to immediate
access to their GP. From the discussion groups, it became apparent that many people
thought that if they registered with a GP, they could only see that specific GP, not realising
that they could on many occasions ask to see any GP in the Practice and thereby receive
a quicker appointment. In addition, many people did not realise the importance of clearly
stating the seriousness of a problem when making an appointment.

(ii). Many recent migrant workers from the Peterhead and Fraserburgh areas who were
non-English speaking advised that they had problems communicating with the GP
reception staff and their GP. Some commented on the limited availability of the “Language
Line” telephone interpretation system and the non-availability of “face to face” interpreters.
As a result, a number had resorted to taking along a friend to interpret. Feedback from the
involvement and consultation events consistently referred to GP Reception and other
Practice staff not being aware of the needs of recent migrant workers and their families.




                                             22
NHS Grampian


b). The action required
(i). The time taken to see a GP usually depends on the urgency of the problem, as stated
when making the appointment. A willingness to see another GP in the same Practice, can
also reduce the waiting time. This information needs to be widely disseminated to our
local ethnic communities. The production of this information will be taken forward by the
NHS Grampian Racial Equality Working Group, in close co-operation with GPs and the
Local Community Health Partnerships.

The Scottish Government “HEAT” target (Health improvement Efficiency and Access to
Treatment) for access to GP services in 2008 is to ensure that anyone contacting their GP
surgery will have guaranteed access to a GP, nurse or other health care professional
within 48 hours. This will lead to reduced waiting times.


(ii). In the Fraserburgh and Peterhead areas, there is a need to :-

      Provide more racial equality awareness training for GP Reception and Practice
       staff.

      Increase the numbers of staff trained in the use of the “Language Line” telephone
       interpretation service.

      Increase the number of “Language Line” Access Points.

      Increase the number of trained “face to face” interpreters available in North
       Aberdeenshire.

This work will be take forward by the Equality and Diversity Manager, in co-operation with
the Fraserburgh and Peterhead GPs, the North Aberdeenshire Local Community Health
Partnership and the Grampian Racial Equality Council.



5. Racial equality awareness training for NHS Grampian staff

a). The topics raised
Feedback from the involvement and consultation events referred to a small minority of
NHS Grampian staff, in different parts of Grampian, not being aware of the needs of the
recent migrant workers and their families.


b). The action required
A great deal of racial equality training has been undertaken by NHS Grampian over the
last three years. However, not all staff have received training and there are also new staff
who still need to be trained. Racial equality awareness training will be stepped up.
Training will be provided for 900 staff per year, for the next three years to overcome this
problem. The training will be provided by the NHS Grampian Equality and Diversity
Manager on a joint basis with the Grampian Racial Equality Council and in close co-

                                             23
NHS Grampian
operation with the Local Community Healthcare Partnerships, Acute Sector and Mental
Health Service.



6. Information on specific health care services
a). The topics raised
Many members of our local ethnic communities acknowledged that a great deal of
information has been produced by NHS Grampian, in the main local ethnic community
languages. However, the clear message was that more information is required. The health
care services for which more information is required are :-
         Maternity Services, including follow up care and information on postnatal checks
          carried out on babies

         Ophthalmic Services

         Pharmacists

         Community Services provided by Health Visitors, District Nurses, Community
          Midwives and Community Nurses.

         School Health, what the service provides.

         Contraception and sexual health services.

         Alcohol, drugs and smoking cessation.

         How to access emergency services.


b). The action required
The NHS Grampian Racial Equality Working Group will work closely with all of the services
concerned to produce the required information. Depending on the volume of material, it
may be possible to combine all of the information into one or more booklets. The drafts of
all material produced will go out to our local ethnic communities, for consultation, prior to
being finalised. The information will then be made very widely available, in both electronic
and hard copy formats, in all of the main local ethnic community languages.

NHS Grampian will also fund the expansion of the translation service provided by the
Grampian Racial Equality Council. This will increase capacity and reduce turnaround
times for the translation of material.




7. Racial Equality Monitoring within NHS Grampian
NHS Grampian carefully monitors racial equality within its own workforce. Each year, an
NHS Grampian Racial Equality Workforce Monitoring Report is produced. The report is
discussed and agreed at a Health Board meeting, before it is widely distributed. The
                                             24
NHS Grampian
2007/08 Report was approved at the August 2008 Health Board meeting. The Board noted
the overall satisfactory position of NHS Grampian in relation to racial equality within its
own workforce. Work will continue to collect and collate the information required to
produce the 2008/09 Monitoring Report.

8. Equality and Diversity Impact Assessment
All new or updated NHS Grampian-wide policies must be Impact Assessed using the
prescribed methodology. This process has been in place since May 2005. NHS
Grampian has a trained Impact Assessor Trainer, who has trained 47 managers and staff
to be Level One Impact Assessors. The next one day Training Seminar to train additional
Impact Assessors will be held in December 2008. At present, work is underway to Impact
Assess existing policies and strategies. Each area within NHS Grampian which generates
polices or strategies should ideally, have at least two trained Impact Assessors.

NHS Grampian has also trained Impact Assessors for other organisations, free of charge,
in a spirit of co-operation and joint working. These organisations include :-

      The Scottish Ambulance Service
      Grampian Police
      Grampian Fire and Rescue Service
      The Moray Council
      Aberdeen City Council
      Aberdeenshire Council
      Scottish National Blood Transfusion Service
      Three local charities



9. “Language Line”
Due to the increasing numbers of non-English speaking patients in Grampian, it is
important to expand the availability of the “Language Line” telephone interpretation
system, across Grampian.

The aim is to increase the number of fixed landline Access Points from 350 to 450,
increase the number of Mobile Access Kits by 60 and provide an additional 20 Polycom
conference call units.




                                             25
 NHS Grampian


 10. Cost summary for the 2008/09 Action Plan

Item                                                                 Cost in 2008/09
Dental services

(i) Improved access to NHS dental services.                 The NHS Dental Plan 2008 -2012
                                                             has been approved by the NHS
This work is already being taken forward by Dental          Grampian Health Board. Work is
Services.                                                    underway to identify sources of
                                                                       funding.



(ii) Production of leaflets and posters in the main local                £2,350
ethnic community languages to promote the Emergency                 (Already funded)
Dental Service

GP Services

(i) Production of leaflets in the main local ethnic                      £2,150
community languages, to explain how to get the most                  Already funded
from GP services. Distribution of leaflets NHS
Grampian-wide.


(ii) Provide racial equality awareness training for GP       Training will be provided as part
Reception and Practice staff in the Fraserburgh and           of the £10,000 Annual Racial
Peterhead areas.                                              Equality Training Programme


(iii) Expand the provision of the “Language Line”           Already funded as part of the
telephone interpretation system in North                    drive to increase “”Language
Aberdeenshire.                                              Line” Access Points from 350 to
                                                            450 by 31st March 2009.

                                                               Equipment cost of £13,800
                                                                    already funded.

                                                             Additional revenue costs will be
                                                             met by the North Aberdeenshire
                                                                          LCHP.


(iv) Create a pool of trained and competency assessed         The Grampian Racial Equality
“face to face” interpreters in the North Aberdeenshire      Council have already been funded
and Moray areas.                                            to carry out this work on behalf of
                                                               NHS Grampian, at a cost of
                                                                          £10,000



                                               26
 NHS Grampian
Racial equality awareness training for NHS
Grampian staff

Provide more racial equality awareness training for           Already funded. Training to be
NHS Grampian staff. Step up the programme to provide         provided on a joint basis with the
training for 900 staff per year.                             Grampian Racial Equality Council

Information on specific health care services
Produce leaflets and posters in the main local ethnic
community languages, for four of the 8 identified priority
areas. The 8 priority areas are :-
        Maternity Services, follow up care and
         information on postnatal checks carried out
         on babies
        Ophthalmic Services
        Pharmacists                                           Production and translation of
        Community Services provided by Health                  information for four of the 8
         Visitors, District Nurses, Community                   priority areas, cost £11,000
         Midwives and Community Nurses.                                Already funded.
        School Health, what the service provides.
        Contraception and sexual health services.
        Alcohol, drugs and smoking cessation.
        How to access emergency services.



Racial Equality Monitoring within NHS
Grampian
Collection and collation of the information required to
produce the NHS Grampian Racial Equality Workforce             Programme of work already
Monitoring Report 2008/09.                                             funded


Equality and Diversity Impact Assessment
Work ongoing, already funded. A Seminar to train more
Level one impact assessors will be held in December                   Already funded
2008.

“Language Line”
Increase the numbers of fixed “Language Line” access
points from 350 to 450, increase the numbers and                      Already funded
Mobile access Kits by 60 and expand Polycom
conference call facilities to a further 20 locations.

                             Total budget allocated                      £60,300




                                               27
NHS Grampian


                                                     Action Plan Appendix I


     Members of the NHS Grampian Racial Equality Working Group


Ms Jennie Biggs, Alcohol Advisor/Partnership Representative

Staff Nurse Rosie Bird, Representing A&E

Ms Sarah Campbell, Grampian Racial Equality Council

Ms Fran Doorghan, Community learning Disability Nurse

Ms Jeannie Felsinger, Director, Grampian Racial Equality Council

Mr Nigel Firth, Equality and Diversity Manager (Chair)

Mrs Margaret Gray, Learning and Development Manager

Mrs Lakshmi Mani, Ethnic Community Representative

Mrs Laura McKenna, Support Services Manager

Mr Bill Mitchell, Support Services Manager, Mental Health

Noor Mohd-Nor, Grampian Racial Equality Council

Mr Gregory Poon, Lead Nurse, Aberdeen City CHP

Ms Helen Thompson, HR Officer, Moray

Ms Andrea Thomson, Equality and Diversity Assistant




                                      28
                                                                                                                  Action Plan Appendix II

                                             Racial Equality Action Plan : Supporting Actions


        Priority Area                               Action                                    Actioned By :-                Completed By :-

Dental services


(i) Improved access to          Implement the NHS Grampian Dental Plan            NHS Grampian Dental Services.                  2012
dental services                 2008-2012.


(ii) Improve awareness of       Production of leaflets and posters in the main    The Equality and Diversity Manager
the NHS Grampian                local ethnic community languages to promote       assisted by the NHS Grampian Racial
Emergency Dental Service        the Emergency Dental Service                      Equality Working Group, in co-operation    February 2009
amongst the members of                                                            with NHS Grampian Dental Services,
the local ethnic                                                                  the Grampian Racial Equality Council
communities.                                                                      and members of the local ethnic
                                                                                  communities.

GP Services

(i). Provide the local ethnic   Production of leaflets in the main local ethnic   The Equality and Diversity Manager
communities with more           community languages to explain how to get the     assisted by the NHS Grampian Racial         March 2009
information about GP            most from GP services. Distribution of leaflets   Equality Working Group, in co-operation
services.                       NHS Grampian-wide.                                with GPs, Practice Managers, and the
                                                                                  LCHP`s, the Grampian Racial Equality
                                                                                  Council and members of the local ethnic
                                                                                  communities.
     NHS Grampian

(ii) Improve the patient       Provide racial equality awareness training for     The Equality and Diversity Manager, in
experience for members of      GP Reception and Practice staff in the             co-operation with the Grampian Racial
the local ethnic communities   Fraserburgh and Peterhead areas.                   Equality Council, GPs and the North        February 2009
using GP services in the                                                          Aberdeenshire LCHP Management
Fraserburgh and Peterhead                                                         Team.
areas.




(iii) Make “Language Line”     Increase the number of staff trained in the use    The NHS Grampian Equality and
more readily available in      of “Language Line and provide a further 20         Diversity Manager, in co-operation with      March 2009
North Aberdeenshire LCHP       Access Points.                                     GPs and the North Aberdeenshire
                                                                                  LCHP Management Team.



(iv) Make “face to face”       Create a pool of trained and competency            The Grampian Racial Equality Council
interpreters more readily      assessed “face to face” interpreters in the        have already been funded to carry out        March 2009
available in North             North Aberdeenshire and Moray areas.               this work on behalf of NHS Grampian.
Aberdeenshire.


Racial equality
awareness training for
NHS Grampian staff

Provide more racial equality   Step up the current programme to train 900         The Equality and Diversity Manager, in    New programme to
awareness training for NHS     staff per year.                                    co-operation with the Grampian Racial       be in place by
Grampian staff.                                                                   Equality Council.                          December 2008.




                                                                             30
     NHS Grampian
Information on
specific health care
services

Meet the identified         Production of leaflets and posters in the main    The Equality and Diversity Manager, in    Information on four
information needs arising   local ethnic community languages, for four of     co-operation with each of the services   of the eight services
from the involvement and    the eight identified priority areas. The eight    concerned, the Grampian Racial            to be available and
consultation events.        priority areas are :-                             Equality council and members of the      distributed by March
                                     Maternity Services, follow up care      local ethnic communities.                        2009.
                                        and information on postnatal checks
                                        carried out on babies
                                     Ophthalmic Services
                                     Pharmacists
                                     Community Services provided by
                                        Health Visitors, District Nurses,
                                        Community Midwives and
                                        Community Nurses.
                                     School Health, what the service
                                        provides.
                                     Contraception and sexual health
                                        services.
                                     Alcohol, drugs and smoking
                                        cessation.
                                     How to access emergency services.




                                                                       31
     NHS Grampian


Racial Equality       Collection and collation of the information                 Hall Harper, Partnership and           2008/09 Report to
Monitoring within NHS required to produce the NHS Grampian Racial                  Staff Governance Manager              be available by July
                      Equality Workforce Monitoring Report 2008/09                                                              2009
Grampian                                                                          Ann Miller, Workforce Information
                                                                                   Analyst
                                                                                  Ed Rennie, Head of HR
                                                                                  Anne Inglis, Head of Learning
                                                                                   and Development
                                                                                  Richard Morrison, Head of
                                                                                   Service, Human Resources
                                                                                   Service Centre
                                                                                  Jen Park, Recruitment Manager
                                                                                  Neil Gordon, HRSC Team leader
                                                                                   Systems Development
                                                                                  Diane Annand, Project Manager
                                                                                   Agenda for Change
                                                                                  Nigel Firth, Equality and Diversity
                                                                                   Manager (to co-ordinate).


Equality and Diversity
Impact Assessment
Continue to meet the            Equality and Diversity Impact Assess all                                                     Ongoing
statutory requirements of        new or updated NHS Grampian policies
the NHS Reform (Scotland)        or strategies.
Act 2004.                       Continue the process to Impact Assess      The 47 NHS Grampian Impact                        Ongoing
                                 existing policies or strategies.           Assessors.
                                Train additional level One Impact
                                 Assessors.
                                Run one training additional course         Equality and Diversity Manager                December 2008


                                                                    32
      NHS Grampian



“Language Line”

 (i) Increase the number of   Meet all current requests by sourcing the
fixed line “Language Line”    necessary equipment.                              The Equality and Diversity Manager,
Access Points from 350 to                                                       Equality and Diversity Assistant, Mr Ian   March 2009
450.                             For each area carry out :-                     Gulline, Voice Service Manager,
                                  A full technical assessment                  Communications Centre.
                                  Provide staff training
                                  Produce and issue the “Language Line”
                                    Access Kits.
                                  Provide ongoing support


(iii) Roll out a further 60         Identify the areas where the Mobile Kits   The Equality and Diversity Manager,
Mobile Access Kits for               are required                               Equality and Diversity Assistant, Mr Ian   January 2009
community staff.                    Provide training                           Gulline, Voice Service Manager,
                                    Issue the Mobile Kits                      Communications Centre, Sector and
                                                                                LCHP staff.


(iv) Provide a further 20           Identify the areas where the Polycom       The Equality and Diversity Manager,
Polycom Conference call              Units are required                         Equality and Diversity Assistant, Mr Ian   March 2009
units                               Provide training                           Gulline, Voice Service Manager,
                                    Issue the Polycoms                         Communications Centre, Sector and
                                                                                LCHP staff.



      NGF/REWG/October 2008




                                                                          33
NHS Grampian




                                           Race Equality Scheme Appendix II


                           Demography in Grampian
Grampian is currently undergoing the biggest population change in its history. The
main reasons for this increase are:-

(i) May 2004 – May 2006
From 1st May 2004, there was a large influx of migrant workers and their families
into Grampian from the Eastern European Countries who joined the European
Economic Area (EEA). The main countries of origin were Poland, Lithuania and
Latvia. It has been difficult to establish definitive figures for the influx. However,
both the Grampian Racial Equality Council (GREC) and the NHS Grampian Racial
Equality Working Group agreed that from their knowledge, an estimated figure of
around 800 migrant workers and family members per month, coming to
Grampian, in the period May 2004 to May 2006, was realistic. Of these 800
approximately 400 were Polish.

To try and obtain more definitive information, a number of agencies such as the
Immigration Service and Practitioner Services were approached but these
organisations had only limited data.

The Ebury House Office of Jobcentre Plus in Aberdeen were able to provide some
useful statistics. Ebury House issues National Insurance numbers for all of
Aberdeen and large areas of Aberdeenshire. For North Aberdeenshire, National
Insurance numbers are issued by the Peterhead Job Centre.

National Insurance numbers are issued to eligible persons who are about to take up
employment. But national insurance statistics do not include non-working family
members.


(ii) May 2006 - June 2008
From May 2006 to June 2008, the numbers of migrant workers and their families
coming to Grampian increased to approximately 1,200 per month. For NHS
Grampian, this was reflected in the increased usage of “Language Line” telephone
interpretation services and requests for “face to face” interpreters. There was also
an increase in the volume of requests for health care material to be translated from
or into Polish, Latvian, Lithuanian and Russian. GP Practices in areas where there
was a substantial migrant worker population, such as North Aberdeenshire LCHP,
saw an increase in the numbers of migrant worker and their families seeking
treatment. There were also increasing numbers of migrant workers and their families
coming to Grampian from Estonia and the Czech Republic.




                                           34
NHS Grampian




(iii) July 2008 onwards
From July 2008 onwards, there is clear evidence that this figure has reduced to just
over 800 per month. The two major factors in this reduction are the reduced
volume of available jobs and the fall in the value of Sterling against the Polish Zloty.


Additional sources of information
Over the last two years, NHS Grampian has expanded its sources of information on
the numbers of migrant workers and their families coming to Grampian. We now
obtain information from :-

      GP Practices
      Hospitals
      Health Visitors, District Nurses, Community Midwives, Community Nurses and
       School Nurses
      “Language Line” Usage
      Demand for “face to face” interpreters
      Demand for documents in translation
      Local Authority Education Departments
      EAAL/ESL Departments
      Local ethnic community groups
      Inward Migration Units
      Employers with large number of migrant workers in their workforce

There are no definitive figures available for the increase in the numbers of migrant
workers and their families coming to Grampian. However, the more information that
we collect, the more accurate the NHS Grampian Racial Equality Working Group and
GREC estimate appears.

There is clear evidence that the overwhelming majority of the workers and their
families are not “migrant” but are permanently settling in Grampian. However, a very
small number of mostly Polish migrants are known to have returned to Poland, often
due to difficulties in getting their qualifications recognised in the UK.


(iv) Work Permit Holders
Many non-EEA nationals and nationals from countries that do not have EEA
reciprocal agreements enter the UK on a Work Permit each year. In Grampian there
are many Work Permit holders, most of whom are located around the Buchan Coast.
Most come from China. Work Permit holders and their families are not entitled to
free NHS health care if the Work Permit held is for less than 6 months. However,
they are entitled to free emergency care. If the Work Permit held is for more than 6
months, the Work Permit holder and their family are entitled to free NHS Health care.
Accordingly, Work Permit holders and their families tend to seek routine health care
only after they have been in Grampian for over 6 months.



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NHS Grampian




The Government does not record the number of Work Permits issued or the intended
destination of the Work Permit holders. Accordingly, there are no reliable statistics
on the number of Work Permit holders in Grampian. Recent discussions with a large
number of GPs and practice staff in North Aberdeenshire LCHP suggest that the
numbers are substantial. However, due to the lack of firm information, no estimate
of work permit holder numbers is included in the overall estimate of migrant workers
coming to Grampian.


(v) Asylum Seekers. Grampian is not an area to which asylum seekers have been
officially relocated, pending the application process. However, there is an unofficial
dispersal pattern which has seen approximately 20 asylum seekers per month come
to Grampian during 2005/06, 2006/07 and 2007/08. Most of the asylum seekers are
located in the North of Grampian. Asylum seekers are entitled to free NHS health
care, while their application for asylum is being considered, but are not permitted to
take up gainful employment. Accordingly, asylum seekers are not being included in
statistics on the issue of new National Insurance numbers.

(vi) Refugees. There are a small number of refugees in Grampian, mostly located
around the Buchan Coast. Refugees are entitled to free NHS health care, while their
application for refugee status is being considered, but are not permitted to take up
gainful employment. Accordingly, refugees are not included in statistics on the issue
of new National Insurance numbers.




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