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Stage 2 – Full Assessment
Please make sure that the Stage 1 Screening form is attached as it contains information you can
use in this stage of the assessment. (Please expand boxes as necessary)
Q1. Does the full assessment need to involve additional partners or other agencies / service
providers? If so who? How will you involve them in this assessment, how will you involve those
intended to benefit from your Process and how will you feedback your results?
The national IAPTs programme has been through an EIRA process and various
recommendations from this document were used as the building blocks from which to
develop both an appropriate steering group and the basis of the service specification.
Consultation on the service specification has been extensive. The steering group included
members from organisations which represent mental health service users and carers. Thus
the views of service users and carers have been central to the development of the service
specification. The Black Wellness Initiative was commissioned to undertake research into the
opinions of BME communities in Derby and to provide feedback into the project development. The
Director of the BWI was a standing member on the Steering Committee. A full list of those invited on
the steering committee is included below:
Project Director – Derbyshire County PCT
User and carer reps x 2
Rethink x 2
Commissioner Derbyshire County PCT x 3
Commissioners Derby City PCT x 2
Public Health Representative NHS Derby City x 1
Black Community Wellness Initiative (now Community Wellness Initiative) x 2
Derbyshire Mental Health Services Trust x 2
Trent CBT x 2
Counsellors x 2
Derby Millennium Network x 1
Open Doors x 1
General Practitioners x 2
CSIP x 1
The service specification has been sent out in consultation to all of the voluntary sector organisations
working with people with Mental Health problems in Derby. This was undertaken by Southern
Derbyshire Voluntary Sector Mental Health Association. A list of the organisations consulted is
included below:
Relate – Derby and South Derbyshire
Women’s Work
P3
Rethink
Derbyshire Coalition for Inclusive Living
Stepping Stones
Step Forward
South Derbyshire CVS
Sevak Ladies Group
Opieka
Nottingham & Derby Supported Housing
NACVA
Lauren’s Link
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Joint Venture
Horizon
Derby Millennium Network
Hadari Project
Erewash CVS
Derbyshire Mind Rosehill Club
Derbyshire Mind
Derbyshire Housing Aid
Derbyshire Association for the Blind
Derbyshire and Derby City Young Carers Project
Derby Home Start
Derby City and Derbyshire South Mental Health Carers Forum
Community Concern, Erewash
Amber Valley CVS
Age Concern, Derbyshire
Shaw Trust
The Federation Support Team
South Derbyshire Mental Health Association
South Derbyshire CVS
Perinatal Illness
North Derbyshire Voluntary Action
Making Space
Life Matters Advice & Counselling Service
Green Health Partnership
First Steps Derby
Farm Crisis Network
Derbyshire Voice
Derbyshire Rape Crisis
Derbyshire Friend
Derby Women’s Centre
Derby Racial Equality Council
Derby Depression
Derbyshire Chinese Welfare Association
Derby and South Derbyshire Crossroads Caring
Burton & Derby Cruse Bereavement Care
British Red Cross
Erewash Mental Health association
Amber Valley CVS
2Care Travayler
Mental Health Action Group
SDVSMHF
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Q2. Which key strands are you going to focus on in your full assessment? (Please refer to your
screening information)
Yes No
Age X
Gender (Male, Female and Transsexual)? X
Learning Difficulties / Disability or Cognitive Impairment? X
Mental Health Need? X
Sensory Impairment? X
Physical Disability? X
Race or Ethnicity? (Including cultural beliefs and norms) X
Religious, Spiritual belief ? X
Sexual Orientation? X
Homeless or chaotic lives? X
Others — Carers X
If you have answered no to any please briefly state why
The actions taken to date via the national and local processes have suggested that the service
specification is robust in these areas.
Brainstorming ideas / concerns
Q3. What does your brainstorming tell you about possible Equality Risks in the Process? What areas
are you going to concentrate on? What outcomes are you aiming for? Please capture thoughts, facts
or concerns from you may have used in your Screening.
The IAPTS National Equality Impact Assessment report was used as the screening tool. It
was decided that Derby, as an IAPTS Pathfinder site, would focus on issues relating to Black
and Ethnic Minority Groups. This is not to say that other key strands were ignored, rather the
issues of BME groups were given a higher profile within the process. Money was made
available to ensure that this area was addressed in depth.
The following points were picked up from the screening:
1. Monitoring:
Under the Race Relations Act 1976 (Statutory Duties) Order 2001 institutions need to
ensure that relevant information is collected to improve equality performance. This was
identified within the original National EIA and it was suggested that the use of the full
IAPTS DATA Set, which includes information on age; gender; ethnicity; sexuality;
religion; disability and language would allow for service improvement through appropriate
monitoring should be encouraged. This will be tested at Tendering evaluation level. (see
page 2 IAPTS Review Criteria Answers).
2. Age
Within the National IAPTS EIA the needs of children and young people are highlighted
and special reference is made to their need to be able to access psychological services.
It also notes that the services within the pathfinder sites service users over the age of 65
were under represented, however during the consultation it was noted that the minimum
age for access to the service was 18 with an upper age limit of 65. These discrepancies
of provision were dealt with as follows:
a. Under 18 - NHS Derby City commissions separate services via CAMS for children
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and young adults and this includes access to a range of psychological interventions,
however it was accepted that those over the age of 16 might be more amenable to a
service for adults and it was agreed that, in exception circumstances (i.e. where they
felt the service offered via CAMS was unsuitable) young adults aged 16 or over could
access the service (see section 2.8 of Service Specification).
b. Over 65 - The upper age limit was completely removed to ensure that the service was
opened up to elders within the various communities. Given the high prevalence of
dementia in older adults (which gradually increases with age) a statement was put
into the service spec stating that people with dementia would not be excluded from
the service. NHS Derby City is currently looking to commission new dementia
services within the city and the need for psychological interventions for people
suffering from early stage vascular dementia and late onset depression and anxiety
will be further examined within that process. That is not to say however that they
should be excluded from this current process. The need to address services
specifically to this group has been picked up within the tender evaluation questions
(see sections 2. and 2.2.1 of the service specification).
3. Disability
For people with disabilities the problem may primarily be one of mobility and access. The
ability for all service users to access the service is addressed at the Tender Evaluation
stage ((see page 2 IAPTS Review Criteria Answers).
The National IAPT EIA also noted the need to include people with long term conditions,
such as diabetes and heart disease, within the service and this is included at point 2.2 in
the Service Specification. The consultation undertaken ensured that as wide a number of
organisations representing people with disabilities was included. This was picked up at
PQQ where there is a requirement for the provider to evidence conformity to the
legislation and duties to support people with disabilities and finally at the Tender
Evaluation stage where it is included under access.
4. Learning Difficulties / Disability or Cognitive Impairment
The National EAI identifies the need for the service to be accessible to people with
Learning Disabilities who experience anxiety and depression. This was therefore included
within the Service Specification at 2.2.1 where people with both learning difficulties and
dementia are identified as being service recipients. The providers ability to support this
segment of the community will be checked at Tender Evaluation (see IAPTS Review
Criteria Answers)
5. Mental Health Need
The whole of the IAPTS programme addresses the needs of mental health service users
and the National EAI has little to say on this topic, traditionally however people with
enduring mental health problems such as personality disorder have been excluded from
CBT services. To ensure that the service was available to people with more enduring
mental health problems two service user representatives were included on the steering
group. Access for people with personality disorders was therefore included in the service
specification at 2.2.1. Where people suffer from severe and complex mental health
problems it is more appropriate that they be assessed and treated by specialist mental
health services based in secondary care to ensure their safety and the appropriateness
of the service they receive. Many organisations representing mental health service users
were consulted in the process (see list above).
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6. Sensory Impairment
The initial National EIA noted that for users of British Sign Language (BSL) the problem is
more one of communications rather than disability. NHS Derby City currently
commissions translator services from Translation Unlimited and Signhealth for people
who use BSL to good effect in a range of health care arenas and this service includes
people accessing the IAPTS service. Organisations representing service users with
sensory impairments were well represented in the consultation (see list above).
7. Race or Ethnicity (Including cultural beliefs and norms)
The ‘Delivering Racial Equality in Mental Health Care’ action plan gives clear drivers for
services for people from BME. The National EIA gave clear indications that, where
services are adjusted appropriately, BME communities were not reluctant to access
them. (See table 3: Patient Ethnicity by referral source in Newham, National IAPTs EIA).
Local consultation, as mentioned previously, included a wide range of ethnic minority and
other BME community groups (see list above). Furthermore NHS Derby City
commissioned the Black Wellness Initiative to undertake research into the needs of BME
communities in relation to accessing IAPTS. The key findings from this report (which has
not yet been finalised) are as follows:
1. People from marginalised and under-served communities would like to access
treatment earlier than they presently do. They, however, consider the offer on the
table inadequate primarily because the premises of that offer are skewed away from
their own daily lived experience.
Response - The new service, with many more therapists available to people in their
communities and GP surgeries should go a considerable way towards supporting early
access to psychological therapies. There will always be people from all communities who
do not see the CBT model as matching their lived experience. It is for this reason that the
service specification (and indeed IAPT) makes it clear that alternative, proven and
approved psychological therapies should be made available and service users offered a
choice in which model they wish to work in.
2. The understanding of what psychological services are by marginalised and under-
served communities can be categorised into two general groupings:
a) There are those that know something about the services but don’t understand
what the service should do for them versus what it actually does. As a result
they have defined psychological services on the basis of their encounter with
the service rather than what the service should offer them.
b) There are those that do understand the service but are not clear what the
outcomes of the service should be like. They struggle with questions like:
o when one is a recipient of the service, what is the destination point,
what is the arrival point?
o what should be the outcome of a recovery process, how should it look
like?
The role of the Community Development Worker should help support an understanding
of psychological therapies amongst BME communities, however this was tested at PQQ
and again at Tender evaluation where the service providers will have to lay out their
engagement strategy with regards to BME communities, A representative from the BME
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CD workers will be on the evaluation panel.
3. The marginalised and under-served communities’ experience of psychological
services is generally at secondary care points, heightening the notion that for these
communities the route to mental healthcare is predominantly via forensic services.
The new services will be based entirely within primary care and community settings.
Their accessibility by BME communities was not questioned in the consultation exercise
when many BME community groups were consulted (see list above). This was also
tested out at PQQ and will be again at Tender evaluation stage.
4. There is a heightened readiness by the community to engage with primary care
services if they get the right offer on their tables.
The suggestion from the National EIRA and the work from Newham suggests that one
factor which is essential to the equal use of psychological interventions by the BME
community is access to services without health care worker referral. This has been
included within the service specification, and the provider’s ability to provide and manage
such a service will be checked out at Tender evaluation stage.
From ‘Black & Minority Ethnic Communities and Psychological Services –
An Executive Report’ (2009) Derby City PCT IAPT Pathfinder Special Interest Group
Pathway Pilot
The National EIA also identified the need to have staff who were culturally sensitive and
NHS Derby City has commissioned the Black Wellness Initiative to undertake this training
for staff involved in IAPT delivery.
8. Spiritual Beliefs
The National IAPT EIA report indicates that further research into the impact of faith and
spiritual beliefs is ongoing and the outcomes of this will be closely monitored by the
group.
9. Sexual Orientation
Whilst the National IAPT EIA suggested that the needs of gay and lesbian service users
may not be being met there was no dissatisfaction expressed by Derby Friend via the
consultation process. That is not to say that commissioners are therefore complacent that
these needs are being addressed and this issue was picked up at both PQQ and in the
tender evaluation.
10. Religious Beliefs
NHS Derby City has not received any adverse feedback from groups containing people of
different faiths, however the national research currently being undertaken at the
Yorkshire and Humber project will be examined with great interest and the issues of faith
groups will be picked up at the tender evaluation.
11. Homeless or chaotic lives
The consultation process sought the views of those who support homeless and itinerant
populations. There was no adverse feedback however NHS Derby City is currently in the
process of commissioning a new homelessness service and the need to be able to
access psychological therapies will be picked up within this. The provider’s ability to work
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with this client group will also be tested at tender evaluation.
12. Others — Carers
South Derbyshire and Derby City Carers Group has had seats on the IAPT steering panel
and were also part of the wider consultation process. No concerns have been expressed
from them around the provision of the IAPT service.
EIRA Form - f57fcc39-0e02-401e-87e6-cdae1b8a325f.doc p7
Equality Impact Risk Assessment Form
To support your initial brainstorm consider using elements in this section
Q4. With reference to the groups you are checking against what evidence do you have about the possible impact of the Process you are
assessing – consider both qualitative and quantitative data
Data / When and how was it Where is it from What does it tell you about the key What gaps are there?
Information collected equality groups?
Comprehensive Gives comprehensive data as outlined
Customer Please see question 3 IAPT data set + above at 3.1
feedback and above other user
complaints feedback will
be collected as
well as intel
from PALS and
NHS Derby
City usual
monitoring
processes
Consultation Comprehensive See all of 3. above
with the Please see question 3 from a wide
community / above range of
users organisations
Take up and Comprehensive See 3.1 above These will be measured against Derby population
usage by key Please see question 3 IAPT data set + statistics and the psychiatric morbidity stats.
groups above other user
feedback will
be collected
Comparative National IAPT Data Psychiatric See 3.1 above
information Psychiatric morbidity morbidity stats
where there is stats 2007 2007
EIRA Form - f57fcc39-0e02-401e-87e6-cdae1b8a325f.doc p8
Equality Impact Risk Assessment Form
no local data Population survey for Population
Derby City 2007 survey for
Derby City
2007
Census, National IAPT DATA Psychiatric
national or Psychiatric morbidity morbidity stats
local stats stats 2007 2007
Population survey for Population
Derby City 2007 survey for
Derby City
2007
Access audits
Please see question 3
above
Workforce
profile of Please see question
those 3.1 above
delivering the
process
Monitoring
and scrutiny Please see question 3
outcomes above
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Equality Impact Risk Assessment Form
National, Please see question 3
regional or above
local issues
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Equality Impact Risk Assessment Form
Q5. Looking at your answers to question 3 and 4 – What actions are needed to address any
evidence or gaps in evidence. What consultation are you going to carry out to address the
evidence of impact or the gaps in evidence?
1. Rigorous probing of the potential service providers at tender evaluation stage.
2. Ongoing monitoring of all equality data collected
3. Review of services at regular intervals to ensure that the equality issues are
being addressed
4. Ensure the service provider chosen continues to address workforce and
access issues within an equality framework
5. Continue to review national and local research into the equality of IAPT
services.
Use the action planning form on page 6 to record your next steps.
Q6. What modifications are you going to make to the Process to address the impacts you
have found?
All modifications have now been made in order to ensure that the process addresses the
equality issues. These will be monitored carefully via the usual NHS Derby City monitoring
and management processes.
Use the action planning form on page 6 to record your next steps.
Please now complete the front cover sheet and send to the E&D Dept
Please also follow the next step in the process for the policy/ service development that
is relevant to your work or Directorate (e.g. Clinical Policy Framework).
EIRA Form - f57fcc39-0e02-401e-87e6-cdae1b8a325f.doc p11
Equality Impact Risk Assessment Form
EIRA Action planning form
Objective Planned action Resource Target Review Person Where will
implications date date Responsible this go
next?
Equal use of service Ongoing review of equality The current MH Septe Monthly AT
commissioning team
by all Derby data collected within NHS Derby City mber
communities is too small for this to 2010
be done effectively. The
development of s
specific commissioner
for Primary Care Mental
Health should resolve
this problem.
User match in Ongoing review of staffing The current MH Septe 6 AT
commissioning team
workforce data collected within NHS Derby City mber Monthly
is too small for this to 2010
be done effectively. The
development of s
specific commissioner
for Primary Care Mental
Health should resolve
this problem
Review national and Ongoing The current MH Septe 6 AT
commissioning team
local equality research within NHS Derby City mber Monthly
into IAPT services is too small for this to 2010
be done effectively. The
development of s
specific commissioner
for Primary Care Mental
Health should resolve
this problem
EIRA Form - f57fcc39-0e02-401e-87e6-cdae1b8a325f.doc p12
Equality Impact Risk Assessment Form
Please add further action sheets if required
EIRA Form - f57fcc39-0e02-401e-87e6-cdae1b8a325f.doc p13
