(1) Information about the Policy/Proposal

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1 Equality, Good Relations and Human Rights Screening Template ***Completed Screening Templates are public documents and will be posted on the Trust s website*** See Guidance Notes for further background information on the relevant legislation and for help in answering the questions on this template (follow the links). (1) Information about the Policy/Proposal (1.1) Name of the policy/proposal Re-organisation of Laboratory Out of Hours service (1.2) Is this a new, existing or revised policy/proposal? This is a new policy proposal. (1.3) What is it trying to achieve (intended aims/outcomes)? This project was initiated prior to the introduction of Agenda for Change rates of pay and terms and conditions for staff working on the OOH laboratory rotas for Biochemistry, Haematology and Blood Bank. These three laboratory services are currently provided on a 24/7 basis on the RGH site, the BCH site and the MIH site. The OOH sessions operating on the BCH, MIH and RGH sites are: 5:00pm to 8:00pm 8:00pm to 9:00am Weekends 9:00am to 5:00pm (covered by a separate rota) Overnight sessions 5:00pm to 9:00am Prior to 1 st October 2012 staff participating in the OOH rota were scheduled to work between 5:00pm and 8:00pm on the evening before they cover the overnight session. Staff were remunerated in line with the old Whitley terms & conditions and in addition, staff working overnight also receive time off in lieu. On the MIH site, the workload out of hours during weekdays and at weekends requires 1 fully qualified BMS for the biochemistry and 1 fully qualified BMS for blood bank/haematology.. Since the temporary closure of the BCH A&E department (Nov 2011) the 1

2 biochemistry out of hours cover for weekdays and weekends is provided by 1 member of staff. Blood Bank and Haematology have 3 qualified BMS staff working between 5pm and 8pm on Mondays, Tuesdays and Wednesdays, reducing to 2 fully qualified BMSs on Thursdays and Fridays between 5pm and 8pm. Between 8pm and 9am weekdays and at weekends this reduces to 1 fully qualified BMS. The workload on the BCH site for blood bank/haematology and biochemistry reduces significantly after 8pm until 7am. Therefore there is the requirement for an extended day on this site. For the RGH, biochemistry has a team of BMS staff, reducing to 2 BMS staff after 12midnight until 8am weekdays and at weekends. Blood Bank/Haematology have 4 fully qualified BMS staff until 7pm, with 4 BMS staff providing cover between 7pm and 9am weekdays and at weekends. The clinical profile of the RGH is such that this site is by far the busiest out of hours and at weekends, following the recently clinical service reconfigurations, in particular vascular and A&E. When there is only 1 fully qualified member of staff on duty out of hours, this person needs to be suitably experienced as there is no other support. Although the workload is heaviest on the RGH site, this is the only site that can use less experienced staff or BMS staff who are not fully qualified, out of hours, as there is more than 1 person on duty. The OOH rotas for fully qualified BMS staff Biochemistry, Haematology and Blood Bank up until October 2012, were solely dependent on staff volunteering to work overtime and service continuity has been vulnerable. The decision was taken in 2010/11 to create a number of new posts within Blood Bank/Haematology and Biochemistry for BMS band 5/6 which included the requirement to provide a 24/7 service as part of their contract of employment. In early 2012, 12 new members of staff were appointed for Blood Bank Haematology and 9 for Biochemistry. From October 2012, 7 of these staff are now suitably qualified to participate on the out of hours rota for Blood Bank/Haematology. Given that these members of staff are still relatively unexperienced, they will be rostered to cover the Royal Hospitals service where there is support from more experienced staff. To date, none of the new appointments in Biochemistry are suitably qualified to participate in the Biochemistry out of hours rotas. It should also be noted that under the present working arrangements, staff who participate in the OOH sessions are not available during the core working hours which puts pressure on service delivery in the peak operating times for the specialties laboratories support. In addition, the specialist sections of the 2

3 laboratory perform a significant clinical role in support of services such Haematology and Oncology. As the highly trained staff in these sections also participate in the general OOH rota this leaves the specialist work particularly vulnerable. The frequency of the current overnight rota is 1:7. This is a challenging rota which staff feel is unsustainable going forward. Work has been on-going in partnership with Trade Unions for some two years looking at the development of a sustainable OOH service delivery model for the Laboratory service. While some progress had been made, the recent introduction of AFC Terms and Conditions in October 2012 has resulted in the need for urgent change to be considered to ensure the continuity of service. Whilst for some staff groups the change in Terms and Conditions has resulted in an improvement in remuneration for work undertaken, for others it has represented a significant decrease in remuneration. This is largely as a consequence of the terms and conditions only recognising on-call remuneration associated with occasional call outs as opposed to the 24/7 requirement in some services for a continuous presence. This is of particular relevance to Band 6 BMS staff working in laboratories. Under AfC payment is based on the hourly rate, uplifted by overtime and unsocial hours payments. Therefore the BMS staff providing the same standard out of hours service are paid on the basis of their banding on this basis the Band 6s receive less pay than their Band 7 colleagues for working the same out of hours shifts. The differential in out of hours payment for these staff between the old terms and conditions and the new terms and conditions in place from 1 October 2012 is very significant. It should be noted that the newly appointed qualified BMS 5/7 whose contracts reflect the requirement for 24/7 working, work the out of hours shifts as part of their contracted 37.5 hours. The only additional payment they receive for hours that they are rostered to work is the payment for unsocial hours. There is the opportunity for overtime for these staff if they work additional hours to support the out of hours rotas. It is recognised that the Trust needs to put in place an agreed plan (in line with other laboratories) to create a workforce that works under the same terms and conditions, but this cannot be achieved in the short term. The change in payments is only one of a number of factors which had led to a reduction in the number of staff who will agree to participate in out of hours rotas on a voluntary basis. Other factors include the intensity of the work, particularly 3

4 on the Royal site and the frequency of the rotas. With fewer staff agreeing to participate in the rotas, the frequency is increasing in order to maintain the 3 existing sites. From 1 February 2013, it will not be possible to sustain 3 sites out of hours for Blood Bank and Haematology laboratory services given the number of staff who are available to staff the out of hours rotas (which included weekends). Therefore it is necessary to put in place a temporary contingency plan without a temporary reduction in the number of sites there will not be enough staff to cover the existing 3 site solution and a planned reduction is preferable to closing a laboratory service at short notice without proper contingency plans in place to address service continuity. From 1 February 2013 the Mater hospital will not have an on-site 24/7 service for these laboratories. The potential problems associated with the removal of an on-site out of hours service relate to the timely provision of test results (for both blood bank and haematology) and the timely provision of blood and blood products to support the clinical services on the Mater site out of hours. The laboratories must be able to provide a service for both urgent and routine requests for lab tests and blood/blood products. 8 Units of O Negative red cells and 4 units of AB compatible fresh frozen plasma will be kept on the Mater site for use out of hours which can be safely issued to any patient, regardless of blood type in an emergency. Apart from this, the only blood which can be issued to a patient on the Mater site out of hours is blood that has been cross matched and issued for the use of a specific patient. This means that a very robust transport system between the Mater site and the Royal Victoria Hospital is required which minimises delay, particularly for urgent requests and when invoking the protocol for massive blood loss. Given the proposed opening hours during the working week (8.30am to 16.00) the Trust will provide its own dedicated transport system from to 09.00, supplemented by the provision of motor cycle couriers who can transport samples between the Mater and the Royal Victoria Hospital during the evening rush hour from 4pm to 8pm. Every effort has been made to minimise the differences between the delivery of laboratory services in hours and out of hours. The laboratory service will put in place laboratory staff who have sufficient training and experience to undertake maintenance of equipment out of hours 4

5 and will also provide a reception/distribution service. It must be emphasised that these staff are not trained BMS staff and will have a very limited range of duties. The nature of their contract of employment is such that they can be deployed on a 24/7 basis as required by the Trust. This means that the samples can continue to be taken to the labs on the Mater site as normal, out of hours and the lab staff will forward the samples to the Royal Victoria Hospital for processing. The blood and blood products will be taken from the Royal Victoria Hospital to the Mater labs and receipted by the lab staff on duty out of hours The Mater staff will have to phone the RVH blood bank and haematology laboratories directly when there is no onsite service in the Mater this means that they will be able to communicate directorate with experienced BMS staff who are accustomed to dealing requests for emergencies, urgent and routine samples and issue of blood and blood products. For Blood Bank it will be necessary to move to manual forms (in line with practice elsewhere within the Trust) and these will be used both in and out of hours. Clinical staff on the Mater site will have to look up the results for both blood bank and haematology tests on lab centre or the web browser both in and out of hours the existing order comms system can only be used for ordering haematology tests. A trial has been arranged for 4 days in advance of the go live date. It is proposed to provide support for the staff who will be working in the Mater out of hours from experienced BMS staff initially to ensure that any problems which are identified can be rectified. (1.4) Are there any Section 75 categories which might be expected to benefit from the intended policy/proposal? N/A (1.5) Who owns and who implements the policy/proposal - where does it originate, for example DHSSPS, HSCB, and the Trust? HSC Belfast Health and Social Care Trust 5

6 (1.6) Are there any factors that could contribute to/detract from the intended aim/outcome of the policy/proposal/decision? (Financial, legislative or other constraints?) The Trust needs to ensure compliance with the European Working Time Directive regarding hours worked by staff and compensatory rest. (1.7) Who are the internal and external stakeholders (actual or potential) that the policy/proposal/decision could impact upon? (staff, service users, other public sector organisations,, trade unions, professional bodies, independent sector, voluntary and community groups etc) Staff and Trade Union representatives Service users (1.8) Other policies with a bearing on this policy/proposal (for example regional policies) - what are they and who owns them? The Belfast Way : A vision of excellence in Health and Social Care New Directions : A conversation on the future delivery of Health and Social Care Services for Belfast 6

7 (2) Available evidence Evidence to help inform the screening process may take many forms. What evidence/information (both qualitative and quantitative) have you gathered to inform this policy? NB: Specify the details for each of the Section 75 categories for any staff affected, the Trust Workforce, any patients/clients affected and the Trust general population in the following tables if appropriate. 2.1 Staff Affected by this Policy/Proposal A total of 123 Biomedical and Clinical Scientist staff were involved in providing the Out of Hours service. The Table below shows the composition of the staff compared to the composition of the Trust as a whole. RELIGION Trust Staff Labs OOH Protestant 45% 58% Roman Catholic 49% 37% Other 6% 6% GENDER Male 21% 40% Female 79% 60% AGE GROUP Under 45 57% 54% % 46% DISABLED No 65% 67% Yes 2% 2% Unknown 34% 30% MARITAL STATUS Married 57% 49% Single 38% 46% Other/ Not Known 5% 5% CARING RESPONSIBILITIES Carer 21% 17% 19% 25% Unknown 60% 58% 7

8 POLITICAL OPINION Unionist 7% 7% Nationalist 6% 7% Other 7% 6% Do not wish to answer/ Unknown 80% 81% RACE White 77% 90% BME 4% 2% Unknown 19% 7% SEXUAL ORIENTATION Opposite Sex 35% 32% same/both 1% 0% Do not wish to answer/ Unknown 64% 68% (3.1) Taking into account the information above what are the different needs, experiences and priorities of each of the Section 75 categories and for both service users and staff. (NB: Use relevant statistical and qualitative data to complete the table below) Section 75 Category Gender Details of Needs, Experiences and Priorities Staff Service Users The majority of staff affected are The laboratory out of female. (60%) This is lower than in the hours service is a Trust workforce as a whole. service that is Carer s Northern Ireland statistics available to any patient indicate that 64% of Females are that may require it and carers. would apply to all Section 75 categories. There are no specific needs, experiences and priorities in terms of Section 75 groups in relation to the nature 8

9 Section 75 Category Age Religion Political Opinion Marital Status Dependent Status Disability Details of Needs, Experiences and Priorities Staff The composition is similar to the Trust as a whole. There is no indication of differing needs in relation to age There is a higher proportion of Protestants than in the Trust as a whole There is no indication of differing needs in relation to religion The composition of laboratory staff is similar to that of the Trust as a whole. There is no indication of differing needs in relation to political opinion There is a higher proportion of single people than in the Trust as a whole. There is no indication of differing needs in relation to marital status 17% of staff have indicated that they have caring responsibilities. Research indicates that 1 in 8 people in Northern Ireland have caring responsibilities. 2% of staff have indicated that they have a disability. This is similar to the Trust as a whole. The Trust is committed to ensuring that reasonable adjustments will be facilitated according to any individual needs identified in accordance with the Service Users of this proposal. There is an overall requirement that the out of hours service provides an adequate service appropriate to need. It is envisaged that the robust nature of practices put in place in respect of the service will ensure there will be no adverse impact on service users. 9

10 Section 75 Category Ethnicity Sexual Orientation Details of Needs, Experiences and Priorities Staff Service Users Trust s Framework on the Employment of People with Disabilities. 90% of the staff involved are White. There is no indication of differing needs in relation to ethnicity. There is no indication of differing needs in relation to sexual orientation (3.2) Provide details of how you have involved stakeholders, views of colleagues, service users and staff etc when screening this policy/proposal. Regular Laboratory Service Implementation Group meetings held (Calendar from I Carleton) involving senior members of laboratory, HR and Staff side representatives. Communication circulars sent out to staff Staff meetings OOH specific meetings One to one meetings with OOH staff Issues raised: Equal pay for equal work (different bands of staff participate on the OOH rota) 10

11 (4) Screening Questions You now have to assess whether the impact of the policy/proposal is major, minor or none. You will need to make an informed judgement based on the information you have gathered. (4.1) What is the likely adverse impact of equality of opportunity for those affected by this policy/proposal, for each of the Section 75 equality categories? Section 75 category Gender Age Religion Political Opinion Marital Status Dependent Status Disability Ethnicity Details of policy/proposal impact Staff There is no indication of adverse impact in relation to gender There is no indication of adverse impact in relation to age There is no indication of adverse impact in relation to religion There is no indication of adverse impact in relation to political opinion There is no indication of adverse impact in relation to marital status Research indicates that 1 in 8 people in Northern Ireland have caring responsibilities. Only members of staff have indicated that they have a disability. The Trust is committed to ensuring that reasonable adjustments will be facilitated according to any individual needs identified in accordance with the Trust s Framework on the Employment of People with Disabilities. There is no indication of adverse impact in relation to Ethnicity Service Users Level of impact? Minor/major/non e 11

12 Sexual Orientation There is no indication of adverse impact in relation to sexual orientation (4.2) Are there opportunities to better promote equality of opportunity for people within Section 75 equality categories? Section 75 category Please provide details The proposal would benefit all Users in terms of the service provided (4.3) To what extent is the policy/proposal likely to impact on good relations between people of different religious belief, political opinion or racial group? minor/major/none Good relations category Religious belief Political opinion Details of policy/proposal impact Due to the nature of the policy there are no implications in terms of Good Relations. Level of impact Minor/major/none Racial group (4.4) Are there opportunities to better promote good relations between people of different religious belief, political opinion or racial group? Good relations category Please provide details The Trust is committed to promoting good relations and has a strategy in place. Trust ensures that all buildings provide a welcoming inclusive environment for Users and Staff. Staff receive mandatory Equality, Good Relations and Human Rights training. 12

13 (5) Consideration of Disability Duties (5.1) How does the policy/proposal encourage disabled people to participate in public life and promote positive attitudes towards disabled people? The Trust is committed to equality of opportunity for people with disabilities. Disability awareness training is available to all staff and a Disability Action Plan is being implemented. Reasonable adjustments are made as appropriate. 13

14 (6) Consideration of Human Rights The Trust has a duty to act compatibly and must take Human Rights considerations into account in its day-to-day functions/activities. (6.1) How does the policy/proposal impact on Human Rights? Complete for each of the articles Article Positive impact Negative impact = human right interfered with or restricted Neutral impact Article 2 Right to life Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment Article 4 Right to freedom from slavery, servitude & forced or compulsory labour Article 5 Right to liberty & security of person Article 6 Right to a fair & public trial within a reasonable time Article 7 Right to freedom from retrospective criminal law & no punishment without law Article 8 Right to respect for private & family life, home and correspondence. Article 9 Right to freedom of thought, conscience & religion Article 10 Right to freedom of expression Article 11 Right to freedom of assembly & association Article 12 Right to marry & found a family Article 14 Prohibition of discrimination in the enjoyment of the convention rights 14

15 Article 1 st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education Positive impact Negative impact = human right interfered with or restricted Neutral impact Please note: If you have identified potential negative impact in relation to any of the Articles in the table above, speak to your line manager and/or Health & Social Inequalities on Tel: / 0070 / 0071 It may also be necessary to seek legal advice. (6.2) Please outline any actions you will take to promote awareness of human rights and evidence that human rights have been taken into consideration in decision making processes. Human Rights are considered in designing and developing all Trust policies i.e.: Human Rights Act (1998) UN Convention on The Rights of Disabled People UN Convention on the Rights of the Child 15

16 (7) Screening Decision (7.1) Given the answers in Section 4 of this template, how would you categorise the impacts of this decision or policy/proposal? (Please tick one option below and list your reasons for the decision in 7.2 below) Major impact See Page 7 of Guidance Notes (click here) EQIA Required? (Delete as appropriate) No Minor impact See Page 7 of Guidance Notes (click here) Mitigation Required Alternative Policy Required No No No impact See Page 7 of Guidance Notes (click here) Ongoing screening (7.2) Please give reasons for your decision and detail any mitigation or alternative policies considered. In terms of staff, the proposal aims to enhance Trust Service standards and ensure compliance with Working Time Regulations, Agenda for Change terms and conditions and HSC Circula. In relation to service users, it is deemed appropriate that this screening is regarded as an ongoing screening to enable monitoring over a 6 month period to assess any unforeseen adverse impact. 16

17 (7.3) Do you consider the policy/proposal needs to be subjected to ongoing screening? NB: for strategies/policies that are to be put in place through a series of stages screen at various stages during implementation. See above Yes No 17

18 (8) Monitoring (8.1) Please detail how you will monitor the effect of the policy/proposal for equality of opportunity and good relations, disability duties and human rights? This proposal will be monitored to assess impact on an ongoing basis - regular meetings will be set up for the first few months to provide a forum for clinical staff to provide feedback and comments sheets will left at ward level for staff to ensure that all clinical staff have the ability to comment. Approved Lead Officer: Anne Moffatt Position: Telephone No: Date: Policy/proposal screened by: 1 February 2013 Miriam Gibson, Veronica McEneaney Please forward completed screening template to orla.barron@belfasttrust.hscni.net for recording and uploading onto the Trust website. 18