Commissioning Independent Living Support Services (ILSS)

Equality Impact Assessment

Assessing impact on equality is a process which develops along with your policy. You must complete the table below to ensure that the EqIA process can be tracked.

Version Number / 1.2
Date Last Reviewed: / 23rd April 2012
Approved by: / Grainne Siggins
Date Approved: / 23rd April 2012
Next Review Date: / December 2012
Saved as:

1.  Management of the EqIA

Lead – Anna Saunders- Interim Commissioning Manager, Adults services

Contributions from –

Dawn Patrick- Operational Policy Officer

Bola Atanda- Support officer, Commissioning team

Asela Ibrahim-Elmorsy- Contracts officer

Jacky Gruhn- Integrated Commissioning manager- Disability

Charlotte East- integrated Commissioning manager- Learning Disability

Tony Jobling- Head of Service for Social Care Adults

Local Involvement Network ran focus groups.

Older People’s Reference Group

Cllr Laguda- Lead for A

Date: 2nd December 2011

Linked Papers:

·  ILSS service specification

·  Newham Quality Assurance framework- ILSS

2.  Identification of policy aims, objectives and purpose

The London Borough of Newham’s current homecare contracts are due to expire at the end of September 2012. This has given Newham the opportunity to develop a new service aimed at promoting self-directed care in the market and increasing flexibility and choice of provision for all customers, whilst ensuring sustainable capacity is available and can be secured within a costed framework.

The London Borough of Newham wish to commission these services for adults, children and young people.

We wish to continue delivering a high quality of service, in partnership with customers and providers at the same time as moving towards the purchase and provision of services that are refocused on:

·  Building personal resilience;

·  Achieving personal outcomes; and

·  Achieving greater independence through prevention and enablement.

The purpose of Independent Living Support Services is to support customers to remain in their own home and achieve and maintain their potential in relation to physical, intellectual, emotional and social capacity.

The proposal is to develop a framework contract that will include a number of ‘elements’:-

·  Personal support (adults)

·  Personal support for people with enhanced needs (adults)

·  Domestic support

·  Personal support (children and young people)

·  Personal support for people with enhanced needs (children and young people)

Each of these elements will have a ‘list’ of providers that have been evaluated against the service specification. This list will be used by brokerage to purchase directly commissioned services as well as being available for personal budget holders to use to inform their decisions when purchasing services.

3.  Scope / focus of the EqIA

This EqIA has been completed to identify the impact of retendering the homecare contracts as ILSS upon individuals from the protected characteristics group. The service is currently offered to older or disabled people so the change will directly affect people from the protected characteristics groups.

Full regard has been had to the requirements of the Equalities Act 2010 and proper regard has been had to the nature and extent of the duties owed by it.

The EqIA is a way of estimating the likely equality/diversity implications of decommissioning homecare services as ILSS. It will determine whether or not the impact or effect has a negative, neutral or positive impact on some groups or individuals.

Protected Characteristic / Assessment of relevance or potential to impact:
- positive and negative
- High, Medium, Low/No / Reason for this assessment
If Low/No you must provide evidence or a clear explanation of your reasoning.
Age / High relevance
Positive +/ Negative / A number of service users are older people and will be affected by any change in services Services for Children and Young People are up to the age of 18 and there are often attachment and separation issues so they may be affected by any change in service.
Disability / High relevance
Positive +/ Negative / A number of service users are disabled and will be affected by any change in service
Transgender / Medium relevance
Positive +/ Negative / Potential service users will require choice as to the gender of their care givers and this is particularly important during transition as there may be specific care requirements
Pregnancy and maternity / Medium relevance
Positive +/ Negative / A small proportion of potential service users will require ante- and/or post-natal support due to disability / language issues.
Race/Ethnicity / High relevance
Positive +/ Negative / Potential service users are from a variety of ethnic backgrounds and have specific cultural and language requirements relevant to their care.
Religion / belief / Medium relevance
Positive +/ Negative / Service users come from a range of backgrounds and beliefs. Some of these influence the care that they wish to receive and therefore they may be affected by any changes in services.
Sexual orientation / High relevance
Positive +/ Negative / Sexual orientation may influence the support that individuals require and therefore will influence the service that needs to be commissioned in the future.
Sex / Medium relevance / Service users may require choice as to the gender of their care provider and will be affected by any changes to the service
Class or socio-economic disadvantage / Medium relevance
Positive / The potential service users are across the full range of socio-economic groups and the level of care required will be determined by the other characteristics. The general impact will be building people’s resilience by carers using an enablement approach and therefore building people’s personal capacity.

4.  Relevant data, research and consultation

a.  Provide sources of data you have used

Newham Home Care Survey 2009

The Department of Health required that, during early 2009, all local authorities with adult social care responsibilities should undertake a survey with Home Care service users aged 65 and over. The London Borough of Newham decided that they would expand that survey in two ways:

·  All Home Care service users under 65 would also be given the opportunity to take part in the survey.

·  Additional questions would be added in to the survey to get more in depth information about some of the key local priorities.

The key messages from this survey include:

a)  While 83% of respondents expressed some satisfaction with their service, only 47% were very or extremely satisfied (proxy indicator for NI127) which places Newham in the lowest quartile for this indicator in London;

b)  64% of respondents are always happy with the way their care workers treat them (proxy indicator for NI128) which places Newham above the London average but below the average for England as a whole;

c)  There is inconsistency in the quality of care provided by different care providers;

d)  There is an inconsistency in the quality of care workers, with particular issues around agency cover and weekend care workers;

e)  A number of issues need to be addressed around communication and provision of information.

Analysis of the comments made to elaborate on overall satisfaction again highlighted communication and information, including a large number of respondents who were not sure who their social worker was. It also highlighted: the inconsistency of care workers, particularly Agency cover (this was a recurring theme throughout the responses); the suitability of the service for the respondents needs; the standard of the work carried out by care workers and the reliability of care workers. Analysis also showed considerable variation in satisfaction from different care organisations.

There were no specific questions on equality, diversity freedom from discrimination and harassment However, there has been some analysis by demographic group of overall satisfaction and of dignity and respect.

·  Respondents aged 18-49 were more likely to be satisfied with their home care than other age groups

·  Respondents from black communities were less likely to be satisfied with their care and respondents from Indian communities were most likely to be satisfied.

·  Respondents who received less than one hour home care per week were most likely to be dissatisfied with their home care service.

·  Respondents from black communities were least likely to feel they were treated with dignity and respect by their care workers.

Gender

Overall satisfaction by gender

Male / Female
Extremely or very satisfied / 49% / 46%
Quite satisfied / 32% / 34%
Neither satisfied or dissatisfied / 8% / 9%
Dissatisfied / 7% / 7%

There is very little difference in overall satisfaction between male and female respondents and all differences are within the margins of error.

Treated with dignity and respect by care workers, comparing by gender

Male / Female
Yes, all the time / 80% / 81%
Yes, some of the time / 19% / 16%
No, never / 1% / 3%

Examining whether respondents felt treated with dignity and respect also shows very little difference by gender. The graph below shows a similar picture by age.

Age

The graph below shows satisfaction by age group. The error bars at each split show the margin of error for that group. For example, the margin of error for the 65 – 74 age group means that, because 12% of the respondents are dissatisfied, we can deduce that between 6% and 17% of all those in that age group who receive Home Care are likely to be dissatisfied.

Overall satisfaction by age group

Just because of my situation and age, my comments and feelings are not considered as important as theirs.

One gets to age 65 and over, no one wants to know.

A lower sample size and response rate for the 18 – 49 group means that the margin of error is larger and the averages for all respondents are within that margin of error. However the data suggest that satisfaction is higher in younger age groups.

Treated with dignity and respect by care workers, comparing by age

Ethnic group

There is a large difference in overall satisfaction by ethnicity with black and Bangladeshi respondents less satisfied than white respondents or respondents from other Asian groups. However the smaller group sizes again make most of the responses within the margin of error of the average.

I am happy that I get help that speaks my language

It could be improved if I get carers who speak my language.

Overall satisfaction by ethnicity

There are two exceptions; there were a large number of respondents from black Caribbean and Indian groups, therefore the margins of error are quite small. These figures can, therefore, be applied with more confidence to the wider Home Care recipient population. The percentage of respondents from black Caribbean groups who are extremely or very satisfied is below average and the percentage of respondents from Indian groups who are extremely or very satisfied is above average.

[What dignity and respect means to me is] treatment due to a human being regardless of age or ethnic origin.

[What dignity and respect means to me is] respecting me and my religion

The graph below shows the difference in whether respondents feel they are treated with dignity and respect by ethnic group, looking only at white, black, Asian and other (this is to keep the margins of error smaller). Results show that those from black ethnic groups are least likely to feel they are treated with dignity and respect all the time than those from white or Asian ethnic groups. This is consistent with the overall satisfaction responses.

Treated with dignity and respect by care workers, comparing by ethnic groups

Potential Issues for young people

Many children and young people who receive a service will form strong bonds with their carers and due to the young ages involved, a change of carer can be a large issue, resulting in or compounding issues of attachment, separation and loss. If a currently used provider does not get accepted to the framework then children and young people will be able to use individual budgets to continue using the same carer if possible. However this issue will only affect those who receive directly commissioned services and current Individual Budget holders will have freedom of choice.

Transition

Children’s and adult services do not have a shared list of support providers; this means that children may have to change providers when they go through the transition from children’s to adult services. This causes a lack of continuity and consistency in the support provided as well as stress and anxiety for users and carers around change.

Specific feedback from user groups in relation to protected characteristics.

The Disability Reps Forum have fed back via the Disability Partnership Board that home carers do not always have the requisite communication skills to support people with sensory impairments. The Greenhill Community Group have also said that carers should be able to provide appropriate, proactive support to people with communication needs (eg aphasia).

The Older People’s Reference Group have fed back that people will dementia can become confused about who is a formal carer, particularly if they don’t wear uniforms. This can mean that they allow/ don’t allow people into their home and are not sure what they are there for.

Carers from the learning disability forum have fed back that they sometimes had to ‘train’ carers themselves as the carers didn’t always have specialist skills that were needed to support people with complex needs.

Current contract arrangements

There are currently 11 providers on the home care contract. They provide 17700 hours home care a week, which comprises 89% of homecare. These services are provided in the main to older people..(Approx 70%). The contracts are regularly monitored by the Adults contracts team.

The remaining 11% of homecare is provided on ‘spot contracts’ by a range of providers. These tend to be for people with more complex needs, including people with physical and sensory impairments and people with learning disabilities. Spot contracts are not routinely monitored by adults contracts team, which raises issues around variable quality and value for money.

Move to personal budgets

In 2010-11, 33% of Newham’s community based service users were receiving their care through Self Directed Support. While some of these had care packages managed by Newham, 19% of community based service users received their support through a cash payment. An audit of personal budget holders showed that the majority used some or all of their money to purchase home care.