Barts Health Equality and Human Rights Impact Assessment Report

EDS Goal 2: Improved Patient Access and Experiencewww.brap.org.ukMerger issuePositive implicationsof the mergerNegative implications of the mergerMitigationImplications forcompliance with PublicSector Equality DutyImplications forprotection andpromotion ofhuman rightsEmphasis onplans torespond toNorth EastLondoncommissioningstrategy(increasedaccess toprimary care/moreoutpatient andcommunitybased care)Strategy will reducepressure on acuteservices (particularlyuseful given increasesand changes indemographic profile).This strategy will alsohelp with serviceintegration acrosshealth economy/patients will benefitfrom care closer tohome – less risk of latediagnosis, etc.When this strategy is considered alongside what iscurrently known about patterns of health service useby traditionally excluded and vulnerable groups anumber of risks/ negative implications emerge. Firstly,the baseline review notes there are residents who are‘below the radar’ of primary care providers orresidents that do not know how to contact/ accessprimary care services (e.g. Other White, Chinese,African people much less likely to know how tocontact out of hours GP). Also the review identifiedpeople living in poverty who can’t afford to keep allappointments. These people often rely on acuteservices when health problems come to a head. Thishas implications for effectiveness of care pathwaydevelopment and ensuring seamless support forservice users.Secondly, in some cases (e.g. diabetes) particulargroups of people are less likely to identify healthproblems early enough. There is a risk that thisbehaviour will be replicated. The ‘closer to home’approach has potential to reap benefits, but relies onstrong commissioning of community-based and highqualityservices – which emphasises the importanceof preventative/awareness activity.FBC does indicateintentions of merged Trustto work closely with GPsand influence pathways ofcare. Important that equalityand human rightsimplications of ‘closer tohome’ strategy areconsidered fully. Thestrategy may reduce costs,but there are longstandingissues of poverty and healthservice usage patternswhich need to beconsidered.Trust should feed intocommissioningspecifications, particularlygiven its knowledge aroundvulnerabilities/ quality ofservice required bycommunity/ home-basedcare providers.None identified for theTrust, though Trust caninfluence others toensure they do notdiscriminate in provisionof services.None identifiedfor the Trust,though Trust caninfluence othersto ensure they donot infringe rightsof patients (e.g.influencingquality standardsfor other localproviders)Improvedaccess tospecialistservices(particularly forresidents inWalthamImproved access forpeople in these parts ofthe catchment. FBCidentifies that people inNewham will still bewithin 30 minutes-driveof between five andDespite no significant changes in access for someresidents/ improved access for others, there will stillbe accessibility issues going forward. Our reviewidentified significant challenges faced by those inpoverty and those without access to transport/ thatface mobility problems.The Trust may already havelobbied local transportationservices to improve access/lower costs for its serviceusers. However, it may beimportant for the Trust tocommunicate it has doneIn advancing equality ofopportunity, the Trustneeds to show it haslistened to the views oftraditionally excludedgroups around access toservices (even if it is toNone identified.198