South Wales Programme Stage 3 EIA (16 th December 2014)
Contents Introduction... 4 The South Wales Programme Remit and structure... 5 South Wales Programme Options and decision... 6 Demonstrating due regard in the decision process... 6 Knowledge... 7 Timeliness... 8 Rigorous analysis... 8 Non-delegation... 9 Continuing duty... 10 Record keeping... 10 Conclusion... 11 Annex A: Abertawe Bro Morgannwg UHB... 12 Knowledge... 12 Timeliness... 12 Rigorous analysis... 13 Non-delegation... 13 Continuing duty... 13 Record keeping... 14 Annex B: Aneurin Bevan UHB... 15 Knowledge... 15 Timeliness... 15 Rigorous analysis... 16 Non-delegation... 16 Continuing duty... 16 Record keeping... 16 Annex C: Cardiff and Vale UHB... 18 Knowledge... 18 Timeliness... 18 Rigorous Analysis... 19 Non-delegation... 19 Continuing duty... 19 Record keeping... 20 Annex D: Cwm Taf University Health Board... 21 Knowledge... 21 2
Timeliness... 22 Rigorous analysis... 22 Non-delegation... 22 Continuing duty... 23 Record keeping... 23 Annex E: Powys Teaching Health Board... 24 Knowledge... 24 Timeliness... 24 Rigorous analysis... 25 Non-delegation... 25 Continuing duty... 25 Record keeping... 26 3
Introduction Section 149 of the Equality Act 2010 places a duty, referred to as the general duty, on public sector bodies. Public bodies subject to the general duty are required when designing policies or making decisions to have due regard to the need to: Eliminate unlawful discrimination, harassment and victimisation. Advance equality of opportunity between different groups. Foster good relations between different groups. Welsh public sector bodies are required under the Welsh Public Sector Equality Duties to conduct an equality impact assessment of their policies and decisions which are likely to have an impact upon people with protected characteristics. Due to the scale and complexity of the South Wales Programme the decision was taken that an iterative approach to the equality impact assessment (EIA) report would be taken. The South Wales Programme EIA was broken down into three stages. A Stage 1 EIA was produced to inform the South Wales Programme public consultation. The Stage 1 EIA was an evidence document which outlined the evidence behind the need for the South Wales Programme, and provided a summary of available evidence from research reports and other related documents on what the anticipated impacts may be on protected characteristic groups within the community and within NHS staff. The Stage 1 EIA was not intended to be a definitive statement on the potential impact of the South Wales Programme on protected characteristic groups. The document s purpose was to describe our understanding at that point in the EIA process of the likely impact. By following the EIA process it was intended that the South Wales Programme Board would identify and address any gaps in their knowledge by engaging and consulting with the public and stakeholders. The Stage 2 EIA presented the findings from the public consultation, along with the earlier analysis of the available evidence on potential impacts from the Stage 1 EIA. Where relevant new research or evidence became available the analysis Stage 1 EIA was updated to reflect this. The purpose of the Stage 2 EIA was to help inform the decisions of the board members from the five health boards that were partners within the South Wales Programme as to which of the options should be adopted, and what potential mitigations may be required to address any identified impacts on protected characteristic groups within the community and within NHS staff. The general duty cannot be delegated, so it was incumbent upon each health board in the South Wales Programme to demonstrate that they had assessed how the South Wales Programme may impact upon their service users as well as the wider public in the South Wales Programme area. To facilitate health boards in meeting this requirement the analysis 4
presented in the Stage 2 document considered potential impact at a local authority level where data was available. A separate appendix for each health board was also provided which supplemented the analysis in the body of the document. As such, it is important to emphasise that the analyses in the main Stage 2 EIA and its appendices needed to be read in conjunction with each other, and not in isolation. This document is the Stage 3 EIA, and has been produced after the decision on the South Wales Programme was made. It should be noted that the scope of the Stage 3 EIA has changed slightly from that originally envisaged in the Stage 1 and Stage 2 EIAs. It was originally intended that the Stage 3 EIA would present the final decision, the reasons behind that decision, outline any proposed mitigations, and describe how the implementation of the South Wales Programme will be monitored and reviewed. The complexity and regional nature of the South Wales Programme has meant that implementation is not simple and will not happen overnight. New regional structures (i.e. Acute Care Alliances) have been created to oversee the implementation of the outcome of the South Wales Programme and are developing implementation plans, and through these arrangements there will be continued due regard to equality issues. It is therefore not possible at present to comment on the implementation of the South Wales Programme, or any potential mitigating actions at this stage. As such, this document describes how the board members of the health boards made their decision on the South Wales Programme, and the steps taken to ensure that they fully complied with their duty to show due regard. The South Wales Programme Remit and structure The South Wales Programme was set up in 2012 to look at the challenges facing consultantled maternity services, neonatal care, inpatient children's services and emergency medicine (A&E) delivered by the five local health boards and ambulance service covering the south Wales area i.e.: Abertawe Bro Morgannwg University Health Board (ABMU) Aneurin Bevan University Health Board (AB) Cardiff and Vale University Health Board (C&V) Cwm Taf University Health Board Powys Teaching Health Board Welsh Ambulance Service NHS Trust (WAST) A Programme Board was established to oversee the South Wales Programme with membership comprised of Chairs and Chief Executives from the five health boards and WAST, the Wales Deanery and the Programme Director. The South Wales Programme Board was commissioned by the health boards to provide a recommendation on which model of future service provision should be taken forward to implementation. The final decision as to which option should be taken forward did not therefore rest with the South Wales Programme Board itself, but remained the 5
responsibility of each health board. In making their decision each health board would need to consider what was in the best interests of the population they served. South Wales Programme Options and decision The South Wales Programme proposals for service reconfiguration recommended concentrating consultant-led maternity and neonatal care, inpatient children s services and emergency medicine (A&E) in four or five hospitals. Four options for the service reconfiguration were consulted upon, Option 3, suggested as the best fit option: Option 1: UHW, Morriston, SCCC plus Prince Charles Hospital Option 2: UHW, Morriston, SCCC plus Royal Glamorgan Hospital Option 3: UHW, Morriston, SCCC plus Prince Charles and Princess of Wales hospitals Option 4: UHW, Morriston, SCCC plus Prince Charles and Royal Glamorgan hospitals The formal consultation process on the South Wales Programme proposals commenced on 23rd May 2013 and closed on 19th July 2013. On 18 th March 2014 the health boards confirmed their collective agreement to the recommendations from the Programme Board. These included the creation of three acute care alliances (ACAs) and concentration of consultant-led service on five sites as the starting point in the transition to the three ACAs. Demonstrating due regard in the decision process The Brown Principles 1 are the legal standard by which the health boards and the South Wales Programme Board need to comply to demonstrate they have shown due regard in their decision making process. The Brown Principles are a set of six principles derived from case law which describes the legal expectation of due regard as set out in section 149 of the Equality Act 2010. These principles, state that in order to show due regard public bodies must ensure: Knowledge Timeliness Rigorous analysis Non-delegation Continuing duty Record keeping 1 R (Brown) v Secretary of State for Work and Pensions [2008] EWHC 3158 (Admin) 6
The remainder of this report describes the decision making process employed by the health boards and the South Wales Programme Board against each of the six Brown Principles. Knowledge This principle states that those who exercise a public body s functions (i.e. its staff and leadership) should be aware of the duty s requirements. Meeting the duty involves a conscious approach and state of mind. Decision makers should therefore be aware of the implications of the duty when making decisions about their policies and practices. Awareness of the general duty throughout the South Wales Programme process was facilitated by the creation of a dedicated Equality, Editorial and Engagement (3Es) workstream. The 3Es team consisted of an engagement lead/planner and equality lead from each of the five health boards and the Welsh Ambulance Service NHS Trust (WAST). In addition to the staff from the health boards and WAST, the 3Es team was also supported by a representative from the NHS Centre of Equality and Human Rights (NHS CEHR) and the South Wales Programme Manager and the South Wales Programme Communication lead. The 3Es workstream remit was to plan for and co-ordinate feedback from the engagement and consultation activity undertaken for the South Wales Programme and report directly to the Programme Team and through the Director to the Programme Board. The 3Es workstream team ensured that the South Wales Programme consultation was accessible to all members of the public, with particular focus on the accessibility requirements of members of the public with protected characteristics as defined by the Equality Act 2010. The 3Es team held a mid-consultation review to determine whether there were any gaps in which protected characteristic groups had responded to the consultation. Where gaps were identified additional workshops were arranged to facilitate participation by those groups. The consultation material was made available in a range of formats (e.g. easy read, large print, audio books) to address the diverse communication needs of people from the protected characteristic groups. The 3Es team was also responsible for the production of the South Wales Programme Equality Impact Assessment, which was distributed to health boards as part of a suite of documents made available by the South Wales Programme Board. By drawing on staff from each of the health boards, the 3Es team was able to provide regular feedback on any issues or concerns relating to equality to their respective Boards. Awareness of the general duty, the importance of the Equality Impact Assessment, and the Board s scrutiny obligations were also promoted via four training sessions run over two days for health board and CHC members run by the NHS Centre for Equality & Human Rights on behalf of the South Wales Programme in August and September 2013. Minutes from the special board meetings held by each of the health boards clearly demonstrate that the board members were aware of the general duty, and the need to 7
consider any equality issues in their deliberations. Direct references to the Equality Impact Assessment and relevant equality concerns are captured within the minutes for each health board. Timeliness Due regard must be paid before and at the time that a particular decision is being considered, not later. Attempts to justify a decision as being consistent with the exercise of the duty when it was not, in fact, considered before the decision, are not sufficient to discharge the duty. The duty arises before and at the time that a particular policy is under consideration and a decision is taken. A public authority cannot satisfy the duty by justifying a decision after it has been taken. The creation of the Equality, Editorial and Engagement workstream early in the South Wales Programme demonstrates that equality was a conscious consideration from the outset of the South Wales Programme. The programme lead for the 3Es team also held meetings with the NHS CEHR prior to the start of the public consultation to discuss how equality could be mainstreamed into the South Wales Programme. As a result of this meeting, a member of the NHS CEHR team was invited to join the 3Es team to provide additional support and expertise in equality. Similarly the mid-consultation review held by the 3Es team, and the references within the minutes of the special board meetings all demonstrate that equality was considered throughout the process i.e. before and at the time that the decision was considered. Rigorous analysis The duty must be exercised with rigour and with an open mind it is not a question of just ticking boxes. There must be substantial sifting of relevant facts and research, and fair attention to conflicting views. There must be meaningful consultation and engagement with interested parties. The South Wales Programme dedicated significant resources to the production of the EIA. In addition to the work undertaken directly through the programme structure, the South Wales Programme contracted a specialist consultancy firm, ORS, to analyse the consultation submissions which included analysis from an equality perspective. The employment of ORS to analyse the consultation submissions ensured that the analysis was independent and rigorous. The South Wales Programme took further steps to ensure the rigour and robustness of the consultation process by employing the Consultation Institute, an independent expert agency on consultation, to quality assure the consultation process. Frequent meetings were held with the Consultation Institute throughout the consultation to monitor and review the process. 8
An initial analysis of anticipated equality impacts was produced and made available to the public at the launch of the consultation so that the public could make an informed decision on the proposals before them. Response to the consultation was greater than the Programme Board had initially anticipated, with over 60,000 responses eventually being submitted. In recognition of this the Programme Board made the decision to allow additional time for the analysis of the consultation responses. This decision enabled the Programme Board to fully comply with the third and fourth of the Gunning Principles of consultation. 2 That is: 3. Adequate time must be given for consideration and response; and 4. The product of consultation must be conscientiously taken into account The findings of the consultation were fully incorporated into the EIA and used to build upon the initial impact analysis. The general duty requires that public bodies give due regard to the potential impacts upon the protected characteristics, however the South Wales Programme EIA went beyond this with its consideration of socio-economic factors, human rights implications, impact upon Welsh Language speakers, and the potential impact upon staff. Evidence of the rigour of the analysis was further demonstrated by the inclusion of a chapter looking at potential mitigation options that the health boards could consider. In recognition of the fact that each health board would need to make a decision based on the best interests of their client population, separate analyses for each health board were produced alongside the overarching regional analysis. Board members were directed by the South Wales Programme and their own board secretaries that they should read both the overarching analysis as well as their individual analysis in order to inform their decision appropriately. Non-delegation The duty to have due regard cannot be delegated. The duty rests with the public authority even if they have delegated any functions to another organisation. As noted above the health boards did not delegate their decision on the South Wales Programme proposals to the South Wales Programme Board. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health boards. 2 The first and second of the Gunning Principles are (1) Consultation must take place when the proposal is still at a formative stage; and (2) Sufficient reasons must be put forward for the proposal to allow for intelligent consideration and response. 9
Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of Acute Care Alliances to oversee the implementation phase of the South Wales Programme. Continuing duty The duty is a continuing one. It cannot be exercised once and for all, but must continually be revisited and borne in mind. The health boards recognise that the duty is a continuing one. The health boards have established the Acute Care Alliances to plan the implementation phase of the South Wales Programme with support from the South Wales Health Collaborative, and through these structures there will be continued due regard to equality issues. In addition the health boards through meetings with the South Wales Health Collaborative and the Acute Care Alliances have acknowledged the need for further EIAs to be conducted as more detail on the implementation of the South Wales Programme becomes clear. The complexity of the programme inevitably means that in making changes to consultant-led maternity services, neonatal care, inpatient children's services and emergency medicine (A&E) there will be knock-on effects to related services and staff. Record keeping The law requires transparency about how decisions are reached. This involves recording the evidence used and publishing records of equality considerations with the relevant policy / proposal. It is useful to carry out this process when developing new policies as well as in the review of old policies. The South Wales Programme has been conscientious in producing appropriate documentation on the South Wales Programme proposals, and the decision making process. Extensive material used in supporting the South Wales Programme (e.g. consultation documents, service models, travel times maps) were published on a public facing website 3. The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations of the South Wales Programme Board, framework for making recommendations, EIA, consultation findings report produced by ORS). These were also published on the South Wales Programme website and each of the health board s websites. In addition, minutes of the special board meetings held by the health boards to decide upon the South Wales Programme proposals are public documents and show that the EIA and the equality issues it highlighted were discussed within those meetings. 3 http://www.wales.nhs.uk/swp/home 10
Conclusion The process employed by the South Wales Programme has been rigorous and robust, it has ensured that equality and human rights concerns were a conscious consideration throughout. We therefore believe that the South Wales Programme has met its obligations under the general duty of the public sector equality duty, and is able to demonstrate fully that due regard has been given. 11
Annex A: Abertawe Bro Morgannwg UHB Knowledge Training was provided for all board members prior to receiving the SWP EIA. ABM board members were able to attend sessions run by the health board itself, as well as separate training sessions organised by the South Wales Programme. The Assistant Director of Planning at ABM was the lead for the South Wales Programme Equality, Engagement and Editorial (3Es) workstream. In addition to the Assistant Director of Planning, ABM s Equality Manager was a member of the 3Es workgroup. The 3Es workstream was responsible for ensuring that the SWP met its legal duties with regard to engagement/consultation and the Equality Impact Assessment. As part of ABM s decision making process, its Stakeholder Reference Group (SRG) was consulted with, and the output from this engagement was fed back to the Board. The health board s SRG membership is made up of a range of stakeholders drawn from its health board area. These stakeholders represent a range of bodies and groups including statutory organisations that work in partnership with the health board, community partners, provider organisations and special interest groups which reflect protected characteristics from the Equality Act plus other relevant special interest groups. Board papers for the South Wales Programme special board meeting were made available to all board members in hard copy, and board members were made aware of the need to read the EIA. The minutes of the board meeting show that in making their decision the ABM board was aware of the Equality Act and their legal obligations under that Act, as well as the need for the board to use the evidence in the EIA to inform their decision. For example the minutes show that the board discussed the access issues raised in the EIA. Timeliness The ABMU chair and chief executive were members of the SWP Programme Board, and membership of the 3Es workstream is set out above; all reported back to ABM on a range of issues, of which equality was one. This ensured that the ABM board was aware of the equality implications of the SWP proposals from the outset. The minutes of the board meeting show that equality was a conscious consideration before and at the time of the decision. The minutes make reference to the EIA and that relevant issues were discussed by board members e.g. the access issues raised in the EIA. 12
Rigorous analysis ABM had responsibility for consultation within its area, the approach to which was coordinated through the South Wales Programme structure to ensure consistency. An inclusive approach was taken to local consultation with different equality groups targeted to ensure they had an opportunity to highlight the potential impact of the proposed service changes. Important adjustments were made to the standardised consultation approach to enable participation, for example the use of BSL interpreters and easy read consultation documents and questionnaires. The EIA was also coordinated through the South Wales Programme structure. ABM staff as members of the 3Es workstream contributed to the production of the EIA, and authored the separate ABM analysis contained within the main EIA. Non-delegation ABM did not delegate their decision on the South Wales Programme proposals to the South Wales Programme Board. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health board. Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of the Acute Care Alliances to oversee the implementation phase of the South Wales Programme. Continuing duty The access issues raised in the EIA have been highlighted by the board as an area of particular concern. As such ABM ran a series of workshops to consider patient flow, and there are ongoing discussions by the board on these issues. The ABM board recognises that as the South Wales Programme proposals are implemented there will need to be additional EIAs conducted as the detail on how the SWP proposals will be implemented become apparent. The implementation of the South Wales Programme proposals is being led by the Acute Care Alliances on a regional basis with support from the South Wales Health Collaborative (SWHC). The governance structure for the implementation of the South Wales Programme proposals was agreed by health boards at their scheduled meetings in September and October. 13
Record keeping A governance document was created at the outset of the South Wales Programme which each health board signed up to. The governance document specified the decision making process by which the health boards would decide upon the SWP proposals. The ABM board secretary reviewed the South Wales Programme governance document to ensure that it fit with existing ABM decision making processes. The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations of the South Wales Programme Board, framework for making recommendations, EIA, consultation findings report produced by ORS). In addition, minutes of the special board meetings held by the health boards to decide upon the South Wales Programme proposals show that the EIA and the equality issues it highlighted were discussed within those meetings. Any decisions relating to the South Wales Programme proposals were made by the ABM board and these are made public via the ABM UHB website. 14
Annex B: Aneurin Bevan UHB Knowledge The Aneurin Bevan UHB has a Committee for Workforce and Organisational Development (WOD). This committee has lead responsibility on ensuring the board meets its duties under the Equality Act and other associated work. The WOD Committee meets quarterly and equality is always an agenda item. The WOD Committee is chaired by the chair of the board, and reports back to the full board with assurance reports highlighting any equality issues on a regular basis. The lead officer is the Director of WOD, who is the executive lead for the organization on equality matters. An equality champion also sits on the board, and is a member of the WOD Committee. The terms of reference of the committee has a section within it which clearly states the committee s role in relation to equality matters and to ensure that the full Board is aware of equality issues. As such there is a strong awareness at board level of the Equality Act. Board members also attended training sessions run by the South Wales Programme on the Equality Act and EIAs which were run in August and September 2013. The board held a specific meeting to focus on the issues raised by the South Wales Programme, at which every board member had a hard copy of the EIA. Minutes of that board meeting demonstrate that the EIA was directly referred to and referenced in the ensuing discussion among board members. For example many board members referenced the EIA in terms of transport issues for disadvantaged members of the population served by Aneurin Bevan UHB. Equity of access to service was a particular issue. Timeliness Early consideration of the Equality Act and its duties was ensured by having staff from Aneurin Bevan UHB (Equality Manager and Head of Strategic & Operational Planning) sit on the South Wales Programme workstream that focused on equality (Equality, Engagement and Editorial or 3Es). Full and comprehensive documentation was made available to the board in good time for them to consider it, to ask questions, and seek clarification on any of the points, to enable them to come to an informed decision when the special board meeting was held to discuss the SWP proposals. The EIA was a comprehensive and far reaching piece of work. Board members found it helpful in coming to their final decision. It was evident from the board discussion that board members were referencing material from the EIA, in determining what assurances they sought before making their final decision on the SWP proposals. 15
The minutes of the special board meeting also demonstrate how the evidence in the EIA influenced the board in reaching their decision. It was not a retrospective decision. Rigorous analysis Aneurin Bevan UHB had responsibility for consultation within its area, the approach to which was coordinated through the South Wales Programme structure to ensure consistency. The EIA was also coordinated through the South Wales Programme structure. Aneurin Bevan staff as members of the 3Es workstream contributed to the production of the EIA, and authored the separate Aneurin Bevan analysis contained within the main EIA. The EIA genuinely made a difference. The EIA helped inform throughout the development of the South Wales Programme, there were considerations throughout the consultation as well around venues, accessibility, how it was designed to reach the harder to reach groups in the Aneurin Bevan service area. The profile of the EIA as evidenced in the minutes and documentation show it had an impact. The EIA did influence members in relation to the way they thought about the programme, and how services would be configured for the future. The documentation informed their questioning for the final decision they came to. Non-delegation Aneurin Bevan did not delegate their decision on the South Wales Programme proposals to the South Wales Programme. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health board. Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of the Acute Care Alliances created to oversee the implementation phase of the South Wales Programme. Continuing duty The board has made clear that the issues and concerns they raised when considering the South Wales Programme proposals (e.g. transport and equity of access) need to be key considerations going forward. These are areas that they will continue to seek assurances on. There are key actions and recommendations from and for the board as detailed within the legacy document and statement. Aneurin Bevan has an Equality Action Plan for the organisation within which the SWP features. Record keeping The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations from the Programme 16
Board, framework for making a recommendation, EIA, consultation findings report produced by ORS). In addition, minutes of the special board meetings held by the health boards to decide upon the South Wales Programme proposals show that the EIA and the equality issues it highlighted were discussed within those meetings. Relevant records relating to the SWP held by Aneurin Bevan UHB include: Minutes of board meetings E-mails Attendance records at training Documentation considered in the SWP special board Meeting Documentation describing how the board was involved during the engagement and consultation phases of the SWP. 17
Annex C: Cardiff and Vale UHB Knowledge Board members attended training sessions on the Equality Act and EIAs run by the South Wales Programme. Some board members had already received equality training via internal training sessions run by Cardiff and Vale UHB. Correspondence sent out to all board members relating to the South Wales Programme equality briefing sessions included reference to the Equality Act and the general duty to ensure board members were aware of the relevance of the briefing sessions to their legal obligations under the Equality Act. Cardiff & Vale UHB has an Equality, Diversity and Human Rights Sub Committee which is chaired by an independent member which ensures that there is a good awareness of equality and the requirements of the general duty amongst the board. Two members of staff from Cardiff & Vale UHB (Equality Manager and the Strategic Partnership and Planning Manager) were members of the South Wales Programme Equality, Engagement and Editorial (3Es) workstream that focused on equality. The minutes of the special board meeting held on 13 th February 2014 to discuss the SWP proposals contain references to the EIA, and demonstrate that the board members were conscious of the equality issues raised by the EIA. Timeliness Documentation relating to the SWP (including the EIA Stage 2) was provided to board members well in advance of the Special Board Meeting in February. In addition to electronic documentation, hard copies of the EIA were made available to the board members, who were informed that they needed to read it. The 3E s workstream of the South Wales Programme was set up to ensure that consideration of equality was built into the South Wales Programme structure. As mentioned earlier, the Equality Manager and the Strategic Partnership and Planning Manager from Cardiff and Vale UHB were members of this workstream, and reported back to the board of Cardiff & Vale UHB on the progress of this workstream. The minutes of the special board meeting show that equality was a conscious consideration before and at the time of the decision. The minutes make reference to the EIA and that relevant issues were discussed by board members. 18
Rigorous Analysis Cardiff & Vale UHB had responsibility for consultation within its area, the approach to which was coordinated through the South Wales Programme structure to ensure consistency. The EIA was also coordinated through the South Wales Programme structure. Cardiff & Vale staff, as members of the 3Es workstream, contributed to the production of the EIA, and authored the separate Cardiff & Vale analysis contained within the main EIA. This local analysis provided the opportunity to highlight issues specific to the diverse population resident in Cardiff and the Vale of Glamorgan and to evidence the efforts taken to engage with some key seldom heard groups potentially affected by the proposals. Quotes extracted from responses served to bring to life some of the issues identified by residents with a particular emphasis on comments relating to protected characteristics. Non-delegation Cardiff and Vale did not delegate their decision on the South Wales Programme proposals to the South Wales Programme Board. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health board. Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of the Acute Care Alliances created to oversee the implementation phase of the South Wales Programme. Continuing duty The minutes of the special board meeting held in February show that the board was aware that the duty is a continuous one. The minutes make reference to the fact that as the South Wales Programme moves from proposal to implementation further equality analyses will be required. Cardiff and Vale UHB recognises that review and post implementation evaluation of the implementation of the South Wales Programme will be required but, as this is a collaborative project across the five health boards and the Welsh Ambulance Service Trust, these will be based upon timescales agreed through the collaborative structure. There is a number of health board staff participating in this process who will all have a role to ensure that the continuing duty is taken into account as appropriate. In addition, all policies developed in Cardiff & Vale UHB undergo an EIA. The policy and the EIA are both published on their website. 19
Record keeping The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations from the Programme Board, framework for making a recommendation, EIA, consultation findings report produced by ORS). These documents are published on the Cardiff and Vale UHB web site. In addition, minutes of the special board meetings held by the health boards to decide upon the South Wales Programme proposals show that the EIA and the equality issues it highlighted were discussed within those meetings. Relevant records relating to the SWP held by Cardiff and Vale UHB: Report considered at board meeting which specifically referenced the EIA and provided an electronic link to the document Minutes of board meetings E-mails 20
Annex D: Cwm Taf University Health Board Knowledge During the decision process Cwm Taf invited independent governance advice from Dame Rennie Fritchie, and conversations were also held with the NHS CEHR. The Director of the NHS CEHR was brought in to speak to the chairman, the chief executive of Cwm Taf UHB, and the vice chair to discuss whether Cwm Taf UHB was paying due diligence in terms of the way they used the EIA. In addition Cwm Taf board members attended training sessions organized by the South Wales Programme on the findings from the consultation and how that information could be utilized, EIAs, the Equality Act, and their legal duties under that act. The South Wales Programme training sessions were run in August and September 2013 i.e. prior to the special board meeting in February 2014. Internally the Equality Manager for Cwm Taf also delivered a training session for the Board on the EIA process at the outset of the SWP. Several board sessions were held which discussed the equality issues, and the minutes of those sessions reflect this (e.g. the flow data, and A&E data). At the time of the South Wales Programme the Vice Chair of Cwm Taf UHB was a lawyer specialising in human rights and equality, who took great interest in the equality implications of the SWP for Cwm Taf. The Vice Chair reviewed the EIA before it went before the board. Once the EIA was published Cwm Taf UHB engaged with the NHS CEHR again to discuss how they should interpret the evidence in the EIA. The decision process was very rigorous. This ensured that awareness by the board of their duties under the Equality Act was very high. A governance paper produced by Cwm Taf includes a section on what was their duty under the Equality Act. Cwm Taf can also demonstrate that they held discussions on mitigation. The board used the NHS CEHR guidance on scrutiny. Awareness of the Equality Act and its duties was also ensured by having staff from Cwm Taf (Equality Manager and Assistant Director - Partnerships) sit on the South Wales Programme workstream that focused on equality (Equality, Engagement and Editorial or 3Es).
Timeliness The Cwm Taf board members are able to evidence that they had read the EIA. The minutes of board meetings show that the EIA was a constant theme throughout their decision making process, with board members referring back to the EIA in their discussion. To ensure that board members read the EIA it was made available to them in hard copy as part of a suite of documents. Rigorous analysis Cwm Taf UHB had responsibility for consultation within its area, the approach to which was coordinated through the South Wales Programme structure to ensure consistency. The EIA was also coordinated through the South Wales Programme structure. Cwm Taf staff as members of the 3Es workstream contributed to the production of the EIA, and authored the separate Cwm Taf analysis contained within the main EIA. Cwm Taf s Director of Public Health asked that a health impact assessment be produced alongside the EIA. In doing so Cwm Taf went wider than the generic EIA in considering the potential impacts of the SWP proposals on the population served by Cwm Taf UHB. Cwm Taf UHB serves a geographical area that includes a lot of very deprived areas, with concomitant issues such as high rates of low birth weight babies, with mothers who may therefore need to access special care. The Cwm Taf area also has low rates of car ownership, and poor public transport which present particular challenges in relation to moving A&E services, and the ability of family members to access hospitals to provide family support. These are highlighted as key considerations in the paper presented to the Cwm Taf board. Non-delegation Cwm Taf did not delegate their decision on the South Wales Programme proposals to the South Wales Programme Board. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health board. Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of the Acute Care Alliances to oversee the implementation phase of the South Wales Programme.
Continuing duty In terms of the proposals made by the South Wales Programme the Acute Care Alliance is now the mechanism by which these are taken forward. The Acute Care Alliance governance structures are being established now, and there are EIA implications within that. The Equality Act general duty is referenced within those governance structures. The clinical reference groups established under the SWP are continuing, and it is the understanding of Cwm Taf UHB that the implications of the equality impact are constantly under consideration. As such as the South Wales Programme moves into the implementation phase the EIA continues to underpin everything and is part of the governance structure. Until Cwm Taf know exactly what the final shape of the reconfigured service is, they recognize that there will need to be continuous assessment of the potential impacts, so further EIAs will be required. Due to the nature of the South Wales Programme, implementation will have impacts upon wider health specializations than those four initially reviewed as part of the South Wales Programme. Cwm Taf is taking part in wider ongoing work to account for this. Record keeping The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations of the Programme Board, framework for making a recommendation, EIA, consultation findings report produced by ORS). Relevant records relating to the SWP held by Cwm Taf UHB: Governance document Specific mention within minutes of meetings E-mail trails asking for more work to be undertaken (e.g. health impact assessment) E-mail trails of conversations with NHS CEHR.
Annex E: Powys Teaching Health Board Knowledge The Powys Board received training sessions specifically on equality and human rights prior to making their decision on the South Wales Programme proposals. Sessions were run internally, as well as the training sessions run by the South Wales Programme in August and September 2013. Awareness of equality and human rights amongst the Powys board is also high as Powys health board has a Strategic Equality Plan. Powys Board members were kept apprised of potential equality and human rights issues throughout the development of the South Wales Programme EIA via their staff members on the 3Es workstream team i.e. the Equality Manager and the Communications Manager. The Board received and passed commented back to the South Wales Programme on the drafts of the Powys annex of the South Wales Programme EIA. Copies of the South Wales Programme suite of documents were made available to Powys Board members both electronically and in hard copy, with clear instructions from the board secretary that the board members should read this material prior to attending the February 2014 special board meeting held to decide upon the South Wales Programme proposals. Minutes of the February 2014 special board meeting demonstrate that the board members complied with these instructions as the minutes include specific references to the South Wales Programme framework which includes the South Wales Programme EIA. For example travel and accessibility issues raised in the EIA were areas of concern for the Powys board, and this was fed back to the South Wales Programme Board. Prior to the February 2014 special board meeting, board members had met informally in December 2013 to discuss the South Wales Programme framework. Timeliness The 3Es workstream of the South Wales Programme Board was set up to ensure that consideration of Equality was built into the South Wales Programme. The Equality Manager and the Communications Manager from Powys Health Board were members of this workstream, and reported back to the Powys board on the progress of this workstream. Documentation relating to the SWP (including the EIA Stage 2) was provided to board members well in advance of the special board meeting in February. In addition to electronic documentation, hard copies of the EIA were made available to the board members, who were informed that they needed to read it.
The minutes of the special board meeting show that equality was a conscious consideration before and at the time of the decision. The minutes make reference to the EIA and that relevant issues (e.g. travel and accessibility concerns) were discussed by Board Members. Rigorous analysis Powys Health Board had responsibility for consultation within its area, the approach to which was coordinated through the South Wales Programme structure to ensure consistency. The EIA was also coordinated through the South Wales Programme structure. Powys staff as members of the 3Es workstream contributed to the production of the EIA, and authored the separate Powys analysis contained within the main EIA. Non-delegation Powys health board did not delegate their decision on the South Wales Programme proposals to the South Wales Programme Board. The South Wales Programme Board s role was to provide a recommendation, with the final decision resting with the health board. Recognition of their obligation not to delegate the duty of due regard continues post South Wales Programme, with the establishment of the Acute Care Alliances to oversee the implementation phase of the South Wales Programme. Continuing duty The Powys Health Board recognises that the duty of due regard is a continuing one, and therefore continue to hold meetings to discuss the progress of the South Wales Programme. The Acute Care Alliances have been set up to continue the collaborative regional approach of the South Wales Programme. However, the Acute Care Alliances at the time of writing this report are not sufficiently developed to produce Action Plans which would further demonstrate the Powys Board s recognition of the continuing duty. As such, no review dates have been put in place, and these will be set by the Acute Care Alliances. Powys Health Board recognises the need for further EIAs to be conducted as the implementation of the South Wales Programme progresses. The complexity of the programme inevitably means that in making changes to consultant-led maternity services, neonatal care, inpatient children's services and emergency medicine (A&E) there will be knock-on effects to related services and staff.
Record keeping The South Wales Programme made available a suite of documents to board members to help inform their decision (e.g. core cover report, recommendations from the Programme Board, framework for making recommendations, EIA, consultation findings report produced by ORS). Relevant records relating to the SWP held by Powys Teaching Health Board: Minutes of board meetings E-mails