Equalities Health Impact Assessment

Stakeholder Engagement/Co-Production Tool

Please return completed template to: hafccg.engagement@nhs.net

This document is to provide stakeholders with information in support of co-development of EHIAs across North West London Clinical Commissioning

Groups. The template will describe the evidence and assumptions made to date and provide stakeholders with an opportunity to validate or provide

input.

Brief description of scheme: Resonate Arts is a pioneering programme of innovative arts based activities and experiences for local residents with dementia and their families.

The service:

• Initiates a range of arts programmes for people living with dementia, including individual and group based arts projects, home visits, outings and visits linking to local organisations

• Works with a wide range of providers to support referrals to/from the service

CCG/Service Hammersmith and Fulham

Service Resonate Arts

Completed by: Name / Organisations

Date 17.04.2019

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• Produces/distributes a monthly list of arts opportunities in the borough suitable for people with dementia and their carers

• Supports people to attend events via telephone call reminders, planning travel, providing escorts to enable people to remain socially engaged.

• Supports other arts organisations to work with people living with dementia and the three boroughs to become a Dementia Friendly Community

• Develops a resource base of artists, volunteers and arts organisations competent to work with clients across the 3 boroughs including training

• Produce art works and artistic legacies with/ for individuals and or their care communities

Given the current financial position of HFCCG and along with our duty to commission services within the allocated budget, it is now proposed to de-

commission the service giving the provider the required notice period.

Drivers for change:

Resonate Arts programme is commissioned via the Joint Commissioning Team (JCT) on behalf of the three Clinical Commissioning Groups (CCGs),

Hammersmith & Fulham CCG, Central London CCG and West London CCG.

The programme was originally commissioned by Westminster PCT in 2009. The service has been commissioned in HFCCG and WLCCG from 2015. A single

tender waiver was awarded in 2017 and the contract term ended on 31st March 2018 with no provision to extend. Regularisation of contractual

arrangements across all 3 CCGs has been delayed pending the outcome of the wider CCG and Local Authority (LA) review of services funded via the section

75.

Dementia Arts Service outcomes were within scope of a LA led 3 Borough re-tender for a remodelled dementia service which was expected to be in place

from April 2018. The LA re-tender did not proceed as planned and the 3 Boroughs have subsequently been reorganised into Bi-Borough (Westminster City

Council & Royal Borough of Kensington & Chelsea) and LB Hammersmith & Fulham.

Options Considered:

Programme Spend Area Summary of options Type of Scheme Net Financial Impact (£000)

QIA Required

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Joint Commissioning

Third sector commissioning

Decommission of preventative service supporting people with dementia through creative arts projects.

Transformation

£10,000 (HFCCG only)

Yes

Intended outcomes

Our plan for the service suggests that the Resonate Arts service currently commissioned by HFCCG and provided by Westminster Arts for Hammersmith &

Fulham residents will no longer be available.

Any agreement to decommission these services will mean that service users will be signposted to alternative support services that offer opportunities for

social interaction, peer support, enjoyment, cognitive stimulation and carers support.

HFCCG in partnership with the Local Authority jointly commission Carers Network, a service that offers carers assessment, access to Carers personal

budgets, Information, Advice and Guidance and support. Commissioners are committed to working closely with incumbent providers to ensure that carers

are signposted to Carers Network.

It is acknowledged that the service change proposed may impact certain groups who have accessed Arts services particularly age, women, disability and

carers. To mitigate the risks the CCG will work closely with the incumbent providers to ensure that service users are aware of and signposted to a range of

alternative provisions as necessary.

Who will be affected by this proposal?

1. Residents with dementia and their carers. The service has a resident/carer/professional cohort list of 236 recipients in Hammersmith and Fulham who receive the monthly events listings collated and distributed by Westminster Arts. Of this cohort 43 people with dementia have attended Resonate Arts projects although it is acknowledged that attendees are likely to be higher but data is not collected at all events i.e. music concerts.

2. Westminster Arts staff - Director x1 FTE, x2 part time staff. As of Q2 2018/19 x38 artists and x 19 volunteers

3. WLHT Cognitive Impairment Dementia Service (CIDS)

4. Primary Care including GPs and H&F Dementia link worker service

5. Adult Social Care

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6. Other commissioned and third sector services that people will be signposted to i.e. Dementia Day Services at St Vincent, Dementia Support Worker, HF Carers Network

7. Other Local Arts organisations that people will be signposted to

8. Other voluntary sector services that people will be signposted to i.e. H&F Age UK

Below is a summary of the evidence that the CCG has considered in reaching its conclusion and a summary assessment. In the final column the CCG is

asking for further feedback on whether there are additional actions and mitigations that need to be considered

EHIA Analysis Area Summary of CCG Assessment / Evidence Stakeholder Feedback

Evidence Considered:

Consideration has been made using information as provided by:

Public Health Observatory Data

LocalStats

Hammersmith and Fulham borough profile (2018)

Hammersmith and Fulham people profile (2016)

TriBorough Dementia JSNA

HFCCG GP Dementia register Systm1

Financial Recovery Equality Event 27/03/19

Patient Representative Group Forum 04/04/19

Service level data 2018/19

Is there any other National or Local Evidence that you feel should be considered?

Age Impact including Alignment to proposed Change

The main risk factor for dementia is getting older and ageing.

The number of people with dementia is increasing, mirroring the increase in the size

of the elderly population who are at particular risk of dementia.

There are currently 897 on the Hammersmith & Fulham Dementia Register, age

profile as shown in the table below:

Age range Patient Count

Population % of population with dementia

% of total with dementia

Are there any other factors you think the CCG should consider with regards to age?

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0-64 36 245,398 0.0% 4.0%

65-74 128 11,835 1.1% 14.3%

75-84 345 6,664 5.2% 38.5%

85-94 343 2,291 15.0% 38.2%

95+ 45 201 22.4% 5.0%

TOTAL 897 266,389 0.3% 100.0%

Age profile service specific information These arts services are commissioned to support people with dementia. Resonate Arts age profile as shown in the table below:

Age Range No of SUs

<65 1

65-74 3

75-84 11

85 + 10

Unknown 13

Total 43

Looking at the age profile of those supported by the service in 2018-19 there is a higher prevalence in the 75+ age group. At the equalities engagement event held on 27th March 2019 attendees commented that the proposal would have a greater impact on the older person cohort and an ageing population means the number of people with dementia will increase. One attendee in receipt of the Resonate Arts service commented that there is a need for age relevant services for the younger age cohort.

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As a result, this change will have no impact on the vast majority of the local HF population. However given that dementia is an age related disease, the impact among the very old in particular is increased as the likelihood of having dementia within this age group is high (e.g. 22% of 95 + year olds are on a dementia register). We therefore acknowledge that the decommissioning of the Resonate Arts service may impact predominantly on older people.

EHIA Analysis Area Summary of Assessment / Evidence Stakeholder Feedback

Disability Prevalence Data and Alignment to Proposed Change

Dementia is more prevalent among people with a learning disability than the general population. However, this dementia arts service was not intended to be commissioned to specifically meet the needs of people with learning disability although this cohort of people may access these services. Data on uptake by this cohort is not recorded by providers The following feedback has been received via the equalities engagement event, PRG forum and one of the dementia arts providers:

o By the very nature of a person having a dementia diagnosis they are a vulnerable group.

o Dementia in itself is a protected characteristic

o All service users have a disability i.e.

Are there any other factors you think that the CCG should consider with regards to disability? Is there any additional data that you can provide that the CCG should consider?

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dementia o People with disabilities may, due to their

dementia have mobility difficulties, and other age related conditions and therefore find it harder to travel to the location of alternative services that may be on offer to residents.

We therefore acknowledge that the decommissioning of the Resonate Arts service may impact people with dementia and their carers.

Gender Reassignment Data and Impact Known

There is no routinely collected data on access by this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group.

Are there any other factors you think that the CCG should consider? Is there any data that you can provide that the CCG should consider?

Marriage and Civil Partnership Data and known Impact

An attendee at the PRG forum on 4th April 2019 commented that those without families and isolated people would be more impacted. There is no routinely collected data on access by this group. There was no indication so far other data sources that the proposals would result in an adverse impact on this group.

Are there any other factors you think that the CCG should consider? Is there any additional data that you can provide that the CCG should consider?

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EHIA Analysis Area Summary of Assessment / Evidence Stakeholder Feedback

Pregnancy and Maternity Analysis and Known Impact

There is no routinely collected data on access by this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group.

Are there any other factors you think the CCG should consider? Is there any additional data that you are aware of that you think the CCG should consider?

Race Profile Analysis and known impact

Generic National and Local data on breakdown of population by race provided. The Triborough Dementia JSNA identified that there was no evidence to suggest that the rate of dementia by ethnic group are either the same or different to the population. There is no routinely collected data on access by this group from the service provider. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group. There is no evidence to suggest there is a disproportionate negative impact on this group.

Are there any other factors you think the CCG should consider? Is there any additional data that you are aware of that you think the CCG should consider?

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EHIA Analysis Area Summary of Assessment / Evidence Stakeholder Feedback

Sex Analysis and known Impact

Based on local population data and existing service usage the impact of the plan would be greater on women than men. Resonate Arts Service usage by sex:

Male Female

Resonate Arts 10 33

Are there any other factors you think the CCG should consider? Are there any adverse equality impacts that you think the CCG should consider?

Sexual Orientation Analysis and known impact

There is no routinely collected data on access by this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group.

Are there any factors you believe the CCG should consider? Do you agree with the CCGs initial conclusion? (please provide rationale)

Other Groups Identified: Informal Carers

There is no routinely collected data on access by this group. Attendees at the PRG event 4th April 2019 fedback that Carers tend to be women therefore also impacting this group.

Please consider any other data/evidence the CCG should have considered regarding carers? Please state whether you agree/disagree with the CCG initial conclusion – including the number of

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We therefore acknowledged that the decommissioning of the Resonate Arts service may impact carers

carers supported by the service?

Other Groups Identified: Homelessness and Rough sleeping and known impact

There is no routinely collected data on access by this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group.

Are there any other areas that you feel the CCG should consider?

Other Groups Identified: Female Genital Mutilation

N/A

Other Groups Identified: Trafficking N/A

Other Groups Identified: Deprivation There is no routinely collected data on access by this group. There was no indication so far from the engagement or other data sources that the proposals would result in an adverse impact on this group.

Are there any other factors you think that the CCG should consider? Is there any additional data that you can provide that the CCG should consider?

Assessment of EHIA Analysis Assumptions through stakeholder Engagement: It is acknowledged that the service change proposed may impact certain groups who have accessed this service particularly older age cohirt, women, disability and carers. To mitigate the risks the CCG will work closely with the incumbent providers to ensure that service users are aware of and signposted to a range of alternative provisions as necessary as follows; • Dementia Link Service – x4 dementia link workers attached to the three Primary Care GP networks • GPs

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• Cognitive Impairment Dementia Service (WLMHT) • St Vincent’s Day Service for people with dementia • Dementia Support Worker (Alzheimer’s Society) • Saturday Café (Alzheimer’s Society) held monthly at St Vincent’s Day Centre, Third Saturday of every month, 2–4pm • Carers Support Group (Alzheimer’s Society) Fortnightly on Thursday, 10.30am–12pm • Carers Network • Music for Memory (Age UK) Tuesday 10.45am till 11.45am at Age UK centre on 105 Greyhound Road, W6 8NJ • Other non-dementia specific services offered by the Third Sector e.g. Age UK , Bishop Creighton House • Turtle Song (Turtle Key Arts) 9 week programme at the Lyric • At PRG forum the GP Fed suggested signposting people to football clubs offering different workshops – sporting memories programme with Fulham and Chelsea offered The CCG will also explore an alternative service collating and distributing the monthly HF events listings with service user/carer consent.

Assessment of EHIA Analysis Assumptions through stakeholder Engagement: The CCG undertook a range of engagement activities with local communities to help address any gaps and ensure that our EHIA screening was as robust as possible. During phase 1 of the engagement we heard from members of our Patient Reference Group, the local BME Health Forum, and from other local residents via an Equality Workshop at the local Irish Cultural Centre and via a digital survey. The digital survey and the equality workshop were advertised to all of our patient and public networks, Community Champions, Patient and Participation Group Chairs, our website and social media channels, and via our community and voluntary sector partners. Flyers were sent to community and voluntary sector organisations to advertise the event to their client groups and, based on feedback from local people, we created targeted flyers for particular protected groups (e.g. rainbow flyer for the LGBT community, Easy read flyer for people with learning disabilities, etc). The verbatim feedback received from phase 1 of our engagement is detailed below. Phase 2 of the engagement will involve circulating this document to our Patient Reference Group, relevant service providers, the BME Health Forum, Community Champions, Patient and Participation Group Chairs and community and voluntary sector colleagues for final comments and input. This is to provide a further opportunity to comment on the impact identified to date and provide further input into the evidence that will be considered in the final decision.

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Verbatim feedback from phase 1 of engagement:

Name of event Date feedback was given Feedback

BME Health Forum quarterly meeting

Wednesday 27 March “What are the GPs’ views on the proposed changes?”

“How have you tried to evaluate the impact of the dementia support services?”

“We need to raise awareness around dementia, using community settings e.g. via schools and libraries.”

“The dementia art support services are actually more significant than hospital services, and people with dementia are themselves part of a protected characteristic group due to having a disability.”

“There is already a gap in terms of support services for people with dementia.”

“The NHS Long Term Plan is all about social prescribing. Why are we proposing to reduce the types of services which can be used in social prescribing?”

“The “Ideal Programme” from the University of Essex shows that mental health style interventions should be a top priority where dementia is concerned.”

“Dementia support services have a positive impact on people’s emotional well-being and as such have clinical importance.”

“Not enough evaluation and research has been done on dementia support services and their impact.”

“Potential mitigation: What are the alternative services for people with dementia to access which cover the same types of activities and outcomes? Arts and singing are very specific but the alternative services seem very generic.”

Equality workshop Wednesday 27 March “Travel/transport issues for people with dementia if services are not local.”

“Impact is on Older People/older age cohort.”

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“By the very nature of a person having a dementia they are a vulnerable group and therefore disadvantaged by the proposal.”

“What other Befriending options are there?”

“Need different types of services not just Arts.”

“What is the total amount of savings for all these services?”

“What engagement is there with service users?”

“Have you asked people what services they want?”

“Engage with people via Housing Trusts i.e. Shepherds Bush Housing, Notting Hill, Peabody etc. and local churches as they have good links with the local community.”

“Recommend using local musicians with a sound box (easy set up) in Care Homes based on first-hand experience”

“A service user in receipt of Resonate Arts Befriending service commented that they were not in favour of decommissioning as this service supports people to get out of the house, opportunities to engage with others and give carers support. Need age relevant services for younger age cohort.”

“Are the services proposed for decommissioning quality services?”

“What is the amount, even if services support a small cohort of people there may be a demonstrable impact on their well-being?”

“What is the measurable outcome on resident’s health & well-being (pre and post questionnaires)?”

Patient Reference Group Thursday 4 April “Save our Hospitals has had some discussion about this and is deeply deeply concerned at what seems to be a rather mean reaction to dementia services. I’m not sure how many people here have had people with dementia, I have two parents who had dementia. What isn’t here is any indication of how much money may even be saved from this but I don’t think it will be much but I think it’s a very petty move. It takes something very

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valuable away from not just people with dementia but also their carers to have a much fuller life with some sort of cultural involvement and engagement which in many cases will bring back memories and help their condition. I think this proposal is shocking.”

“Agree with SoH. Amount of money you are talking about is minor. We all understand you are under pressure financially. I am not a dementia specialist but I know the value of music to someone with dementia is extraordinary and to remove that is so counterproductive because it can provide extraordinary to someone with dementia and you almost can’t put a financial value.”

“What are these services with capacity and where are they?”

“Those without families and isolated people would be more impacted”

“Find out who uses the service then you will know what protected groups are more impacted”

“If those services are not meeting clinical outcomes why can’t that money be redirected to support people with dementia in other ways”

“Ageing population means number of people with dementia will increase”

“Football clubs offering different workshops – sporting memories programme with Fulham and Chelsea offered”

Digital survey Thursday 21 March – Sunday 7 April Can you think of any specific groups that would be affected more by this change – Dementia

“Older people and their carers. Music and singing are particularly important for the wellbeing of people with dementia”

“older people”

“Elderly”

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“Elderly”

“Carers. Family of people with dementia. They may meet other people through this and this might be a really important part of their lives. & Respite for carers and families”

“People with dementia”

“Everyone”

“This will be heart breaking for those with dementia who currently use these services. It is a heartless decision”

“=”

“When my late mother was diagnosed with vascular dementia these options were not provided to us. These 3 seevices only serve a small monority of people who like singing as a passtime. Waste of public money. Age UK could host such activities if there was a need for it. Funding for more adequate carers would be more beneficial and physios who actually do their job to help people stay mobile”

“Elderly people with early dementia homeless bme”

“Those who have used and enjoyed the services would be affected. You need more Link workers and to educate NHS and Social Care teams more effectively about Link workers and their remits”

“Older people & their carers”

“Dementia sufferers and their carers and families”

“yes a lot of sufferers of dementia”

“No”

“The premise in the Plan is incorrect, that it mainly affects 65+. And therefore not much on a lot of people in the area. My husband was diagnosed with frontotemporal dementia at age 62 and this has an impact on his family e.g I am his spouse and main carer and I am 10 years younger than him. Also our two children ages 25 and 28 live in lbhf and when they are able they give me respite. So this one person's dementia really IMPACTS

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on his family of 3 more people. He has attended Singing for the Brain in many west London locations since 2014, accompanied by me or his carer (I employ a carer on Tuesdays when I work one day a week). This activity is VERY IMPORTANT TO US - My husband and carer. It provides a meaningful social and stimulating cognitive function. So long as we can get there (taking the tube when necessary as the locations move from time to time), I am counting on it continuing! Resonate Arts supports the Music for the Moment concerts and I take my husband to almost every one -concerts usually on Fridays. You should not underestimate the value the concerts have for BOTH people with dementia and carers in the outstanding quality of music. I personally feel refreshed after every concert. SINGING FOR THE BRAIN and RESONATE ARTS are very important to us. Another really important activity to us is Music Therapy through Nordoff Robbins presently Monday morning sessions at Albert Hall. Resonate Arts publicises this. We have participated in other activities publicised by Resonate Arts. I hope the changes will not stop these activities.”

“Yes it’s just crazy. I use this service 3/4 a week I don’t think I could manage without it”

“those that need a lot of care”

“Elderly sane independant people”

“older people and their carers”

“The elderly and their carers”

“Those also with mental illnesses”

What do you think we should do to ensure people are not adversely affected by this change – Dementia

“Do not cut services”

“go to their nearest hospital”

“Don't know”

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“A befriending program should be available. I have experience of volunteering and is a huge first step in keeping people active and engaged, also to help with loneliness and its mental health consequences”

“New information must be put out. Must be clearly set out and clearly put and as simple as possible. Send reminders in the first year, second year . If there are any further changes, communicate these clearly and in a wide range of ways and immediately also, including via GPs”

“Get private funding from benefactor”

“Keep it going by add other locations”

“Don't make the change”

“=”

“Doubt many will be affected”

“Keep the service”

“You appear to be working hard to help carers via your Carers Network. If you have a record of the people who have used the soon-to-be-eliminated services, use that information to contact their carers directly (not by group email) to discuss the proposed changes”

“Keep them informed of other alternatives”

“Keep these services. Dementia affects whole families, not just the patients. If these services are taken away it may have an adverse effect on a great many people with connections to the patient”

“leave well alone”

“Maybe keep few classes as arts and carfs for elderly together with Dementia link workers services and etc...”

“I think there are maybe too many advice points and not enough To Do activities. For Example the GP surgery sent a dementia nurse to us recently for a home visit. I did not ask for this-it was offered. It was a waste of time. The nurse had no

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advice for an issue I was concerned about and said that as my husband had been seen at the memory clinic she had nothing to add. I have not found the GP particularly knowledgeable and the one time I asked for help I was told that my 10 minute appointment slot was not enough and I should go back to the memory clinic. In fact I was given 7 minutes only but waste of time. The GP surgery appears ill equipped to advise on dementia. This is the North End Medical Centre. I am going to givee it another try on 8 April but again my slot is 10 minutes. So I am not impressd so fa4 by the GP surgery and their services for dementia. There are many GPs there who come and go and they do not seem to have specialists in dementia”

“Create more”

“allocate funds”

“Increase smaller decentralised homes. Not isolate in institutions”

“any reduction in dementia care is too much - we will be needing more in coming years rather than less”

“This seems a cruel cut. You need to accept responsibility here not just "signpost" them (i.e. wash your hands of them). Scrap this plan”

“See my above reply to question 5”