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Equality and Human Rights Screening Template

The BSO is required to address the 4 questions below in relation to all its policies.

As part of the audit trail documentation needs to be made available for all policies and decisions examined for equality and human rights implications. The screening template is a pro forma to document consideration of each screening question.

For information (evidence, data, research etc.) on the Section 75 equality groups see the Equality and Human Rights Information Bank on the BSO website: http://www.hscbusiness.hscni.net/services/1798.htm

What is the likely impact on equality of opportunity for those affected by this policy, for each of the Section 75 equality categories? (minor/major/none) Are there opportunities to better promote equality of opportunity for people within the Section 75 equality categories? To what extent is the policy likely to impact on good relations between people of a different religious belief, political opinion or racial group? (minor/major/none)

Are there opportunities to better promote good relations between people of a different religious belief, political opinion or racial group?

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SCREENING TEMPLATE

See Guidance Notes for further information on the ‘why’ ‘what’ ‘when’, and ‘who’ in relation to screening, for background information on the relevant legislation and for help in answering the questions on this template . (1) INFORMATION ABOUT THE POLICY OR DECISION

1.1 Title of policy or decision

Project 404 proposal

1.2 Description of policy or decision

what is it trying to achieve? (aims and objectives)

how will this be achieved? (key elements)

what are the key constraints? (for example financial, legislative or other)

The Health and Social Care Board commissioned Business Services Organisation to establish a specialist unit to develop work plans to identify people accessing Health and Social Care Services who are not entitled to access these services free of charge. The Access to Healthcare Team where established in June 2013 and have developed work plans for Primary, Secondary and Social Care. Project 404 aims to explore issues within Primary Care. A report has been run by BSO Information Technology Demographics which has identified 404 people who are registered with a GP under a Northern Ireland address who accessed Secondary Care and provide a non-Northern Irish address. Project 404 aims to identify people who are not ordinarily resident in Northern Ireland who are currently registered with a GP in Northern Ireland and remove these patients from the GP registration list. When a patient is identified the Health and Social Care Trust in which they have received treatment may be notified. The Trust may decide to complete further checks on the person’s

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entitlement to free HSC services to ascertain if the person is chargeable and raise invoices where required. In conducting stream one of the proposal Counter Fraud and Probity Services (CFPS), Business Service Organisation (BSO) also plan to increase public awareness in relation to access to Health and Social Care Services. Each person identified in the report will be sent a questionnaire which they will

be asked to complete and return along with supporting documentation. The

questionnaire and supporting documentation will be assessed by members of

staff within CFPS and a decision will be made in relation to a person’s

entitlement to be registered with a GP in Northern Ireland. Where a patient is

identified as not being ordinarily resident their information will be passed to

Family Practitioner Services who may make a decision to remove the patient

from the GP registration list. The information may also be passed to the HSC

Trust in which the patient received treatment, the Trust may decide to investigate

the case further and where the Trust determines the patient was not entitled to

free HSC services raise a bill.

Key constraints in relation to the implementation of this policy include:

Data Protection Act 1998 in relation to Data Sharing

Human Rights Act 1998

Time Constraints

Resource Constraints

1.3 Main stakeholders affected (internal and external)

For example staff, actual or potential service users, other public sector organisations, voluntary and community groups, trade unions or professional organisations or private sector organisations or others External Stakeholders:

Members of the public identified in report – patients, carers and relatives

Community and Voluntary Groups

Law Society

Citizens Advice Bureau

Equality Commission

Human Rights Commission

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Age NI

Older Persons Commissioner

Children’s Commissioner

General Practitioners

Health and Social Care Trusts Internal Stakeholders:

Business Service Organisation – Counter Fraud and Probity Services, Information Technology Services, Directorate of Legal Services, Family Practitioner Services and Customer Care and Performance

Department of Health Social Services and Personal Safety

Health and Social Care Board

Health and Social Care Trusts

1.4 Other policies or decisions with a bearing on this policy or decision

what are they?

who owns them?

Health and Personal Social Services Order (Northern Ireland) 1972

Provisions of Health Services to Persons not Ordinarily Resident Regulations (Northern Ireland) 2005

Circular HSS(PCD) 10/2000 – Family Health Services for Persons not Ordinarily Resident in Northern Ireland

2004 General Medical Services Regulation

EU Directive 2011/24/EU on the application of patients’ rights to cross border healthcare

EU Directive 2004/58/EC on the Rights of Citizens of the Union and their Family Members to Move and Reside Freely within the Territory of the Member States

Circular (PCCD 01/2012) - The Arrangements for Handling Outstanding Debtors to the Health Service in Northern Ireland and Co-operative Work with UK Borders Agency

Immigration Rules 2011

The Children (Northern Ireland) Order 1995

Disability Discrimination (Northern Ireland) Order 2006

Race Relations (Northern Ireland) Order 1996

United Nations Convention on the Rights of the Child

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(2) CONSIDERATION OF EQUALITY AND GOOD RELATIONS ISSUES AND EVIDENCE USED

2.1 Data gathering

What information did you use to inform this equality screening? For example previous consultations, statistics, research, Equality Impact Assessments (EQIAs), complaints. Provide details of how you involved stakeholders, views of colleagues, service users, staff side or other stakeholders.

2.2 Quantitative Data

Who is affected by the policy or decision? Please provide a statistical profile. Note if policy affects both staff and service users, please provide profile for both. Also give consideration to multiple identities.

Category

What is the makeup of the affected group? ( %) Are there any issues or problems? For example, a lower uptake that needs to be addressed or greater involvement of a particular group?

Census Data 2011 Make up of 404 people identified from Project 404

Gender

Females – 51%

Males – 49%

Females – 56% Males – 44%

Age 0-15 – 20.95% 0-15 – 9.1%

Review of Legislation

Views of BSO Equality Department, Access to Healthcare Establishment Group and Family Practitioner Services

Looked at NI List Inflation work carried out by BSO Information Unit

Attended meetings with BSO Information Technology Demographics Unit

Review of Department of Health Personal Services and Public Safety circulars

Meeting with Health Service Executive in Republic of Ireland

Census 2011

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16.19 – 5.61%

20-24 – 6.96%

25-60 – 46.71%

60-64 – 5.21%

65-74 – 8.04%

75-84 – 4.79%

85+ - 1.73%

16.19 – 5.2% 20-24 – 5.9% 25-60 – 70% 60-64 – 1.5% 65-74 – 4.5% 75-84 – 2.1% 85+ - 1.7%

Religion

Catholic – 45.14%

Protestant – 48.36%

Other – 0.92%

None – 5.59%

Political Opinion

British only – 39.89%

Irish only – 25.26%

Northern Irish only – 20.94%

British and Northern Irish – 6.17%

Irish and Northern Irish – 1.06%

British, Irish and Northern Irish – 1.02%

British and Irish – 0.66%

Other – 5%

Marital Status

Married – 47.56%

Single – 36.14%

Same sex civil partnership – 0.09%

Divorced/separated – 9.43%

Widowed – 6.78%

Dependent Status

Provide unpaid care to family members, friends, neighbours or

others because of long term physical or mental health/disabilities

or problems related to old age – 11.81%

Provide 50 hours + of care – 3.11%

Households which contain dependent children -33.86%

Household which contain at least one person with long term health problems or a disability – 40.29%

Disability

People who regard themselves

as having a disability or long

term health problems which

impact on their day to day

activities – 20.69%

People who do not have a long

term health condition – 68.57%

There is an expectation that people who have a disability may make up a greater percentage of the 404 than they do of the entire population as they are potentially more likely to interact with Health and Social Care Services as a result

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Deafness or partial hearing loss

– 5.14%

Blindness or partial sight loss -

1.7%

Communication difficulty –

1.65%

Mobility of Dexterity difficulty –

11.44%

Learning or intellectual, social or

behavioural difficulty – 2.22%

Emotional, psychological or

mental health condition – 5.83%

Long-term pain or discomfort –

10.10%

Shortness of breath or difficulty

breathing – 8.72%

Frequent confusion or memory

loss – 1.97%

A chronic illness – 6.55%

Other condition – 5.22% No condition – 68.57%

of their disability.

Ethnicity

White – 98.21%

Chinese – 0.35%

Irish traveller – 0.07%

Indian – 0.34%

Pakistani – 0.06%

Bangladeshi – 0.03%

Other Asian – 0.28%

Black Caribbean – 0.02%

Black African – 0.13%

Black other – 0.05%

Mixed – 0.33%

Other 0.13% Language spoken – English – 96.86%

Polish – 1.02%

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Lithuanian – 0.36%

Irish – 0.24%

Portuguese – 0.13%

Slovak – 0.13%

Chinese – 0.13%

Filipino – 0.11%

Latvian – 0.07%

Russian – 0.07%

Hungarian – 0.06%

Other – 0.75%

Sexual Orientation

Estimated figure of 5%-7% of Northern Ireland population are either lesbian, gay or bisexual

2.3 Qualitative Data

What are the different needs, experiences and priorities of each of the categories in relation to this policy or decision and what equality issues emerge from this? Note if policy affects both staff and service users, please discuss issues for both. Also give consideration to multiple identities (such as single parents for example).

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Category

Needs and Experiences

Gender No impact identified for proposal

Age People aged between 0-15 may be less likely to hold evidence that would confirm that they are ordinarily resident (e.g. utility bills, rental agreements, benefit book) The ageing population may be more likely to need to avail of health and social care services and will therefore potentially be more affected by this proposal.

Religion No impact identified for proposal

Political Opinion

No impact identified for proposal

Marital Status People who are married or in a civil partnership may not have supporting documentation to provide in their name as their payments etc. may be in the name of their partner

Dependent Status

People who are dependent may not have supporting documentation to provide in their own name as they may be dependent on a parent or guardian, who pays the rent/mortgage on a home, is employed etc. People with caring responsibilities may be required to explain the contents of correspondence to the people they care for and assist them with the completion of documents, they may also be required to contact Trusts on their behalf.

Disability Learning Disability/Mental Health - people with learning disabilities or mental health problems may have difficulty fully understanding what they are required to do and the consequences of what might happen if they fail to complete the form and return it to BSO Physical Disability – people with a physical disability affecting their mobility may be unable to meet deadlines in relation to providing evidence to confirm their entitlement. Sensory Impairment – people with a visual impairment may have difficulty reading the correspondence and determining what action(s) they are required to take. People with a hearing impairment may be disadvantaged as they may not be able to contact the BSO by phone with any queries in relation to the correspondence.

Ethnicity Consideration needs to be given to people from different ethnic backgrounds who possibly do not speak English as a first or competent second language and may not have a full understanding of the communication between them and the BSO

Sexual Orientation

No Impact Identified for the proposal

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2.4 Making Changes

Based on the equality issues you identified in 2.2 and 2.3, what changes did you make or do you intend to make in relation to the policy or decision in order to promote equality of opportunity?

In developing the policy or decision what did you do or change to address the equality issues you identified?

What do you intend to do in future to address the equality issues you identified?

Age – people aged 0-15 will not be required to produce evidence in their own name, however, their legal guardian will be required to produce evidence in relation to their own entitlement on behalf of their children. The child’s entitlement will be based on the entitlement of their guardian. Decisions on a child’s entitlement can also be based on relevant legislation when it is not possible to gather information on the parent or guardian.

A public awareness programme will be implemented before and during the pilot, the public awareness programme will target all age groups including the ageing population. The Access to Healthcare Team plan to liaise with community and voluntary groups catering for the ageing population to help to ensure that there is a clear understanding of why they may be asked to provide evidence of their entitlement to free healthcare.

Marital Status – people who are married or are in a civil partnership who do not have sufficient information due to them not being a name person on bills etc. can provide supporting documentation for their partner, proofing that their partner is ordinarily

Throughout project 404 equality issues will be evaluated, if staff are made aware of difficulties faced by certain groups of the community in relation to the process mitigating actions will be put in place were possible. A formal evaluation will be completed once the 404 people have been contacted, the evaluation will consider issues such as age, disability and ethnicity when evaluating the effectiveness of the process.

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resident along with their marriage/ civil partnership certificate. This will provide sufficient proof to make a decision on the person’s entitlement to free HSC services.

Dependent Status – people who are dependents may not have sufficient supporting documentation in their own name, where this is the case a person can contact BSO for assistance and alternative forms of evidence will be suggested.

People with dependents will be required to fully understand the process and be able to provide information on the process to the people they have caring responsibilities for. The Access to Healthcare Team plan to engage with community and voluntary groups who work with carers to provide information on the process and provide contact details for any queries that may arise.

Disability – Learning Disability/Mental health – engagement with community groups and social services is planned in order to ensure staff working in these areas are aware of the processes and feel confident to explain them to the people they support. Correspondence sent out to patients will have contact details for any person who may have queries and information does not need to be returned for 4 weeks therefore there is adequate time for queries to be raised and resolved.

Physical Disability – engagement with community and voluntary groups is planned in order to ensure staff

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working in these areas are aware of the processes and feel confident to explain them to the people they support. Correspondence sent out to patients will have contact details for any person who may have queries and information does not need to be returned for 4 weeks therefore there is adequate time for queries to be raised and resolved and alternative arrangements put in place if necessary.

Sensory Impairment – all correspondence will be offered in different formats including large print and braille. People with queries will have a number of options on how they contact the BSO for information such as telephone, email or text phone.

Ethnicity – all correspondence will be offered in different formats including a number of different languages. Phone interpreters will also be available for any person who contacts the BSO by telephone with a query.

All correspondence issued by BSO will include a statement asking that people who require special arrangements to be made get in contact with staff in BSO. Where necessary staff will consider conducting a home visit to ascertain a person’s entitlement to free HSC treatment

2.5 Good Relations

What changes to the policy or decision – if any – or what additional measures would you suggest to ensure that it promotes good relations? (refer to guidance notes for guidance on impact)

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The Access to Healthcare Team does not anticipate that this proposal will have an impact on good relations.

Group Impact Suggestions

Religion

Political Opinion

Ethnicity

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(3) SHOULD THE POLICY OR DECISION BE SUBJECT TO A FULL EQUALITY IMPACT ASSESSMENT?

A full equality impact assessment (EQIA) is usually confined to those policies or decisions considered to have major implications for equality of opportunity

How would you categorise the impacts of this decision or policy? (refer to guidance notes for guidance on impact)

Please tick:

Major impact

Minor impact

No further impact x

Do you consider that this policy or decision needs to be subjected to a full equality impact assessment?

Please tick:

Yes

No x

Please give reasons for your decisions.

No further impact – the proposal has been developed in accordance with the duties. Specific actions have been introduced as the process was developing to address any identified inequality or action to better promote equality of opportunity.

The Access to Healthcare Team believes that this policy will not affect the service provision. In developing this proposal the intent was for the proposal to be inclusive and positive action has been taken to mitigate any inequality of opportunity.

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(4) CONSIDERATION OF DISABILITY DUTIES 4.1 In what ways does the policy or decision encourage disabled people

to participate in public life and what else could you do to do so? No specific impacts anticipated in the context of the specific disability duties

How does the policy or decision currently encourage disabled people to participate in public life?

What else could you do to encourage disabled people to participate in public life?

4.2 In what ways does the policy or decision promote positive attitudes

towards disabled people and what else could you do to do so?

How does the policy or decision currently promote positive attitudes towards disabled people?

What else could you do to promote positive attitudes towards disabled people?

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(5) CONSIDERATION OF HUMAN RIGHTS

5.1 Does the policy or decision affect anyone’s Human Rights? Complete for each of the articles

ARTICLE

Yes/No

Article 2 – Right to life

No evidence to indicate any effect

Article 3 – Right to freedom from torture, inhuman or degrading treatment or punishment

No evidence to indicate any effect

Article 4 – Right to freedom from slavery, servitude & forced or compulsory labour

No evidence to indicate any effect

Article 5 – Right to liberty & security of person

No evidence to indicate any effect

Article 6 – Right to a fair & public trial within a reasonable time

No evidence to indicate any effect

Article 7 – Right to freedom from retrospective criminal law & no punishment without law

No evidence to indicate any effect

Article 8 – Right to respect for private & family life, home and correspondence.

Yes

Article 9 – Right to freedom of thought, conscience & religion

No evidence to indicate any effect

Article 10 – Right to freedom of expression No evidence to indicate any effect

Article 11 – Right to freedom of assembly & association No evidence to indicate any effect

Article 12 – Right to marry & found a family

No evidence to indicate any effect

Article 14 – Prohibition of discrimination in the enjoyment of the convention rights

No evidence to indicate any effect

1st protocol Article 1 – Right to a peaceful enjoyment of possessions & protection of property

No evidence to indicate

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any effect

1st protocol Article 2 – Right of access to education No evidence to indicate any effect

If you have answered no to all of the above please move on to Question 6 on monitoring

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5.2 If you have answered yes to any of the Articles in 5.1, does the policy or decision interfere with any of these rights? If so, what is the interference and who does it impact upon?

List the Article Number

Interfered with?

Yes/No

What is the interference and who does it impact upon?

Does this raise legal issues?*

Yes/No

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Yes

A person’s right to respect for private and family life, home and correspondence may be impacted upon as they will be asked to provide details on their residence within Northern Ireland, this may include providing information on their employment/benefits and so on. However, there is an extensive list of documents which can be provided and the patient can chose which documents they are happy to disclose to BSO from the list.

No

* It is important to speak to your line manager on this and if necessary seek legal opinion to clarify this 5.3 Outline any actions which could be taken to promote or raise

awareness of human rights or to ensure compliance with the legislation in relation to the policy or decision.

The proposal operates in line with legislation as the Health and Personal Social Services (Northern Ireland) Order 1972 states that a person must be ordinarily resident in order to receive free HSC treatment. Human Rights have been considered and it was determined that people may feel that a person’s right to respect for private and family life, home and correspondence may be impacted upon, however, the proposal has recognised this and put mitigating factors in place. There is an extensive list of supporting documentation that can be provided and on request patients may also be given advice and guidance on what additional documentation can be provided to support the information

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provided on the questionnaire

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(6) MONITORING 6.1 What data will you collect in the future in order to monitor the effect

of the policy or decision on any of the categories (for equality of opportunity and good relations, disability duties and human rights)?

Equality & Good Relations

Disability Duties Human Rights

Evaluation of pilot – evaluation sections to be analysed in relation to demographics (age, ethnicity, geographical area, disability) to highlight any potential difficulties

Review of complaints – looking at demographics and reason for complaints

Monitoring of processes and compliance – Project Team to ensure that CFPS staff work in line with proposal guidelines including equality considerations

Evaluation of pilot – evaluation sections to be analysed in relation to demographics to highlight any potential difficulties

Review of complaints – looking at demographics and reason for complaints

Monitoring of processes and compliance – Project Team to ensure that CFPS staff work in line with proposal guidelines including Human Rights considerations

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Approved Lead Officer: Lorraine Giles

Position: Regional Manager Access to Healthcare

Date: 15th December 2013

Policy/Decision Screened by: Lorraine Giles, Kelly McWatters

Please note that having completed the screening you are required by statute to publish the completed screening template, as per your organisation’s equality scheme. If a consultee, including the Equality Commission, raises a concern about a screening decision based on supporting evidence, you will need to review the screening decision.

Please forward completed template to: Equality.Unit@hscni.net

Template produced November 2011 If you require this document in an alternative format (such as large print, Braille, disk, audio file, audio cassette, Easy Read or in minority languages to meet the needs of those not fluent in English) please contact the Equality Unit:

2 Franklin Street; Belfast; BT2 8DQ; email: Equality.Unit@hscni.net; phone: 028 90535531 (for Text Relay prefix with 18001); fax: 028 9023 2304