delivering: working together for success€¦ · „treating people fairly‟ we acknowledge the...

March 2012 Final Version 3. 1

Delivering: Working Together For Success

Strategic Equality Plan 2011-2014

“Treating People Fairly”


Statement of Commitment ................................................................ 3

1. Introduction and context.......................................................... 4 Introduction............................................................................................................. 4 About the Welsh Ambulance Service..................................................................... 4 About the Outcomes and Objectives...................................................................... 5 The Vision............................................................................................................... 6 The Values.............................................................................................................. 6

2. The story so far......................................................................... 7 The process............................................................................................................ 7 Involvement and Consultation................................................................................. 7 Our Approach.......................................................................................................... 8 Externally Facing..................................................................................................... 9 Internally Facing...................................................................................................... 9 North Wales Partnership.......................................................................................... 9

3. Publishing Reporting and Reviewing....................................... 11 Meeting our Equality and Human Rights Objectives................................................ 11 Monitoring our progress........................................................................................... 11 Scrutiny.................................................................................................................... 12 Reviewing and revising the Strategic Equality Plan................................................. 12 Measures................................................................................................................. 12 Annual Reporting..................................................................................................... 12

4. Employment and Training......................................................... 14 Welsh Ambulance Service Workforce...................................................................... 14 Pay .......................................................................................................................... 18 Training.................................................................................................................... 20 Welsh Language...................................................................................................... 20

5. Welsh Ambulance Service Policy............................................. 22 Equality Impact Assessments.................................................................................. 22 Procurement............................................................................................................ 22

6. Identifying the Gaps................................................................... 24

7. Bridging the Gaps...................................................................... 30

Contents


Statement of Commitment

This is the Welsh Ambulance Service‟s first Strategic Equality Plan. This plan builds upon the work which is currently delivered in the Welsh Ambulance Service and covers the requirements of the Equality Act 2010 and the Welsh Specific Duties. At the Welsh Ambulance Service, our vision is to become an ambulance service for the people of Wales which delivers high quality care wherever and whenever it is needed. This Strategic Equality Plan and our Strategic Equality Objectives are integral to delivering our vision and as we launch „Treating People Fairly‟ we acknowledge the contribution of equality and diversity in the wellbeing of our workforce, our patients and the communities we serve. We have listened and heard key messages from staff and service users to inform this work and value the feedback we have received. We also have evidence which has been gathered from national and local reports to inform this plan. We will continue to work with all our partners as we develop the specific and local actions which will enable us to deliver on these objectives. We are committed to advancing equality of opportunity and protecting and promoting the rights of everybody to achieve better outcomes for all. We recognise that equality is not one person‟s role but should be embedded in everyone‟s everyday actions and we will use key messages to ensure that this is embedded into our service. This Plan seeks to ensure that the way in which people are treated in all situations is properly considered within the organisation and influences decision-making at all levels. Importantly, it promotes knowledge and understanding of the general and specific duties amongst our employees in easy to understand messages and help shape the culture of our organisation. As a board we will scrutinise implementation of this Strategic Equality Plan and the underpinning equality objectives which we have all agreed. We will promote our vision for equality that goes beyond legal compliance, and will work to ensure that the Welsh Ambulance Service „treats people fairly‟. Stuart Fletcher Elwyn Price-Morris Chairman Chief Executive


Introduction The Welsh Ambulance Services NHS Trust (WAS) recognises the importance of equality of opportunity and diversity in respect of its responsibilities both as an employer and as a provider of health care services to the community. The purpose of this Strategic Equality Plan is to provide a single point of access to the work which the organisation is currently undertaking in line with the Equality Act 2010 and the Public Sector Equality Duty for Wales. This document will provide an outline of the organisations‟ work so far, the Equality Objectives WAS will be working towards, along with the evidence of how we as an organisation have reached these objectives, the actions we plan to take in order to achieve our Equality Objectives and the intended outcomes for our service users, employees and communities. Through bringing Equality to the forefront of our organisation we seek to guarantee dignity, respect and equality of opportunity for all, and to develop a culture in which all forms of discrimination are considered unacceptable. The Strategic Equality Plan is written to reflect and meet the requirements of current legislation, incorporating all areas and work structures of our organisation and taking into account the far reaching communities that we serve. It has been developed through the use of a wide range of information sources including legislation, best practice from other Public Sector Organisations and through the incorporation of expertise from our wide and continuing engagement with our workforce and communities. The Strategic Equality Plan applies to all staff of the Trust and supersedes any other race/gender/disability equality schemes currently in place in the Trust. This document would not normally apply to issues of capability, sickness absence or clinical competence. These are dealt with in separate procedures, which should be applied as appropriate. About WAS WAS serves a population of approximately 3 million across the whole of Wales. Formed in 1998 WAS delivers Unscheduled Care and Planned Patient Care Services to the public, employs 2,944 staff and is supported by 2,500 volunteers.

The main purpose of the Equality and Human Rights Strategic Equality plan is to meet the three public sector general duties as set out in the Equality Act 2010, to: -eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Act; -advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; -Foster good relations

between persons who share a

relevant protected

characteristic and persons

who do not share it


Unscheduled Care – which consists of emergency and urgent care services which has not been pre-planned by the patient. These are accessed either by calling 999 or 0845 46 47

Planned Patient Care Services – we provide transport for patients to a variety of planned hospital appointments and outpatients clinics. This is essential in supporting patients to access the care they need and to assist them in living independently within their own homes and communities.

To find out more about our services visit our website at: http://www.ambulance.wales.nhs.uk

About the Outcomes and Objectives Our work to date has included a review of existing national and local reports, literature and other evidence from which a number of key themes have emerged in relation to equality. These are presented within this report as a number of high level “Outcomes” which describe what we are seeking to achieve. A number of “Outcome Focused Objectives” are then listed which will inform the development of specific actions which will be integrated into the Trust service plans that will help to tackle inequality and move us closer to the our desired outcomes. The Chief Executive has overall responsibility for the achievement of our Strategic Equality Plan and he will work closely with the Senior Management Team to ensure progress is made towards achieving the equality objectives and delivering on the action plan.

This Strategic Plan has been developed by drawing on a range of information and expertise

including the following:

-The previous Race, Gender and Disability Equality schemes and our experience of implementing these -The Trust‟s Equality and Human Rights Steering Group -The relevant legislation and guidance provided by the Commission for Equality and Human Rights and its predecessor organisations -Best practice from both within and outside the NHS, accessed through networks and research

-And continues to be developed through the feedback and engagement with our communities

and diverse groups

http://www.ambulance.wales.nhs.uk/


„Working Together for success‟ is our organisational strategy and sets out the five year vision to become an Ambulance Service for the people of Wales which delivers high quality care wherever and whenever it is needed. In order to enable this to be achieved the strategy is underpinned by three objectives

To achieve all of the national quality standards and clinical requirements

To provide the right service with the right care, in the right place, at the right time with the right skills

To provide high quality planned patient care services which are valued by users. Underpinning this vision we want to ensure that all service users can access our services without any form of discrimination. In order to achieve this vision we understand that we need to embed a culture of respecting

difference into our workforce by changing attitudes and behaviours. This will allow us to better

support our service users and employees enabling WAS to excel as a provider of high quality

healthcare services.

The whole organisation was involved in identifying that the following values are those which should underpin „the way we do things around here‟:

• The healthcare needs of the users of our services are paramount. We seek opportunities to engage meaningfully with those users in planning, designing and delivering care

• Openness and honesty • Everyone deserves to be treated with dignity and respect in equal measure. This is true of

every relationship we form, including with colleagues. • Effective communication • Pride in our work and out Trust • Shared ownership for our work and to continuously strive to improve what we do • Accountability, being personally responsible for our actions and behaviours

These shared values were used to inform the rights and responsibilities of service users and staff and underpinned the Staff Charter which is appended to this document (Appendix 1). It is clear to see that both explicitly and underlying these values is the essence of equality and diversity and these values will be embedded into all Trust strategies moving forward.


The Process

Involvement and consultation

WAS is committed to including as many people and groups as possible in contributing to the decision making process that affects the health community it serves and its staff and has a dedicated Partners in Health Team whose main purpose is to consult and engage with the communities in Wales in order to improve our services. Where WAS works jointly with other public, private or voluntary organisations, we recognise that we as an organisation are still responsible for meeting our general duty to promote equality as a whole. We will continue to cultivate good relations with wide ranging groups and seek to broaden our work with outside agencies such as the Race Equality Councils, Disability agencies, Equality & Human Rights Commission etc. The Equality and Human Rights Task and Finish Group along with the Partners in Healthcare Panel will be the main forums for involvement and consultation in driving the equality and diversity agenda. Underpinning this all other working groups and committees (including the Board) should actively drive concerns, aims and expectations in terms of supporting the plan. Trade Union and other staff side representatives have a responsibility to work in partnership with management to tackle discrimination, prejudice, bullying and harassment at work. Staff representatives are formal members of the Equality and Human Task and Finish Group. WAS currently uses a wide range of methods of consultation and involvement including:

Consultation through the website (inviting views and comments);

Discussion forums/focus groups with staff;

Sharing draft documents with key community groups to invite comments from their members and contacts;

Joint consultative and engagement events;

Using patient and staff surveys to receive anonymous feedback;

Equality Impact Assessment process;

Partners in Healthcare Panel.

Information from

National Research

Information from

Engagement

Local and Workforce

Information

Evidence based

Equality Objective

Analysis of information and

recurring areas


However we recognise that more work needs to be completed in order to fully utilise some of these methods and to engage on a wider basis with those who fall under the protected characteristics of the Equality Act 2010. The Partners in Health Team are key to the work which has been implemented in order to engage with hard to reach and minority groups. The team have built up key partnerships across many different and wide ranging networks including those which represent the protected characteristics under the Equality Act 2010 and regularly engage with individuals, charities and groups. WAS aims to utilise the feedback it receives through these engagement methods and can demonstrate this through the key achievements to date by the Partners in Health Team including The Room which is a bilingual health website providing relevant quality information to young people aged 13-17 years across Wales. This can be found at www.theroom.wales.nhs.uk or in Welsh at www.yrystafell.wales.nhs.uk. These websites also invite interaction from the young children. Following engagement with the deaf and hard of hearing community, a medical card has been produced to assist the user to inform ambulance staff of their medical history. Deaf, hard of hearing and those with communication difficulties can now text for an ambulance Patients have the opportunity to record Digital Stories which are placed on the WAS website. This gives patients and service users an opportunity to share their experience in accessing healthcare from the Trust. As a direct result the Trust has addressed issues highlighted around equality and diversity in access to services. Further examples of which can be found in Appendix 2. Our Approach As part of the requirements of the specific duties, the Trust has to publish equality objectives to help ensure that our services and employment practices are fair and accessible. We are also required to engage with the public in completing our objectives. Our approach has been to build on work already started and to review existing equality information held to identify gaps in our information base. Where we have gaps in our information base, we have used feedback from engagement to fill them. Reports such as “How Fair is Wales?” published by the Human Rights Commission and “Hidden in Plain Sight” have been used to inform the work carried out within the Trust. This has been particularly helpful for sensitive areas where individuals have been more able to share views through face to face contact.

South Wales: Example A joint „Have Your Say‟ Event was held on 20 October 2011 with Neath Port Talbot County Borough Council, Neath Port Talbot Council for Voluntary Services, Neath Port Talbot College and the ABMU Health Board to get views on equality issues that affect people in Neath Port Talbot. Local people and organisations were able to have their say about how local services can be fair, responsive and respectful of diversity.

http://www.theroom.wales.nhs.uk/

http://www.yrystafell.wales.nhs.uk/


Externally facing

We used our consultations with the community and hard to reach groups in order to gain an insight

into their experiences with WAS, barriers to access of the service and the outcomes which they

expected from the organisation. We looked at the groups which the organisation currently engages

with and mapped this against the communities within Wales population statistics,

We actively listened to this feedback and looked jointly at ways in which these outcomes could be

achieved creating a Gap Analysis from where we are now and where we want to be.

We have engaged jointly with other local public sector organisations in all areas of Wales to help draft our equality objectives. This has been carried out by linking into existing forums and community groups across Wales. North Wales Public Sector Equality Network

During 2011 WAS as a partner in the network has conducted joint activities to develop a set of shared

objectives which every partner has signed up to. These are:

1. Reduce Health inequalities 2. Reduce unequal outcomes in Education to maximise individual Potential 3. Reduce inequalities in Employment and Pay 4. Reduce inequalities in personal Safety Reduce inequalities in Representation and Voice 5. Reduce inequalities in access to information, services,

buildings and the environment

These objectives, the research behind these and the consultation completed have been considered

when forming the WAS equality Objectives. An Event was held on the 21st of September 2011 where

two key questions were asked to stakeholders and partners attending

1. Do you think that the identified themes correctly capture the issues we should be addressing

as an organisation-are there any gaps

2. What issues are most important to you

The report on the feedback from this event is available on the WAS website.

Internally facing

Along with external consultation internally to WAS a Equality and Human Rights Steering group has

been established which includes a wide representation from across the organisations workforce This

group is chaired by the Chief Executive and also includes membership of the Director of Workforce

and OD and a non- executive director in order for the messages and drive to come from the highest

level within WAS. The draft Objectives were considered at the board development day on the 2nd of

February 2012 and through internal consultation at a number of internal events.

A workshop will be held on the 2nd March 2012 which will analyse half way results of consultation and

formulate strategic actions on how to achieve the objectives going forward.


Board support for the finalised Objectives and Strategic Equality Plan will be given prior to

publication.

In order to review our workforce we used our updated ESR system to analyse the information which

we hold on employees in order to produce the WAS workforce monitoring information which we have

provided in this report.


Meeting our Equality and Human Rights Objectives

The Senior Management Team are responsible for ensuring that the development of our equality

objectives are aligned to our Trust Strategic Planning Process.

The equality outcomes and objectives will inform the development of specific actions within the

delivery plans for services across the Trust.

The Health Wellbeing and Equality Manager with support from the Equality and Human Rights

Steering group will provide support and advice during the development and implementation of actions

to meet the equality outcomes and objectives. This will include providing information about legal

responsibilities and the provision of bespoke interventions to enhance understanding and capability at

management level and within teams.

Monitoring our progress

The Strategic Equality Plan and supporting Action Plan will continue to be monitored by the Equality and Human Rights Task and Finish Group which is chaired by the Chief Executive. It will be reported on annually, taking into account progress within action areas and results of consultation and involvement activities. We will report on our progress towards achieving the equality objectives and specific actions that we have set. New actions may be identified during the reporting period based on the changes in legislation or supporting guidance. This Plan will be a working document which will inevitably have to change to reflect the Trust and communities different needs on an ongoing basis. If parts of the Strategic Equality Plan are revised before 2015, the updated version will be published on the website following appropriate consultation and evidence gathering. In regard to revisions within the Strategic Equality Plan we are required to:

Have due regard to relevant information held by the authority

Use other information that the authority considers would be likely to help to review

Revise the arrangements, objectives or the Strategic Equality Plan if the review process

evidences the need for an amendment

Publish these changes as soon as possible in an accessible way

We will completely review and revise this Plan in 2015.


Scrutiny

Whilst the Equality Objectives and Strategic Plan will become embedded into business as usual the

Equality and Human Rights Task and Finish Group will scrutinise progress and provide assurance to

the Quality and Safety Group which is a sub-committee of the Board. Heads of Service will be invited

to present their action plans and progress on equality initiatives.

We will undertake a review of the objectives each year and progress will be formally reported and

published in our Annual Report.

The Partners in Healthcare external Stakeholder Network comprising individuals and groups

representing people with protected characteristics will be invited to monitor progress on plans and

actively be engaged in any further consultation and monitoring.

Reviewing and revising the Strategic Equality Plan

The Trust will review progress towards our Equality Objectives every year and undertake a full review

of the SEP after three years, working with staff, our communities and service users to take into

account information gathered including outcomes of impact assessments.

Measures

In order to be able to measure the results of our objectives the Trust have developed outcome-

focused objectives. We recognise that there is further work necessary in order to achieve our

objectives and the Trust will sets out clear actions that will help us move closer to our objectives,

whilst embedding them into business as usual.

WAS is exploring the establishment of a number of performance measures for equality and human

rights within Health Services in Wales. This is being progressed in collaboration with Health Service

partners and facilitated by the NHS Centre for Equality and Human Rights. These joint KPIs will help

to assess progress and performance within Health Services against a number of key measures

including meeting the requirements of the Specific Equality Duties for public sector organisations in

Wales.

Equality and Human Rights measurement will be embedded into the integrated performance

management of the Trust and individual Heads of Service will be required to set measures for

Equality Objectives which are relevant to their area of service and the communities that they serve.

A network of internal equality champions will be developed within the Trust which enables a link

between the corporate equalities agenda and operational areas ensuring that the measures are fit for

purpose and that Equality and Human Rights becomes „everyone‟s business‟ through the „Treating

People Fairly‟.

Annual Reporting

To demonstrate the Trusts commitment to promoting and protecting rights and advancing equality we

will publish a report annually containing a summary of;


The steps we have taken to fulfil our equality duties and what we have done over the past year to eliminate discrimination and promote equality of opportunity and meet our targets

The results of the information-gathering – what evidence has been obtained and what it indicates

What the Trust has done with the information gathered and what actions will be taken as a result

What our stakeholders think of the progress we have made

This information will be made available in a range of accessible formats and circulated internally and

published on our website


WAS workforce

Employment duties contained in equalities legislation require the Trust to monitor a range of workforce matters. These include:

A review of applicant numbers, short listed and appointed profiles

Types of jobs being undertaken by disabled people, grades and salary levels

Training courses attended

Career progression

Personal Development reviews

Disciplinary action

Reports of harassment and how resolved

Durations of employment

Numbers in full or part time work to include gender profile

Analysis of exit interviews.

Gender pay gap audit

This data will be published as part of the Trust Annual report after the 31st March 2012 for the

financial year of April 2011 until March 2012. To ensure that the data published is meaningful and

useful an in depth analysis and pay audit will be undertaken by the Trust, details of which is contained

within the Trust objectives and action plan.

However we have completed a basic analysis of the WAS workforce (taken from data correct as of

December 2011) and present the below findings in order to inform our Objectives set out in this

Strategic Equality Plan.

Table 1. Gender Breakdown of all Workforce

Gender Full Time Equivalent Headcount

% of Workforce

Females 954.72 1,056 35.20%

Males 1,845.80 1,944 64.80%

Table 1 presents the gender breakdown of our workforce at WAS.

It shows that compared to the gender distribution across Wales, WAS has a low representation of

females. This is not typical of an NHS organisation, as many organisations have a high percentage of

female workforce. The NHS as a whole has % female workforce.

The role of the paramedic has traditionally been seen as a masculine role and this can be seen to be

reflected within the overall representation of females in the workforce. There is an increasing number

of female paramedics who are entering the workforce due to the changes in the entry requirements.


However the organisation has a low turnover rate at 6.39% (headcount 5.88% FTE) which means that

large percentage changes in the gender make-up of WAS will take time. The highest level of turnover

is seen in Nurses and Ambulance Officers. This may be due to retirements and many return to

employment following this however does not highlight a concern.

Imagery across the organisation includes the use of females and these feminine images are present

throughout Trust Documents and communications.

Table 2. Age Bands of Workforce

Age Band

Full Time Equivalent Headcount

% of Workforce

16 - 20 4.40 5 0.16%

21 - 25 106.18 108 3.82%

26 - 30 168.43 176 6.06%

31 - 35 302.88 324 10.90%

36 - 40 468.00 499 16.84%

41 - 45 431.66 451 15.53%

46 - 50 538.32 561 19.37%

51 - 55 383.79 398 13.81%

56 - 60 251.68 275 9.05%

61 - 65 124.47 152 4.48%

Table 2 presents the age breakdown of our workforce at WAS.

There are 3 main points which can be highlighted from this data.

1. Over half of the WAS workforce are aged between 36 and 50 years old

2. There is a low representation in the age categories 16 and 30 years old

3. There is a low representation above the age of 56 with no records of staff aged over 65 years

old

This is important to consider with the aging population of Wales and the need for employers to make

adjustments for this.

Drivers employed by the Trust have to be over the age of 21 years and must have held a full driving

licence for 2 years.

This shows that the

over half of the

workforce within

WAS are aged

between 36 and 50

just over 10% of the

workforce are age 30

or under.


Table 3. Working patterns of employees

Working Pattern

Full Time Equivalent

Headcount % of Workforce

Full Time

2,491.00 2,493 83.10%

Part Time

309.51 502 16.73%

Table 3 presents the full time/part time breakdown of our workforce at WAS.

This profile shows that over 83% of the workforce work full time hours. This is representative of

Ambulance Services across the UK as a whole.

Of the 502 employees who work part time 11% are male and 29% are female. Showing. That females

are more likely to work part time hours than males.

Pay band

Part Time Employee Headcount

Percentage of band Part Time

Band 1 7 100%

Band 2 63 35%

Band 3 225 26%

Band 4 54 11%

Band 5 59 6%

Band 6 83 27%

Band 7 8 7%

Band 8A 1 3%

All those employed at Band 1 are all female. Bands 2-4 are predominantly administration roles;

however Band 4 also covers Ambulance Technicians which is a predominantly male dominated role.

Band 6 covers Nurse advisors who are predominantly female which would explain the high number of

part time workers at Band 6. From these 83 individuals 74 are female.

From the table below it can be seen that it is most common to have individuals working part time

(from differences between full time equivalent and headcount) if they have shorter lengths of service

within WAS in particular 15 years and under.

Table 4. Years of service

83%

17%

Working Patterns

Full Time Part Time

Lower banded roles

are shown to have

more part time

employees. No roles

above band 8a have

Part Time

Employees.


Service Band (Years)

Full Time Equivalent

Headcount % of Workforce

0 - 1 163.03 185 5.82%

01 - 05 782.51 893 27.94%

06 - 10 722.27 759 25.79%

11 - 15 350.20 368 12.50%

16 - 20 297.26 306 10.61%

21 - 25 285.96 289 10.21%

26 - 30 127.28 128 4.54%

31 - 35 55.00 55 1.96%

36 - 40 15.00 15 0.54%

40+ yrs 2.00 2 0.07%

Table 5a. Workforce Ethnicity Breakdown

Headcount

Ethnic Origin Female Male

White (Any Background) 580 1017

Not Stated 472 911

White & Black Caribbean 1 0

Mixed - Any other mixed background 1 2

Asian or Asian British - Indian 2 1

Asian or Asian British - Any other Asian background 0 3

Black British 0 1

Chinese 1 0

Table 5a shows that the majority of the workforce within WAS have stated white background as their

ethnic origin. 0.4% of the workforce report being from a non white background which is 3.7% lower

than the ethnic composition of Wales.

Even with the increased effort by the Trust to gather equality data, employees have returned

monitoring forms with do not wish to declare as the response to the questions. This will be addressed

by the Trust going forward.

Over half of the

workforce are from

a white ethnic

background.

Over half of the

workforce have

between 1 and 10

years service within

WAS


Pay Differences

The Equality Act 2010 is the current legislative source on equal pay for the protected characteristic of

gender. It requires that women and men are paid on equally favourable terms where they are

employed on „like work‟ or „work rated as equivalent‟ or „work of equal value‟

Within WAS over 90% of staff are paid in accordance with the Agenda for change terms and

conditions (AFC). AFC terms and conditions are a nationally negotiated framework of terms adopted

by NHS organisations across the United Kingdom. All posts under AFC are evaluated and allocated

to one of nine pay bands. AFC means that the role is evaluated regardless of the person within it and

therefore the pay is not linked to any personal characteristic. The consistent application of AFC

means that no individual is discriminated against with regards to their pay in relation to any protected

characteristic.

Within WAS a Pay Analysis group has met to begin analysis of staff pay to ensure that throughout the

organisation no person is paid differently to another in regards to any protected characteristic. The

findings of this group will be published where it is appropriate to do so having due regard to the

confidentiality of individuals and the protection of personal data.

The data which has been used is pulled from the Trust Electronic Staff Record (ESR).

The group have considered pay data in relation to the protected characteristics of -

Age

Gender

Sexual Orientation

Religion and Belief

Ethnicity

Disability

The group have recognised that there are gaps within the data that WAS holds in relation to the

protected characteristics of individuals. It is therefore identified that in order to provide meaningful

analysis of pay in relation to -Sexual Orientation, Religion and Belief, Ethnicity, Disability that further

work needs to be carried out across the Trust in order to gather this information from employees.

WAS will continue the work in regards to this collection of workforce data and will carry out pay

analysis which is more accurate to inform future objectives.

We will use workforce data as equality evidence, to shape both our current and future equality employment objectives.

Make appropriate arrangements to ensure that we periodically identify relevant information we hold, and identify and collect information that we do not have

Publish relevant information that we hold, unless it would be inappropriate to do so


The organisation holds information which allowed the group to carry out a top level analysis of both

pay in relation to Age and pay in relation to Gender.

During this it was recognised that the data used within this analysis may not be completely accurate

as there are some inaccuracies in the way in which position titles are coded in the Trust ESR. As this

may have an effect on the data further analysis into the causes of any identified difference will be

analysed fully following the completion of current work being carried out to cleanse and restructure

ESR.

Age

Following a high level analysis of pay data by age the group could not identify any significant

difference between age groups which could not be attributed to increases of pay by reason of

experience, qualifications and incremental progression through pay scales over time. There is a peak

in earnings identified in the age group of 45-49 with a slight decrease in pay following this. There are

a number of explanations for this including individuals reaching the top increment of their salary band

and choosing to stay within that role, some individuals choosing to reduce hours due to the nature of

their role. The larger drop in earnings is shown within the age band 60-64 and is likely to be

attributable to when staff are able to access benefits which allow them to retire and then return to

work.

Gender Pay

Following a high level analysis of pay data by gender the group identified difference between the total

earnings for men and women employed within all staff groups. These differences could be accounted

for in a number of different ways which include

- The types of role which fall into the staff groups

How do different roles affect overall average basic pay within staff groups?

- The coding of staff groups within ESR

Due to the coding with ESR certain roles may have been coded to the wrong staff group

therefore changing the figures presented in an overview analysis

- The naming of roles within different areas of the organisation

If roles are named differently across the organisation are the job descriptions evaluated at the

same band?

- Part-time working

Where more women work part time within a staff group this will significantly reduce their actual

earnings

- Access to flexible working arrangements

Is this consistent and available to all?

- Access to overtime:

Where overtime is available this is offered to all members of staff within that role through an

online system. However overtime is mainly available to Operational staff which may account

for higher levels of overtime being completed by males.


Our Gender pay objective will include actions to further explore and develop WAS recruitment activity

and flexible working initiatives. The work which has been carried out by the Pay Analysis group is

used to inform the actions included within our Gender Pay Action Plan, which can be found in

Appendix 3.

Training

The Trust‟s Strategic Plan recognises the need for effective training to be provided to all employees

to help them meet their duties. The Trust is committed to the provision of such training to support the

development of a culture built on positive attitudes, non-discriminatory practice and valuing

difference. We recognise that a single intervention on equalities training is not sufficient to ensure that

our employees maintain an up to date equality understanding and awareness. All employees

undertake equality and diversity awareness training at corporate induction and the Trust aims to

integrate equality understanding and awareness into all training modules available to staff. Through

this we aim to encourage discussions about equality issues and challenging people‟s opinions where

these show evidence of prejudice. This will be driven by the „Treating People Fairly‟ aims and

distribution of information for self assessment will become an adopted method of training.

Equality Impact Assessment training was previously rolled out to key individuals across the Trust and

has been delivered on an ad-hoc basis where the need is identified. The Trust will ensure that future

training is tailored towards the need of those attending and that one-to-one meetings are available to

support through the impact assessment process.

Where we are now (2011)

Where we want to be (2014)

The training offered within corporate induction which specifically covers Equality, Diversity and Human Rights is specific and misses some key messages around difference. Equality and Diversity is not currently embedded within the WAS training structure however steps to promote respecting differences is being rolled out through the influencing through understanding programme.

The corporate induction will provide an overview where it is pointed out that specific differences exist and encourage those attending to read around so that their practice is not purely based on relying upon their own needs, belief systems and conventional practices. All training offered will be based on the approach of treating everyone with dignity and respect. It will encourage sensitivity to the needs of others, mindfulness of social, cultural, religious, moral, ethical and legal issues with the whole persons needs being considered. More disability awareness training and awareness specific training will be provided where needed to ensure understanding. E-Learning will enable staff to update their knowledge of Equality and Human Rights.

Welsh Language


The Welsh Language Act (1993) required all public organisations to have a Welsh Language Scheme

placing a duty on the public sector to treat Welsh and English on an equal basis, when providing

services to the public in Wales. It required that Welsh and English must be treated on the basis of

equality in the conduct of public business and law in Wales. More recently, the Welsh Language

Measure 2011 confirmed the official status of the Welsh language, creating a stronger system of

standards placing a duty on bodies to provide services through the medium of Welsh and appointing

a Welsh Language Commissioner to oversee the implementation of this Measure and associated

standards. The Welsh Government sets out its commitment to increasing the use of Welsh in Wales

in the document „Iaith Pawb‟.

The Trust is committed to promoting services of an equal standard in both Welsh and English. Its

statutory Welsh Language Scheme ensures that people who deal with the Trust are able to receive

services in the language of their choice, be that Welsh or English.


Impact Assessment

Where we are now (2011)

Where we want to be (2014)

The Trust currently has in place a system to equality assess all documents against protected characteristics, and a training programme for those who write or are involved in policies, strategies or anything that would have an effect on individuals. It is not clear within the Trust how much detail these impact assessments currently contain or how frequently they are completed. Some seem to be completed as part of a tick box exercise and are not accurate. There is no central record of the impact assessments completed.

The Trust will be an organisation that embeds the use of equality impact assessments within its day to day behaviour and business as usual. The Trust will deliver services in a fair way . More support will be offered to staff in completing Equality Impact Assessments and the Trust will nominate a named point of contact. The Trust will have researched available toolkits and ensure that the impact assessments completed within the Trust reflect the Equality Act and take into account all aspects of equality including children‟s rights and spirituality.

Where any Impact Assessment reveals that there is a potential substantial adverse impact upon any of the protected groups which may impact on our ability to meet the general duty, we will publish the assessment in a transparent way. Equality Impact Assess all financial decisions.

Through the „Treating People Fairly Agenda‟ the Trust will develop a new approach to Equality Impact

Assessment which will be led y the Board.

Procurement

The Trust often contracts with external organisations for the provision of works, goods or services. In

the context of this Plan, procurement is the contractual process by which a public authority agrees for

another organisation to carry out works and/or to provide goods and/or services on its behalf.

The 1EHRC guidance states that when procuring works, goods or services from other organisations

on the basis of a relevant agreement the public body must:

1 Procurement: A guide for listed public authorities in Wales


Have a due regard to whether it would be appropriate for the award criteria for the contract to include considerations to help meet the general duty

Have due regard to whether it would be appropriate to stipulate conditions relating to the performance of the contract to help meet the three aims of the General Duty

The Specific Duties on procurement only applies to contractual arrangements that are relevant

agreements, which in this context means either the award of a public contract or the conclusion of a

framework agreement. Both are regulated by the Public Sector Directive (Directive 2004/18/EC).

The Trust needs to have a due regard to eliminate discrimination, advance equality of opportunity and

foster good relations when spending public money. This applies to all procurement regardless of the

value of the contract. We must have a „due regard‟ at all stages of the procurement process to the

need to advance equality.

The NHS across Wales is considering the current tender process to ensure fairness and equality.


The following table highlights how our research and engagement with our communities has informed

our Equality Objectives-

Emerging Theme 1: Health inequalities

Literature and Research Engagement

-All Wales figures from the Welsh Health Survey indicate that men are less likely than women to access a range of health services -The Welsh Consumer Council (2005a) reported on consumer access to health information and concluded that those from ethnic minority groups faced barriers from: difficulties in finding professional translators; losing spontaneity when using a translator; and doctors not always explaining illness or medication adequately - The „How Fair is Wales‟ document has pointed out that 1 in 7 transgender people who responded to a survey felt that they had been treated adversely by healthcare professionals because of their transgender status. The Triennial review „How Fair is Britain?‟ also suggested that gay and lesbian people are more likely to say that they have been treated with respect in health services only some of the time or rarely. -Respondents living in North Wales were more likely to report discrimination than those living in South and Mid and West Wales. Cook et al, 2007 conducted research on LGBT people‟s experiences in North and Mid Wales, which particularly focused on the impact of disclosure of sexual orientation on staff attitudes. They concluded that it is necessary to increase awareness and understanding Although quantitative data is not currently well developed a series of qualitative studies have demonstrated concerns about the treatment of older people receiving care. The most significant is the „Dignified Care?‟ The experiences of

-Feedback included discussion about groups who find it hard to access healthcare services and suggestions for improving this. It was felt that greater understanding was required by frontline staff in relation to the needs of Lesbian Gay Bisexual Transgender service users and of people with mental health problems -Understanding of the social model of disability was mentioned as fundamental to improving access including in the health setting. There were specific suggestions for staff to receive mental health first aid training. It was suggested service users to be made more aware for the model care pathway for trans people. There is potential for good practice and positive experiences here which can be lost due a lack of knowledge. Take-up of appropriate health screening was highlighted as a particular issue for trans people. -Interpretation services were seen as key to access. Suggestions were made to improve the availability of British Sign Language (BSL) and other language interpreters. A concern highlighted from ethnic minority communities was that use of family members as interpreters was inappropriate when dealing with sensitive and confidential issues. -Participants described a range of problems which could arise for any older person receiving care. In particular, specific concerns were raised about isolation and differing support networks of friends and families for older LGBT people. -Problems of communication between


older people in hospital in Wales produced by the Older Peoples Commissioner for Wales. -“Hidden in Plain Sight” Equality and Human Rights Commission Report which highlights the problems gypsy travellers encounter in Health Care Settings -In March 2009 the Health Ombudsman published a report concerning the neglect of six people with a learning disability who died in NHS care. Subsequently groups including Mencap have campaigned on improving health and care services for people with learning disabilities.

professional and older people with learning disabilities was recognised as leading to poor experiences in care for this group. -Participants commented that investment in preventative work with Gypsy and Traveller communities was generally not sufficient. -Representatives from advocacy groups suggested that communication between care providers and people with learning disabilities was not always successful and that this could have serious consequences if the needs of service users were not understood.

Emerging Theme 2: Inequalities in Employment


-All Wales figures indicate much lower levels of employment among disabled people than non-disabled people and older people compared with the standard working age group. -National research indicates inequalities in the levels of pay between different genders, ethnicities and between disabled people and non-disabled people -The majority of people across Wales identify themselves as heterosexual and of those who completed the WG population survey in 2010 this was 95.2%. 1.2% identified themselves as gay/lesbian or bisexual and 0.4% as other. These results are broadly similar to the results for the UK as a whole, though the non-response rate for Wales was higher than for the UK. - In Wales, 96.3 per cent of people identified themselves as White, 1.6 per cent identified as Asian or Asian British and 2.2 per cent of people identified themselves in another ethnic group. Between 2001 and 2009, the percentage of people in Wales from minority ethnic groups increased from 2.1 per cent to 4.1 per cent. -The largest minority ethnic group in Wales is Asian or Asian British. In 2009, this group made up 1.8 per cent of Wales‟ population.

-Suggestions form participants included the development of a standardised employment monitoring form which would allow better data and understanding of trends. Also raised was a need to improved staff training and awareness particularly for those staff involved in recruitment. -The idea of „positive mental health and wellbeing policies‟ for employees was raised as a way of making employers more attractive to disabled employees and increasing retention of staff. -Some participants raised concerns about the language requirements for some specific posts and an absence of roles where fluency in BSL was expected. Support networks for staff with different protected characteristics were generally encouraged and welcomed where they were present. -Flexible working was also welcomed and its extension was seen as important for allowing older and disabled people and people with caring responsibilities to balance life and work. -Some specific concerns were raised about reasonable adjustments for blind, deaf and other disabled candidates in job interviews. A demand rose for more „real jobs‟ for people with learning disabilities rather than employment placements


-At a local authority level Cardiff, Newport, the Vale of Glamorgan and Swansea had the highest proportions of people from minority ethnic groups in 2009. - Both employment rates and pay levels are lower than average for most ethnic minority groups (though not for those of Indian origin), with, in many cases, the gaps being largest for those whose arrival in the UK is most recent. Members of ethnic minority groups are generally under-represented at senior levels in organisations across the public and private sectors. The level of Disability Discrimination Act (DDA) disability in Wales in 2010 as reported in the Welsh Government Statistics was around one fifth of the working age population and around three-quarters of DDA disabled people were also work-limiting disabled. In 2010 over one third of people between the ages of 55 years and pensionable age in Wales had a DDA disability. Across Wales employment rates for DDA disabled people were consistently low compared to the non-disabled population. -Rates of disability increase through the lifespan, with an incidence of 3% at 16-19 and 71% at 80+. -Several forms of impairment are more prevalent in people from socio-economically disadvantaged backgrounds. These include progressive wear and tear from manual occupations, and higher rates of obesity, predisposing to musculo-skeletal problems and Type 2 diabetes (a risk factor for peripheral arterial disease and amputation), and higher rates of cigarette smoking (a risk factor for strokes, emphysema and peripheral arterial disease). -Disabled men are much less likely to be in employment than non-disabled men and for those in work are more likely to be in low-skilled jobs -Disabled people or those with a limiting long-term illness are much more likely to report bullying or harassment in the workplace than non-disabled people

although difficulties in securing the right balance between benefits entitlement and paid work were recognised. -Individuals feel at a time when there is little opportunity to gain employment that volunteering could be made more widely available and accessible especially in more remote places such as Powys.


-Disabled people and those with limiting long-term illness are twice as likely as people who are not disabled to suffer poor mental health

Emerging Theme 3: Inequalities in personal Safety


-All Wales figures indicate that homophobic, transphobic, disability-related and religiously and racial motivated hate crimes and bullying are a significant issue across Wales A large body of evidence exists which highlights the problem of domestic violence and the disproportionate impact it has on women‟s lives. -In Wales between 2007 and 2008 1,505 women and 1,338 children were accommodated in refuges by Welsh Women‟s Aid groups - 2,700 women were turned away due to a lack of available refuge space -13,982 calls were made to the All Wales domestic abuse helpline between 1 April 2007 and 31 March 2008 -In North Wales there have been more than 30,000 domestic violence attacks or threats in the last three years – one for every 25 people living in the region -19% of Welsh population think domestic abuse is best handled as a private matter -The Welsh Ambulance Service does not have any Domestic Abuse Policy or Procedure currently for staff

-Reasons for low levels of reporting were thought to be complex and varying but included a lack of information about how and where reporting can be done. A fundamental issue was confidence. -The comments made offered a range of insights into victims and their needs rather than a focus on specific required actions. -Discussions focused on training staff to improving awareness and attitudes. The need to promote available services to victims and potential victims was also discussed as was the need for more safe spaces for reporting. -The process of reporting also received attention with concerns highlighted about the need to ensure support systems protect confidence/ identity and that „private spaces‟ should be available for passing on confidential and sensitive information wherever reporting can take place.

Emerging Theme 4: Inequalities in Representation and Voice


-A range of 3rd Sector and service user groups are engaged in a range of ways in the development of public sector policies and plans. Specific engagement has taken place to develop equality objectives and Strategic Equality Plans across North Wales.

-There is strong demand for a more co-ordinated approach to be taken by the public sector to ensure it involves the public, service users and local networks and groups in policy development, impact assessments and other aspects of service design and delivery.


-A more coherent and consistent approach is needed to enable effective engagement and to empower people across all of the protected characteristics. -The Equality Act 2010 and Public Sector Equality Duties provide clarity about engagement and consultation with the public, service users and local networks and groups. There is a need to review these mechanisms, on a North Wales basis, to extend the range of this work, improve and develop relationships and avoid duplication.

-Suggestions include the development of a regional coalition to represent disabled people‟s interests and to act as a point of contact for public authority engagement work. It has been further suggested that a broad regional structure, capable of providing this function across the full range of protected characteristics, would be desirable.

Emerging Theme 5: Access to information and services


-The population of North Wales has relatively high numbers of people declaring themselves to be disabled or have a limiting long term illness. North Wales also has a particularly high level of older people as a percentage of the overall population. -In the coming years this is predicted to increase. Older people are more likely to experience hearing loss, sight loss or mobility problems all of which can affect access if no steps were taken to cater for these circumstances. To illustrate there are 480,000 deaf and hard of hearing people in Wales with 70% of people over the age of 70 having hearing loss. -British Sign Language (BSL) is the first or preferred language of approximately 3,000 people in Wales. The number of people using British Sign Language in North Wales is estimated to be [figure still sought]. NHS research demonstrates that 70% of BSL users admitted to A&E were not provided with an interpreter to help them communicate. We also know that provision for BSL interpreters to assist access to council services is also variable across North Wales. -Language can also be a barrier for those who speak a language other than Welsh or English. Our knowledge and understanding of language

-Interpretation services were seen as key to access. Suggestions were made to improve the availability of British Sign Language (BSL) and other language interpreters. -A concern highlighted from ethnic minority communities was that use of family members as interpreters was inappropriate when dealing with sensitive and confidential issues. -There is no text facility for deaf patients to book PCS vehicles -PCS are sometimes late collecting a dialysis patient, which means that they may miss their slot at the clinic or have to go a long time without food – Bedlinog area. -PCS not turning up at all, despite a booking being made – Georgetown -A patient from Gurnos has to travel to Cardiff for dialysis. This makes it an even longer day for the patient, with the additional travelling and sometimes, they are late leaving the dialysis clinic and the PCS driver is kept waiting. - At an over 50‟s forum in south east Wales only a few members of the group were aware of NHS Direct Wales.


needs is at different stages of development across different partners and across the region. Further work needs to be done to produce a more comprehensive picture. -A range of research also highlights issues for blind and partially sighted people across Wales. This includes difficulties in which arise when information is presented as in written form. Evidence suggests a lack of staff training in relation to awareness of visual impairment.

- During a Chinese elderly meeting in Cardiff it was quickly identified that communication was the biggest barrier to accessing health services including the Ambulance service, with many members of the association relying on younger relatives to contact various services on their behalf due to them being unable to speak English. -In Neath Port Talbot equality events communication formed a large section in the discussion. It was mentioned the methods used to communicate information, and that if people have difficulties with reading or writing they may be disadvantaged. -People with hearing impairments may find using the phone difficult. Telephone systems where options must be selected frustrate some people. -It was noted that many areas in Neath Port Talbot have poor broadband speed. People with no computers/internet access or who do not know how to use a computer/internet are unable to access information on websites. Some information on websites is out of date and therefore not helpful. It was noted that whilst some services such as online shopping were very helpful that IT was not the answer to everything, and that using the computer can be very isolating and people can‟t discuss information.


Our objectives are focused on achieving the following outcomes:

Each of these outcomes is underpinned by specific equality objectives.

Equality Objectives

Health Objectives

1. Increase the number of people choosing healthy lifestyles and accessing preventative health care services

2. Improve the care of

-Older People -Disabled People -Lesbian, Gay, Bisexual, Transsexual and transgender people By ensuring that they are treated with dignity and respect

Employment Objectives

3. Strengthen the workforce by increasing the overall diversity of Staff and Volunteers

4. Reduce gender pay differences through further exploration of data

Reduction in Health inequalities

Reduction of inequalities in the Workforce

Reduction of inequalities in personal Safety

Reduction of inequalities in Representation and Voice

Improve Access to information and services


5. Improve staff awareness, understanding and ownership of equality and human rights issues

through „Treating People Fairly‟ agenda Safety Objectives

6. Increase staff awareness of hate crime, harassment and domestic abuse Representation and Voice Objective

7. Improve engagement with people from all protected groups in the review and re-design of services

Access Objective

8. Improve outcomes for people with from protected groups by improving access to services


The Welsh Ambulance Services NHS Trust aims to provide the highest quality of service which is

responsive to the needs of the diverse population it serves. However, we realise that, on occasion,

the level of service can be improved and as a result, would very much welcome your feedback. If you

would like to raise any issues in relation to our Strategic plan please use the following contact:

Health Wellbeing and Equalities Manager: Welsh Ambulance Services NHS Trust Dyfed-Powys Police

Police Headquarters

PO Box 99

Llangunnor

Carmarthen

SA31 2PF

If you wish to raise a concern, you should discuss the matter with a member of staff, the Local Ambulance Officer or the Regional Director. They may be able to sort out your concern immediately.

If you would rather raise your concern formally you can contact a member of our concerns teams by:

Telephone North Wales – 01745 532929 Central & West – 01792 311704 South East – 01633 626207

Email [email protected] [email protected] [email protected]

You can also write to our Trust Head Quarters:

Mr Elwyn Price Morris Chief Executive Welsh Ambulance Services NHS Trust Trust Headquarters HM Stanley Hospital St Asaph Denbighshire LL17 0RS

If you would like additional support, the Community Health Council (CHC) can provide you with free confidential help and advice if you have a problem or concern with NHS services. You can find the contact details of your local CHC by contacting:

Board of Community Health Councils in Wales Tel: 0845 6447814 / 029 20 235558 www.communityhealthcouncils.org.uk Email: [email protected]

Useful website: Putting Things Right - arrangements for dealing with concerns about NHS services www.puttingthingsright.wales.nhs.uk

The Trust can provide interpreters, including British Sign Language interpreters on request.

mailto:[email protected]



http://www.communityhealthcouncils.org.uk/


http://www.puttingthingsright.wales.nhs.uk/


Appendix 1.

Rights

We will be given the

opportunity to…

Responsibilities

We will take every opportunity to…

Be open and honest

and to engage in 2-

way regular

conversations

Participate in regular communications with colleagues

Talk to our manager if we have concerns

Ask someone if we don‟t know the answer

Be clear in the message that we are trying to give the public or

colleagues

Be fully involved in

planning and

implementing change

Be open to safe, evidenced based change and innovation in service

delivery

Contribute to and take responsibility for changes to our work to improve

the service we deliver

Find out what is happening and what is planned in the Trust through our

manager

Ensure concerns about quality of service or employment issues are

raised through appropriate channels and actively support others to raise

such concerns

Work in an

environment which

encourages learning,

innovation and

continuous

improvement within a

positive and fair

culture

Take ownership for developing our skills and knowledge portfolio

Participate in personal development review process

Openly discuss and share good experiences

When something goes wrong use this as an opportunity for learning and

future improvement

Be provided with a

safe working

environment

Provide safe, high quality services to the best of our ability through

following safe practices

Keep the work environment safe and healthy for ourselves and others


Be provided with an

environment which

promotes dignity and

respect

Value and respect each other‟s differences and contributions and

recognise the legitimate interests we may represent

Actively listen to our colleagues‟ contributions

Think about what we are about to say or do before we do it to consider

the impact on individuals and groups we are talking to/dealing with

Encourage each other

to take ownership of

our work and

behaviours

Be accountable for our behaviours and actions

Be open to legitimate scrutiny from colleagues or the public

Provide the best quality of work that we can achieve

Encourage pride in

our work, the Trust

and our achievements

Recognise and celebrate colleagues‟ achievements and act as an

ambassador for the Trust at all times


Appendix 2.

Other WELSH AMBULANCE SERVICE Equality and Human Rights achievements include-

General

The Trust has hosted a staff member of NHS Centre for Equality and Human Rights (CEHR) for the last 3 years and continues to receive their support and expertise in guiding the Trust in all aspects of Equality and Human Rights.

The Equality and Human Rights Steering Group is chaired and directed by a non executive Trust Board member. Within the workforce There is now a Corporate Induction programme in place which promotes the Staff Values, Staff Charter, Equality and Human Rights. In order to reach all existing staff including Voluntary staff, each member has received a personal copy of the Trust Staff handbook which again has been used as an opportunity to promote staff development, health and well being, personal development reviews. All Training staff within the Trust have received a one day Train the Trainer session in relation to Equality and Human Rights. This was delivered with the support of NHS CEHR.

The Trust has a statutory / mandatory training programme in place for all staff which includes Equality and Human Rights. This is being delivered during 2010/11 and 2011/12. There is an established Management Skills Learning Programme in place which delivers management training on the following topics

Influencing People and Managing Conflict.

Defining roles, recruitment and selection

Managing Sickness Absence

Personal Development reviews All of the above support the Equality and Human Rights agenda within the Trust. The Trust contacted all staff in 2009 to complete a data monitoring exercise. A return rate of 45% was achieved which has enabled the Trust to have a clearer understanding of the diversity of the workforce. Equality Impact Assessment training has been introduced, with a programme to ensure that the training is delivered to all policy owners and those who develop projects and services. The Equality Impact Assessment Guideline document is now in place. All documents submitted for Board approval must now be accompanied by a summary document that describes the outcome of the Equality Impact Assessment in respect of Equality and Human Rights. To support staff health and well being the Trust now has in place a Child Care voucher scheme and a Cycle to Work scheme.


The Trust holds the Two Tick Symbol. This symbol is awarded by Job Centre Plus to recognize employers who have agreed to meet five commitments regarding the recruitment, employment, retention and career development of disabled people.

Equality and Human Rights training and awareness sessions have been delivered to Trust Board. These sessions have been delivered with the support of CEHR training staff Staff Exit Interview policy has been revised and now provides more detailed information in relation to reasons for leaving. A staff disability questionnaire was sent out in 2007. Results and feedback was used to inform the development of the Disability Equality Scheme. To improve disability awareness Managers received training (2008) provided by Remploy. This was well attended and received positive feedback. Continued partnership working with “Access to Work” has facilitated staff and managers to gain expert advice about adaptations when required. For our service users Language line is available in our Ambulance Control Centres and NHSDW call centres. A Multi-lingual phrase book is available on ambulances to support operational staff when dealing with non English speaking patients. On occasions when this has been used staff have reported how helpful this resource has been. The Patient Clinical Record document was amended in 2006 to include the collection of patient‟s ethnicity details.

Dialysis patients in all three regions have received a questionnaire and have participated in an ongoing consultation process to improve services (2009/10). This has resulted in more appropriate pick up and departure times which has resulted in improved health care outcomes for the patients.

The Trust‟s Partners in Healthcare (PIH) Panel continue to work closely with the equality team and provide vital links for engagement with their Service User Representatives. Minicom facilities are available at NHSDW site in Swansea and Typetalk is available to all NHSDW callers. WAS is committed to including as many people and groups as possible in contributing to the decision making process that affects the health community it serves and its staff and has a dedicated Partners in Health Team whose main purpose is to consult and engage with the communities in Wales in order to improve our services.