KENT COUNTY COUNCIL
EQUALITY ANALYSIS / IMPACT ASSESSMENT (EqIA)
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Directorate: Social Care and Wellbeing
Name of policy, procedure, project or service
Procurement of Kent School Public Health Service
What is being assessed?
School Public Health Service for - 5-19 year olds
Responsible Owner(s)/ Senior Officer(s)
Colin Thompson – Public Health Consultant Lead
Jo Tonkin – Public Health Specialist
Karen Sharp – Head of Public Health Commissioning
Date of Initial Screening
15/10/15
Date of Full EqIA:
TBC
Version / Author / Date / Comment1 / J Tonkin / 15/10/2015 / Initial draft
2 / A Agyponge / 22/10/2015 / E & D Team Comments
3 / J Tonkin / 23/10/2015 / Amendments following comments from E & D Team
4 / J Hill / 26/10/2015 / E & D Team Comments
5 / R Parsons / 28/10/2015 / Amendments following comments from E & D Team
6 / J Hill / 28/10/2015 / E & D Comments
7 / R Parsons / 29/10/2015 / Amendments following comments from E&D Team
8 / J Hill / 30/10/2015 / E & D Comments
Screening Grid
Characteristic / Could this policy, procedure, project or service, or any proposed changes to it, affect this group less favourably than others in Kent? YES/NOIf yes how? / Assessment of potential impact
HIGH/MEDIUM
LOW/NONE
UNKNOWN / Provide details:
a) Is internal action required? If yes what?
b) Is further assessment required? If yes, why? / Could this policy, procedure, project or service promote equal opportunities for this group?
YES/NO - Explain how good practice can promote equal opportunities
Positive / Negative / Internal action must be included in Action Plan / If yes you must provide detail
Age / YES – The service is for children and young people only. The service will need to differentiate between the needs of children across the age range and ensure that one group is not favoured over others. / Medium / Medium / It is proposed that the 5-19 service is remodelled into age specific services meeting the needs of primary age and secondary and tertiary age children.
The age group of the children and young people will shape the way in which the service is delivered in line with the age specific health interventions articulated in the DH ( 2009) Healthy Child Programme and the PHE Framework for the Health and Wellbeing of Young People
Disability / YES – The service could fail to systematically identify children with disabilities, ensuring that their needs are not fully integrated within core service provision. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan.
The specification for the service requires that children and young people with disabilities are systematically identified though health review and assessment.
Gender / YES – The service could be accessed more by one gender rather than other other. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan.
Publicity, communication as well using the views of young people themselves in the development and delivery of the service are all valuable in understanding how the service can be accessible to both genders. The school health workforce is predominantly female. Further user consultation may be required to identify the extent that this is a barrier.
Gender identity / YES – Issues of gender identity amongst children and young people are likely to be identified as part of a health assessment. / Low / Low / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan. / Training to raise awareness of the sensitivities relating to Gender Identify will be included within the service specification.
The service offers an opportunity for the needs of children and young people with gender identity issues to be better understood and managed within education settings.
Race / YES – there are racially specific trends and population characteristics associated with child health.
These need to be incorporated and accommodated within the service specification.
English language skills may also be a barrier to accessing services. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan.
The service specification includes the need to develop district level health plans which will provide intelligence as to the ethnicity of the children in the population.
This provides an opportunity to plan and deliver services that better meet the need of ethnically diverse children and young people. / Communication channels, availability of information in alternative languages and formats, and training in cultural sensitivities will all be incorporated within the service specification.
Religion or belief / YES - There are aspects of universal and proportionate child health provision that may conflict with those of particular religions or beliefs. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan. / Specific training in the needs of minority service users will be included within the service specification.
Sexual orientation / YES – The service may fail to be assessable to children and young people who identify as lesbian, gay or bisexual. / Low / Low / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan.
Communication and service accessibility will need to be considered in de-stigmatising service access for certain minority user groups. / The specification should include the need to proactively understand the support services available for children and young people who are exploring their sexuality or who identify as lesbian, gay and bisexual.
Pregnancy and maternity / YES- young people who are pregnant may require additional support to access educational settings. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan. / We will work with the service to build capacity in the future to provide support to pregnant young women and fathers in school settings and to access education, where they would otherwise not.
Marriage and Civil Partnerships / No – it is not anticipated that the service will impact on this characteristic. / Low / Low / No specific actions identified.
Carers responsibilities / YES– children who are carers may require additional support to access educational settings and will benefit from the service. / Medium / Medium / Further actions are required to ensure that the positive outcomes are achieved as part of the service design – these are included in the Action Plan.
Young carers will be systematically identified through the health assessment. This will lead to additional support in the educational setting.
Part 1: INITIAL SCREENING
Low / Medium / HighLow relevance or Insufficient information/evidence to make a judgement. / Medium relevance or Insufficient information/evidence to make a Judgement. / High relevance to equality, /likely to have adverse impact on protected groups
Proportionality - Based on the answers in the above screening grid what weighting would you ascribe to this function – see Risk Matrix
State rating & reasons
Overall, it is anticipated that risks to service users are low-medium and in many cases no negative impact is likely. Specific actions have been identified in this document to identify areas to promote equality through service provision.
Context
The School Public Health Service provides expert advice, information and various help to children and young people aged 5-19 in school settings across Kent.
Specialist Community Public Health Nurses (SCPHN) lead in the delivery of the Healthy Child Programme. In addition, the service is commissioned by NHS England to deliver school elements of the National Child Immunisation Programme.
The service starts with the handover of cases from Health Visitors and is followed by the Year R health review at school entry, which includes audiology and vision screening. The National Child Measurement Programme (NCMP) is undertaken at Year R and Year 6. Outside of this, school-aged children can be referred into the service to address particular public health needs, which they or a professional has identified.
Packages of care are delivered to address these needs and referrals to additional services are made when necessary.
The service offers support around issues, including:
· Healthy weight
· Substance misuse (drug, alcohol and smoking)
· Sexual health
· Behaviour and emotional health and wellbeing (of children and parents)
· Domestic abuse
· Parenting
Whole school health improvement is promoted across all schools with a focus on those schools where need is greatest. The offer to each school is explained in school and district level plans.
The Public Health Outcomes linked to this service are:
4 - 11 year olds
· Reducing excess weight in 4-5 and 10-11 year olds
· Reducing hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0-14
· School Readiness
11 - 18 year olds
· Smoking prevalence at age 15
· Alcohol-related admissions to hospital
· Under 18 conceptions
· Chlamydia Diagnosis
· Hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0-14 and 15-24 years
· Emotional well-being of looked after children
In addition the service will contribute to:
· Increases in young people’s self-reported emotional health and wellbeing
· Reductions in child admissions for mental health
· Reductions in young people’s hospital admissions for self-harm
· Reducing pupil absence
This procurement recognises that there are many different faiths, cultures and lifestyles in Kent. It also recognises that people in Kent will have a diverse range of needs (such as access for disabled people). It is essential that all service providers and service users recognise and respect this diversity.
In order to ensure that Kent County Council provides the best possible services for the local population, the following has been identified (see action plan below) and need to be addressed in future commissioning of the service:
· The current service provision across the county is not equitable and there are differences in the availability of access to services Due to historic commissioning arrangements service delivery is inconsistent across Kent. The service currently delivers more packages of care in primary schools than in secondary schools. Groups of young people outside of mainstream school settings, like Pupil Referral Units and young offenders have not consistently received a service despite having greater and more complex needs. In addition, the offer to the tertiary education sector is not consistent; currently vision and audiology screening is not delivered across the county.
· The Health Review at Year 6, part of the Healthy Child Programme, is not currently delivered.
Beneficiaries:
The service benefits all children between the ages of 5-19.
In addressing health inequalities for children and young people the Kent School Health Service has a particular focus on children and young people who are:
· Living in deprived wards and at risk of poor outcomes
· Young people with mental health needs
· Young Carers
· Children with Disabilities
· Children who are in Pupil Referral Units
· Children and Young People who are Young Offenders
· Young Parents
Information and Data:
The service delivery is directly linked to the Public Health Outcomes for children, which is reported as part of a national data set. KCC uses this data and information to ensure that scarce resources are focused on helping children and young people reach their full potential. The service transferred from the NHS to KCC in April 2013. Since then, a review of the service has highlighted the need to improve the collection and monitoring of children and young people’s protected characteristics to enable us to ensure that everyone who needs a service has access to that service.
Data is provided to commissioners on individual packages of support delivered to children, the provision of the year R health assessment, screening activity levels and the number of health care plans supported, all at district level. This allows us to understand service provision across the county. However, as it is not broken down by protected characteristic it does not effectively identify equality of provision.
Whilst we have access to a vast amount of child population data (this is also publicly available from the Kent Public Health Observatory) we do not have sufficient data relating to the protected characteristics of the users of this service in particular.
The fact that this data is not currently reported by the service is picked up in the action plan. The team will work with providers and ensure that going forward data collection and reporting improves knowledge of the demographics of service users and better identifies any protected characteristics they may have. The current service provider has recently implemented computerised record keeping which will enable greater scrutiny going forward.
Involvement and Engagement:
A joint pubic consultation with the Health Visiting Service is due to be undertaken from 2nd November. We are looking into alternative ways to deliver these services, and some of these ways include looking across both services and focussing provision across the different age groups within the 0-19 range. For example, one of the options considers grouping 0-11 (children from birth to primary school) together and 12-19 (young people in secondary school) together. We have identified that the public health needs of 8 year olds and 13 year olds are not the same, and thus we are exploring ways to better meet the specific needs of different groups of children and young people 0-19.
Feedback from this consultation will be used to inform and shape the future commissioning activity around both of these services. We will be undertaking a procurement exercise in order to ensure that the services are able to deliver the best outcomes for children and young people in Kent. These new contracts are expected to start in October 2016.