Summary Report Template

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1 Section 4 Integrated Impact Assessment Summary Report Template Audit Risk level (Risk level will be added by Equalities Officer) Each of the numbered sections below must be completed Interim report Final report (Tick as appropriate) 1. Title of plan, policy or strategy being assessed Hydrotherapy Review 2. What will change as a result of this proposal? NHS Lothian currently operates three hydrotherapy pools one at the Western General Hospital (WGH), one at St John s Hospital (SJH), and one at Astley Ainslie Hospital (AAH). The two proposals being considered are as follows: 1. The closure of all three hydrotherapy pools in NHS Lothian. Some patients who would previously have received hydrotherapy as part of their care would receive other, land-based treatments. 2. An intermediate option the closure of one pool, with all or most of the usage there transferred to the other two pools. With this option, there would not be a reduction in the number of sessions run overall, but the patient experience may change, for example in travelling to a different hospital for their session. Both options would aim to achieve cash releasing efficiency savings. Savings would accrue to the facilities department budget. There would not be any reduction in staffing posts associated with either option. 1

2 Current situation - Hydrotherapy in NHS Lothian NHS Lothian currently operates three hydrotherapy pools one at the Western General Hospital (WGH), one at St John s Hospital (SJH), and one at Astley Ainslie Hospital (AAH). These are managed on a day to day basis by the physiotherapy departments at each site, with maintenance and cleaning carried out by the facilities department (either in house or contracted to an external company). In addition, other departments use the pools to different extents at each site. The pool water temperature is maintained at 35.5C. Each pool is also hired for sessions run by third sector organisations such as BackCare UK, and the National Ankylosing Spondylitis Society (NASS). They provide their own staff, and are covered by their own insurance, for these sessions, which are usually held in groups. As practised in NHSL, a hydrotherapy intervention typically comprises 6 sessions across 6 weeks. Patients are individually assessed and individual treatment plans set and progressed. According to their needs and ability, multiple patients may be supervised in pool by physiotherapy staff but their treatment is individualised. Patients are individually referred by physiotherapists for outpatient sessions of hydrotherapy (MSK and pain management); for other departments, the referral pathway can also be through their consultant. Discharge from the service includes information and encouragement to continue to exercise in local swimming pools and/or with 3 rd sector organisations. 3. Briefly describe public involvement in this proposal to date and planned A six week consultation is planned, to be informed by this IIA. Hands off Hydro campaign has collated personal testimonies from patients outlining the benefits they have received from hydrotherapy, and has also organised a petition in support of keeping the pools which has been signed by patients with 23 different conditions, and by 34 professionals. 4. Date of IIA 20 May

3 5. Who was present at the IIA? Identify facilitator, Lead Officer, report writer and any partnership representative present and main stakeholder (e.g. NHS, Council) Name Job Title Date of IIA training (if applicable) Margaret Douglas Consultant in Public Health IIA lead (Facilitator and report) David Griffiths Chief Executive, ECAS Not NHS training Sam Rankin Hands Off Hydro Eddie Balfour Kay Hildersley Lynsey Murray Dawne Deuchars Ann Findlay Caroline Alexander Fiona Sutherland Physiotherapy Manager, Chair of Review Group Physiotherapist, WGH Partnership Rep/ Physio Physiotherapist Paediatrics, West Lothian Lead Physiotherapist, Learning Disabilities Specialist Physiotherapist Physiotherapy Support Worker ~ 2 years ago eddie.balfour@nhslothian.scot.nhs.uk kay.hildersley@luht.scot.nhs.uk lynsey.murray@nhslothian.scot.nhs.uk dawne.deuchars@nhslothian.scot.nhs.uk ann.findlay@nhslothian.scot.nhs.uk caroline.alexander@nhslothian.scot.nhs.uk fiona.sutherland@nhslothian.scot.nhs.uk 3

4 Lianne Swadel Liz Ramsay Hazel King Efficiency & Productivity Programme Manager Physiotherapist, St John s Hospital Efficiency & Productivity Project Manager lianne.swadel@nhslothian.scot.nhs.uk liz.ramsay@nhslothian.scot.nhs.uk hazel.king@nhslothian.scot.nhs.uk 6. Evidence available at the time of the IIA Evidence Available? Comments: what does the evidence tell you? Data on populations in need Data on service uptake/access Data on equality outcomes Some Yes No See above for details of use of the pool. Hydrotherapy is used for management of range of conditions in children and adults. These include chronic pain, MSK, rheumatological, orthopaedic, neurological conditions, stroke and post op rehab especially to allow physio in patients who cannot weight bear on dry land. It can also benefit people with mental health problems and with learning or physical disability, who often find it more difficult or impossible to use mainstream pools. The temperature of the waters and provision of hoists and suitable changing facilities are important to allow them to use the pool. See below. Research/literature Yes Literature review of evidence for 4

5 Evidence Available? Comments: what does the evidence tell you? evidence Public/patient/client experience information Evidence of inclusive engagement of service users and involvement findings Evidence of unmet need Good practice guidelines Some No No Some hydrotherapy in treating certain conditions is in draft form. Does not compare to evidence for similar landbased interventions, and focuses on the main clinical populations where the pool is used - neurological rehabilitation (both out-patient and in-patient); adults with learning disability; musculoskeletal (MSK)/ rheumatological conditions; chronic pain management. Some anecdotal feedback provided by hands off hydro campaign, supportive of their experiences of the hydrotherapy pools (both NHS patients and third sector users). A consultation will be carried out, informed by the IIA. Consultation will be carried out; to be informed by IIA. Some anecdotal evidence from patients that some patients have waited for long periods to gain access to hydrotherapy. None of the pools is used to full capacity. Neither SIGN nor CSP have guidelines that specifically promote the use of hydrotherapy for certain conditions. However it is a recognised treatment option for therapists to recommend for patients. The group heard that the neurological services review is considering the benefits of hydrotherapy. Environmental data Some Energy costs estimated at approx. 5

6 Evidence Available? Comments: what does the evidence tell you? 15,000 annually per pool. New heat exchanger fitted in AAH should drop this by as much as half after the refurbishment. No data as to how that compares to lighting/heating the space if it was used for other purposes. Risk from cumulative impacts No There are cumulative impacts arising from the closure of pools previously managed by voluntary sector organisations. There would also be cumulative impacts if a pool closed and subsequently the AAH pool was not reprovided if and when the site closes. Other (please specify) Additional evidence required Income from external organisations using the pool totals less than 10,000 per year. It is estimated this could be increased to a maximum of 20,000 if all organisations paid the same hourly rate and additional organisations were recruited to maximise pool use. Service uptake Patients receive hydrotherapy after being referred by the relevant clinical department (see timetable), where staff feel that the patient would benefit from hydrotherapy as opposed to (or in addition to) other treatments. Patients do not self refer to the pools, nor are they referred directly from their GPs. Hydrotherapy is carried out by NHS staff from the department referring the patient; for the most part, this is physiotherapists from musculo-skeletal (MSK) departments however other departments also use the pools for example Paediatrics at SJH. 6

7 Astley Ainslie: This site has been closed for refurbishment for over a year, however it is not expected that the post-refurbishment timetable and usage levels would change significantly; there may be extra third sector hiring of the pools as new organisations have expressed an interest. For an indication of patient figures, in 2013 there were 1920 patient treatments, with an average of 4 treatments per patient. This equates to approximately 480 patients treated over the year. Western General: In the months Sept 2014 until Feb 2015 it has had 146 new patients (which would equate to approximately 292 new patients per year). There is also one Muscular Dystrophy group session (1.5 hours) and one Rheumatology Group session (1 hour) per week, which we do not currently have patient figures for. Patients can attend for One Off teaching sessions to enable them to confidently embark on self management at their local pool, although most referred patients attend for 4-6 sessions. This is dependent on the condition and the response to the pool intervention. St John s: Over a period of one year 1168 patient sessions were carried out in the pool at SJH. This was 186 sessions with an average of 6.28 patients per session, with each patient getting an average of 5-6 sessions. This equates to approximately patients seen during this time. This figure does not include patients treated by other departments who use the pool, but covers MSK only. The paediatric department has time booked to see 2-3 patients per hour, 3 sessions per week. In 2014 they saw 179 patients in total; although it is believed this may have been affected by staffing levels. 7. In summary, what impacts were identified and which groups will they affect? Equality, Health and Wellbeing and Human Rights Affected populations Positive No positive impacts on equality or health identified Negative Significant negative impacts for the groups of people who currently use the pool and will no longer be able to do so, or may have to travel further to access a pool. People in all the patient groups listed above as users of the pools If all NHS Lothian pools are closed, there will be no 7

8 access to hydrotherapy for adults. There is one other hydrotherapy pool run by a voluntary organisation but it is due to close. Hydrotherapy for children may be reprovided in schools, but there is currently no alternative pool in West Lothian. If one pool is closed, users of that pool will need to travel further for hydrotherapy. For some clients, the physical impact of travelling on their condition may cancel out the benefit of hydrotherapy. Their carers As the pool is used by people with a disability, they will be disproportionately affected. If users need to travel further to access hydrotherapy this may increase travel and staffing costs. The most significant impacts would be the loss of the therapeutic benefit of hydrotherapy to the people who receive it. The literature review has found little research comparing outcomes from hydrotherapy compared with land based physiotherapy. However professional opinion, and care guidelines for some patient groups, support use of hydrotherapy. Some patients who currently use hydrotherapy may be able to have land based physiotherapy instead. Some patients may be able to use mainstream pools but lack of hoists and suitable changing facilities may make this more difficult for the patients, carers and staff. Patients with some conditions such as disfigurement or challenging behaviours may be able to access mainstream pools but may be subject to harassment. For some patients there is no alternative available - for example people unable to weight bear on land, and people receiving chemotherapy who cannot use a mainstream pool due to infection control issues. People using the sessions organised by voluntary sector organisations are unlikely to be able to access an 8

9 alternative. People who currently use hydrotherapy and are no longer able to do so will lose the benefits including: Relief from pain and stiffness Improved self management Increased confidence Potential increased physical activity and mobility in the longer term following the intervention Shorter rehabilitation times for people who cannot weight bear on dry land Development of skills eg some children with a disability learn to swim due to hydrotherapy intervention Social interaction and reduced isolation from group sessions Psychosocial benefit of therapy in the pool where people with reduced mobility are more equal Reduced dependence on carers Reduced dependence on pain killers Reduced time for some to get back to work Potential increase in falls as land based physio has greater risk of falls compared with hydrotherapy The review itself has caused anxiety and concern to patients and to the patients, voluntary sector Patients and physio staff Patients 9

10 organisations and their service users using the pools Staff of voluntary sector organisations If patients need to travel from one site to another to access hydrotherapy this will cause disruption and increased work for staff and confusion for patients. NHS staff Affected patients Environment and Sustainability Affected populations Positive Closing one or more pools would reduce the requirement for heating Global Negative Closing one or more pools would lead to increased travel impacting on patient and staff time, cost and emissions NHS Staff and patients Economic Affected populations Positive Closing one or more pools would release associated funding Negative Potential increase in use of pain medication and other demands for healthcare if loss of hydrotherapy increases symptoms and reduces ability to self manage NHS funding opportunity cost would affect patients of other services that could be funded NHS Patients, Staff and Physiotherapy Depts. Cost of re-providing the service for some groups, and of 10

11 increased staff time to travel to other pools If voluntary organisations were no longer able to make use of the pools, some of their staff would lose their jobs Staff in relevant voluntary organisations At least one of the voluntary organisations may no longer be viable as its services depend on the pool Voluntary organisations that use the pool Closing one or more pools would reduce NHS volunteering opportunities Loss of income for local contractor who maintains pools NHS volunteers Relevant contractor 8. Is any part of this policy/ service to be carried out wholly or partly by contractors and how will equality, human rights including children s rights, environmental and sustainability issues be addressed? A local contractor provides maintenance services for the pools. Details of the contract not available to the IIA group. 9. Consider how you will communicate information about this policy/ service change to children and young people and those affected by hearing loss, speech impairment, low level literacy or numeracy, learning difficulties or English as a second language? Please provide a summary of the communications plan. The current plan is to consult on the proposals for 6 weeks, in line with Scottish Health Council recommendations. The IIA group recommends this be extended see recommendations below. 10. Is the policy a qualifying Policy, Programme or Strategy as defined by The Environmental Impact Assessment (Scotland) Act 2005? (see Section 4) No 11. Additional Information and Evidence Required 11

12 If further evidence is required, please note how it will be gathered. If appropriate, mark this report as interim and submit updated final report once further evidence has been gathered. The IIA group noted the evidence above. The group recommended that to inform planning of care, the review group should do some further work to quantify the numbers of patients in different patient groups see below. 12. Recommendations (these should be drawn from 6 11 above) The decision makers should be made aware that closing one or more pools will inevitably impact disproportionately on people with a disability, who are a protected group under the Equality Act. The adverse impacts could be mitigated partially for some affected people, but not all, through the provision of alternative land based physiotherapy or supported access to mainstream public pools. The wording of option 1 above should be amended to recognise that for some patient groups there is no realistic land based alternative to hydrotherapy (update done. Now reads some patients... ). There should be further work to identify, and if possible quantify: the patient groups who could receive alternative land based physiotherapy; the patient groups who could use a mainstream pool with support; the patient groups for whom alternative hydrotherapy will need to be reprovided in schools or possibly the private sector; the patient groups for whom there is no realistic alternative to the NHS Lothian pools. There should be work to quantify the costs of re-providing the services including direct costs and staff time. If the pools continue to operate, there should be further work with voluntary organisations to maximise their use. As the other hydrotherapy pool in Edinburgh is due to close, there are likely to be other organisations interested in using the NHS Lothian pools. If the pools continue to operate, NHS Lothian should explore whether other NHS Lothian services could use them. 12

13 If the pools continue to operate, there should be further work with leisure providers, GPs and private physiotherapists to improve pathways from hydrotherapy pool use to mainstream pool use. The consultation period should be extended to recognise that some of the affected people may have communication difficulties and some groups will be closed over the summer. NHS Lothian should consider whether there is potential for asset transfer of any of the pools. 13. Specific to this IIA only, what actions have been, or will be, undertaken and by when? Please complete: Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) Who will take them forward (name and contact details) Deadline for progressin g Review date 1. Review process timescales to be amended to include longer consultation period of more than 6 weeks. Hazel King, hazel.king@nhslothian.scot.nhs.u k Lesley Baxter Lesley.baxter@nhslothian.scot.nh s.uk, Lynne Douglas lynne.douglas@nhslothian.scot.n hs.uk Exact timescale to be agreed when consultation start dates are being arranged likely August 2015 Before consultation begins. 2. Briefing paper put together to investigate community asset transfer. This will feed into recommendation to the CMT. Hazel King, hazel.king@nhslothian.scot.nhs.u k End of July Work with staff using the pool to identify broad patient groups, and what the alternatives would be Hazel King and Eddie Balfour. hazel.king@nhslothian.scot.nhs.u August

14 Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) Who will take them forward (name and contact details) Deadline for progressin g Review date for their treatment in the event of pool closure. Establish whether these groups can be quantified using the data and resources available. This will feed into recommendation to the CMT. k, eddie.balfour@nhslothian.scot.nh s.uk 4. Work with staff in facilities and those using the pool to gain clarity on the cost of re-provisioning the service, including direct costs and staff time. This will feed into recommendation to the CMT. Hazel King and Eddie Balfour hazel.king@nhslothian.scot.nhs.u k eddie.balfour@nhslothian.scot.nh s.uk August If pools remain open, work to be done to explore options around charging model, invoicing process, and increased NHS and/or third sector usage of the pool. Also, to look at options around follow up care through pools, GPs, council, etc. Dependent on outcome of review process. This work has been started already as part of the overall review process currently it is being carried out by Hazel King, Project Manager. Hazel.king@nhslothian.scot.nhs.u k Ongoing dependent on outcomes of review process. 14. How will you monitor how this policy, plan or strategy affects different groups, including people with protected characteristics? 14

15 15. Sign off by Head of Service Name Lynne Douglas Date 1 / 7 / Publication Send completed IIA for publication on the relevant website for your organisation. See Section 5 for contacts. 15