Equality Impact Assessment - Hospital Restaurants and Retail Catering Outlets Food Standards

Transcription

1 Name of Policy: Section A: Assessment Hospital Restaurants and Retail Catering Outlets Food Standards Persons Conducting Assessment: Dr Suzanne Wood Consultant in Public Health Medicine, Cardiff and Vale Public Health Team; Dr Rebecca Cushen Specialty Registrar in Public Health, Cardiff and Vale Public Health Team; Rhianon Urquhart Principal Health Promotion Specialist, Cardiff and Vale Public Health Team; Dr Sharon Hopkins Responsible Senior Manager: Date: 18 June 2015 Section 1: The Policy Is this a new or This is a new set of standards which will be mandatory for all Cardiff and Vale University Health Board (UHB) provided hospital existing policy? restaurants, cafes, and trolley services. What is the aim/purpose of the policy The purpose of these standards is to ensure that all staff and visitors have easy access to healthy affordable nutritious food at all Cardiff and Vale UHB provided hospital restaurants and retail catering outlets. It is also to ensure that staff, visitors and patients utilising these services are both educated about, and encouraged to choose, healthy food and drink options Overweight and obesity are linked to an energy-rich diet and are directly associated with a range of health effects such as joint and back problems, diabetes, depression and premature death (Swanton 2008). Globally, 44% of diabetes mellitus, 23% of ischaemic heart disease and 7-41% of certain cancers are attributable to overweight and obesity (WHO 2014c). In 2008/9 the associated cost to the Welsh NHS for obesity and its related problems was estimated to be 73 million for the obese population, and 86 million for the overweight and obese population combined (Phillips et al. 2011). This includes the cost to primary, secondary, and tertiary care, ranging from General Practice consultations to hospital admissions. However, the impact of obesity and its consequences goes beyond that of the NHS, with considerable costs to individuals and communities, costs to employers as a result of sickness absence, plus the costs associated with benefits and social care (Swanton 2008). Globally the prevalence of obesity has doubled since the 1980s, and has now reached epidemic proportions (WHO 2014c). 1

2 How do the aims of the service change fit in with the Corporate priorities? Who will benefit (or be affected most) by the policy change? What outcomes are wanted from the policy? According to the Welsh Health Survey 55% of adults in Cardiff and Vale are overweight or obese and 20% are obese (Welsh Health Survey 2014). Cardiff and Vale UHB has a statutory responsibility to improve health and prevent ill-health in the local population, as well as providing individual patient centred care and `Caring for People, Keeping People Well underpins the ethos of all that the UHB delivers. In 2010 Cardiff and Vale UHB committed to become a Practising Public Health Organisation, essential to which is the creation of healthy working environments and the development of health improvement initiatives, including the provision of opportunities to access healthy food and drink within the workplace. The UHB therefore has a responsibility to positively contribute towards the health and wellbeing of the 14,500 staff that it employs. As a Practising Public Health Organisation, it is important that Cardiff and Vale UHB is an exemplar of best practice, and as such, all staff should be enabled and encouraged to purchase healthy, nutritious food within Cardiff and Vale UHB hospital sites. Progress has already been made at University Hospital of Wales and University Hospital Llandough restaurants to increase the availability of healthy options and this needs to be built upon, to ensure that the majority of food available within Cardiff & Vale UHB restaurants is healthy, nutritious, and affordable. The UHB is also talking a Prudent healthcare approach to support the delivery of better care, better outcomes and better value from the system caring for staff is a fundamental part of this approach. The implementation of mandatory standards across UHB provided hospital will secure the UHB s position as a leader in delivering healthcare without harm. All users of UHB provided hospital restaurants, cafes and trolley services. This will in the main be Cardiff and Vale hospital staff and visitors and many thousands of people visit the UHB hospital sites annually. 1) There are a greater proportion of healthy options available for purchase at Cardiff and Vale UHB provided restaurants and retail catering outlets than other options 2) Healthy options available for purchase at Cardiff and Vale UHB provided restaurants and retail catering outlets are more visible than other options 2

3 3) The fat and sugar content of all hot and cold meals served at Cardiff and Vale UHB provided restaurants and retail catering outlets are displayed to the customer. 4) At all Cardiff and Vale UHB provided restaurants and retail catering outlets, only healthy options are promoted. 5) There is a meal of the day available every lunchtime at all Cardiff and Vale UHB provided hospital restaurants 6) A higher proportion of staff/visitors/patients using Cardiff and Vale UHB provided hospital restaurants, cafes, and trolley services choose healthier options than alternative options 7) All Cardiff and Vale UHB provided hospital restaurant, cafe, and trolley service users are able to purchase healthy food options if they wish, and that there are affordable options for those on benefits or low incomes. 8) Through their use of Cardiff and Vale UHB provided hospital restaurants, cafes, and trolley services, individuals are more aware of the types of food that are healthy, and are encouraged to choose these options more frequently whilst at home, at work, etc. Are there any factors that might prevent outcomes being achieved? Training As a result of the implementation of these standards front line catering staff are likely to receive questions and queries from users relating to the instigated changes, and may also receive more queries regarding the nutritional content of available meals. Front line catering staff may feel unable to appropriately answer queries if they have not received approriate training. It will be necessary to ensure all front line catering staff are supportive are the changes and portray this to customers Practice Culture Human With up to 25% of the products on offer not the healthier options and taking current lifestyle trends into consideration, customers of the services including the Hospital restaurant, cafe, and trolley service may continue to choose less healthy food and drink options despite the implementation of standards to encourage otherwise. Financial resources There are some concerns that the UHB might experience a reduction in revenue however, anecdotal evidence from other healthcare organisations which have introduced similar initiatives and criteria tells the opposite that revenue has increased. 3

4 What qualitative data do you have about the policy relating to equalities groups (e.g. monitoring data on proportions of service users compared to proportions in the population)? Section 2 : Data Collection AGE Nutritional standards will positively impact on people of all ages in terms of health outcomes, according to the literature: Children and young adults According to: Health Promotion Guidance Nutritional Guidance for Children and Young People in Residential Care Settings (2011), the "Improvements to the diet of children and young people can positively influence their current and future health, playing an important role in the prevention of diet-related diseases". Working age adults The Centers for Disease Prevention and Control states that: A workplace nutrition program encourages healthy eating among all employees, emphasizing fruits and vegetables and whole grain products; low fat dairy products, lean meats, poultry, fish, and legumes; and small amounts of salt, sugar, and saturated fat. Older people According to the BDA Malnutrition Task Force: Prevention and Early Intervention of Malnutrition in LaterLife: Best Practice Principles & Implementation Guide. 2013: "Malnutrition is a major cause and consequence of poor health and older people are particularly vulnerable. It is estimated that in the UK around one million people over 65 years old are malnourished or at risk of malnutrition". CARING RESPONSIBILITIES According to Carers UK, Nutrition is an important but often hidden issue for carers and their families, with 60% of carers worrying about the nutrition of the person they care for. Furthermore they state that: As a carer, eating a balanced diet is essential to provide your body with all the nutrients it needs. A balanced diet will keep your body strong and give you enough energy to provide the best care for the person you are caring for and yourself. Therefore having a greater range of options of healthy food will assist carers in looking after themselves and the person that they care for. DISABILITY According to Center for Excellence in Disabilities at WVU: Good nutrition enables individuals to reach their full physical, mental, and emotional potential. Individuals with disabilities are often at risk for nutritional problems resulting from: 4

5 Special eating or feeding problems that make it difficult to meet nutritional needs Movement or neurological limitations that affect activity levels and alter calorie needs Weight problems (overweight or under weight) Diets that are inappropriate or unbalanced Vitamin and mineral deficiencies and other side effects of long term or multiple medications Alternate forms of feeding, such as G & J feeding tubes Special nutrient requirements. According to the Montana Disability and Health Program, nutrition is linked to a variety of health outcomes linked to disability: Nutrition may be viewed as a risk factor for secondary conditions. (Poor nutrition, nutritional status, or eating habits make the secondary condition worse.) Nutrition can be a protective factor. (Good nutrition, nutritional status, or eating habits can improve the secondary condition.) Poor nutrition in the form of deficiencies can be a secondary condition itself. Many secondary conditions can further modify one s diet and create subsequent nutritional problems. Therefore having a range of healthy options will help to assist people with disabilities to prevent the occurrence, help to prevent disability getting worse and to maintain a healthier lifestyle. GENDER REASSIGNMENT Apart from research suggesting that transgender people were more likely to have an eating disorder, there was no literature on the impact of nutrition on gender reassignment, through Press for Change, GIRES or Google. However, the healthier options would be equally accessible to people with gender reassignment. MARRIED/CIVIL PARTNERSHIP The evidence of the influence of marriage on healthy eating behaviours is mixed, in that for some people it will mean adopting healthier nutritional behaviour, and in others weight gain, according to the US Department of Health and Human Services. In another article, Families, Systems, and Health it was noted that: the rate of obesity among married men was a staggering 58.5%, and that the coupled-up were 25% more likely to be overweight than their unwedded peers. There was no further 5

6 literature on Stonewall or Google on civil partnership and nutrition. Healthier options would be equally accessible to those who are married or in a civil partnership. PREGNANT/JUST HAD A BABY Improving Maternal and Infant Nutrition: A Framework for Action (2011) states that: "We know that the diet and nutritional status of the mother before conception and during pregnancy, the feeding received by the infant in the first few months of life, the process of weaning onto solid foods and the diet and nutrition status of the growing infant all contribute significantly to the long term health of the population". According to Medline Plus: When you're pregnant, eating healthy foods is more important than ever. You need more protein, iron, calcium, and folic acid than you did before pregnancy. Therefore, a range of healthy options will help pregnant women and those who have just had a baby to eat well. RACE Research by Szczepura at Warwick University demonstrates that within the south Asian community, conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth - all making preventive care important. However, the evidence is mixed as according to Leung and Stanner, minority ethnic groups are more likely to report eating five fruit and vegetables a day; having a lower fat intake; but a higher salt intake as compared to the general population. Sugar intake was highest in the Black population in one quoted study. Also, there were conflicting results on the amount of fat consumed by South Asians. RELIGION, BELIEF OR NON-BELIEF According to Garduno Diaz at Leeds University, religious background can translate into different dietary practices. She states that: Food selection is due to different reasons, with religion being one of the strongest principles on which diets are based. Sacred space and time (altars, shrines, feast and fasting days), as well as symbolism and myth (what foods represent or the stories they recall) are all part of religious rituals linked to food. Regardless of religious views, it is important to follow a balanced diet and favourable lifestyle for optimum health. The ability for people from all religions/beliefs/non-beliefs to access the healthier options on display at UHB sites will be monitored closely. 6

7 What quantitative data do you have on the different groups? (e.g. findings from discussion groups, information from comparator authorities)? GENDER Oniang o and Mukudi state that: The socially constructed gender roles of men and women interact with their biological roles to affect the nutrition status of the entire family and of each gender. Because of women s cyclical loss of iron and their childbearing, their nutrition status is particularly vulnerable to deficiencies in diet, care, and health or sanitation services. Moreover, the nutrition status of newborns and infants is intimately linked with the nutrition status of the mother before, during, and after pregnancy. The evidence is mixed as in terms of eating five-a-day boys and adult males eat less fruit and vegetables than their female counterparts within Cardiff and Vale according to the Director of Public Health Report If this is a proxy for eating well, then males are eating less well than females in Cardiff and Vale. SEXUAL ORIENTATION According to some research, people of lesbian, gay or bisexual orientation are more likely to have an eating disorder. Aside from that there was no further literature on sexual orientation and healthy food choices. The healthier options would be equally accessible to people regardless of sexual orientation. WELSH LANGUAGE A literature review revealed no findings on an association between the Welsh language and nutrition or healthy options. Cardiff and Vale UHB employs around 14,500 staff who will have access to the healthier options. The sites also serve a local population of near 500,000, plus more people from outlying areas for specialised services. Therefore the breadth of footfall through the healthier options on display has wide ramifications for protected characteristics. Below is a breakdown of the locally served population, by protected characteristics. 7

8 Age (mid-2013 statistics) Local Authority Aged 0 to 15 Aged 16 to 64 Aged 65 and over All ages Vale of Glamorgan Cardiff Gender (mid-2013 statistics) Local Authority Male Female Persons Vale of Glamorgan Cardiff Caring responsibilities (Census 2011 statistics) Local Authority All Usual Residents Provides no unpaid care Provides 1 to 19 hours unpaid care a week Provides 20 to 49 hours unpaid care a week Provides 50 or more hours unpaid care a week The Vale of Glamorgan Cardiff

9 Disability (Census 2011 statistics) Local Authority All Usual Residents Day-to-Day Activities Limited a Little Day-to-Day Activities Limited a Lot Day-to-Day Activities Not Limited The Vale of Glamorgan Cardiff Race (Census 2011 statistics) Ethnic Group The Vale of Glamorgan Cardiff All categories: Ethnic Group 126, ,090 White 2 121, ,593 Gypsy / Traveller / Irish Traveller 3, Mixed / Multiple Ethnic Groups 5 1,695 10,031 Asian / Asian British: Indian 566 7,886 Asian / Asian British: Pakistani 216 6,354 Asian / Asian British: Bangladeshi 121 4,838 Asian / Asian British: Chinese 454 4,168 Asian / Asian British: Other Asian 610 4,639 Black / African / Caribbean / Black British ,201 Other Ethnic Group 347 6,859 9

10 Religion, belief or non-belief (Census 2011statistics) Religion/belief The Vale of Glamorgan Cardiff All Usual Residents No Religion Christian Buddhist Hindu Jewish Muslim Sikh Other Religion Religion Not Stated

11 Married/civil partnership (Census 2011 statistics) Marital status The Vale of Glamorgan Cardiff All categories: Marital and civil partnership status 102, ,115 Single (never married or never registered a same-sex civil partnership) 31, ,380 Married 50, ,008 In a registered same-sex civil partnership Separated (but still legally married or still legally in a same-sex civil partnership) 2,348 6,056 Divorced or formerly in a same-sex civil partnership which is now legally dissolved 10,235 23,130 Widowed or surviving partner from a same-sex civil partnership 7,741 16,916 Welsh Language (ONS 2011 statistics) Welsh language skills The Vale of Glamorgan Cardiff All categories: Welsh language skills 126, ,090 No skills in Welsh 106, ,586 Can understand spoken Welsh only 4,174 10,572 Can speak Welsh: Total 13,325 37,194 Can speak but cannot read or write Welsh 2,074 5,155 Can speak and read but cannot write Welsh 1,067 2,633 Can speak, read and write Welsh 10,032 29,016 Can speak and other combinations of skills in Welsh Can read but cannot speak or write Welsh 1,737 4,274 Can read and write but cannot speak Welsh 686 1,929 Can write but cannot speak or read Welsh

12 Please indicate the source of the data gathered (e.g. concerns /service/ department /team/other ) What gaps in data have you identified? (Please put actions to address this in your action plan?) Qualitative Google, GIRES, Press for Change, Stonewall. Quantitative ONS and Stats Wales. There was little qualitative data on: Gender reassignment Sexual orientation Welsh Language There was little quantitative data on: Gender reassignment Sexual orientation What relevant data is held about the impact on groups? See previous section Section 3 : Impact What relevant information is needed to ensure that the protected characteristics are taken into account? policy impacts on An EqIA has been undertaken to ensure that all of the protected characteristics are considered through ongoing consultation and engagement with key stakeholders The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diets of people of all ages, and help them to develop good eating habits, regardless of their age. Overall, the Food 12

13 people because of their age? impacts on people because of their caring responsibilities? Standards will have a neutral impact on people due to their age. The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive impact on the diets of carers and help them to develop good eating habits, as carers are often time poor and might make unhealthy food choices because of this. service change impacts on people because of their disability? (This includes Visual impairment, hearing impairment, physically disabled, Learning disability, some mental health issues, HIV positive, multiple sclerosis, cancer, diabetes and epilepsy.) service change impacts on people because of Gender The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive impact for disabled people s diets and help them to develop good eating habits, regardless of their disability or impairment. Many conditions are exacerbated by poor diet and unhealthy food choices. The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people with gender reassignment and help them to develop good eating habits, regardless of gender reassignment. Overall, it will therefore have a neutral impact on people because of gender reassignment. 13

14 reassignment? (This includes Trans transgender and transvestites) service change impacts on people because of their being married or in a civil partnership? service change impacts on people because of their being pregnant or just having had a baby? This has been discussed with the Cardiff and Vale UHB Lesbian, Gay, Bisexual and Transgender representative who has supported the changes There is neutral impact anticipated as the policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people and help them to develop good eating habits, regardless of being married or in a civil partnership. The impact will be positive due to the importance of a healthy and balanced diet for mother and baby during pregnancy. The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people and help them to develop good eating habits, regardless of being pregnant or just given birth. service change impacts on people because of their race? (This includes colour, nationality and citizenship or ethnic or national origin such as Gypsy and Traveller Communities.) The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a neutral contribution to the diet of people because of their race. It will help people to develop good eating habits, regardless of race or cultural predisposition to obesity. 14

15 service change impacts on people because of their religion, belief or nonbelief? service change impacts on men and women in different ways? The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution for the diet of people and help them to develop good eating habits, regardless of their religion, belief or non-belief. Therefore there will be a neutral impact due to religion, belief or non-belief. The availability and provision of cultural foods is and will continue to be monitored. The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of men and women and help them to develop good eating habits, regardless of gender. The Food Standards will have a neutral impact on gender overall. service change impacts on people because of their sexual orientation? (This includes Gay men, heterosexuals, lesbians and bisexuals) service change impacts on people because of their Welsh language? Will the changes impact on the The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people and help them to develop good eating habits, regardless of sexual orientation. This has been discussed with the Cardiff and Vale UHB Lesbian, Gay, Bisexual and Transgender representative who has supported the changes. Overall the Food Standards will make a neutral impact on people because of their sexual orientation. The policy will ensure greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people and help them to develop good eating habits, regardless of Welsh language ability. Overall the Food Standards will have a neutral impact because of Welsh language. This will have a positive impact on all individuals through encouraging healthy eating, by ensuring greater availability of healthy food and drink at all uhb sites, which will make a positive contribution to the diet of people of all ages and help them to 15

16 workforce? develop good eating habits. It will also contribute to improved mental wellbeing and increased morale amongst staff who recognise that the uhb is actively promoting their health and wellbeing whilst they are at work. Which Equality groups have positive or negative impacts been identified for? Is the service change directly or indirectly discriminatory under the equalities legislation If the service change is indirectly discriminatory can it be justified under the relevant legislation? What consultation needs to take place with equalities groups? What monitoring/evaluative Section 4: Summary Positive impacts have been identified for: Carers Disabled people People who are pregnant or just had a baby No N/A Section B: Action Section 5 : Action Plan Ongoing consultations exercises are planned with users / customers of both the restaurant and retail provision and ongoing engagement with stakeholder groups through the Local Partnership Forum, Staff Side Groups and external agencies, such as the Cardiff Community Health Council are planned. Ongoing consultations exercises are planned with users / customers of both the restaurant and retail provision and ongoing engagement with stakeholder groups through the Local Partnership Forum, Staff Side Groups and external agencies, such as 16

17 will be required to further assess the impact of any changes on equality target groups? Relevant report / documentation Where will the EQIA results be published When will the EQIA will be subject to review? the Cardiff Community Health Council are planned. Section 6 : Report, Publication & Review This will be signed off by the Quality, Safety and Experience Committee. The EqIA results will be published on the Cardiff and Vale UHB Intranet and Internet. The EqIA will be reviewed in June Name of person completing Dr Suzanne Wood Signed Date: 18 June 2015 Name of Senior Manager Authorising Assessment Plan for publication Dr Sharon Hopkins Signed: Date: 18 June

18 Appendix 4 Format for publication of EQIA results Executive Summary Overall the EqIA shows a neutral or positive impact across the protected characteristics. Background The Hospital Restaurants and Retail Catering Outlets Food Standards aim to ensure that the populations visiting premises within Cardiff and Vale UHB will have an appropriate range of healthy eating options to choose from. The context is that over half the population is overweight or obese and we need to respond to this challenge by leading by example and allowing the population we serve to have healthy eating options. The EqIA was produced by Dr Suzanne Wood, Consultant in Public Health Medicine, Dr Rebecca Cushen, Speciality Registrar in Public Health and Rhianon Urquhart, Principal Health Promotion Specialist, with assistance from Keithley Wilkinson, Equalities Manager at Cardiff and Vale UHB. The scope of the EQIA The likely effects were assessed through looking at statistical, research, previous and other related EQIA policies and through consultation through invested stakeholders. It was felt that the comments received were valid, and necessary for the UHB for us to demonstrate its commitment to equality, diversity and human rights as well as demonstrating that we would listen and act upon the views of others. Key findings There was overwhelming evidence found that supports the need to have such a procedure to demonstrate UHB commitment to equality, diversity and human rights. It was clear that the impact would overall be positive, particularly as the procedure recognises that sometimes people need to be treated differently so as to achieve an inclusive workplace. The key findings were that the following groups would have a positive equalities impact from the Food Standards, the other groups were neutral in terms of equalities impact: Carers Disabled people People who are pregnant or just had a baby Recommendations It is recommended that this policy is reviewed in line with the current guidelines of the UHB, unless there is a change in relevant legislation in which case, the policy should be reviewed within 6 months of any new legislation and changes made accordingly. The policy will be monitored and reviewed by the 18

19 Equality, Diversity & Human Rights Sub Committee. It will be issued via the intranet, administrator and to Clinical Boards/Corporate areas management teams and lead trade union representatives. 19