There has been little attention paid to how human rights and the Equality Act 2010 are being ignored when mental health trusts make their austerity cuts. A prime example is of a mental health trust: the Norfolk and Suffolk mental health trust and a CCG: the Great Yarmouth and Waveney CCG in their collusion over bed cuts at Carlton Court Lowestoft (see the entry for 3 June 2013).
In their latest developments they have set out how they are to proceed in the future: when they ran a consultation for these changes they chose not to carry out an equality impact assessment. Their documents suggest they also undertook little examination of possible inequalities during the consultation. The upshot is, as part of their planning, they have decided to close the adult psychiatry unit at Carlton Court Lowestoft, moving the adult mental health services to Northgate hospital in great Yarmouth.
Now I know that having the only mental health hospital in Great Yarmouth causes much difficulty over access to the hospital for people living in Lowestoft. I complained about the discrimination towards people in Lowestoft by this policy (those in Gt Yarmouth and Gorleston will have easy access; those in Lowestoft won’t). My complaints and the responses from the CCG CEO are set out below:
Formal Complaint
At the Gt Yarmouth & Waveney CCG meeting at Beccles House on 25th September at 13.30, you approved your recommendations for changes to the Carlton Court Mental Health Services.
Among the changes is action to remove the Acute Mental Health Services from Carlton Court to Northgate Hospital, Gt Yarmouth. That action will discriminate against the people of Lowestoft with mental health problems or caring for those with mental health problems, causing them, as a result, to have to travel many miles more than the people of Gt Yarmouth to engage with their Mental Heath Services.
This means you are treating those in Lowestoft less favourably that those in Gt Yarmouth which is a breach of the Equality Act 2010 sections 13 (1) and 149 (1) ((a and ((b)).
I look forward to your reply.
And in the response of Mr Andrew Evans, the CeO he said (on 18th November):
“Great Yarmouth & Waveney CCG did not produce a separate document called an equality impact assessment (sic)...As you may be aware, there is no requirement for a public body to undertake such an assessment,...
Instead, the CCG chose to have regard to the aims set out in the general equality duty substantively throughout the engagement process and the duty was considered specifically during the options appraisal...
I have attached a copy of the options appraisal document...and would refer you to pages 17 to 38...
You will see the the impact on those individuals with protected characteristics was considered”
(What a load of utter crap that last sentence is. You can see equality impact is barely mentioned - and if I was at all cynical, I might have said it was a afterthought- Mike).
And here is the Options Appraisal document:
Dear Mr Cox
Please find a link to the options appraisal document referred to in our response letter, please accept my apologies that this was not in my original email.
http://www.greatyarmouthandwaveneyccg.nhs.uk/_store/documents/20140925_governingbodyagendaitem7.pdf
And my reply:
Mike Llywelyn Cox, The Lilting House, Beccles Road, Thurlton,
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Norfolk, NR14 6AJ.
01508 548615 micox@stollard.plus.com
Dear Mr Evans.
Re: your ref., 0053/2014-15
Thank you for your letter of 18th November in response to my complaint of 7th October. I am not satisfied with your reply and I must ask you to look again at what you are proposing. I will make the following points.
I am aware you are right in saying an Equality Impact Assessment is not an absolute requirement of a public authority in their planning process. However, it is considered to be 'good practice' and I have to remind you that 'good practice' is taken into account by the courts.
I have looked through the text of the “Meeting of the Governing Body... 25 September 2014” but have seen very little relating to 'Equality Duty' requirements – not in the description of the processes, the workshop or the conclusions. The only very brief mention (looking just like an afterthought) is in your Benefit Criterion 2: “Improving access to services and patient experience” in which the last of the bulleted “Factors to be considered” is: “Supports the delivery of equality and diversity requirements.” There is nothing in the text of document to say that factor has been considered.
The above (in 2.) means there is no evidence for your assertion: “...the impact on those individuals with protected characteristics has been considered.”
Compare that with the thoroughness of the “Great Yarmouth and Waveney Primary Care Trust 2012 – 13 Annual Report and Accounts” (I make no apology for quoting this in full):
“Equality and Diversity
Equality and diversity have been fundamental to the achievement of our core vision. We recognise that this has been a huge agenda for the organisation and we have been committed to ensuring that we meet our statutory obligations as a commissioner of healthcare and as an employer; we have policies in place to promote equal opportunities for all, including disabled employees and all protected groups. As a public authority we have a legal obligation under the Equality Act 2010 to promote equality of opportunity, foster good relations and eliminate discrimination in relation to the protected groups of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion, belief, sex, and sexual orientation. We have strived to move beyond our “legislative requirements” and have developed plans and strategies that are robust, meaningful and can deliver real change for our diverse communities.
During the last 12 months, NHS Norfolk and Waveney developed a legacy for CCGs in order to build on the work achieved, this includes INTRAN interpretation and translation services for our patients, the NHS Equality Delivery System and Public Sector Equality Duties. We have worked closely with Norfolk Community Cohesion Network to take forward county wide initiatives, including those from ‘Hidden in Plain Sight’ the report by the Equality and Human Rights Commission into Disability Hate Crime. Part of our legacy has been to ‘hand over’ the findings from the Eradicating Racism in Norfolk NHS (ERINN) 2011 report to CCGs”
There are many but I will highlight just one point: had you examined things in that detail you could not have removed the Carlton Court adult mental health beds and services to Northgate Hospital, Gt Yarmouth at the same time as making the statement 'to promote equal opportunities for all,'
I have to tell you my special interest in this matter arises from the fact that in 1978, I came to Norfolk to take up the position of Mental Welfare Officer (to change to ASW in 1983) and Mental Health Social Worker, based at St Nicholas Hospital, Gt Yarmouth. I shared an office with a Lowestoft colleague similarly qualified.
Our functions included contributing to discussions about the quality of the mental health overall services (there were no mental health community services then) and through many meetings and conferences the inequality of the services between the Lowestoft and the Gt Yarmouth areas was a regularly recurrent headlined subject. There were many pressing appeals from the professionals to the then District Health Authority to develop the services in Lowestoft. We worked hard to bring social justice to the people of Lowestoft and Waveney.
In 1985 I took a post with Suffolk as a Generic Community Social Worker and ASW with a special interest in mental health, working from the Beccles Social Services Office. The invidious increased inequalities faced by families with a relative in hospital, living in say, Halesworth and the Saints or Bungay were well evidenced.
In 1990, when the NHS and Community Care Act was overwhelmingly influential, I firstly worked for a year as a drugs and alcohol counsellor with Fred McKevitt at the Alexandra Road Resource Centre, Lowestoft, a temporary arrangement while the regular counsellor was at University. Afterwards I moved to work in the specialist mental health social work team based at a separate office in Clapham House, along with a well augmented day services unit at 44Kirkley Cliff – a long fought for much enhanced mental health service for the people of Lowestoft alongside the then long established Community Mental Health Nursing service at Alexandra Road Resource Centre, including a forensic service working with Lowestoft Police.
From a now non-involved (with employment) standpoint I see the above investment, hard work and development of mental health services for the people living in the Waveney area wilfully wrecked. We unarguably established the need for services close to the people; where people had ease of close access without having to travel near impossible miles to care.
By seemingly retrograde anti-social actions more closely linked to cutting services while setting up consultations you, in an apparently influential collusion with the Norfolk and Suffolk Mental Health Trust, have concluded by clearly discriminating against the people of the Waveney area.
“The core principles of today’s NHS and care services need us to be responsive to the needs of different groups and individuals within society. We need to challenge discrimination on the grounds of race, gender, gender identity, age, ethnicity, religion and belief, disability and sexual orientation. Services have to treat the people who use them as individuals, with respect for their dignity. Protection and promotion of individuals’ human rights lies at the heart of good care. This is why the Care Quality Commission has adopted a rights-based approach to regulation. An emphasis on equality is also central to the registration framework.” (Equality and human rights in the essential standards of quality and safety, Care Quality Commission)
I know that after I retired Adult beds were opened in Carlton Court with Adult Acute Services attached: a huge improvement towards equality. And there must have been some influence in this from all those pressures we had made over the years.
You are now reversing those advances and by doing so, clearly and indisputably discriminating against those who live in the Lowestoft and Waveney areas.
Can you please reply to this letter within the usual 21 days.
Yours sincerely. Mike Llywelyn Cox. c.c. Bob Blizzard, Mark Harrison.
I was surprised to receive a reply from them by almost return of post. This letter by email on 18th December said:
Dear Mr Cox
Thank you for your letter dated 15 December 2014 your comments of which have been noted.
I am sorry that you do not agree with the decision but I am unable to look again at the proposals regarding the changes in mental health and dementia services in great Yarmouth and Waveney. The consultation process has closed. We have made our decisions and this was approved at the governing body meeting on 25 September 2014.
I note with interest your reference to the great Yarmouth and Waveney Primary Care Trust 2012– 13 annual report and accounts but would like to refer you to the NHS Great Yarmouth and Waveney Clinical Commissioning Group Annual Report 2013 to 2014, section 2.9 Equality report on page 33 which clearly states our current objectives.
http://www.greatyarmouthandwaveneyccg.nhs.uk/_store/documents/gyw–annualreportwith accounts–v11–finalwithoutsignatures.pdf
I appreciate that this is not the answer that you had hoped for but would like to thank you for your comments.
Yours sincerely
Andrew Evans
Chief Executive
Heddwch.
Mike
27th December, 2014.
In their latest developments they have set out how they are to proceed in the future: when they ran a consultation for these changes they chose not to carry out an equality impact assessment. Their documents suggest they also undertook little examination of possible inequalities during the consultation. The upshot is, as part of their planning, they have decided to close the adult psychiatry unit at Carlton Court Lowestoft, moving the adult mental health services to Northgate hospital in great Yarmouth.
Now I know that having the only mental health hospital in Great Yarmouth causes much difficulty over access to the hospital for people living in Lowestoft. I complained about the discrimination towards people in Lowestoft by this policy (those in Gt Yarmouth and Gorleston will have easy access; those in Lowestoft won’t). My complaints and the responses from the CCG CEO are set out below:
Formal Complaint
At the Gt Yarmouth & Waveney CCG meeting at Beccles House on 25th September at 13.30, you approved your recommendations for changes to the Carlton Court Mental Health Services.
Among the changes is action to remove the Acute Mental Health Services from Carlton Court to Northgate Hospital, Gt Yarmouth. That action will discriminate against the people of Lowestoft with mental health problems or caring for those with mental health problems, causing them, as a result, to have to travel many miles more than the people of Gt Yarmouth to engage with their Mental Heath Services.
This means you are treating those in Lowestoft less favourably that those in Gt Yarmouth which is a breach of the Equality Act 2010 sections 13 (1) and 149 (1) ((a and ((b)).
I look forward to your reply.
And in the response of Mr Andrew Evans, the CeO he said (on 18th November):
“Great Yarmouth & Waveney CCG did not produce a separate document called an equality impact assessment (sic)...As you may be aware, there is no requirement for a public body to undertake such an assessment,...
Instead, the CCG chose to have regard to the aims set out in the general equality duty substantively throughout the engagement process and the duty was considered specifically during the options appraisal...
I have attached a copy of the options appraisal document...and would refer you to pages 17 to 38...
You will see the the impact on those individuals with protected characteristics was considered”
(What a load of utter crap that last sentence is. You can see equality impact is barely mentioned - and if I was at all cynical, I might have said it was a afterthought- Mike).
And here is the Options Appraisal document:
Dear Mr Cox
Please find a link to the options appraisal document referred to in our response letter, please accept my apologies that this was not in my original email.
http://www.greatyarmouthandwaveneyccg.nhs.uk/_store/documents/20140925_governingbodyagendaitem7.pdf
And my reply:
Mike Llywelyn Cox, The Lilting House, Beccles Road, Thurlton,
01508 548615 micox@stollard.plus.com
Dear Mr Evans.
Re: your ref., 0053/2014-15
Thank you for your letter of 18th November in response to my complaint of 7th October. I am not satisfied with your reply and I must ask you to look again at what you are proposing. I will make the following points.
I am aware you are right in saying an Equality Impact Assessment is not an absolute requirement of a public authority in their planning process. However, it is considered to be 'good practice' and I have to remind you that 'good practice' is taken into account by the courts.
I have looked through the text of the “Meeting of the Governing Body... 25 September 2014” but have seen very little relating to 'Equality Duty' requirements – not in the description of the processes, the workshop or the conclusions. The only very brief mention (looking just like an afterthought) is in your Benefit Criterion 2: “Improving access to services and patient experience” in which the last of the bulleted “Factors to be considered” is: “Supports the delivery of equality and diversity requirements.” There is nothing in the text of document to say that factor has been considered.
The above (in 2.) means there is no evidence for your assertion: “...the impact on those individuals with protected characteristics has been considered.”
Compare that with the thoroughness of the “Great Yarmouth and Waveney Primary Care Trust 2012 – 13 Annual Report and Accounts” (I make no apology for quoting this in full):
“Equality and Diversity
Equality and diversity have been fundamental to the achievement of our core vision. We recognise that this has been a huge agenda for the organisation and we have been committed to ensuring that we meet our statutory obligations as a commissioner of healthcare and as an employer; we have policies in place to promote equal opportunities for all, including disabled employees and all protected groups. As a public authority we have a legal obligation under the Equality Act 2010 to promote equality of opportunity, foster good relations and eliminate discrimination in relation to the protected groups of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion, belief, sex, and sexual orientation. We have strived to move beyond our “legislative requirements” and have developed plans and strategies that are robust, meaningful and can deliver real change for our diverse communities.
During the last 12 months, NHS Norfolk and Waveney developed a legacy for CCGs in order to build on the work achieved, this includes INTRAN interpretation and translation services for our patients, the NHS Equality Delivery System and Public Sector Equality Duties. We have worked closely with Norfolk Community Cohesion Network to take forward county wide initiatives, including those from ‘Hidden in Plain Sight’ the report by the Equality and Human Rights Commission into Disability Hate Crime. Part of our legacy has been to ‘hand over’ the findings from the Eradicating Racism in Norfolk NHS (ERINN) 2011 report to CCGs”
There are many but I will highlight just one point: had you examined things in that detail you could not have removed the Carlton Court adult mental health beds and services to Northgate Hospital, Gt Yarmouth at the same time as making the statement 'to promote equal opportunities for all,'
I have to tell you my special interest in this matter arises from the fact that in 1978, I came to Norfolk to take up the position of Mental Welfare Officer (to change to ASW in 1983) and Mental Health Social Worker, based at St Nicholas Hospital, Gt Yarmouth. I shared an office with a Lowestoft colleague similarly qualified.
Our functions included contributing to discussions about the quality of the mental health overall services (there were no mental health community services then) and through many meetings and conferences the inequality of the services between the Lowestoft and the Gt Yarmouth areas was a regularly recurrent headlined subject. There were many pressing appeals from the professionals to the then District Health Authority to develop the services in Lowestoft. We worked hard to bring social justice to the people of Lowestoft and Waveney.
In 1985 I took a post with Suffolk as a Generic Community Social Worker and ASW with a special interest in mental health, working from the Beccles Social Services Office. The invidious increased inequalities faced by families with a relative in hospital, living in say, Halesworth and the Saints or Bungay were well evidenced.
In 1990, when the NHS and Community Care Act was overwhelmingly influential, I firstly worked for a year as a drugs and alcohol counsellor with Fred McKevitt at the Alexandra Road Resource Centre, Lowestoft, a temporary arrangement while the regular counsellor was at University. Afterwards I moved to work in the specialist mental health social work team based at a separate office in Clapham House, along with a well augmented day services unit at 44Kirkley Cliff – a long fought for much enhanced mental health service for the people of Lowestoft alongside the then long established Community Mental Health Nursing service at Alexandra Road Resource Centre, including a forensic service working with Lowestoft Police.
From a now non-involved (with employment) standpoint I see the above investment, hard work and development of mental health services for the people living in the Waveney area wilfully wrecked. We unarguably established the need for services close to the people; where people had ease of close access without having to travel near impossible miles to care.
By seemingly retrograde anti-social actions more closely linked to cutting services while setting up consultations you, in an apparently influential collusion with the Norfolk and Suffolk Mental Health Trust, have concluded by clearly discriminating against the people of the Waveney area.
“The core principles of today’s NHS and care services need us to be responsive to the needs of different groups and individuals within society. We need to challenge discrimination on the grounds of race, gender, gender identity, age, ethnicity, religion and belief, disability and sexual orientation. Services have to treat the people who use them as individuals, with respect for their dignity. Protection and promotion of individuals’ human rights lies at the heart of good care. This is why the Care Quality Commission has adopted a rights-based approach to regulation. An emphasis on equality is also central to the registration framework.” (Equality and human rights in the essential standards of quality and safety, Care Quality Commission)
I know that after I retired Adult beds were opened in Carlton Court with Adult Acute Services attached: a huge improvement towards equality. And there must have been some influence in this from all those pressures we had made over the years.
You are now reversing those advances and by doing so, clearly and indisputably discriminating against those who live in the Lowestoft and Waveney areas.
Can you please reply to this letter within the usual 21 days.
Yours sincerely. Mike Llywelyn Cox. c.c. Bob Blizzard, Mark Harrison.
I was surprised to receive a reply from them by almost return of post. This letter by email on 18th December said:
Dear Mr Cox
Thank you for your letter dated 15 December 2014 your comments of which have been noted.
I am sorry that you do not agree with the decision but I am unable to look again at the proposals regarding the changes in mental health and dementia services in great Yarmouth and Waveney. The consultation process has closed. We have made our decisions and this was approved at the governing body meeting on 25 September 2014.
I note with interest your reference to the great Yarmouth and Waveney Primary Care Trust 2012– 13 annual report and accounts but would like to refer you to the NHS Great Yarmouth and Waveney Clinical Commissioning Group Annual Report 2013 to 2014, section 2.9 Equality report on page 33 which clearly states our current objectives.
http://www.greatyarmouthandwaveneyccg.nhs.uk/_store/documents/gyw–annualreportwith accounts–v11–finalwithoutsignatures.pdf
I appreciate that this is not the answer that you had hoped for but would like to thank you for your comments.
Yours sincerely
Andrew Evans
Chief Executive
So the CCG has made its decisions but this can't be the end of the matter we can't let it rest here and I will be referring this correspondence to the ombudsman and to Monitor.
I am though, aware that's there is some futility in this because it's clear that public organisations are able to ignore the equality act 2010 and there is practically nil accountability. I would welcome your comments.
Heddwch.
Mike
27th December, 2014.
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