Equality impact assessment - Exercise of care act easements in Health and Adult Services (Coronavirus Act 2020)

Equality impact assessments are public documents. Equality impact assessments accompanying reports going to county councillors for decisions are published with the committee papers on our website and are available in hard copy at the relevant meeting. To help people to find completed equality impact assessments we also publish them in the Equality and Diversity section of our website. This will help people to see for themselves how we have paid due regard in order to meet statutory requirements.

• Name of directorate and service area - Health and Adult Services
• Lead officer and contact details - Richard Webb Richard.webb@northyorks.gov.uk
• Names and roles of other people involved in carrying out the equality impact assessment - Louise Wallace, Assistant Director Health Integration, Sheila Hall, Head of Engagement and Governance and Erin Outram, Governance Manager
• How will you pay due regard? e.g. working group, individual officer - officer working group
• When did the due regard process start? - 31 March 2020

Section 1. Please describe briefly what this equality impact assessment is about.

This equality impact assessment relates to the Key Decision to suspend certain requirements under the Care Act 2014, as provided by the Coronovirus Act 2020. 

This act allows local authorities delay its statutory duties under the Care Act 2014, if required, in order to ensure that individuals with care and support needs continue to receive the care that they need and that all individuals within the area are kept safe and well. 

Due to rapidly growing pressures on the authority it is anticipated that Health and Adult Services will no longer be in a position to provide business as usual services by week ending 19 April and will therefore need to streamline certain arrangements to ensure that those with the most urgent and acute needs are prioritised. 

Note that the key decision relates to actions to be taken to manage demand and capacity, particularly increased demand and reduced staffing capacity, rather than service changes enacted in order to abide by the government guidance on coronavirus protections, for example the provision of services in a different way in order to meet social distancing and shielding guidance. 

This equality impact assessment will consider the potential impact of the proposals, but also take into account the potential impact should the proposals not be implemented.

Section 2. Why is this being proposed?

The decision to exercise the Care Act Easements is being proposed in the context of the current coronavirus pandemic, in order for the authority to make use of the provisions in the Coronavirus Act to adapt services to manage demand and capacity. 

Current data and modelling indicates that the impact of the pandemic on demand and capacity is as follows:

Demand:

• Whilst lower than areas such as London and Birmingham, numbers of people within North Yorkshire diagnosed with Covid-19 are increasing daily 
• Nationally, it is acknowledged that a growing number of people are symptomatic although not officially diagnosed due to policy on testing/lack of testing capacity, and it is reasonable to assume that this is also the case in North Yorkshire 
• North Yorkshire has a higher proportion of older people, including those who are 85 years plus, than many areas of the country, and we know that this virus disproportionately affects older people 
• North Yorkshire is the largest County Council in the country, and therefore the authority needs to ensure that it is able to provide services across a range of footprints and acute trusts, including two mental health trusts, who are already under significant pressure, particularly within Harrogate. 
• Rurality within North Yorkshire also adds to the complexity and challenges within the care market
• In March, NHS England announced that NHS hospitals across the country are taking a range of action to prepare, including freeing up 30,000 of the overall 100,000 beds available by postponing non-urgent operations and providing care in the community for those who are fit to be discharged. Across North Yorkshire and York this equates to around 400 beds. The NHS is also sourcing up to 10,000 in independent and community hospitals, which this deal largely now delivers. This has seen substantial pressure placed upon our partners in acute care. They have now all enacted the governments Covid-19 hospital discharge service requirements, namely that as of 19 March 2020, all NHS trusts, community interest companies and private care providers of acute, community beds and community health services and social care staff in England, must discharge all patients as soon as they are clinically safe to do so. Transfer from the ward should happen within one hour of that decision being made to a designated discharge area. The discharge service requirements state that discharge from hospital should happen within 3 hours of the decision being made that the person is ready for discharge from hospital. The discharge service requirements is expected to free up to at least 15,000 beds with discharge flows maintained after that. Acute and community hospitals must keep a list of all those suitable for discharge and report on the number and percentage of patients on the list who have left the hospital and the number of delayed discharges through the daily situation report.

Section 14 of the Coronavirus Act 2020 states that the clinical commissioning groups does not have to comply with Regulations to take reasonable steps to assess for eligibility of Continuing Healthcare. Although the legislation delays such assessments. Therefore, NHS Continuing Healthcare assessments for individuals on the acute hospital discharge pathway and in community settings will not be required until the end of the COVID-19 emergency period. The government has agreed the NHS will fully fund the cost of new or extended out-of-hospital health and social care support packages, referred to in this guidance. This applies for people being discharged from hospital or who would otherwise be admitted into it, for a limited time, to enable quick and safe discharge and more generally reduce pressure on acute services.

The table below sets a summary of additional weekly referrals from hospitals at 60% compliance with Covid-related government advice. As can be seen from the data, it is anticipated that by the end of June we will be running at a 204% increase in hospital referrals.

There is a risk that the emerging numbers of actual referrals arising from Covid-19 cases do not reflect those indicated by the modelling – (could be too many or too few). As a consequence, we would not have the appropriate resources in the right places across the health and care system.

Capacity:

In addition to usual sickness and vacancy levels, Covid-19 is impacting on available staff capacity within the authority’s Care and Support Teams due to: 

A) Staff absence caused directly by diagnosis or symptoms of Covid-19

B) Reduction in people able to carry out their usual job role due to health conditions, including colleagues who are required to be shielded

Overall, there is estimated to be 34-36.6% pressure on the workforce as of 3 April 2020 and this is expected to rise over the coming days and weeks.

This does not take into account the concurrent reduction in capacity in the commissioned care market, which is likely to increase the pressure on the Authority.

Mitigation of capacity pressures:

Health and Adult services are actively recruiting to the current established vacancies and over-recruiting by some 395 posts largely across our reablement and care and support workforce. We have streamlined our assessment and support planning processes, introduced a trusted assessment model, reorganised our workforce to meet the Covid-19 hospital discharge service requirements (including working Monday to Sunday 8am to 8pm), purchased 200 care home beds across North Yorkshire, are working collaboratively with NHS colleagues, across acute Trusts, community health colleagues and primary care networks. We have introduced a rapid recruitment and appointment process, created a campaign to attract people to adult social care positions from other sectors negatively affected by Covid-19, considered re-deployment from other parts of the council to support adult social care and other parts of the council, completed a skills audit, and brought people back from retirement. We have also issued warrants to approved mental health professionals whose warrants had previously lapsed.

Section 3. What will change? What will be different for customers and/or staff?

The changes to Care Act provision enacted by the Coronavirus Act 2020 fall into four key categories, each applicable for the period the powers are in force: 

1. Local authorities will not have to carry out detailed assessments of people’s care and support needs in compliance with pre-amendment Care Act requirements. However, they will still be expected to respond as rapidly as possible to requests for care and support, consider the needs and wishes of people needing care and their family and carers, and make an assessment of what care needs to be provided. 
2. Local authorities will not have to carry out financial assessments in compliance with pre-amendment Care Act requirements. They will, however, have powers to charge people retrospectively for the care and support they receive during this period, subject to giving reasonable information in advance about this, and a later financial assessment. This will ensure fairness between people already receiving care before this period, and people entering the care and support system during this period. 
3. Local authorities will not have to prepare or review care and support plans in line with the pre-amendment Care Act provisions. They will however still be expected to carry out proportionate, person-centred care-planning which provides sufficient information to all concerned, particularly those providing care and support often at short notice. 
4. The duties on local authorities to meet eligible care and support needs, or the support needs of a carer are replaced with a power to meet needs. local authorities will still be expected to take all reasonable steps to continue to meet needs as now. In the event that they are unable to do so, the powers will enable them to prioritise the most pressing needs, for example enhanced support for people who are ill or self-isolating, and to temporarily delay or reduce other care provision.

Mitigation:

In order to help ensure that the provisions in the Act are applied in the best possible way, with the greatest regard towards the needs and wishes of those using our services and their carers the following protections and safeguards will apply. 

• the easements are temporary. The Secretary of State will keep them under review and terminate them, on expert clinical and social care advice, as soon as possible.
• all assessments and reviews that are delayed or not completed will be followed up and completed in full once the easements are terminated.
• North Yorkshire County Council will remain under a duty to meet needs where failure to do so would breach an individual’s human rights under the European Convention on Human Rights. These include, for example, the right to life under Article 2 of the European Convention on Human Rights, the right to freedom from inhuman and degrading treatment under Article 3 and the right to private and family life under Article 8.
• the Care Quality Commission will continue to provide oversight of providers under existing legislation. Throughout this period the Care Quality Commission will take a pragmatic approach to inspection and proportionate action as necessary while maintaining its overriding purpose of keeping people safe. The Health and Adult services Quality and Monitoring team continue to work in partnership with Care Quality Commission regularly to ensure the appropriate support is provided to all of our providers and maintain market oversight. 

Other important duties on North Yorkshire County Council remain in place, including:

• duties in the Care Act to promote wellbeing and duties relating to safeguarding adults at risk 
• providers’ duties under regulations made under the Health and Social Care Act 2008 
• duties in the Mental Capacity Act 2005 relating to Deprivation of Liberty Safeguards. Guidance on the operation of Deprivation of Liberty Safeguards during the emergency period will be published separately. However, Health and Adult services are continuing to authorise Deprivation of Liberty Safeguards and maintain oversight of those subject to the safeguards. Contact and assessments are being undertaken via means such as skype and video link to ensure this can continue. 
• local Authorities’ duties relating to prevention and providing information and advice. The provision of information and advice for public reassurance will be particularly important during this period. To help with good communications Local Authorities should continue to draw on their helpful relationships with trusted partners in the voluntary sector and a full range of digital and other channels which help reach people with differing needs and in different circumstances during this period (for example to make up for the closure of libraries). The Health and Adult services customer response team continues to respond to all complaints and comments and this is being monitored for any delays to responses. All Covid-19 related complaints are being collated and reported to HASLT on a weekly basis in order to identify any trends and problem areas. 
• duties imposed under the Equality Act 2010 also remain, including duties to make reasonable adjustments, the Public Sector Equality Duty and duties towards people with protected characteristics. These should underpin any decisions made with regard to the care and support someone receives during this period.

Section 4. Involvement and consultation

Given the current national emergency and the time-critical nature of these proposals, it has not been possible to conduct public consultation as the Authority would normally endeavour to do. 

However, it is subject to oversight and scrutiny by elected members, and will be monitored by Health and Adult Services in order to capture, understand and report on impact.

Section 5. What impact will this proposal have on council budgets? Will it be cost neutral, have increased cost or reduce costs?

In accordance with the Covid-19 hospital discharge requirements, any person being discharged from hospital or where interventions are put in place to avoid an admission to hospital will be fully funded by the NHS. Monies have been made available across clinical commissioning groups and local authorities and they are required to develop pooled fund for costs associated with Covid-19, this includes interim arrangements for Continuing Health Care and s117 Aftercare. Formal agreements are currently being explored. Mechanisms to monitor spend against Covid-19 have been developed.

Section 6. How will this proposal affect people with protected characteristics?

Age

Make things better and make things worse

Why will it have this effect?

North Yorkshire has a greater number of older people than other counties and this is reflected in the make-up of people accessing social care support from the Authority.

61.9% of people in receipt of some form of care and support from the council are 65+, and 38.1% are younger than 65.

In addition, older people are more vulnerable to serious illness caused by Covid-19.

Given the current state of emergency, if the proposals are implemented, it is anticipated to have a positive impact by allowing the authority to adapt service provision in order to continue to provide services to those most in need of support. This has to be the priority for the authority. 

However, the proposals may also have some negative impact, as it is likely that assessment, support planning and the nature of support will be reduced in comparison to the usual standards.

This is likely to be heightened by the unavoidable reduction in services as a result of social distancing guidelines introduced by the government – although partially mitigated by alternative arrangements including the significant effort around community support.

For young people transitioning into adult service the easements have the same effect in terms of the duty to assess becomes a power.

Disability

Make things better and make things worse

Why will it have this effect?

In terms of primary support reason, 46.8% of people in receipt of some form of care and support are receiving support with personal care, 21.6% due to learning disability, 9% for mental health support, and 7.2% for memory and cognition, 10.5% other reasons and 4.8% as support to unpaid carer.

As outlined for age, above, evidence points towards this illness having a greater effect on people with certain health conditions and therefore disabled people are likely to be at higher risk, as well as having a greater need for social care support than non-disabled people.

People with learning disability may be at higher risk, as they are already at higher risk of death due to respiratory causes; the most recent North Yorkshire Learning Disability Mortality Review report indicated that in 2018/19, the medical conditions most frequently cited in Part I of the medical certificate of cause of death were pneumonia (34%) and aspiration pneumonia (25%). These are higher than the nationally reported cases in 2018 of pneumonia (25%) and aspiration pneumonia (16%). 

Note that people in will be affected by the need for rapid discharge from hospital whether the reason for their stay is due to Covid-19 or another medical issue.

Sex

Make things better and make things worse

Why will it have this effect?

59.1% of people in receipt of some form of care and support are female and 40.9% are male.

Of those aged 65+, 66.8% are female and 33.2% are male.

As the age profile for North Yorkshire and North Yorkshire County Council social care is weighted towards the older age-range and because of the longer lifespan of women, it is likely that more women will be impacted by the proposals.

However, the available data so far suggests that men are more likely to die because of Covid-19 infection than women: international figures suggest that the split is approximately 70% male to 30% female. However, it is still very early days for the international community to understand the behaviour of this virus.

Race

No impact

Why will it have this effect?

92% of people in receipt of some form of care and support are White British, 2.2% are White Other/ Black, Asian and Minority Ethnic, and for 5.9% ethnicity is not recorded.

The proposals should not have any substantially greater impact on any ethnicity, however it is possible that people from some minority backgrounds may be at higher risk due to a higher prevalence of underlying conditions such as heart disease and diabetes, for example South Asian communities. This may lead to a higher need for social care support in communities where historically there has been a lower uptake, for example in Craven.

Gender reassignment

No impact

Why will it have this effect?

Unlikely to have any impact on people on grounds of gender reassignment.

There may be some adverse impact caused by the unavoidable reduction in services as a result of social distancing guidelines introduced by the Government – although partially mitigated by alternative arrangements including the significant effort around community support. This, however, is not directly related to the Care Act easements proposals.

Sexual orientation

No impact

Why will it have this effect?

Unlikely to have any impact on people on grounds of sexual orientation.

There may be some adverse impact caused by the unavoidable reduction in services as a result of social distancing guidelines introduced by the Government – although partially mitigated by alternative arrangements including the significant effort around community support. This, however, is not directly related to the Care Act easements proposals.

Religion or belief

No impact

Why will it have this effect?

Unlikely to have any impact on people on grounds of religion or belief.

There may be some adverse impact caused by the unavoidable reduction in services as a result of social distancing guidelines introduced by the Government – although partially mitigated by alternative arrangements including the significant effort around community support. This, however, is not directly related to the Care Act easements proposals.

Pregnancy or maternity

No impact

Why will it have this effect?

Women in pregnancy are currently advised to practice rigorous social distancing under the government guidelines, and pregnant women with significant heart disease come under the ‘shielding’ guidance.

Note Public Health sexual health services will continue albeit with changes in method of delivery due to social distancing requirements.

Marriage or partnership

No impact

Why will it have this effect?

No evidence of impact

Section 7. How will this proposal affect people who…

..live in a rural area?

Make things better

Why will it have this effect?

Make things better: by changing the way we do things and redirecting capacity to meet demand, the authority will be better placed to meet the highest priority needs including those in rural areas where it can be challenging to source social care.

..have a low income?

Make things better and make things worse

Why will it have this effect?

The easements will allow for financial assessments for care to be provided promptly in order to meet the highest priority needs.

The authority will have powers to charge people retrospectively for the care and support they receive during this period, subject to giving reasonable information in advance about this, and a later financial assessment. This allows for fairness.

However, there is some potential for adverse impact if this is not clearly communicated to people so that they are able to make necessary financial provisions to pay the accumulated amount.

This is unlikely to impact on those below the income threshold as they will not be required to contribute, but those just above the threshold may be particularly vulnerable.

..are carers? (Unpaid family or friends)

Make things better and make things worse

Why will it have this effect?

In the 2011 census there were approximately 65,000 people who identified as being an unpaid carer, however we know the real number is likely to be significantly higher. This is higher than the average both nationally and through the Yorkshire and Humber region.

The 2011 census also identified that almost one in four (24.3%, 15,538 people) of the female population aged 50-64 are providing unpaid care, which rises to 25% in Ryedale and 26.6% in Craven, compared with a national average of 23.5%.

In terms of age, over a quarter of carers in North Yorkshire are over the age of 65. There are also over 18,000 carers aged 25-49 and over 3,000 under the age of 25, including young carers under the age of 18.

North Yorkshire County Council Health and Adult Services completed 1716 carers assessments during 2019/20, of which 1200 (70%) were for female carers and 516 (30%) for male.

Potential for positive impact by the proposals allowing the authority to continue to provide a service by redirecting capacity to priority areas.

Potential for adverse impact by necessarily reducing input into assessments and support plans for the cared-for person which may increase pressure on carer; however, practice will continue to be person-centred. Potential for adverse impact as the result of isolation and social distancing measures. Limited ability for carers to have a break from their caring role if they share the household with the cared for person.

Potential for adverse impact by reduced capacity for carer assessments; however, the authority continues to commission carer support via the carers centres, and additional community support via the voluntary sector partnership / universal + offer.

Section 8. Geographic impact

North Yorkshire wide - Yes

Section 9. Will the proposal affect anyone more because of a combination of protected characteristics?

Older people with underlying health conditions are more likely to be seriously affected by Covid-19, and the available data so far suggests that men are at higher risk of mortality than women.

The demography of North Yorkshire and of people currently accessing adult social care is weighted towards older people, with a higher proportion of women than men.

Unpaid carers in North Yorkshire are predominantly female, and it should also be noted that the social care workforce is predominantly female.

It is reasonable to conclude, therefore, that the proposals will have a greater impact, whether positive or negative, on older people particularly those with underlying conditions. For women, there may be greater impact due to higher numbers of older women requiring social care support, higher numbers of unpaid female carers, and higher numbers of female workers in the social care workforce.

Section 10. Next steps to address the anticipated impact

Adverse impact - continue the proposal - The equality impact assessment identifies potential problems or missed opportunities. We cannot change our proposal to reduce or remove these adverse impacts, nor can we achieve our aim in another way which will not make things worse for people. (There must be compelling reasons for continuing with proposals which will have the most adverse impacts. Get advice from legal services)

Explanation of why option has been chosen.

There is potential for adverse impact due to the changes in assessment and support planning, and the power to reduce or delay care provision to those deemed not to be most at risk.

However, it must be noted that this adverse impact is outweighed by the potential for adverse impact should the easements not be enacted, given the expected increase in demand and pressure on capacity; if this is not managed, it is possible that the care needs of those most at risk will not be met.

The provisions under the easements will be monitored for impact and mitigations have been outlined above.

Legal Advice

Section 15, Schedule 12 of The Coronavirus Act 2020 (the Act) disapplies and modifies provisions of the Care Act 2014 to relax the duties of local authorities regarding care and support during the Covid-19 outbreak. The local authority must however have regard to and comply with “The Care Act easements: guidance for local authorities” which sets out how the local authorities can use the new Care Act “easements” created under the 2020 Act. Of particular note is that a “local authority should only take a decision to begin exercising the Care Act easements when the workforce is significantly depleted, or demand on social care increased, to an extent that it is no longer reasonably practicable for it to comply with its Care Act duties (as they stand prior to amendment by the Coronavirus Act) and where to continue to do so is likely to result in urgent or acute needs not being met, potentially risking life”. A local authority must also have regard to “The ethical framework for adult social care” to assist local authority decision making when responding to Covid-19. The easements are temporary and wherever possible the local authority is still expected to fulfil its duties under the Care Act 2014 and must continue to meet needs where a failure to do so would breach an individual’s human rights under the European Convention on Human Rights.

Section 11. If the proposal is to be implemented how will you find out how it is really affecting people?

• Reviews of service provision, prioritisation and data every two weeks led by corporate director for Health and Adult Services and Chief Social Worker
• Complaints and commendations

Section 12. Action plan.

Consider data and feedback on protected characteristics when reviewing / monitoring the changes

Lead

Chief social worker

By when

Every two weeks retrospectively, is clearly communicated at earliest opportunity

Ensure requirement to contribute towards social care costs, including retrospectively, is clearly communicated at earliest opportunity

Lead

Anton Hodge

By when

Ongoing

Continue to work in partnership with statutory and community sector to provide community-based support to reduce pressure on Adult Social Care and mitigate against reduction in services

Lead

Richard Webb

By when

Ongoing

Section 13. Summary

The proposals considered in this equality impact assessment are made in order for the authority to be able to continue to meet the needs of those in receipt of or requiring social care, in the context of a national emergency which will put considerable upward pressure on demand and at the same time reduce capacity.

There is potential for adverse impact due to the changes in assessment and support planning, and the power to reduce or delay care provision to those deemed not to be most at risk.

However, it must be noted that this adverse impact is outweighed by the potential for more severe adverse impact should the easements not be enacted, given the expected increase in demand and pressure on capacity; if this is not managed, it is possible that the care needs of those most at risk will not be met.

Both positive and negative impact is most likely to be experienced by older people with underlying health conditions, and by disabled people. Women may experience more negative impact than men.

The provisions under the easements will be monitored for impact and mitigations have been outlined above.

Section 14. Sign off section

Name: Shanna Carrell
Job title: Participation and Engagement manager
Directorate: Health and Adult services
Signature: S Carrell

Completion date: 6 April 2020
Authorised by relevant Assistant Director (signature): Louise Wallace
Date: 6 April 2020