NHS Lothian
Gender Equality Scheme
Annual Report June 2009
1
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
CONTENTS
1. Introduction
2. Executive summary and status report of progress on the five Checking for Change areas:
2.1
Energising the Organisation
2.2
Demographics
2.3
Access and Service Delivery
2.4
Human Resources
2.5
Community Development
3. Conclusions and Recommendations
4. Appendices : 1. Key Action Points
2. Updated Action Plan with Progress Report on the five Checking for Change areas
3. Annual Workforce Monitoring Report on Gender 2008-9
2
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
1.
INTRODUCTION
NHS Lothian published its first Gender Equality Scheme in June 2007 setting out its commitment to progressing gender equality. It
published its Equal Pay Scheme in September 2007.
This report provides an overview of the actions taken by NHS Lothian over the last year to meet its objectives in the five Fair for All
areas of activity in relation to gender equality and outlines priority areas for 2009-2010. A traffic light system has been used to indicate
the status of a particular area of work. GREEN indicates work completed or near completion, AMBER indicates work underway, RED
indicates work yet to commence or off target.
2.
EXECUTIVE SUMMARY OF PROGRESS ON THE FIVE CHECKING FOR CHANGE AREAS
In 2007 NHS Lothian reported its intention to utilise the audit framework, Checking for Change, initially developed to monitor progress
in race equality, to assess progress and benchmark its current position. Although the framework has not yet been developed across
other equality strands it provides a structure to review progress in gender equality and is used to highlight areas for future work.
Topic
Progress
2.1
Energising
the
organisation/
leadership
1. Establishing senior level of coordination of gender equality activity.
Position
Recommendations
Status
A Non-Executive Director appointed to Completed
chair the Equality and Diversity Steering
group.
Group responsible for the
strategic lead and monitoring of progress
on equality across the six strands,
including gender, and other groups who
may be disadvantaged because of their
life circumstances.
Identify SMART equality and diversity
objectives, which are inclusive of
gender and in line with the
organisation’s
corporate
responsibilities and strategic priorities.
GREEN
The Director of Human Resources and Completed
Carry out an audit of Executive and
3
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Organisational Development has the
overall Executive lead for Equality and
Diversity. A new post of Head of Equality
and Diversity, appointed in September
2008, will work with the Director of HR
and OD to support the delivery of this
agenda. Lead Managers in operational
divisions contribute to the strategic
development of Equality and Diversity
and facilitate the implementation of
objectives across the NHS. One of the
Lead Managers has responsibility for
leading on Gender.
Senior
Manager
performance
objectives to ensure that Equality and
Diversity objectives are included.
2. Equality Impact Assessment (EQIA).
Progress has been made in the inclusion Completed
of Equalities Legislation and the Specific
Duties with agreement across the
organisation that each strategy or policy
is assessed for equality and diversity
relevance and is impact assessed across
all equality strands either during
development or when being reviewed.
Gender is an integral part of impact
assessment and a group comprised of a
Consultant in Public Health and lead
Equality and Diversity Managers carries
out regular audits of process to ensure
that standards are maintained. Guidance
and a template have been developed for
the
managers
responsible
for
4
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Continue to improve the quality of
Impact Assessments and ensure that
gender issues are considered and any
adverse impacts are addressed.
implementation to ensure quality in
practice. A register is kept of all impact
assessments by the Head of Equality and
Diversity. Training is available and 70
staff have participated in the year.
3. Establish and maintain a monitoring
function using all the forums available
to NHS Lothian.
The joint equality forums with City of Completed
Edinburgh Council, Lothian and Borders
Police, Procurator Fiscal Service and
NHS Lothian have been reviewed and a
new Edinburgh Equalities Network has
been established to increase the
effectiveness of and involvement in public
sector work. East, Midlothian and West In progress
Lothian Councils are also involved in the
integration of equality forums with other
colleagues in the public sector including
NHS Lothian. Patient Forums within NHS
Lothian also play a vital role.
Ensure that all Quality Improvement
Teams actions can be monitored
across equality strands including
gender through effective collection and
analysis of equalities data to identify
inequalities.
The Lead for Patient Focus and Public In progress
Involvement is working with Equality
Leads
to
improve
and
monitor
representation across communities of
interest and continue to develop a range
of options for gathering information on
patient perspectives.
2.2
Information
on
gender
is
routinely In progress Gender specific targets need to be AMBER
5
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Demographics
2.3
Access and
Service
Delivery
collected in all patient areas but is not
routinely analysed to assess significance
of gender differences in uptake and use
of services. It remains difficult to provide
hard information on outcomes because of
the many variables which require to be
considered.
identified by the Equality and Diversity
Steering Group in order to measure
performance.
Gender issues are being addressed in In progress
some areas but this is not yet systematic.
Good examples include work with adult
survivors of child sexual abuse where
there is evidence that amongst mental
health service users nationally 50% of
women and 28% of men have
experienced abuse as a child.
The Equity Audit Core group will
continue to monitor services to identify
gaps in equality of service and health
inequalities and outcomes and where
relevant provide evidence for service
change.
There
have
been
innovative Ongoing
developments in particular in tackling
violence against women, in mental health
services where there has been significant
involvement in service redesign and the
approaches with patients with challenging
behaviour, in smoking cessation, in
diabetes, alcohol misuse and work in
sexual health with young people. There
is evidence of sensitive practice with
transgender people in health services
including health screening.
A more strategic approach to Equality AMBER
and Diversity is being progressed
through the Equality and Diversity
Steering group. The revision of the
Disability
Equality
Scheme
by
December 2009 will facilitate the move
to a Single Equality Scheme and
enable work on cross-cutting themes
and joint equality objectives within a
Human Rights framework.
Work is in progress in terms of increasing In progress The opportunity to re-energise the local
6
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
involvement and in the provision of
clinical information for patients. New
monitoring systems are being developed
to provide evidence of equity in
involvement.
2.4
Human
Resources
implementation
groups
across
Divisions and CH(C)Ps will be a priority
for consideration in 2009.
Work has continued on impact assessing Ongoing
policies and procedures. New systems are
being implemented which will make it easier
to report on gender and other equality
strands and provide evidence to support
changes as required. (Appendix 2)
The
PWA/Empower
system
for AMBER
gathering employee details will help
significantly in monitoring and reporting
on equalities issues in all aspects of
employment and identifying priorities
for action to redress imbalance.
There is evidence of sensitive practice in Ongoing
supporting
transgender
people
in
employment.
The Human Resources Equality &
Diversity Subgroup will take forward a
range of work during 2009-10 to
develop
support
systems
for
transgender people, and to ensure that
HR policies reflect transgender issues.
The revised Human Resources Strategy Ongoing
makes a strong commitment to recruit a
balanced workforce and encourage staff to
consider employment opportunities which
have previously had a gender bias.
Tackling gender inequality in terms of
equal pay in the workplace awaits
national support from the Scottish
Government.
Employee policies support staff with Ongoing
additional caring responsibilities to remain in
employment and it encourages flexible
working.
Quarterly workforce monitoring reports
will provide evidence of change.
The values espoused in the HR Strategy Ongoing
Monitor uptake of training on equality
7
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
2.5
Community
Development
which have been widely promoted to staff
and the implementation of a wide range of
e-learning and face to face training on
equalities issues is welcomed. This will help
to promote cultural change in terms of
attitudes and behaviours within the
organisation and are recognised as critical
to delivering on gender equality and the
other equality strands
including gender.
Systems are in place across Lothian to Ongoing
engage with people on a gender basis and
this will be enhanced by a cross-equality
strand approach. The Equality leads and
Public Involvement staff have access to a
wide range of people who they can signpost
to services who seek involvement. This
work is complemented by the Public
Partnership Forums and Patient Councils
and Edinburgh Equalities Network.
Continue to work in partnership with AMBER
the public and voluntary sector
organisations to improve networks for
involving people particularly those who
have been hard for public sector
organisations to reach across Lothian.
Implement Community Engagement
Framework and Involving People
Strategy.
Effective networks are also being developed
with public sector partners and voluntary
sector organisations across Lothian.
8
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
3.
CONCLUSIONS and RECOMMENDATIONS
This report provides a description and mapping of work in NHS Lothian on gender issues but as yet lacks measurable targets in
certain areas. Despite these reservations much work is being progressed across Lothian and as the equalities work progresses
this will become more coordinated.
The gender strand of equalities work is complex and not easily addressed as a single issue. Impact Assessment enables routine
and formalised scrutiny of strategies and policies to assess differential impacts of policies and services by gender. Issues can be
addressed as a result of this ensuring that the design, development and delivery of services take into account the different needs
of girls and boys and women and men, including transgender people, to provide better outcomes for service users and staff.
Impact assessment facilitates work on gender in a systematic way and is a key lever to tackle inequality.
The areas where gender difference is most obvious nationally are around routes in to illness and equal pay and NHS Lothian
does not appear to be any different. It is recognised that these are significant issues that require action by the organisation.
There is evidence of work in progress in areas of employment and service delivery. However NHS Lothian recognises the need
for ongoing culture change so that the value of collecting data across equality strands is understood. This will assist in the
development of an evidence base to identify areas of inequality and help to focus resources to address these areas. The Equity
Audit Core group is a step towards this but is limited by the lack of complete equality monitoring which is not yet available. Staff
will need help to recognise the importance of effective data collection as a tool to tackle inequalities both from a patient and
employee perspective.
Work on Gender–Based Violence which has a critical impact on health and life circumstances remains a priority area for action
and an area where progress continues to be made. Services particularly targeting gender specific groups e.g. sexual health,
women offenders and maternity services provide good examples of gender based involvement.
Data on all equality strands and agreement of SMART objectives would assist in measuring real progress and focus work to
tackle gender issues and ensure measurable outcomes. This will be dependent on improved data collection across equality
strands and agreement on the coding for equalities data collection.
9
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
4.
Appendix 1
List of actions required following from the Annual Report 2008-9.
1. Identify SMART equality and diversity objectives, which are inclusive of gender and in line with the organisation’s corporate
responsibilities and strategic priorities.
2. Carry out an audit of Executive and Senior Managers’ performance objectives to ensure that Equality and Diversity
objectives are included.
3. Ensure that all Quality Improvement Teams actions can be monitored across equality strands including gender through
effective collection and analysis of equalities data to identify inequalities and direct future work and resources.
4. Ensure that Equality and Diversity objectives are agreed by the Equality and Diversity Steering Group and included in the
annual review of services.
5. The Equality Audit Core group should continue to monitor services to identify gaps in equality of service and outcomes and
where relevant provide evidence for service change.
6. The PWA/Empower system for gathering employee details will be used to monitor and report on equalities issues in all
aspects of employment and identifying priorities for action to redress imbalance.
7. Tackling gender inequality in terms of equal pay in the workplace awaits national support from the Scottish Government.
8. Continue to work in partnership with the public and voluntary sector organisations to improve networks for involving people
particularly those who have been hard for public sector organisations to reach across Lothian.
10
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
APPENDIX 2.
UPDATED ACTION PLAN WITH PROGRESS REPORT ON ACTIVITY 2008-2009
4.1
Energising the Organisation
In this section NHS Lothian has described the actions needed to ensure there is “buy-in” from all staff to changing organisational
culture and making it more conducive to realising equality outcomes.
ACTIVITY
Strategic Coordination
Establish
senior level
co-ordination
of gender
equality
activity
ACTIONS AGREED
LEAD
TIMESCALE
1. Appoint Board level Director to lead
on gender equality issues.
Director
of HR
and OD.
Completed,
EVIDENCE OF PROGRESS
Director of HR &OD will lead
Equality and Diversity agenda.
CEO has a national lead role for
Equality and Diversity for NHS
Scotland.
2. Statement of zero tolerance of
discrimination
and
harassment
supported by the Chief Executive.
Completed
3. Integrate gender into equality and
diversity strands and ensure effective
communication to all staff.
March 2009
4. Lead managers identified to lead,
monitor and report on progress.
Completed
Head of Equality and Diversity
appointment at the Board in
Sept 2008.
Completed
Equality Lead Manager identified
to lead on Gender.
Completed
Gender balance of Equality
Leads in Board area.
11
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Gender included in e-learning
induction, Impact Assessment
and other equalities training and
links to the core competencies in
the Knowledge and Skills
Framework.
5. Develop performance milestones for
gender equality in the implementation
of costed action plans to meet
identified needs and priorities through
consultation and EQIA.
Completed
Further action required as part of
review of the Equality and
Diversity Action Plan.
Integration of equality and
diversity in CHPs and Divisions
is in progress but structural
issues in some areas require to
be resolved.
6. Establish
CHP
and
Divisional
Implementation groups to ensure
ongoing implementation of action to
achieve gender equality, support
Equality Impact Assessments and
performance monitoring of strategy
and implementation.
Ongoing
Ongoing
Good examples of involvement
include development of the new
Centre for Sexual Health,
Clinical Neuroscience
reprovision, the Royal Edinburgh
Hospital Campus review and
Maternity Services strategy.
7. Monitor involvement of service users,
carers and voluntary organisations in
discussion and development of plans
and services in relation to gender
issues through the work of the
Equality and Diversity Lead Managers
and the Patient Focus Public
Involvement Leads.
Ongoing
The Edinburgh Equality Network
have a monitoring form which
was widely consulted on with
diverse communities and this will
be considered as an option for
use in NHS Lothian.
8. Ensure continued integration of
gender
issues
in
strategy
development in NHS Lothian.
Completed
The legal requirement to impact
assess all new and revised
strategies and policies acts as
an aid to address this.
12
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
ACTIVITY
Impact
Assessment
ACTIONS AGREED
LEAD
TIMESCALE
PROGRESS
1. Form an Equality Impact Assessment Steering
Group.
Consultant in
Public Health
and E & D
Leads
Completed
Steering group established in
2007 with regular quality
review of Impact
Assessments and training.
Equality and
Diversity
Leads
Ongoing
A pragmatic approach has
been to give priority to new
and revised strategies and
policies. The Steering group
recommends when a full
Equality Impact Assessment
is required. Reports available
on inter and intra net sites.
Head of
Equality and
Diversity
March 2009
Monthly half-day training
courses are provided and 70
staff have attended in the
year.
Head of
Equality and
Diversity
Ongoing
Action plans are monitored as
part of the quality review
process and systems are
being developed to ensure
that progress is made on
auditing progress on
recommendations.
Assessment of
functions and
policies to
assess each for 2. Identify all relevant new or revised functions
its relevance to
and policies and undertake equality impact
the duty to
assessment (EQIA) which is inclusive of
promote gender
gender equality.
equality and to
make
appropriate
adjustment to
policies to
remove/minimise 3. Ensure uptake of training on EQIA for key staff.
adverse impact
Ensure continued availability of trained staff to
support Rapid Health Impact Assessment
(RHIA) and rapid and full EQIA.
4. Use outcome of EQIA to inform the revision of
policies and implementation.
13
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
5. At Board level, ensure all new policies and
strategies have been subject to Impact
Assessment to promote gender equality.
Completed
Process is in place to ensure
that papers are Impact
Assessed prior to
presentation at Board
meetings. Issues about
training administrators to
monitor this are being
reviewed.
6. Build an evidence base to facilitate EQIA and
promote good practice in service provision and
employment.
June 2009
7. Collate and review the impacts of strategies
and policies which have been impact assessed
at least every three years with interim reviews
as policies are updated. Publish the outcomes
as required by the legislation.
Ongoing and Steering group learning from
review 2010 experience and providing
feedback to inform strategy,
policy and training. More
formalised systems of
reviewing identified actions
are in discussion
8. Produce an annual report of activity to be made
available
to
the
relevant
monitoring
organisations.
14
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
July 2009
A site on the internet and
intranet to provide evidence
of Impact Assessments and
enable additional consultation
is in progress.
A record of all Impact
Assessments is collated by
the Head of Equality and
Diversity and will shortly be
available on the Internet for
public scrutiny. A report will
be included in the annual
Equality and Diversity report.
Establish and
1. Work with the revised Edinburgh Equality
maintain
Network and create opportunities for cross
monitoring
strand working with a specific monitoring
function using all
function. Progress will be reported on the EEN
the forums
website on City of Edinburgh Council’s internet
available to NHS
with links to NHS Lothian.
Lothian
2. Establish regular monitoring and annual
reporting mechanisms with the relevant
Lothian Forums using Checking for Change
Performance Monitoring tool.
E & D Lead in
Edinburgh
CHP
Review
completed
ongoing roll
out of
actions
Joint Equality Forums
reviewed in 2008 and
Edinburgh Equality Network
established to increase
involvement and
effectiveness across all public
sector organisations. Network
database established with 97
members with target of 500
participants by March 2010.
Head of
Equality and
Diversity
Completed
March 2009
National performance
monitoring group established
at Equality and Planning
Directorate, NHS Health
Scotland and await national
lead.
Completed
and Review
date Dec
2009
National Benchmarking
exercise completed on
progress across all equality
strands (report available).
3. Regular sharing of good practice and outcomes Equality Leads
from the review of the action plan delivery to
ensure
it
informs
appropriate
quality
improvement mechanisms.
4. Minutes of the Equality and Diversity Steering
group are routinely provided to Healthcare
Governance and Risk Management Committee.
15
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Head of
Equality and
Diversity
Ongoing
Equality and Diversity
Steering group minutes and
briefing note are
disseminated to these groups
to ensure wider dissemination
of progress in meeting
objectives.
4.2
Demographics
In this section NHS Lothian has outlined the progress made in gender monitoring and where NHS Lothian has used or plans to use
Census data to inform future work.
ACTIVITY
Data Collection
Build on the
baseline data
for gender
profiling and
use evidence of
gender
inequality to
support service
reviews
ACTIONS AGREED
LEAD
1. Review existing database and identify evidence Directorate of
of gender inequality through disaggregated data Public Health
reporting.
&Health Policy
TIMESCALE
EVIDENCE OF
PROGRESS
March 2009
An equity audit of diabetes
services that looks at
gender differences has
been completed.
Differences in prevalence
are difficult to interpret
because of other factors.
An Equity Audit Core group
has been established to
identify equality issues.
There has been significant
work in maternity services.
March 2009
2. Establish – in line with guidance – monitoring
data set and performance indicators identified in
the Checking for Change performance
monitoring system.
3. Improve the collection and analysis of data in
relation to gender and sexual orientation in
order to provide evidence for planning and
service delivery within the context of national
and local priorities and to demonstrate change.
16
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Head of
Equality and
Diversity
2009
Ongoing
Equalities and Planning
Directorate at Health
Scotland established
performance management
group to address this in
June 2008.
Further work is required in
this area to identify the
differing needs of men and
women, including
transgender people.
There is evidence of
pockets of good practice in
primary care in identifying
transgender people for
health screening.
Information from 2001
census is now considered
out of date and has not
captured information on the
increase in European
migrants. However NHSL
has developed and/ or
circulated a range of
information leaflets in
European languages on
registration with GPs and
access to services.
17
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
4.3
Access and Service Delivery
In this section NHS Lothian has outlined activity that will be undertaken to mainstream gender equality and improve customer
experience and confidence.
ACTIVITY
ACTIONS AGREED
LEAD
TIMESCALE
Ensure public
access to
information and
services and
agree
standards of
practice
1. Work with NHS Scotland and other bodies to
develop a national programme of health
information materials which are gender specific.
Associate
Director of
Nursing and E
& D Leads,
March 2009
Clinical Information for
Patients strategy approved.
Communication Department
promote information which
reflects a gender mix.
In progress
The implementation of the
Patient Information strategy is
in progress to improve the
quality and accessibility of
patient information and
identify gaps. Information is
accessible at information
points, GP surgeries and in
patient and out patient
venues within hospital
premises and health centres.
Completed
Gypsy/Traveller women have
information on direct access
to women’s health, maternity
and Emergency Dental
treatment services without the
need for referral from a GP to
improve access to services.
2. Ensure provision of high quality appropriate
leaflets, in a variety of formats, including IT and
add focus to female/male specific diseases.
3. Identify gaps in provision and develop materials
at Lothian level where necessary
4. Review plans for signposting at NHS Lothian
facilities and identify models of best practice.
18
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
EVIDENCE OF PROGRESS
Ensure that
services are
provided that
take account of
gender and
routes in to
5. Lothian NHS is part of a national pilot to collect
Equality and Diversity data in the complaints
procedure.
Completed
March 2009
This pilot was not able to
meet its objectives to identify
groups who were being
differentially disadvantaged
and the need for more
sensitive enquiry was
recommended and will be
addressed through work on
improving the Patient
Experience.
6. Collect evidence on patient experiences and
identify areas of good practice and areas for
improvement
Ongoing
Involving People and
Improving People’s
Experience of Care strategy
is in the process of being
approved. NHS Lothian is a
pilot Board for the Cancer
Services Patient Experience
programme, where patient
stories and the patient
experience are being used to
improve service planning and
delivery.
1. Ensure that staff are open in their
communications with patients giving space to
discuss gender identity if requested and reduce
the risks of gender stereotyping and limiting
gender roles in their communications with
patients.
June 2008
LGBT awareness training
challenges gender
stereotyping and forms part of
the induction process and elearning modules to support
the Key Skills Framework.
19
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
tackling health
problems
Impact Assessment is a
useful process to address
this.
2. Routing people appropriately to the Reproductive
Health Department’s Sexual Problems Clinic
Ongoing
Referrals are primarily
received from GPs.
There is evidence that health
screening in primary care is
sensitive to transgender
people.
Ensure the
ongoing
implementation
of the Violence
Against
Women
Strategy and
review
progress
1. Monitor the implementation of the Violence
Against Women Strategy
March 2009
The Gender –Based Violence
Steering group has been relaunched to develop the
revised Action Plan
superseding previous
guidance issued in 2003.
Completed
2. Develop support for male victims of domestic
abuse in same sex or heterosexual relationships
Senior Clinical
Psychologist
Ongoing
20
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
The Lothian Domestic Abuse
(DA) Toolkit contains good
practice in the identification
and work with both victims
and perpetrators.
Additional partner agency
training related to this has
been completed with plans to
roll out further training in
partnership with the Violence
Against Women Consortium
in 2009-2010.
Ongoing
3. Introduce screening of all pregnant women
Women are routinely
screened for domestic abuse
during ante natal care. Work
is being extended to introduce
routine enquiry of gender
based violence (see action 1.
above).
Completed
4. To ensure the needs of male and female
survivors of gender-based violence are
addressed in health care.
Good practice training has
been developed for staff by
NHS Lothian’s Psychology
Department relating to work
with Adult Survivors of Child
Sexual Abuse (CSA).
National research identifies
50% of female and 28% of
male mental health service
users have experienced CSA.
Staff in this area have been a
priority group to receive
training. CSA is also more
prevalent in substance misusers and the homeless.
Ongoing
Lead Public Health
Practitioner (PHP) has
completed Safe to Train
training for trainers course to
roll out training and good
practice for health and multiagency staff on issues re
21
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
CSA. Staff member currently
seconded to Scottish
Government national initiative
on GBV supporting NHS
Lothian and other Health
Board areas.
Ongoing
March 2008 NHS Lothian
secured Scottish Government
3 year funding to establish an
evidence based intervention
group work programme for
children and young people
affected by Domestic Abuse
as one of three pilot
demonstration sites.
Ongoing
The PHP will lead on the
Violence Against Women
theme in the Edinburgh
Violence Reduction Unit with
Lothian and Borders Police.
Ensure that all
NHS Lothian
facilities are
compliant with
gender access
requirements
1. Ensure that access to primary care services is
provided at times which take account of gender
specific roles and work patterns
General
Manager for
Primary Care
contracts
March 2009
Extended hours for GP
practices have been
implemented in most
practices to ensure services
are more accessible and
increase patient choice.
March 2009
2. The results of audits to be used to prioritise
actions in partnership with users on local
Health
Intelligence
22
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Information is collected on
gender across all services but
forums.
Unit
Ensure that
patients have a
choice of
gender of
health
professional, at
least for
personal
examination.
1. Introduce a chaperone policy for patients which
is gender sensitive
Promote
effective use of
advocacy
services to
NHS staff
through training
and information
dissemination
1. Ensure that information about health and
healthcare needs from advocacy work
influences planning and promotes awareness of
advocacy services among gender equality
groups.
Nurse Director
systems are not yet in place
to scrutinise this by equality
strands.
Completed
Patients may request the
choice of gender of health
professional which will be met
wherever possible.
The chaperone policy is now
in place to ensure that
patients are accompanied by
a member of staff of their own
gender when they require a
personal examination.
March 2009
NHS Lothian Advocacy Plan
has now been revised for
2008-2011. Some gaps were
identified particularly in
relation to access to
mainstream advocacy
services for minority ethnic
people and people with
disabilities.
Ongoing
2. Ensure mapping of advocacy services for
equality and diversity issues and link to the
implementation of the Independent Advocacy
Plan for potential further development of
advocacy services.
March 2009
Ensure access
1. Produce an NHS Lothian Patient Information
23
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Service Level Agreements
need to ensure that where
advocacy is available there is
a choice of gender of
advocate available.
The patient information
framework is being developed
to interpreters
and translated
information
Framework which is inclusive.
Ongoing
2. Establish systems for monitoring existing use
and unmet need for interpreting and translation
for health and healthcare issues by gender.
in line with the national
directive as Clinical
Information for Patients and
has been Equality Impact
Assessed. Issues which
arose will also have an impact
on interpreting services.
Ongoing
3. Update and disseminate code of good practice,
Monitoring uptake of
interpreters by gender is not
available but there is a choice
of interpreter available
wherever possible. National
guidance on this is awaited.
information and training on working with an
interpreter and in providing translated
information.
Promote
gender equality
in Procurement
1. Develop best practice in service procurement to
ensure that all purchased and contracted
services comply with the requirements of
equalities legislation.
2. All procurement and service contracts within
NHS Lothian to include the requirement to
provide evidence of non-discriminatory practices
within employment and service provision.
Provide an
environment
and facilities
that meet the
1. Implement actions from environmental audits
and patient surveys by gender.
24
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Directorate of
Strategic
Planning and
Service
Modernisation,
Director of
Finance and
CHP and
Divisional
Management
Team
Oct 2007
The revised format for Single
Outcome Agreements for
contracting purposes has
been impact Assessed and
meets equalities requirements
to ensure that equality issues
are addressed and can be
monitored. Includes a
requirement to demonstrate
compliance with public sector
legal requirements.
Ongoing
Results of monitoring surveys
including those on Touchscreen are reported to
wards/teams for action and
needs of those
using NHS
services
can be disaggregated by
gender.
2. Implement change where indicated / required
Ongoing
and monitor by gender.
Establish
1. Procedures are in place for the management of
systems for
incidents and there are systems to monitor and
reporting and
review.
collating of
reports of
discrimination
both directed
against staff
and those
2. Support system established for staff affected.
reported to staff
by patients,
carers, or
others.
25
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Wards and Departments are
required to take action on
outcomes but a monitoring
system is not yet in place
across equality strands.
Completed
The DATIX system has been
rolled out across NHS Lothian
including GP premises and
has the capacity to monitor
reports of alleged
discrimination.
March 2009
Staff can request referral to
Occupational Health
Services, see Chaplains for
support and guidance or
access the Confidential
Contacts a group of staff
trained to support staff who
feel that they are
experiencing discrimination
and provide help to secure
appropriate action through
Employee Relations
Department.
Ongoing
The DATIX system will by
2010 have the capacity to
provide evidence which can
be monitored by gender.
Support the
gender aspects
of the national
priorities:
Coronary
Heart Disease
Cancer
1. Equality Impact assess all aspects of the
patient’s journey to ensure that services are
provided in a gender sensitive way.
Managed
Clinical
Network
Managers
March 2009
Impact assessment policy is a
requirement for all new and
revised strategies and
policies and addresses
gender issues.
1. Gender impact assess the patient care pathway
and implement action to address gender equality.
Director of
Public Health
and Health
Policy
Ongoing
Impact Assessment will be a
requirement of the review to
address gender issues.
1. Gender impact assess the patient care
pathways and implement action to address
gender inequality.
Director of
Public Health
and Health
Policy
Ongoing
Planned work on reviewing
patient experience of cancer
services will through impact
assessment identify gender
issues.
61% of women and 38% of
men (1% unknown) have
taken up smoking cessation
in 2008-9. Of those 26% of
women and 17% of men
26
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
reported not having smoked
in a period of two weeks. This
equates to a 43% success
rate in NHS Lothian
compared to a national
success rate of 40%.
Mental Health
Gender impact assess the patient care
pathways and implement action to address
gender inequality.
Director of
Public Health
and Health
Policy
Ongoing
Sexual Health
Strategy
Review the programme of activity for sexual health
planning for compliance with gender equality
Director of
Public Health
and Health
Policy
Ongoing
27
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
3 Courses have been run on
Working with Women with
mental health needs in
community and in-patient
settings and three on Safe
Conversations by the
Inequalities Agenda. The
self-harm project (SHP) which
works predominately with
women offers regular
fortnightly support groups and
a monthly skin camouflage
group. There is an ongoing
group working on Dignity and
Respect improving the patient
experience.
Healthy Respect branding is
aimed specifically at making a
relationship with young
people and is inclusive of
gender. Many young men
attend the drop-ins and all
information is collected and
available by gender.
Feedback from both genders
is part of all I want – LIVE
drop-in standards and informs
service plans.
4.4
Human Resources
In this section NHS Lothian has described activity designed to improve workforce policies relevant to gender and increase knowledge
of the issues among NHS Lothian staff.
ACTIVITY
Duties as an
employer
ACTIONS AGREED
LEAD
TIMESCALE
PROGRESS
1. Review existing employment policies for gender
Directorate of
HR and OD
Ongoing
The NHS Lothian impact
assessment tool requires
policy makers to consider
gender equality in the
workplace. Work is ongoing to
incorporate EQIA into the
review of existing HR policies:
all new policies are already
subject to EQIA.
equality compliance.
Fulfil the
Employment
Duties set out
in the Equality
Act (2006) and
Gender
Equality Duties
28
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
and other
legislation.
2. Review existing employment practices for zero
Ongoing
NHS Lothian is an Equal
Opportunities Employer and
relies on the disclosure of
equalities data by staff to
enable effective monitoring of
homophobia. A zero tolerance
policy on discrimination is one
of the values of the
organisation.
Quarterly
reporting
Job adverts and recruitment
processes are assessed to
prevent any gender bias.
Outputs are recorded and
published in the quarterly
workforce monitoring report.
Quarterly
reporting
Gender information is
included in quarterly
reporting. The roll out of the
PWA/Empower will record all
types of leave and employee
details which will help
improved monitoring by
gender and other equality
strands.
Ongoing
Action on this requires
national lead.
Ongoing
The monthly and quarterly
tolerance of homophobia.
3. Monitor and review all job advertisements and
recruitment processes to address any gender
bias and provide opportunities to increase
gender equality in areas where there is an
imbalance
4. Produce required workforce monitoring reports
and identify any areas of inequality. Consider
appropriate action to address identified
inequalities.
5. Implement an EQIA of the local implementation
of Agenda for Change
6. Monitor and review reporting of discrimination
29
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
and harassment staff and uptake of the support
service.
7. Develop policies for the support of staff before
reporting system for
disciplinary, grievance and
bullying/harassment cases
allows identification of any
discrimination issues to be
raised and addressed.
Ongoing
Human Resources policies
are currently being reviewed
by the HR policy group to
ensure they support
transgender equality issues.
In the meantime an informal
system exists where HR
colleagues contact Equality
leads to provide support and
advice to managers as
required.
Completed
As part of the new Mandatory
Update Scheme introduced in
April 2008 all clinical staff
subject to mandatory updates
are required to undertake a
programme of blended
learning modules over 18
months.
Completed
A ‘Training Passport’ is
issued on completion. The
programme comprises 5
existing Equality and Diversity
and after gender reassignment and for those
who identify as transgender.
Ensure NHS
staff have
equality and
diversity
training in
which gender
issues have
been
appropriately
covered
Ensure all staff
1. Amend existing mandatory training to include
the general duty to promote gender equality.
2. Amend induction training to include the general
duty to promote gender equality and develop elearning module to support this.
30
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
are trained to
provide
services that
are respectful
and sensitive of
gender issues
including for
transsexual
people.
Ensure that
staff involved in
service
management
and planning
have access to
training
programme on
mainstreaming
gender issues.
e-learning modules but these
are being developed to
include more. Gender
Equality is included in the
overview module.
Ongoing
A module with enhanced
focus on gender equality is
currently in development and
will form part of the
mandatory programme when
approved.
4. Develop and implement training programmes for
NHS management and planning staff in gender
awareness and appropriate approaches to
mainstreaming gender equality.
Policy
completed,
ongoing roll
out of
training
Gender issues are included
as part of the Equal
Opportunities in Recruitment
and Selection training to be
delivered to managers in NHS
Lothian with responsibility for
recruiting and selecting staff.
5. Develop and implement training programmes for
front-line NHS staff in gender equality and
appropriate workplace behaviours.
Completed
All new staff are required to
complete the Equality and
Diversity Overview e-learning
module as above.
6. Ensure effective monitoring of training
Completed
The Empower system
enables NHS Lothian to
monitor training uptake by
role and geographical area
within operating divisions.
3. Raise awareness of the right to take appropriate
positive action where gender inequalities in the
workforce are identified.
31
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Publish an
Equal Pay
Statement on
28 Sept 2007
1. Publish an Equal Pay Statement for NHS
Lothian
Directorate of
Human
Resources
3. Monitor and review all job adverts and
Completed
Ongoing
recruitment processes to address any gender
bias and provide opportunities to increase
gender equality in areas where there is an
imbalance e.g. Estates
4.5
This was published in
September 2007.
Systems are not yet in place
to monitor Carers leave by
Gender but all HR policies are
available to staff on the
intranet or in the Employment
Policies Manual
Community Development
In this section NHS Lothian has outlined the progress made in consulting with communities and its capacity building activity.
ACTIVITY
Equality Impact
Assessment
Assess and
consult on the
likely impact of
strategies,
contracts and
policies in
relation to
gender issues.
ACTIONS AGREED
LEAD
TIMESCALE
PROGRESS
1. Involve men, women and transsexual service
users in Rapid Impact Assessment user forums
for existing and new policies.
E and D and
PFPI leads
Completed
The PFPI guidance provides
advice on involvement and
Equality leads provide access
to representatives from
equality networks.
2. Develop effective consultation mechanisms on
gender issues with local public sector partner
agencies and stakeholders building on the
current Joint Equality Forums in Lothian.
Ongoing
The Involving People strategy
is currently being developed.
Joint work with local partners
is in progress with all local
authority areas and in the
Acute Division.
3. Ensure that gender issues are considered in the
Completed
32
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Issue addressed as part of
agreements of contracts and Service Level
Agreements.
Identify leads
and inks with
partner
agencies;
agree strategy
for tackling
gender
discrimination
Ensure that
community
planning
processes
incorporate
gender needs.
Establish
support and
resourcing
needs for
individuals and
communities to
take part in
patient and
public
involvement.
guidance on Service Level
Agreements.
1. Maintain effective partnerships with Joint
Equality Forums in Edinburgh and Lothians to
support multi-agency approach to tackle
discrimination with local partner agencies
E & D Leads
Completed
in City of
Edinburgh
and
Ongoing in
other local
authority
areas
1. NHS Lothian planning mechanisms to be
reviewed to ensure continued development of
engagement mechanisms.
Equality and
Diversity
Leads
Ongoing
2. Ensure gender specific groups are engaged in
the Patient Focus Public Involvement activity
and involved in future NHS Lothian service
developments or redesign processes.
Lead PFPI
33
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009
Local partnerships with
Equality Leads are in place
with local authorities, Lothian
and Borders Police,
Procurator Fiscal, Lothian and
Borders Fire service and
Universities and Colleges of
Further Education.
As above
Guidance is available to staff
on involvement and on
reimbursement of reasonable
expenses.
Examples have been
illustrated in Access to
service section.
Appendix 3
Annual Workforce Monitoring Report on Gender 2008-9
The following series of tables will be included with detail on ethnicity, gender and age for:

The number of Candidates and successful applicants in 2008

New Starts – between the months of April – March 2008

Staff Participating in Training between the months of April – March 2008

Staff who booked and attended course between April – March 2008

Staff who have left between April – March 2008

Staff who have progressed in their career during April – March 2008

The information is displayed by staff group, in addition to these are details regarding Discipline and Grievance cases.

The report also details by age and gender information on Agenda for Change Bandings and Job Families.
Reports are completed quarterly but an annual report on gender issues was not available at the time of completion of this report but will
be made available on NHS Lothian’s inter and intranet sites and the information will be added to this Appendix once it is completed.
34
Lesley Boyd, Health Inequalities Manager, NHS Lothian, June 2009