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