NHSScotland Equality & Diversity Lead Network
Overview of published equality outcomes
September 2013
Purpose of paper
In line with the Equality Act 2010 and the Specific Duty (Scotland 2012), all 22
Scottish Health Boards published their equality outcomes reports at the end of April
2013.
This paper provides an overview of these publications and aims to:
 Identify common themes and approaches to setting and delivering equality
outcomes
 Draw on good practice, share learning and consider transferability across
boards and beyond
 Highlight shared challenges and explore potential problem solving strategies
 Aggregate information nationally and consider ways to measure
progress/performance on equality outcomes across NHSScotland.
To meet these aims, information was drawn from the following areas:
 aims of the Public Sector Equality Duty and protected characteristics covered
 national policy context and alignment with Board corporate/strategic plans
 working with partners
 boards’ infrastructure of support for the equality agenda
 emerging themes re service delivery, workforce and other outcomes

evidence: sources, community involvement processes, evidence baselines
(or proposals to create these)
 measurement indicators and integration of monitoring into existing board
audit/governance systems
 impact assessment processes (EQIA, HIIA/other)
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Introduction
The report covers the 14 territorial (local) health boards 8 national boards.
Most local boards grouped their outcomes under the broad banner of services and
workforce and 3 organised theirs in line with each protected characteristic. The
majority of local outcomes covered services - approx 65%, with just over 20%
covering workforce and the remainder spanning areas such as business (e.g.
procurement), community (including hate crime), involvement and for a small number
of boards, employment and education.
In contrast, national boards had fewer service facing outcomes – approx 35%, with
the majority, 63% covering workforce and the remainder community outcomes.
Public Sector Equality Duty
Many boards aligned their outcomes with all 3 aims of the Public Sector Equality
Duty (PSED) : advancing equality, tackling discrimination and fostering good
relations. Four boards did not refer specifically to alignment with the PSED aims.
The majority focussed on aims 1 and 2 with one board, (NHSGGC) focussing more
on tackling discrimination (5 out of 7 overarching outcomes) and NHS Lothian
including explicit alignment throughout with human rights legislation as well as the
PSED.
Although several boards included the ‘fostering good relations’ duty, the delivery of
this aim was mostly implied but not specifically developed in outputs.
Protected Characteristics covered
Many outcomes (and outputs) covered ‘all’ characteristics, reflecting a recognition of
the intersections between these.
Others were more specific i.e.
o reduction in the impact of hate crime ( race, disability, gender identify,
religion and belief and sexual orientation)
o health needs of marginalised groups addressed (prisoners, homeless
people, Gypsy Travellers, Refugees and Asylum Seekers)
o meeting healthcare and information needs of migrant workers and their
families.
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National policy context
All 14 boards aligned their outcomes to their organisation’s corporate or strategic
plans and for the most part, these were linked consistently to NHS and Scottish
Government (SG) policy priorities.
Alignment with the Quality Strategy, particularly the Person Centred Care
Programme, was most prominent. Other policy areas cited included Equally Well,
HEAT Targets, the Christie Report, Single Outcome Agreements (SOAs), 2020
Vision for Health & Social Care, Human Rights Act, Patients’ Rights Act and UN
Convention on Rights of the Child.
Strategies mentioned included Reshaping Care for Older People, Dementia, Early
Years Collaboration and Health Improvement Plan for people with Learning
Disabilities.
Workforce policies included the 2020 Vision, Staff Governance Standards and PIN
policies.
Working with partners
The outcomes of several boards e.g. NHS Tayside, Highland and Shetland, feed into
their local Community Planning Structures (CPPs) and link directly to SOA
outcomes.
Many boards undertake partnership approaches to tackling specific issues e.g. hate
crime, whilst others are working with a range of national equality organisations such
as Stonewall, Engender, Disability Alliance, Health & Social Care Alliance and some
have established working relationships with EHRC and Scottish Human Rights
Commission.
Board infrastructures to support equality agenda
In most boards, Equality & Diversity Leads have a corporate role to co-ordinate the
agenda. Although reporting structures vary, some boards have Equality Steering
Groups, which include Director level representation and feed into the Chief
Executive.
In practice, some leads are relatively isolated in their roles, others are supported by
operational colleagues and managers and a very small number of boards have a
team of staff.
Some leads have a centralised, co-ordinating role, others support colleagues across
directorates to deliver the agenda within their own settings and in a small number of
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boards, equality is integrated with the person-centred agenda, with the E&D Leads
covering both.
In some boards there are clear links between the equality, person-centred and health
inequalities agenda, although in others there appears to be a degree of disconnect
between these.
Boards where a health inequalities dimension is explicit tend to be those whose
outcomes are integrated into their local SOAs. Other notable examples of wider
partnership working on inequalities include the Western Isles which has outcomes
around community empowerment, redistribution of resources and work on poverty
and Borders, whose outcomes cover education, employment, housing and
homelessness.
Emerging themes: service delivery and workforce
SERVICE DELIVERY
Many boards set general outcomes around the delivery of person-centred care,
which in some cases, were linked to more specific activities or outcomes e.g.
person-centred approaches to routine enquiry of discrimination or gender-based
violence, improved use of feedback and complaints, more accessible health
promotion information and valuing and supporting staff to deliver these outcomes
The majority of outputs for boards focus on improving access e.g. addressing
barriers spanning physical, communication (translation/interpreting/advocacy) and
attitudinal (staff training).
Boards also identified more specific outcomes around the following themes:

Older people e.g. respect and dignity for older people in services, older
people are supported to live independently in their communities, care for older
people in hospital is sensitive to individual need. Most of these outcomes are
linked to Reshaping Care and the Dementia Strategy.

Early years, children and young people e.g. links with family nurse
partnership and improved engagement of at risk groups with antenatal care,
early healthcare interventions and improved parenting. These outcomes
reflect intersectionality and often identify age, ethnicity, disability and social
disadvantage.

Learning disability: A number of outcomes focussed on increasing the
participation of people with learning disabilities in their care and improving
their health e.g. increased uptake of cervical smear testing, improved sexual
health, improved access (support re attending appointments and advocacy).
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Outcomes in this area are aimed at improving accessibility to mainstream
services and have implications for workforce development.

Mental health: Some boards set specific outcomes on mental health. e.g.
increased uptake of psychological services for those over 65 (GCC), improved
access through support making and keeping appointments (Highland), mental
health improved through enhanced access to treatment, preventative
measures and wellbeing initiatives through new technology (NHS 24),
minimise harm resulting from restraint of people with mental health issues in
particular groups - women, men, adolescents, BME and older people (HIS).
Several boards set more general outcomes re improved services for people
who experience hate crimes and gender-based violence.

Gender-based Violence - to date, 9 local and 1 national board (NSS) have
set outcomes for GBV, either in relation to routine enquiry of abuse or the
implementation of the GBV PIN Policy.

Carers: The State hospital and Lanarkshire set specific outcomes targeted at
carers and this was implicit in Highland’s outcomes.

Other recurring themes: Gypsy Travellers, migrant workers (Grampian,
Shetland and Orkney), Keep Well focus on BME, Hate Crime strategies and
LGB&T health.
Training and development to support service outcomes:
Most boards identified training and staff development as actions to support the
delivery of their service outcomes e.g.

Training on processes - Impact assessment for equality & health inequalities
(Health Scotland)

Forth Valley aims to create capacity in teams to develop E&D interventions
specific to departments and create an E&D development tool for managers to
support them and their staff to deliver best practice.

Mainstreaming E&D into other training

Increase opportunities for E&D training (Golden Jubilee)

Lothian plans significant revision and enhancement of their training
programme including consideration of intersectionality and rights-based
approaches.
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
Enhance operational training to include more cultural awareness and
additional disability awareness sessions (SAS)

Development of staff skills in spiritual care (Shetland, State Hospital).

Cultural awareness and human rights in relation to restraint (HIS)
Training and workforce development - Boards have identified a range of specific
issues e.g. person-centred care, gender-based violence, transgender awareness,
communication and support needs of deaf people and those with a visual
impairment, awareness re LGB&T, Gypsy Travellers, mental health (including
learning disability and autism) and staff skills in relation to spiritual care.
In some areas it is clear that there are plans to develop and deliver interventions
locally, usually with the involvement of partners. There are some common areas
where national support may be useful and NES may be the appropriate organisation
to provide such support.
WORKFORCE OUTCOMES
Workforce outcomes were either general (focussing on dignity and respect, fair,
equitable, inclusive employment and recruitment processes) or specific to dignity at
work, access to employment, bullying & harassment, mental health wellbeing and
supporting staff with experience of GBV.
A few boards, including Dumfries & Galloway and Fife, set an outcome for staff to
reflect the diversity of the population. NHS 24 referred specifically to the use of
Modern Apprenticeships to improve access to employment for young people. The
State Hospital set specific targets to reduce the gender pay-gap and gender-related
discrimination for female staff as a result of interactions with patients and NES was
the only board to set an equality outcome around equitable management of
organisational change and one of the few to cover occupational segregation.
Three boards set specific outcomes relating to organisational or management
processes: Deliver and organisational values programme (SAS), senior and line
managers have developed and applied leadership skills to support and motivate staff
to deliver equality sensitive practice (A&A), increased engagement with younger
people in our work (HIS).
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Training to support workforce outcomes
Boards cited a number of workforce training and development activities e.g.

Training on E&D in recruitment and selection (particularly for panellists)

Training for managers to support the implementation of GBV

Increase in access to training on mental health (mental health first aid,
stress awareness)

Establish a programme of mentoring, coaching and skills development
for staff with protected characteristics.

Improving E&D knowledge and skills of Employee Relations staff

E&D training for staff which includes training on bullying & harassment

Organisational values sessions
Business outcomes
A small number of boards set outcomes relating to procurement, performance
management or general organisational development e.g. being an ethical consumer
of goods and services (Fife), reviewing procurement processes (SAS), including
social capital outcomes in service level agreements to build community
cohesiveness and safety (Lothian) and applied leadership skills to senior and line
managers (A&A).
Evidence
Many boards provided summaries of the sources of their quantitative and qualitative
data including those drawn from impact assessments, community involvement
processes and research/evaluation. Please refer to the attached Appendix 1 which
contains a table on the main sources and types of evidence.
There are limitations and challenges to collecting equality monitoring data generally
and also workforce monitoring data, which at present relates mostly to age and
gender. One board that has been successful in gathering workforce data on the
protected characteristics is NES, with the lowest rate of completion being 89.2% for
religion and belief.
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Most outputs focus on improving the collection and quality of data (service and
workforce), and the creation of reliable evidence baselines against which to measure
progress.
Measurement
Some boards have included SMART outputs and measures e.g. the number of
people with a learning disability who access sexual health support and contraceptive
advice will increase by 20% by April 2015. (Highland)
Others have struggled with the lack of baseline data and have proposed to create
these e.g. GCC, Lanarkshire and Forth Valley.
Most measures are aligned with existing board priorities and governance systems
e.g. HEAT targets and some are integrated into broader partnership outcomes such
as SOAs.
NHS Fife is undertaking a ‘small tests of change’ approach (Plan, Act, Study, Do)
and has identified respective indicators.
Summary of key points

There is consistency in alignment with local corporate plans and national NHS
and SG policy priorities.

Some board outcomes are linked into CPP structures and integrated into
SOAs

Approaches to developing outcomes have been characterised by
collaboration – across boards and with external cross sector partners.

There is an infrastructure in place in most boards to support the equality
agenda, but sometimes in isolation and disconnected to related policy work
streams on person-centred care and health inequalities.

There is a contrast in balance between service and workforce outcomes for
local and national boards, with staff requiring training and development
support to deliver on both.

The biggest challenges lie with creating and ensuring the availability and
quality of evidence, setting performance indicators and measuring progress in
a meaningful way.
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Recommendations for action
o To help address the current disconnect in policy work streams within boards,
identify scope at national level to integrate equality, diversity and human rights
legislation explicitly into key NHS and SG policy. Consider using Health
Inequalities Impact Assessment and other tools to assist this process.
o Discuss training and workforce development to support delivery of the equality
outcomes, identifying priorities and areas where national support would be
most useful.
o Consider the most effective ways to create a reliable evidence baseline i.e. by
improving the collection and quality of equalities (and socio-economic) data
for services & workforce and developing a national data set that can be
shared with all boards and cross sector partners to minimise duplication.
(scope for SG Equalities Analysis team/HS/Knowledge into Action Network)
o Establish genuine, ongoing programmes of engagement and involvement with
those affected by inequality/protected characteristics. Consider how best to
share findings from national engagement.
o Share good practice examples of approaches to creating reliable evidence
baselines and devising ‘smart’ outputs and measurement indicators across
boards.
Liz Curran, NHS Health Scotland
Kristi Long, NHS Education for Scotland
September 2013
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Equality outcomes evidence sources (September 2013)
Population
data and
statistics
National
research and
routine data
(ISD/SG
Evidence finder)
Synthesised
effectiveness
evidence
Evidence on
workforce
outcomes - desk
top research
(E&D Workforce
group)
Health Records
Census
Scottish Index
of Multiple
Deprivation
Data from
Scottish
Morbidity
Records
Specialist Service
reviews, evidence
and research
Commissioned
studies
Research
publications from
third sector
equality orgs.
Primary research and
evaluation
Business intelligence
Policy and legislation
Tacit
knowledge
Stakeholder feedback
Annual Review
National SG and NHS
policy context:
Workforce and User
Involvement events.
Workforce equality
monitoring data, exit
interviews
Anecdotal
evidence
from
services,
staff and
public
Equalities Monitoring
Reports.
Patient involvement
processes
Patient and carers
experience/feedback
surveys
Research around carers,
patient experience
Staff Survey
Household
Survey
EHRC national
publications
Audit Scotland
Reports
Evaluation of
previous Single
Christie report
Quality Strategy (2020
Vision)
Employee relations
reports (disciplinary,
capability, ill-health,
redeployment etc)
Equally Well Review
Partnership Forum
feedback
Staff Governance
DATIX incident of harm
monitoring system
Francis Report (NHS
England)
Complaints data
National
Records of
Scotland
Demographic
Fact Sheet
Appendix 1
PFPI Minutes
Internal data i.e. absence
details, complaints data
Research from Scottish
Transgender Alliance
and evidence from
Community groups
National Services Division
reviewing gender
reassignment protocol
and services in Scotland
Person-centred Health
and Care Programme
Informal
discussions
with staff
during
training
sessions
Standards/2020 Vision
Equality & Human Rights
Acts
Local Board Policies and
strategies
Partnership Policies &
Strategies
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Equality Schemes
Annual
Population
Survey (2011)
Research on
Welfare Reform
SG Committee
Reports
Feedback from
community consultation
events.
DNAs
Local ‘intelligence’ e.g.
advocacy monitoring
reports
*primary care
*translation/ interpreting
services
*PIN policies
*GBV routine enquiry
data
*Staff training and
evaluation
NHS Inclusion Index
Survey (2009)
Monitoring reports from :
Patient appointments and
admissions
Quarterly staff
complaints reports
Local migration reports
Spiritual and pastoral
care data
Freedom of Information
(FOI) responses
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