In the course of research early in 2021 into the progress with delivering employment equality being made across NHS Scotland, a number of examples of inaccessible information provided quite a few toe stubs in the traversing of the foothills of what passes for employment equality reporting in the NHS. Just one of too many examples is reproduced here :
Analysis of the staff in post data
Analysis of the staff in post data for the years 2018/19 and 2019/20 indicates that a person’s religion or belief may be a factor in them being less likely to work for NHS 24.[1]
In other work Equality Here, Now has been doing with self-organised groups of disabled people, it has been noticed that as a tool for them in saving time and energy in reading through often unnecessarily lengthy, jargon-filled, public sector policy and strategy papers, groups often resort to asking for the same report being made available in an ‘easy read’ format.
Coupled with the common approach taken by public bodies of flagging all their published reports with such as :
This report is also available in large print and other formats and languages, upon request. Please call NHS Shetland on (01595) 743060 or email: shb.nhs.uk/contactus.asp
it was decided to check the reality of accessible information actually being delivered as opposed to that promised by NHS Boards, hence this research.
A number of recurring threads have emerged from the responses provided by Scotland’s NHS Boards to this
research study :
· Organisational and administrative systems established by most NHS Boards appear to be unfit for purpose in that whilst enabling devolution of responsibility for the commissioning of such as alternative format documents to various workplace units, the IT networks put in place have been designed in ways which do not allow the ready aggregation of all alternative documents produced by a Board at any time;
· None of the responses from the NHS Boards indicated, either directly or indirectly, that they had recently [or since 2010] established a clear understanding of a person-centred service user needs profile in the geographical area covered by the Board and as related to the need for some disabled people to have Board information provided in alternative formats - vital if bodies are to show they have anticipated the needs of disabled people as required by the Equality Act 2010
· There appears to be a widespread if not fundamental confusion across the bulk of NHS Boards as to what constitutes alternative formats[1], with a number of Boards including information produced in languages other than English as part of their responses to this FoI request
· Given the actual known number of alternative format documents produced over the last 3 financial years [485], it is concluded that in the great bulk of the NHS in Scotland engagement with patients and service users in that same timeframe, disabled people who need information in alternative formats are not routinely engaged in service design, service re-design or performance improvement monitoring of NHS services in Scotland
· Just one of Scotland’s NHS Boards/Agencies knew and supplied the data on all information documents it had published and the proportion of those which had been published in alternative formats
· While there is evidence of some NHS Boards using the Plain English Crystal Mark standard for the provision of some information, there is no independent monitoring, enforcement and accountability arrangements in place to check what NHS Boards are doing in publishing some documents with the Crystal Mark and most without the Crystal Mark
· There is little or no evidence that Boards are actively rolling out a culture and practice of using Plain English [non-Crystal Marked] as a baseline approach in their routine production of all documents, so making the bulk of information documents routinely accessible to a recognised standard
· There is a complete lack of awareness evident in the responses from Boards of the change introduced by the Equality Act 2010 where the needs of disabled people should be anticipated[2] when it comes to making reasonable adjustments [such as in the production of alternative formats] instead of the common position taken by NHS Boards in Scotland of waiting on being asked for alternative formats
· Most NHS Boards seemed unaware that they could use the procurement of alternative format documents to help them better perform their general equality duty
· None of the NHS Boards have used the procurement provisions of the specific equality duties to commission the production of alternative format documents in a way which helped them better perform the general equality duty
· The known spend of alternative format documents over the past 3 financial years amounted to £70,068.28 - representing 0.00016883855% of the NHS Scotland budget for that same period
· In the wider context, Scottish government is itself unable to evidence that it is meeting that part of the Public Sector Equality Duty where equality of access to published information is in question
The prevailing common thread running through the responses from most NHS Boards across Scotland is that the sharing of documented knowledge and information by the NHS with all its service users, and in formats suited to the particular needs of those service users is, in terms of equality, going unchecked, unmonitored and unevidenced. It is also evident that the NHS in Scotland is being designed, redesigned and performance monitored without the active [and informed] involvement of people who need information in alternative formats – so creating a self-fulfilling cycle of discrimination and exclusion. Critically, the NHS in Scotland has failed to move from a position of waiting to be asked for information in alternative formats to the one required by the Equality Act 2010 – to anticipate the needs of service users by producing information in alternative formats in advance.
[1] https://www.gov.uk/government/publications/inclusive-communication/accessible-communication-formats
[2] Equality & Human Rights Commission, Written Information Guidance - When a service includes providing written information, a service provider must not unlawfully discriminate against, harass or victimise you because of a protected characteristic in: what the information itself says; the way it is provided.
[1] Equality Mainstreaming Report – Workforce Data Update, 2021, Page 41