Equality in service provision

While Scotland has specific equality duties which require public bodies to gather and publish data on people employed and so enable transparency and accountability in equality of employment opportunity, there are no specific equality duties which require public bodies to gather and publish data which enables scrutiny on just how much equality there is for people in access to, experience of, and outcome from services provided by public bodies.

Recent research in the area of employment equality did reveal as a by-product that there are some public bodies who realise this represents an imbalance and have put in place systems to gather and publish relevant data. Stirling University, for example is able to evidence the size of attainment gap in students, reporting data sets for BME students as against non-BME students.

The Scottish government’s own Equality Evidence Finder resource in relation to equality in health is limited to two surveys, one from 2010 based on the inpatient status of 30,880 people and one in 2011 based on the primary care status of 145,569 people. No evidence is offered based on an any aggregation of what data Scotland’s 22 health boards have themselves gathered and published on equality of access to, experience in and outcome from people using their health services.

In 2016, Equality Here, Now carried out research which aimed to provide an aggregation of what all 22 health boards had been doing in gathering data to evidence equality for people in access to, experience of, and outcome from health services, with a particular focus on the protected characteristics of disability, ethnicity, sexual orientation and religion [particularly people identifying as Catholic or Protestant].

The research concluded :

There are probably three elements which require emphasis in any conclusion on what this research has revealed.

First. The NHS 24 response to the FoI questions included reference to an entry in that Board’s Risk Register. This flagged :

“there is a risk that NHS 24 fails to comply with the Equality Act 2010 due to a lack of co-ordination and consistency when capturing measurable and robust equality monitoring information of the people that use NHS 24's services.”

It would not be unreasonable to conclude that a similar degree and nature of risk could be applied to most if not all of Scotland’s Health Boards in the context of meeting the public sector equality duty on eliminating discrimination in the provision of services.

Secondly, it is also not unreasonable to conclude that there is strong evidence that institutional discrimination is present in the culture and practice of Health Boards providing services to people from all the protected characteristics. Until this is recognised and admitted by Boards themselves, the point of arrival at a time where achieving the goal of eliminating discrimination can be heralded is being pushed ever further into the future and left as something to be achieved by another generation.

Thirdly, the evident confusion between the very different work and goals on eliminating discrimination and that of reducing health inequalities demonstrates very poor strategic leadership and which has led to a confusing conflation between both areas of work in many Health Boards. As with the failure to acknowledge and own up to institutional discrimination, until such times as all involved understand the difference between discrimination and health inequalities, and are led by people who know and provide clear guidance on the distinction, failure to achieve the goal in either area will continue to be haunt the reports on equality in health for many years to come.