Since the turn of the millennium, the NHS in Scotland has put considerable effort and resources into translating legislative requirements on equality into practical reality as employers, starting with Fair for All and evolving this into a strategic multi-strand approach to equality. Alongside this came another NHS Scotland strategy, Patient Focus Public Involvement, which explained:
‘It is no longer good enough to simply do things to people; a modern healthcare service must do things with the people it serves’.
The Equality Act 2010 gave the work on equality a new impetus and provided greater coherence to an oft-times muddled strategic landscape. In that same year, Scottish Government published guidance on Planning with People : community engagement and participation guidance, which has been revised in 2020 and 2023.
The congruence of these major policy and legal milestones has led to an increase in much of the of the work on equality being in partnership with organisations representing the voices of the communities of people who experience discrimination in the workplace, either in getting into a workplace or, when there, in breaking into the upper levels of the hierarchical employment model which continues to prevail in the NHS in Scotland. Some of this work, by the external organisations or ‘influencers’ is paid. Most often it is unpaid. The aim of this research is to understand the extent of equality of treatment when it comes to the NHS paying ‘influencers’ to assist them deliver employment equality. With the Stonewall[1] Workplace Equality Index[2] being probably the best known form of external support used [and paid for] by NHS Boards, this has been used as a benchmark to compare and contrast the extent to which the NHS in Scotland uses influencers representing the other protected characteristics and whether the assistance is paid for, as well as attempting to measure the overall effectiveness of the approach.
The research found that NHS in Scotland’s default approach to delivering equality appears to be one of continuing with the discredited and out-of-date approach of doing things [changing policies, practices and cultures] to people with protected characteristics, and maintaining an exclusion zone between the potential influences of the collective lived experiences of discrimination and the siloed corporate policies and practices where the discrimination in the NHS is embedded.
Government did appear to try and ‘encourage’ NHS Boards to work with [for a short period] a limited number of collectives of lived experience [Stonewall, Business Disability Forum and the British Deaf Association (Scotland)]. Why these were not made long-term collaborations and why this style of working was not extended to cover all the lived experiences of people sharing protected characteristics has not been explained and is not known.
Both government and the NHS in Scotland need to abandon their highly selective approach to partnering with only some of the lived experience available to help eliminate discrimination in the NHS, as well as ditching the clearly hierarchical approach to which lived experience is awarded ‘favoured status’ in enjoying an all-too-brief opportunity to identify and unearth the sources and causes of institutional discrimination in and across the NHS.
[1] Stonewall lobbies on behalf of people who identify as lesbian, gay and bisexual [LGB]. Stonewall also lobbies on behalf of Transgender people.
[2] Stonewall’s Workplace Equality Index [WEI] ‘scores’ employers according to how accessible their workplace is to LGB people. Employers can improve their ‘scores’, and placing in the WEI league table, by adopting recommendations from Stonewall on changing employment policies and cultures.