Equality and Human Rights in Practice
Equality and Human Rights in Practice
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Equality and Human Rights in Practice
As we saw in the health inequalities vulnerability triangle, there are lots of factors that lead to health inequalities.
Public organisations like the NHS can advance equal opportunities under the Public Sector Equality Duty by gathering and using information. This can help to identify groups that might be disadvantaged. The organisation can then make plans to remove or minimise these disadvantages. This helps to reduce inequalities.
Examples of health inequalities
The following are examples of health inequalities:
People living in deprivation die younger than people living in better-off neighbourhoods
People with mental health problems are more likely to be physically ill than other people
Evidence shows higher rates of mental health problems amongst lesbian, gay and bisexual (LGB) people, compared with heterosexual people. There is also evidence that discrimination in society contributes to the higher incidence of mental health problems among LGB people.
British people of Asian heritage are less likely to have a good experience when using NHS services than white British people [
Gathering information
NHS and social care organisations need to gather information to measure these inequality gaps. This information might include:
The numbers of people with different protected characteristics using different services
The results of patient surveys from people with different protected characteristics
What patients with different protected characteristics tell us about their experiences of using our services
The numbers of people with different protected characteristics applying for jobs with us, being shortlisted and being appointed
Using that information
We can also use the same information to measure whether we are being successful in reducing the inequality gaps, as required by the Public Sector Equality Duty.
This is why it’s important to ask patients, job applicants and staff members to fill in forms telling us their age, sex, race etc.
Let's have a look at how this might happen in practice.
Human Rights
FREDA is a way of thinking about human rights in health and social care. Let’s look at the letters.
F
F
Fairness
R
R
Respect
E
E
Equality
D
D
Dignity
A
A
Autonomy
Case Study
Helen is 51 and has learning disability. She lives with her partner, Joel, in independent supported housing.
In January, she was invited to attend a breast screening appointment at her local hospital. She was very frightened and did not want to go.
When Helen uses NHS services she has a right to:
· Fairness
· Respect
· Equality
· Dignity and
· Autonomy
Let's see how this happened in practice for Helen.
Fairness
Only 1 in 2 females with learning disabilities receive breast cancer screening, whereas 2 in 3 females with no learning disabilities receive breast cancer screening.
We don’t know exactly why this happens. It is likely to be a combination of different factors, including:
The letters inviting women for screening are too complicated for someone with a learning disability to read and understand
Someone with a learning disability may have had previous poor experiences of health care when treatment was not explained in a way they could understand and this has meant they have become anxious about any medical procedure
She may therefore decide not to attend screening
Respect
When Helen arrived for her appointment everyone treated her with respect and recognised her right to access breast screening in the same way as a person who did not have a learning disability.
Staff were careful not to patronise Helen or Joel.
Equality
Helen needed information in easy read (uses simple language and pictures). The hospital provided this.
It was sent to her with her appointment letter so she could discuss it with her advocate (advocates don’t speak on behalf of people with a learning disability – they make sure a person's own voice is heard. Advocates support people to develop the skills, confidence and knowledge they need to voice their concerns and make sure they are being treated correctly). Helen needed more time. The hospital learning disability liaison nurse met with her and discussed her needs with the breast screening staff. A double appointment time was booked.
Helen attends breast screening - this shows that Helen does have breast cancer. She attends a follow-up appointment where she is told she has to have an operation to remove a breast lump.
Remember when Helen uses NHS services she has a right to:
· Fairness
· Respect
· Equality
· Dignity and
· Autonomy
Dignity
Helen is very worried about the operation and what her partner Joel will think about this.
The hospital takes her concerns seriously and arranges for Helen to see a breast cancer nurse with Joel. The nurse explains what will happen using easy read - Helen also attends the appointment with an advocate so she can remember the questions she has and be supported to ask these.
Autonomy
Helen attends hospital for her operation. She has been assessed as having capacity to consent.
She has the support of her advocate when she talks to staff about agreeing to the operation.
She has brought a 'Hospital Passport' with her which helps her to explain to staff the things they need to know about Helen, the things that are important to her and her likes and dislikes.
Passports
Passports
Are used in lots of health and social care setting's
They easily enable staff to meet the needs and requirements of a service user.
How to Make an Inclusive Workplace
Farrah, Robert, Ruth and Sophie are employed on Ward 16 at the Hospital of the Future.
Farrah recently started on Ward 16, Ruth recently transferred from Ward 14 after working for over 40 years at the hospital and Robert is a newly qualified staff nurse. Sophie has been employed on Ward 16 since she qualified a year ago.
Ward 16 staff hold a regular ‘girls' night out’. A poster has appeared in the coffee room and several staff are discussing their plans for the night. The last night out was a great success, but it was noticed that some members of staff did not attend despite the night being advertised in the coffee room. It is agreed that to be more inclusive partners can come next time.
Farrah, Robert ,Ruth and Sophie all feel excluded. Why might this be?
Farrah
I love working on Ward 16; I get really good feedback from the patients.
Most of the staff I was working with last night went on the girls' night out. They asked me to go but I’ve never been on this type of night out; it’s not something I think I would be comfortable with.
My religion is important to me and I don’t drink. I feel a bit left out this morning and everyone is talking about it. There is a post on Ward 12 that has been advertised and I’m thinking about applying for it.
Robert
Why didn’t I go on the girls' night out? Well, it’s obvious, isn't it? Don’t get me wrong; I have been invited as a ‘token boy’ but I'm not really comfortable with that. I suppose this is what it’s like working in a profession that is 77% female! Seriously though, I would like to get to know my work colleagues a bit better and have some downtime - it’s really stressful on that ward at the moment.
Ruth
Well, I was going to go as it sounded like a good night out and an opportunity to get to know my colleagues better. But then I was in the toilet and I heard a couple of the staff talking - they said they thought that I probably would not want to go because of my age. I was really upset - it makes me wonder what else they say about me.
Sophie
The girls' night out? Yes, I was invited but I said I couldn’t go.
They were talking about it in the coffee room this morning and decided to make it more inclusive by inviting partners and they know my partner is a woman. They think that’s why I don’t come out, but that’s not it. I’m deaf; everyone is aware and some staff have said 'Don’t worry, Sophie; we treat everyone the same on Ward 16 even if they have a disability', but for me going on a noisy night out is quite difficult. I don’t want to make a fuss - everyone gets on well at work and the girls' night out has been happening for years on Ward 16.
The staff on Ward 16 didn’t deliberately discriminate against any of their colleagues and they hoped their girls’ night out would help to create a friendly atmosphere at work and a good team spirit. They’d made sure that they weren’t excluding their lesbian and gay colleagues when they invited partners along.
Making assumptions
The staff still assumed that everyone would feel comfortable on a noisy girls’ night out with alcohol and this wasn’t the case for Farrah, Robert or Sophie. And some colleagues assumed that Ruth was too old to enjoy a noisy girls’ night out.
It’s very easy to make assumptions. Assumptions like this are part of what leads to inequalities between different groups of people.
Feeling excluded
In this case, some staff felt excluded and this is likely to have a negative effect on their health and how well they contribute at work.
We all need to do our best to make sure that we are including everyone, to avoid making assumptions linked to someone’s characteristics and to talk to colleagues who we see doing this
Making Assumptions
Do you remember the scenario presented to you at the beginning of this session – about the father and son who had been in an accident and the surgeon who wouldn’t operate on the boy?
Did you work out that the surgeon is the boy’s mother?
It could also be that the boy's parents are a same-sex couple and he has two fathers.
We need to be careful about the assumptions we make.
Working in an Equal and Diverse Environment
If we are successful in creating an equal and diverse workplace, we will see the following benefits:
A fair, moral and inclusive society
Better recruitment and retention of staff
Fewer complaints
High staff morale directly linked to better patient care and service delivery, which means patient satisfaction is higher and mortality rates are lower
Reduced bullying and harassment cases and associated sickness rates which result in improved productivity
A better reputation as an organisation
Greater success with organisations meeting their legal obligations
Better access to services for everyone and better experiences when using the services. This is directly linked to the long-term sustainability of health and social care organisations
How to Challenge Prejudice, Discrimination and Unfairness
A Somali asylum seeker is waiting to see a clinician at the health hub. The receptionist, Martin, mentions to his colleague, Sophie, that 'These Africans are always here looking for freebies and shouldn’t be allowed free healthcare'. The patient overhears them and feels embarrassed, especially as she has experienced similar behaviour from healthcare staff on other occasions.
What should Sophie do?
Have a think what would you do? How do you think the woman feels? how would you feel if this was you being spoken about?
Team XL would like Sophie to:
Calmly say 'When you say that, it makes me feel very uncomfortable', then speak to Martin more about it afterwards, Explain how and why the incident was inappropriate and the impact of his comments and views.
If these comments continue to speak to her line manager.
It can be difficult to challenge a colleague’s inappropriate behaviour.
The following suggestions will help:
· Have the conversation face to face rather than via email
· We are all responsible for building an inclusive environment and making it clear that we don't condone discriminatory or stereotypical remarks. It is also important that we do our best to support anyone on the receiving end of a discriminatory remark
· Avoid blame. Confront the issue rather than the person. Your aim is to help the person you are speaking with to understand why their behaviour/remark is not OK (remember that it may not have been deliberate) and to work out how to behave differently in the future
· As in any effective conversation, you should aim to do as much listening as talking. Sometimes we can work out how to do better for ourselves without being told
· You can get advice before the conversation from:
o Your line manager
o A human resources (HR) representative
o An equality and diversity manager
o A freedom to speak up guardian
If you don’t feel able to challenge a colleague, then report the matter to your manager.
The XL Teams response
It is important to challenge this remark but in an educational way rather than in an aggressive way so that Martin can learn to change his behaviour without getting defensive. Not addressing this remark will probably leave the patient feeling unsupported and will not help to ensure the XL Team is an inclusive environment and employer.
It is important to speak up if you witness any unfairness. If you feel you are unable to speak to your colleague directly or you believe the incident was serious please speak to your line manager. The Team XL have an open door policy that enables our staff to escalate to any level appropriate.
The XL Team are proud to be an inclusive employer and service provider and have equality and diversity embedded into our visions, values and ethos. We take all breaches seriously, we believe in education and behaviour changes, however, we have terminated employees that show a complete disregard either online or in-person.
Equality and Diversity - A Summary
While equity and equality are related, there are important distinctions between them. For health and social care providers, equity involves trying to understand and give people what they need to enjoy full, healthy lives, personalising the level of care to the individual. By contrast, equality delivers the same quality of care in order for people to enjoy full, healthy lives. Like equity, equality aims to promote fairness and justice, but it can only be achieved if we remove the barriers (both physical and attitudinal) in society and organisations.
Equality vs Equity
Equality and diversity are not about treating people the same. If we do this, inequalities remain.
Individual Adjustments
Making individual adjustments for individual people makes things fairer and more equal for those people.
Removing Barriers
Removing barriers, or the causes of inequality, is the most effective way to make services and society fairer for everyone now and in the future.
Some inequalities have multiple causes so this can take time and effort but in the long run it’s what we should be aiming for.
There are a number of actions you can take to ensure you can help promote equality.
Do you know what Our organisation’s values are?
Organisational Vision, Mission & Values
VISION
To provide the highest standard and best value service to the community.
Be the best we can be, working hard to ensure our communities are at the centre of what we do. We are committed to keeping people safe, improving quality of life, and making our areas better places to live, work and visit.
MISSION
To improve public safety through prevention, protection, response, and resilience.
Making our communities safer and meeting the needs of the people we serve, by identifying, understanding, and tackling the risks that exist within our sector. We will be accessible and provide a high standard of service 24 hours a day, 365 days a year.
VALUES
Respectful, Honest, Courageous, Ambitious, Inclusive, and Transparent
Guided by the standards of behaviour captured in our values, we will support our staff to embrace challenges, recognise achievements and live out our values in making our communities safer and exceeding expectations. The public expect us to be there when they need us, but also role model the very best standards of behaviour. When we make decisions and work together, our values are the things we keep in mind every time. They are important to us, and non-negotiable.
Open Door Policy
Here at the XL Team, you can report any behaviours freely to all of the management structures directly.
Staff can use the whistleblowing policy.
If you are not aware of our operational structure or contact information please speak with your line manager.
Session Summary
Key Points
· Equality, diversity and human rights are important to everyone working in health and social care, for patients and for service users
· We all have a role to make sure that services are accessible and that everyone has a positive and inclusive experience
· In the workplace we also need to think about inclusion and recognise the diversity of those we work with, ensuring that they feel valued and respected
· Think about what you can do to promote values and behaviours advancing equality, diversity and human rights in the work that you do
Next Steps
Continue to the Equality, Diversity and Human Rights eAssessment. This should be completed to demonstrate the required knowledge and understanding and to complete the training. Remember to also familiarise yourself with local procedures.
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