This talk is designed to be an introduction to equality and diversity. Equality and diversity is a wide-ranging topic, so today we will focus on some key concepts and then on what equality and diversity will mean for you in your work in health, social work and/or social care. We’ll do this by talking about a few scenarios, which illustrate the types of issues that come up in health and social care. We’ll also consider your role in delivering a service which promotes equality and is sensitive to diversity. This is a key element of delivering a quality service, and is a fundamental aspect of client-centredness. Sometimes people assume that equality and diversity are only about legal issues and tribunals, or that it’s just a form of political correctness. Hopefully by the end of today you’ll start to see that equality and diversity is so much more than that – and that it’s much more interesting and important. After all, this is ultimately about people, and people are at the heart of the work that we do. And I suspect that this is important to all of you – if not, you’d be preparing for another line of work. This is, however, an introduction. Hopefully we will equip you with some fundamental information, which will then help you start to ask the right kinds of questions. No one learns everything they need to know in a single lecture or even a single course, so I’ll point you in the direction of some useful sources of further information.
Question for reflection: Why is equality important? What are some of the benefits of diversity?
The Equality Act 2010 is a new piece of legislation that recently replaced the 100+ laws, regulations and statutory instruments that made up previous anti-discrimination legislation. It has largely harmonised, and in some cases extended, protection from discrimination and harassment. In the UK, anti-discrimination law dates from the 1970s, starting with the Sex Discrimination Act and the Race Relations Act. The Equal Pay Act was also passed back in the 1970s, and if you’ve seen the film ‘Made in Dagenham’ you will have seen some of the conditions which led to the passage of that Act. In the years since, protection from discrimination was extended to disabled people and then to people on grounds of sexual orientation, religion or belief, and, to a certain extent, age. Discrimination legislation has focussed on both employment and on the delivery of services and access to premises. The Equality Act 2010 incorporates protection from discrimination, harassment and victimisation on the grounds of a series of protected characteristics, which are listed here. This protect is pretty broad, because you are protected if you have a characteristic, are assumed to have it, are associated with someone who has it or is assumed to have it.
But you’ll have noticed that the list of protected characteristics is limited. After all, there are other reasons why people might experience discrimination, or why they experience inequality. Social class, socioeconomic status, inequalities of income and wealth are important. And, indeed they are very important drivers of health inequalities. That’s why the NHS’s strategy on health inequalities, Equally Well, focuses so much on socioeconomic inequality. You might also want to look at the ‘Marmot review’, which is a major study of health inequalities and offers a vision for improving them. You can find the full report, additional data and a range of other resources at http://www.marmotreview.org/. Also, geographic location affects access to services, and sometimes the quality of service. Plus, the geographic and social environment affects a range of things about your life experiences, social inclusion and your health. So people might experience inequality because they live in a deprived area, or because they live in a remote area. The effects might be different, depending on the situation and the location. So this means that, although equality law is important, there may be drivers of inequality that are not protected in law in the same way. But they are likely to affect our work, so it’s important to be aware of these issues.
The Equality Act, and the previous legislation it replaced, were written to protect individuals and groups of individuals from discrimination. So what, exactly is discrimination? The Act defines three types of discrimination. Direct discrimination can be described as less favourable treatment on the grounds of a protected characteristic. Direct discrimination may also involve situations where reliance on a formally neutral criterion affects one group only, even if that was not the intention. Indirect discrimination when a provision, criterion or practice is applied to an individual or group that would put persons of a particular characteristic at a particular disadvantage compared with other persons. Both of these types of discrimination apply to all the protected characteristics. When a disabled person is treated unfavourably because of something connected with their disability and this unfavourable treatment cannot be justified, this is unlawful and is described as ‘discrimination arising from disability’. This type of discrimination only relates to disability. It also does not require a comparator in a legal action. You’ve probably noticed that there is a fourth type of discrimination listed – ‘institutional discrimination’. This is a very important concept which underpins the ‘promotion of equality aspect of the Equality Act. In 1999, a landmark investigation into the Metropolitan police’s investigation of the murder of a young black man, Stephen Lawrence, argued that the police department was ‘institutionally racist’ because the organisation as a whole failed to take account of the impact of race, resulting in shortcomings in the organisation. It’s worth looking at a couple of quotes from that report: “ Unwitting racism can arise because of lack of understanding, ignorance or mistaken beliefs. It can arise from well intentioned but patronising words or actions. It can arise from unfamiliarity with the behaviour or cultural traditions of people or families from minority ethnic communities. It can arise from racist stereotyping of black people as potential criminals or troublemakers. Often this arises out of uncritical self-understanding born out of an inflexible police ethos of the &quot;traditional&quot; way of doing things. Furthermore such attitudes can thrive in a tightly knit community, so that there can be a collective failure to detect and to outlaw this breed of racism. The failure of the first investigating team to recognise and accept racism and race relations as a central feature of their investigation of the murder of Stephen Lawrence played a part in the deficiencies in policing which we identify in this Report. For example, a substantial number of officers of junior rank would not accept that the murder of Stephen Lawrence was simply and solely &quot;racially motivated&quot;. The relevance of the ethnicity and cultural status of the victims, including Duwayne Brooks, and Mr & Mrs Lawrence, was not properly recognised. Immediately after the murder Mr Brooks was side-lined, and his vital information was inadequately considered. None of these shortcomings was corrected or overcome. What may be termed collective organisational failure of this kind has come to be labelled by academics and others as institutional racism.” This report, known as the ‘Macpherson report’, changed the approach to tackling discrimination in Britain. Now, public bodies, or organisations delivering public services, cannot merely ‘not discriminate’ against individuals. Rather, they need to proactively consider how to tackle discrimination more generally, and to promote equality of opportunity between different groups of people and good relations between communities. This is known as the ‘equality duty’ and it is placed on NHS Boards, local authorities, Scottish Government, educational institutions, etc. You can find the Macpherson report online at: http://www.archive.official-documents.co.uk/document/cm42/4262/4262.htm Although the Macpherson report was specifically concerned with race, the concept if institutional discrimination is relevant in relation to other groups and communities. We’ll talk more about what this means for us in health, social work and social care.
Harassment is another form of prohibited conduct in the Equality Act, and it is closely linked to discrimination. This slide provides the definition of harassment in the Act. In addition, there is another specific type of harassment: Sexual harassment -- Refers to situations where the behaviour is of a sexual nature. Or When someone is treated less favourably because they submit to or reject harassment related to sex or to gender reassignment.
It’s fine to know about the law, but the law is there for a reason. It’s designed to compel and encourage action. So it’s not enough to know the basic concepts – we need to think about how to apply them in our work.
That’s the legal background, but what does discrimination or inequality actually look like? What are the potential implications of inequality when we deliver a service? Let’s think about a few examples. In both cases, consider the experiences of inequality. Think about the relation between barriers to accessing services and experience of services are linked to outcomes. Consider the case of Louise C. Louise is the mother of 3 year old Jack and and one year old Amanda. Louise is taking her son to the dentist for a follow up under the Childsmile programme. Louise lives in a deprived area, and she does not have access to a car. She cannot afford child care for Amanda while taking Jack to the dentist, so she brings her along in the buggy. But she is not able to get on the first bus, because the buggy slot was already taken. She arrives 15 minutes late, and the receptionist curtly informs her that she has missed the appointment and will have to reschedule. Louise explains the circumstances but is told that the policy states that if a patient arrives late they must reschedule. Louise feels upset and humiliated because the receptionist chastised her in front of others in the waiting room. When she returns home, she decides that she will not bother rescheduling the appointment. Now let’s think about Imran. Imran aged 20, experiences major depression and has been re-referred to mental health outpatient services. He can on occasions be medication non-compliant and is resistant to any suggestions from Consultants or CPN’s on what he could do to improve his mental health. He only attends outpatient appointments on an ad-hoc basis (over the past 6 months he has missed 3 of his 5 out patient appointments) and can on occasions prove to be difficult to communicate with. At his latest appointment, Imran stated that he felt the service wasn’t really relevant and that he did not understand the purpose of the appointments. Fiona (41) has been referred to the day hospital with severe depression following the sudden death of her daughter. This is Fiona’s first referral to this service The doctor has explained to Fiona what to expect and asked if she had any questions. Fiona has been left feeling reassured that she is involved in her care and that staff have taken time to explain things to her. They have asked if her partner Ruth is her next of kin and that if this can be recorded in her case notes. During a therapy session, another patient became verbally abusive by making loud derogatory remarks about Fiona’s partner being a woman. What would you do if this happened in your ward/care area?
Person-centredness or client-centeredness are key values in health care, social work and social care. Being equality and diversity aware is an essential part of delivering a client-centred service. You will be caring for a person, not an appendix, a set of teeth, a broken hip or a substance abuse problem. And people inevitably mean diversity.
This slide illustrates the ‘equalities lens’. Think back to the quotes from the Macpherson report. In that report, the police were criticised for being ‘race-blind’- that is, for not thinking about the relevance that race or ethnicity may have for their ‘clients’ and for the way they deliver services. This is a very important point. You may often find that people think that they are ‘equality neutral’ when they are actually being equality blind. Think back about Louise and Imran. Have the services taken account of issues like gender, caring responsibilities, socioeconomic inequality, ethnicity and culture? The ‘equalities lens’ is a way of seeing the world which prompts us to ask ourselves – are we taking account of the inequalities people might face when we deliver the service. Are we actually delivering or developing a service in a way which might perpetuate those inequalities, or even make them worse? If anyone tells you ‘this service is for everyone, or this policy applies to everyone, therefore it does not discriminate’, that’s often a sign that we are being equality and diversity blind. In fact, there is higher risk of indirect discrimination in situations like this. Think back to the questions we asked ourselves earlier – that’s a good starting point for asking equality questions.
People often ask – well, what happens when we don’t have good data or research about particular issues. And how do we become aware of what we don’t know? Engaging with service users is a great way to deal with that, and it’s something that you’re likely to do in design of services. Remember to think about the diversity of service users. Some individuals or groups may need support in order to engage.
Equality and diversity is also about you! You are protected from discrimination.
Equality and diversity is not something delivered by specialists or policy makers. Tackling inequality, improving access, experience and outcomes for all Scotland’s people is a task which requires all of us. It may not always be easy – if it were, we’d have waved a magic wand and done it by now. It takes will and focus, and at times you will have to challenge the behaviour, attitudes and assumptions of others.
Equality & Diversity by Kristi Long
Equality and Diversity Dr Kristi Long NHS Education for Scotland
Outline <ul><li>Key concepts in equality and diversity </li></ul><ul><li>What does equality and diversity mean for health and social care? </li></ul><ul><li>What is my role in delivering equality and diversity? </li></ul><ul><li>Where can I find out more? </li></ul>
Some key concepts <ul><li>Equality is about creating a fairer society where everyone can participate and have the opportunity to fulfil their full potential and no one is unfairly disadvantaged. </li></ul><ul><li>Diversity is about valuing peoples’ differences and addressing their different needs and situations. </li></ul>
Equality law: ‘protected characteristics’ <ul><li>Age </li></ul><ul><li>Disability </li></ul><ul><li>Gender reassignment </li></ul><ul><li>Marriage & civil partnership </li></ul><ul><li>Pregnancy & maternity </li></ul><ul><li>Race (incl. ethnic and national origin) </li></ul><ul><li>Religion or belief </li></ul><ul><li>Sex (gender) </li></ul><ul><li>Sexual orientation </li></ul>
Other drivers of inequality <ul><li>Socioeconomic inequality </li></ul><ul><li>Geography </li></ul><ul><ul><li>Areas of multiple social disadvantage </li></ul></ul><ul><ul><li>Remote and rural areas </li></ul></ul>
Discrimination <ul><li>Legally defined as less favourable or unfavourable treatment because of a protected characteristic. </li></ul><ul><li>Can be: </li></ul><ul><li>Direct discrimination </li></ul><ul><li>Indirect discrimination </li></ul><ul><li>Discrimination arising from disability </li></ul><ul><li>Institutional discrimination </li></ul>
Harassment <ul><li>In the Equality Act 2010, harassment is: </li></ul><ul><li>Unwanted behaviour related to a protected characteristic which has the purpose or effect of: </li></ul><ul><li>Violating a person’s dignity or </li></ul><ul><li>Creating an intimidating, hostile, humiliating, offensive or degrading environment for that person </li></ul>
Inequality: some examples <ul><li>Access to services </li></ul><ul><li>Are there barriers which make it less likely that I can access a service? </li></ul><ul><li>Experience of services or quality of service </li></ul><ul><li>Is the service I receive as good as the service others receive? Does it take account of my needs and preferences? </li></ul><ul><li>Outcomes </li></ul><ul><li>What is the result? </li></ul>
This is also about you <ul><li>Fair treatment: protection from discrimination and harassment (from service users, staff, management, etc), treated with dignity and respect; </li></ul><ul><li>Consultation and engagement -- policies, equality priorities, education; </li></ul><ul><li>Reasonable adjustments, flexible working (where relevant) </li></ul>
A role for all of us <ul><li>It is not your duty to complete the work; </li></ul><ul><li>neither are you free to desist from it. </li></ul><ul><li>Pirkei Avot 11.21 </li></ul>