About Us: Equality and Diversity

NHS Western Isles values and encourages the diversity of cultures represented by both our staff and service users.

We as an organisation are enriched by cultures and beliefs that we encounter day by day in our services, and we seek to learn from these encounters to meet our Corporate Vision and Values.

We seek to be the ‘best at what we do' and to that end we seek to be a healthcare provider that is person-centred in the delivery of our services, and how we treat our staff.

We have in place policies which encourage staff to treat all colleagues and service users with respect and dignity and we do not allow discrimination in our service delivery.

We encourage both staff and service users to discuss with our Equality Leads their experience of either being a member of staff or a service user and such discussions will be used to improve our service and eliminate discrimination.

When service users attend appointments they will be asked to fill in a Diversity Questionnaire for the purpose of analysing the different needs of patients and allowing us as an organisation to be more person-centred in our service delivery. As with all personal information held by NHS Western Isles, this information is treated with strict confidentiality.

Our Equalities & Diversity website explains what we are doing to achieve this.

Age

What is Age?

Unlike other equality strands age does not refer to a discrete group. We have all been young and will all hopefully become old. Age equality means people of every age can take part in society with respect for differences related to their age.

Age may refer to actual or perceived age – based on appearance or assumptions.

Age & Discrimination

Ageism can be very subtle but is common throughout society; it can affect wellbeing, damage confidence and create exclusion. Individuals can be subject to assumptions and different treatment based on their age or perceived age, no matter how old or young they are.

Older people in particular are subject to stigma, prejudice and social isolation. Older people are often also the poorest in society, and some are vulnerable to abuse.

Children and young people can also be discriminated against and can be viewed with suspicion by society. Their lack of power means that their views are often ignored and they are also vulnerable to abuse.

Discrimination arises either because difference is ignored and therefore people’s needs are not met, or difference is recognised but forms the basis of unfavourable treatment or stereotyping.

Age equality means that age should not be used to define or presume anything about the role, value or potential of an individual.

Why Age Matters to Health

Older People
Long life is a sign of good health, and the ageing of the world’s population is an indicator of improving health worldwide. Although there are no specific conditions or illnesses associated with ‘being old’, the older people get the more likely they may be to experience a range of different conditions such as chronic disease, cancer and disability, and to experience more than one of these together.

Young People
Healthcare, lifestyle and experience in childhood and adolescence have a significant impact on physical and mental health in later life. Certain conditions particularly affect young people, such as some inherited problems, accidents and injury, and sexual and mental health issues, or they may have different experiences of conditions which affect all ages e.g. cancer.

All Ages
Traditional assumptions about age related conditions are increasingly being challenged. People with conditions previously associated with childhood, e.g. cystic fibrosis, severe physical disability, are increasingly surviving into adulthood. Similarly, younger people may suffer from conditions previously associated with ‘old age’ such as dementia or the need for social care and support.

Age discrimination and health
Age discrimination in health can lead to inappropriate treatment, misdiagnosis or reluctance from patients to get involved with health services. It may take some of the following forms:

  • stereotyping of old age as being automatically linked to ill-health
  • low expectations of older people’s mental capacity, leading to inappropriate behaviour or symptoms not being believed.
  • health or social care support or treatments having upper or lower age limits.
  • lack of support or time for meals, resulting in undernourishment
  • young people being placed in adult wards
  • information not produced with age group in mind
  • judgemental attitudes
  • confidentiality and anonymity not respected
  • abuse or neglect or older or young people, in hospitals, care settings or at home
  • denial of the right to make choices about health and personal affairs.

Age & Other Protected Characteristics

Age discrimination links to other forms of discrimination –

  • Older people, especially older women are often on low incomes. This is caused by a combination of factors including the state pension not being linked to earnings and women being less likely to have occupational pensions of sufficient level.
  • Disability increases with age, especially visual impairment and blindness. In 2005, 78% of those registered blind or partially sighted in Scotland were over the age of 65.
  • Young people may be discriminated from exploring their sexuality by their family, at school or in hospital. Homosexual young people may be less likely to express their sexuality due to fear of discrimination from family, friends and other young people. This can lead to low self-esteem and serious long-term negative health effects e.g. attempted suicide.
  • Peer pressure can pressure young people into concealing their religious beliefs or practices, while overt symbols of faith make young people more likely to be victims of religious provocation.
  • Ageing may further reduce the ability to communicate for those for whom English is not their first language.
  • Teenage girls who live in areas of deprivation are three times more likely to become pregnant; terminations are less likely in poorer areas and young women are ten times more likely to become teenage mothers.
  • The health of older people in Scotland varies according to social circumstances. The gap in life expectancy between the most affluent and deprived communities has widened significantly in the last 20 years, particularly among males.
  • Death rates from unintentional injuries are three times higher for children living in most deprived sections of the population.

How We are Addressing Age Issues

The NHS Western Isles Equality & Human Rights Policy sets out what the organisation is doing to ensure it meets its responsibilities to promote age equality and remove age discrimination across all its services and functions.

A ban on age discrimination within public services came into force in April 2012. This ban applies to people aged 18 years and over. It offers no protection to those aged under 18 years. However, the Scottish Government is currently seeking to align domestic legislation with the United Nation’s Convention on the Rights of the Child by introducing a Children and Young Peoples (Scotland) Act 2014, which ensures that public bodies such as Local Authorities and Health Boards/Police Scotland must now report every three years on what they have done to improve the rights of children and young people. This came into effect from August 2016

NHS Western Isles continues to work towards introducing inequalities sensitive practice as a means of ensuring no-one using our services is discriminated against on grounds of age or any other protected characteristic.

It is also working to raise awareness of the nature of direct and indirect age discrimination and our responsibilities under equalities legislation. For example, we are reviewing any age-based criteria for accessing services and changing to a needs-based approach to both service access and judgments and decisions about treatment and care.

Overall service planning is increasingly taking account of the changing age profile of the population and the impact this will have on demand for services. Awareness of the need to ensure age equality within our services informs this planning process. However, there are circumstances where a targeted approach to specific age groups is appropriate both when providing services and when consulting and involving individuals. For example, undertaking community consultation and engagement on local dementia services.

Increased protection for older adults is now in place through the Adult Support and Protection Act and the Western Isles Adult Support & Protection Committee.

Support & Resources

There are a number of publications, reports and groups who can provide advice and support.

Publications

Websites

Disability

What is Disability?

A person has a disability that is covered by the Equality Act 2010 if they have a physical or mental impairment that has a substantial and long-term effect on their ability to carry out normal day-to-day activities.

For example:

  • Sensory impairments such as being blind or deaf
  • Mobility difficulties and other physical disabilities
  • Learning disabilities and people who are autistic
  • Mental health problems
  • Facial disfigurements
  • Speech impairments
  • Memory problems, such as
  • Long-term conditions, such as epilepsy, dyslexia and cancer

It is important to note that the definition can cover illnesses and conditions which some people may not immediately think of as a disability, such as asthma, depression, heart disease or diabetes.

The social model of disability
This model recognises that an individual is disabled not by their impairment or medical condition, but by a society which fails to meet their needs.

For example, if an individual is unable to read information provided at an open day because they have a visual impairment, the social model sees the organisation as the problem because they have not provided suitable material that can be read by someone who is visually impaired, such as Braille or large print documents.

Disability & Discrimination

Discrimination occurs when a person or organisation treats a disabled person less favourably than they would treat others. This discrimination can affect issues such as education, employment, income and health.

For example:

  • disabled people of working age face considerable disadvantage compared to people without an impairment. On average their incomes are about 20 per cent lower than the incomes of non-disabled individuals and their employment rates are half the size
  • international evidence shows that people with learning difficulties or long term mental health problems on average die 5-10 years younger than other people, often from preventable illnesses
  • 15% of deaf or hard of hearing people say they avoid going to their GP because of communication problems

Why Disability Matters to Health

People with disabilities can suffer poorer health for a wide variety of reasons. For example, it may be due to the fact that:

  • people can't get access to services or communicate with service providers
  • the health of disabled people is given less priority than that of other patients
  • an illness may be wrongly thought to be part of a person's mental or physical disability
  • people with long term disabilities are particularly likely to live in poverty
  • some conditions are linked to a higher rate of a particular health problems

NHS Western Isles promotes the social model of disability, which means that it is up to the organisation and the people in it to ensure that disabled people have the same opportunities to enjoy good health as non-disabled people.

Disability & Other Equality Groups

A recent survey of people with disabilities found the following –

  • 63% of respondents reported that they were not in work, and 91% of those were not seeking employment – well above national averages.
  • Over 30% of respondents stated that they found it difficult or very difficult to manage on their current income.
  • Nearly half of disabled people in work said that they had experienced discrimination in the workplace.
  • A significant majority of respondents (78%) felt that they faced barriers which limited their life chances.
  • Almost half of those surveyed stated that, because of their disability, their level of academic attainment took longer than non-disabled students, and over half claimed to have had their courses or choice of subjects restricted.

How We Are Addressing Disability Issues

It is the responsibility of service providers and employers not to discriminate against a person on the grounds of their disability, regardless of how the person may describe themselves. This is important because many people may not regard themselves as ‘disabled’, but they will still have rights under the Equality Act. The law applies to all disabled people who use NHS services. This includes visitors and members of the public, as well as patients and staff

Specific examples of work include:

Hospital Access Film

Production of a hospital access film presented to NHS Western Isles Operational Management Group with an action plan on the recommendations, including involvement of film participants to be part of the redesign of reception and hospital signage

Staff Support

Development of a short-term working group to review and discuss the development of a policy to support disabled staff to promote the importance of a workplace culture which supports disabled colleagues.

‘Clear to All' Accessible Information Policy

Development of a local policy to ensure that patients who have communication support needs can have access to written information in the format that meets their needs, such as Braille, words and pictures, British Sign Language or audio version.

Deaf People & Health Services

A range of work currently being undertaken by NHS Western Isles to promote British Sign Language (BSL) as a language and culture and improve the experience of our Deaf BSL patients. This includes a BSL Online Interpreting Service and a plan to include The Western Isles Sensory Centre in the NHS Western Isles Diversity & Equality Steering Group to better meet the needs of deaf and hard of hearing people. Staff training in BSL is also available on request.

Support & Resources

NHS Western Isles Easy-Read Publications

Local Support

  • Autism Eileanan Siar, tel. 0744 442 5322. Email: eilean.siar@gmail.com
  • Community Nursing Service for People and Carers with Learning Disability, Stornoway Health Centre, Springfield Road, Stornoway. 01851 763335
  • Social Communications Team. 01851 708283
  • Western Isles Community Care Forum, Room 14, Council Offices, Tarbert, Isle of Harris, HS3 3BG. 01859 502588.  Email: info@wiccf.co.uk
  • Western Isles Learning Shop. 01851 822718.  Email: learningshop@cne-siar.gov.uk
  • Western Isles Sensory Centre, Esplanade Court, Stornoway, HS1 2XA. 01851 701787

Publications

Websites

Gender/Sex

What is Sex/Gender?

In the Equality Act 2010 ‘sex’ means a woman or a man or a group of women or men. Sometimes it is hard to understand exactly what is meant by the term ‘sex’, and how it differs from the closely related term ‘gender’.

Our sex is determined by the sexual organs we are born with – men are born with a penis, women a vagina.

Gender relates to the types of behaviours society expects of men and women. We learn these behaviours as we grow through a range of images and messages given to us by parents, schools, friends and the media. For example, young girls might be given dolls to play with and princess outfits to play in, while boys may be given guns and soldier uniforms. Society has a set of gender expectations of women and men that differ for each sex.

Currently, masculine characteristics are more highly valued than feminine characteristics and world-wide, this ascribes more power and wealth to men than to women. This in turn reinforces sets of behaviour, which have significant implications for the pathways into poor health.

Sex & Gender & Discrimination

Sex discrimination exists when a person (man or woman) or group of people (men or women) are treated unfairly solely on the basis of their sex. An understanding of gender is important to understanding inequality between women and men. Discrimination on the basis of gender is both subtle and persistent.

Women are expected to be ‘natural carers’ which has led to a huge imbalance in the types of jobs women do, how much they earn, how much housework/ caring they do and disapproval of society if they do not conform to this stereotype.

Men are expected to be ‘strong’ and unemotional, and they can often experience barriers when seeking jobs that require a degree of caring or empathy. Their masculinity can single them out for additional duties that rely on physical capacity rather than capacity to care.

There is a very serious side to this imposed difference. It means that women consistently earn less than men throughout their lives and often live in poverty when they are older. This lack of economic power has also meant that women have less power in society and less access to positions of power in politics.

In most cases we grow up feeling a sense of comfort or acceptance with our gender (as prescribed by biological sex at birth). However, a small number of us (around 1 in 11,500) find as we grow our prescribed gender is so different from our internal sense of where we exist in relation to being a boy/girl, man/women that we express a wish to live in the opposite, more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender people' also covered by the Equality Act 2010.

Why Sex & Gender Matters to Health

NHS evidence has shown that treating women and men the same, without considering the differences between them, means that underlying gender-related links to health problems are ignored and patients’ health needs are not met. For example-

  • One in four women are likely to experience domestic abuse over their life course and that prevalence rates for child sexual abuse are estimated at around 21% of girls and 7% of
  • Men are more likely to participate in risk-taking behaviour which leads to premature mortality and to use their power to commit acts of violence and abuse which affect themselves and women and children of both
  • Men are also less likely than women to participate in health improvement activity or to present to primary care in the early stages of
  • Where men have experienced abuse in childhood, this experience can manifest itself in a range of health and social problems in both childhood and adulthood but is often not identified as part of medical
  • Women still tend to have multiple social roles as employees, as carers and as the primary managers of This imposes stresses that can have physical and psychological impacts on their health.
  • Some diseases have been seen solely as ‘women’s’ or ‘men’s’ diseases due to gendered biases in medical research, leading to delays in diagnosis and treatment (e.g. heart disease – leading cause of mortality in UK women but still seen as a ‘male disease’)

Other examples of where gender expectations affect health are:

  • In Scotland, women are between two and two and a half times more likely to report experiencing depression and anxiety than
  • Suicide rates are almost three times higher in men than in
  • Men are more likely than women to die of injuries outside the
  • The gap between women's and men's smoking rates is changing, with more young girls taking up the habit than
  • Young men aged 16-24 are most at risk of becoming a victim of violent crime

Sex & Gender & Other Protected Characteristics

Gender differences cut across all the other protected characteristics such as age, race and social class.

For example:

  • male life expectancy (76.6 years) is six years lower than for females (82.7 years) in the Western Isles – NHS Western Isles has the largest gap between male and female life expectancy in Scotland
  • male life expectancy in the Western Isles is the fourth poorest in Scotland, four years lower than Orkney which has the highest male life expectancy (80.3 years)
  • female life expectancy in the Western Isles is the highest in Scotland (equal to Highland and Orkney) at 82.7 years
  • Asian women aged between 15-35 are two to three times more vulnerable to suicide and self harm than their non-Asian counterparts
  • retired women and lone parents are most at risk of poverty and average incomes of women in work are

Other inequality issues can prevent people from receiving health services and treatment appropriate to their sex. For example, some disabled women have been told that they do not need cervical smear tests because of assumptions about their sexual behaviour.

How We Are Addressing Sex & Gender Issues

The NHS Western Isles Equality & Human Rights Policy sets out what the organisation is doing to ensure it meets its responsibilities to promote gender equality and remove sex discrimination across all its services and functions. Most actions in this document involve addressing gender issues. In addition, actions on closing the health gap between affluent and deprived communities in NHS Western Isles take into account the different needs of women and men.

Some examples of actions include:

  • Equality Fairness Assessments undertaken throughout NHS Western Isles has a strong gender element
  • An NHS Western Isles Gender-based Violence Action Plan has been in place for a number of years
  • Women and child poverty work has gained increasing prominence in NHS Western Isles
  • Sex and gender issues are key within the NHS Western Isles Equality & Human Rights Policy and the Staff Governance Standard (e.g. Equal Pay Audit and Work, Life, Balance policies)
  • A gender analysis of our equality scheme, NHS Western Isles Equality & Human Rights Policy and the Staff Governance Standard, which sets out how we will meet the needs of equality legislation

Support & Resources

NHS Western Isles Publications

Publications

Websites

Gender Reassignment

What is Gender Reassignment?

In most cases we grow up feeling a sense of comfort or acceptance with our gender but this is not true for all people. Around 1 in 11,500 people will find that as they grow up, they feel less comfortable with the gender prescribed to them at birth, and will instead, find greater comfort and connection to another gender. They may then express the need to live in this different and more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender’ or ‘trans’ people and the process through which we can move from one gender to another is called gender reassignment.

Gender Reassignment & Discrimination

Transgender people will face discrimination and prejudice across their life course and will often experience high levels of abuse before transitioning due to a rejection of their gender at an early age. In this way, many Trans men and women will experience homophobic attitudes (because of how society expects their gender to behave) before transitioning and experiencing both transphobic and homophobic attitudes during and after transitioning.

In regard to transgender equality issues, the Equality Act 2010 provides the following:

  • In the Equality Act 2010 ‘gender reassignment’ is named as an explicit protected characteristic, alongside age, disability, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual
  • The requirement for medical supervision to take place as part of a process of ‘gender reassignment' has been removed so someone who simply changes the gender role in which they live without ever going to see a doctor is
  • All the main protections which already existed for gender reassignment are carried over from the previous Sex Discrimination Act legislation – g. protection from gender reassignment discrimination in employment and goods and services. The previously existing exceptions are also carried over.
  • The Equality Bill offers new protection from discrimination due to association with transsexual people or perception as a transsexual
  • It also offers new protection from indirect discrimination because of gender
  • The public sector equality duty is extended to more fully include gender reassignment as one of the specific protected characteristics for which public bodies must take due regard of: the need to eliminate discrimination, harassment and victimisation; the need to promote equality; and the need to promote good
  • Protection is provided for gender reassignment discrimination in education

 Why Gender Reassignment Matters to Health

Transgender people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many Trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for Trans people include:

  • Mental health problems including suicide, self harm, anxiety and depression
  • Lack of primary care facilities as many GPs have no or little knowledge of transgender people’s needs
  • Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for trans women
  • Lack of awareness and understanding of care providers so that transgender people are in appropriately treated in single gender outpatient and inpatient services.
  • Inconsistent funding and access to gender reassignment services throughout Scotland
  • Lack of social work service to support children, young people, adults and families with gender identity issues.
  • Social exclusion, violence and abuse and the resulting negative impact on health and well-being

Gender Reassignment & Other Protected Characteristics

It is important to remember that transgender people are not all the same and gender variance can be significantly diverse. Transgender people can be straight, gay, bi-sexual and lesbian, black and minority ethnic, old and young, part of a faith group, married, single, with a partner, in a civil partnership, disabled, pregnant, unemployed and living in poverty. People tend to have many facets to their lives so any assumptions about transgender people will invariably be the wrong assumptions.

How We Are Addressing Gender Reassignment Issues

The needs of the transgender community are covered within the NHS Western Isles Equalities & Human Rights Policy which sets out our commitment to ensure equality of access to services that are both appropriate and sensitive. We refer to the Sandyford Initiative which provides a number of specialist services that are recognised as being amongst the best in the UK. However, there are still barriers experienced by transgender people using mainstream NHS services. It is essential that frontline NHS staff do all they can to remove the stigma of gender reassignment and play their part in delivering services of the same standard to transgender people. To this end, training has been offered to support staff in responding to queries from transgender service users.

Support & Resources

Publications

Websites

Inequalities

What is Inequalities?

Inequalities can be defined by:

  • economic factors (wealth, income, occupation)
  • political factors (status, power)
  • cultural factors (lifestyle, education, values, beliefs).

Despite arguments that the class system has changed over the past 50 years it is still the case that important differences in shared beliefs and values relate more obviously to class than any other social category.

Social class leads to inequalities of resources, whether that is income, education, housing or health.

Inequalities & Discrimination

People’s experience of class and poverty can lead to their views not being heard, being left out when decisions are being made, isolation and humiliation.

A recent poll showed that poor people in particular think that class, not ability, greatly affects the way they are seen.

Many people are dependent on sickness or unemployment benefits or low paid work. This has led to growing inequality.

More recently information has become available on the impact of the recession in 2009, changes to tax and benefits as part of the spending review and changes to welfare reform.

A recent review of mortality in EU countries since the recession showed that the downward trend in suicide before 2007 reversed in 2008 and increased by 7% in those younger than 65 years and increased again in 2009. This immediate rise in suicide is an “early indicator” of the recession crisis, such as the turmoil in the banking sector which later led to unemployment.

Stuckler et al. Effects of the 2008 recession on health: a first look at European data, The Lancet, Vol. 378, July 9, 2011

Why Inequalities Matters to Health

Social class leads inequalities of resources, whether that is income, education, housing or health.

The link between social class and health was identified almost 30 years ago. In 1980, there was found to be a clear inequality in life expectancy between men in social class 1 (managers and professionals) and social class 5 (unskilled workers).

The reasons for the link between social class and health includes things such as health risks in low paid, unsafe jobs and stress caused by having low status and lack of power.

Upward and downward social mobility can improve or decrease people’s life chances. Certain events such as leaving home, becoming a parent, losing your job or bereavement can make us vulnerable to falling into a low income or low status in society.

Social class inequality has an impact on the whole of society. Research shows that more equal societies have better health rather than richer societies where there is a bigger gap between rich and poor.

Inequalities & Other Protected Characteristics

There is a strong link between social class and groups with other protected characteristics, as they are often denied access to power, wealth, status, resources and opportunities.

For example:

  • 68% of disabled people have an income of less than £10,000
  • Women are more likely to be poor than men due to lower paid jobs, part-time jobs and the fact that 90% of lone parents are women
  • In Scotland today the pay gap between women and men can translate to a loss of over £330,000 in a woman’s working life – just because she is a woman.

How We Are Addressing Inequalities Issues

NHS Western Isles is carrying out a range of work to tackle inequality as a result of income inequality, poverty and social issues.

We aim to reduce health and social inequalities by improving the health of individuals and families; in particular those who are vulnerable due to poverty and homelessness through:

  • increasing financial support for vulnerable families
  • improving access to public services
  • reducing health consequences of homelessness
  • improving smoking cessation rates in targeted areas
  • increasing health literacy
  • reducing fuel poverty for elderly frail.

Local health and social care partnerships mean that staff work together to give people support with health and social issues to reduce health inequality.

Support & Resources

Local Support

Publications

Websites

Race & Ethnicity

What is Race & Ethnicity?

Ethnicity refers to a common group identity based on language, culture, religion or other social characteristics. This means that people define their own ethnicity, that everyone (and not just those in minorities) has ethnicity, and that a person's ethnic identity may change over time. For example some people might describe themselves as Scottish Chinese.

Race is the group you belong to, or are perceived to belong to, in the light of a limited range of physical factors. The term ‘race’ should be used in relation to legislation only and not to describe people who belong to an ethnic group.

The term BME is often used within the public sector. It’s an abbreviated term for Black and Minority Ethnic and is often used to describe people from minority ethnic groups, particular those who have suffered racism or are in the minority because of their skin colour and/or ethnicity.

Race & Discrimination

Racism refers to the combined use of power with racial prejudice (the belief that some races are inferior to others) which leads to the oppression or discrimination of specific racial or ethnic groups.

Racism can be detected through attitudes, processes, behaviours and actions which impact on any ethnic group/s and can lead to differences in education and employment opportunities, living conditions and health.

The Race Relations legislation is designed to ensure that large public organisations like NHS Western Isles promote race equality and challenge discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origins. We are required to:

  • eliminate unlawful racial discrimination
  • promote equality of opportunity
  • promote good relations between people of different racial

Why Race Matters to Health

Race and ethnicity affect people's health in a number of ways. Our ethnic background can affect our susceptibility to certain diseases and conditions. There is also a clear link between discrimination and health and implications for the way in which health services should be provided.

For example:

  • People of African origin formed just over 5% of the minority ethnic population in Scotland in 2001, but represented 33% of the psychiatric patients in hospitals who were from ethnic minorities.
  • Female service users from several minority ethnic groups have strong preferences for dealing with only female health care staff. Gender issues can play an important factor in the uptake of services.
  • A survey on psychiatric illness rates amongst ethnic minorities found that depression was most common among Indian and Pakistani people.

Race & Other Protected Characteristics

Racism can be intensified by other forms of discrimination, for example on the basis of sex, disability, age and social class.

  • Black African women are six times more likely to die from pregnancy-related causes than white women.
  • Women from the South Asian community are less likely to attend breast cancer screening and only half as likely to accept an invitation to be screened for bowel cancer than members of the non-Asian community.
  • Evidence suggests the health gap between white and black/minority ethnic communities is greater in older people.
  • Over a third of people from minority groups are in poverty after housing costs are taken into account, compared with 17% of the ‘white British' group

How We Are Addressing Race & Ethnicity Issues

The Western Isles Equalities & Human Rights Policy explains how the organisation is meeting the requirements of equality legislation. This includes demonstrating how we will assess the impact of the measures we have put in place to ensure race equality for service users and staff.

Areas of work include:

Interpreting service

Interpreting services address a number of risks for both service users and staff. For example, patients who have a limited understanding of English:

  • may not be able to give informed consent
  • may not be able to ask questions or seek assistance
  • may not be aware of what services are available to them
  • may not be able to use medication properly or follow care plans
  • may come from cultures with different understandings of health and illness
  • may not understand how to use NHS services
  • may not understand their rights and responsibilities within the healthcare system

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned. In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHS Western Isles has a Service Level Agreement with Languageline Solutions which provides interpreters to NHS patients on request. The service is available to a wide range of service areas and departments, including hospital wards, outpatient clinics, medical practices, dental surgeries, pharmacies and opticians located throughout the NHS Western Isles area.

‘Clear to All' Accessible Information Policy

Development of a local policy to ensure that patients who have communication support needs can have access to written information in the format that meets their needs, such as Braille, words and pictures, British Sign Language or audio version.

A toolkit for staff has been developed which helps to provide information and support in the development of accessible information for NHS patients, their carers and the public.  Easy Read materials are produced in consultation with Advocacy Western Isles. The toolkit aims to ensure that the material we develop is clear, consistent with NHS Western Isles guidance, accurate and in everyday language.

Asylum Seekers & Refugees

An Asylum Seeker is a person who has submitted an application for protection under the Geneva Convention and is waiting for the claim to be decided by the Home Office.

A refugee is someone who has had their asylum claim accepted.

Syrian Refugees

Through the Syrian Vulnerable Persons Resettlement Scheme (VPRS), the UK Government Home Office works along with the UN High Commissioner for Refugees (UNHCR) to identify those most at risk and bring them to the UK.

The scheme was launched in January 2014 and has helped those in the greatest need, including people requiring urgent medical treatment, survivors of violence and torture, and women and children at risk.

On 7 September 2015 the Prime Minister announced an additional 20,000 Syrian refugees would be resettled in the UK over the course of the current UK Parliament.

Issues for Asylum Seekers and Refugees

Many of those arriving in Scotland are families with children who are fleeing violence and persecution in their own country. They are coming here because they are vulnerable. We are well-equipped to help. A support structure is already in place for all nationalities seeking asylum. Central government meets the reasonable costs of looking after asylum seekers, so local services will not suffer.

Recent research from Glasgow showed that key issues for people from minority ethnic communities include:

  • safety – racism, hate crime and relationships with the police;
  • social opportunities – culturally appropriate sport and leisure services;
  • health – awareness of services, issues around isolation, lack of culturally sensitive services;
  • employment – high priority issue, some variations in employment levels across ethnic groups;
  • learning – English language classes and culturally sensitive learning opportunities; and
  • other priority areas – suitable housing.

Economic migrants

Economic migrants come from EU countries covered by the European Union. People come to the UK from France, Germany, Spain, Ireland and Italy and, since new countries joined the European Union (known as the Accession Countries or the A8), Polish people, followed by Slovakians, have been the most common economic migrants.

Key Resources

Alternative Languages

Gaelic

NHS Western Isles' Gaelic Language Plan has been in operation since 2012, with the Operational Diversity Lead responsible for developing the Plan.

As part of the Plan, the Board aims to modernise bilingual signage throughout its sites and offers Gaelic conversation language classes to its staff via the University of Highlands & Islands (Ulpan and Ceolas). Gaelic translation is also available on request.

Gaelic resources produced by, on in conjunction, with NHS Western Isles:

Other Languages

NHS Western Isles utilises Languageline Solutions which provides a wide range of interpreting and translation services, as well as an online video BSL service.

For further information or to obtain a translation please contact Rev. T.K. Shadakshari, Head of Spiritual Care Department, Western Isles Hospital, tel. (01851) 704704 ext. 2408 or email: tk.shadakshari@nhs.net

Support & Resources

Publications

Websites

Religion & Belief

What is Religion & Belief?

There are a number of features which can define what religion is, including collective worship, a clear belief system and profound belief affecting the way of life or view of the world. It may be further characterised by prayer, ritual or religious laws. It is also the case that some people who do not formally belong to a faith or belief group will have beliefs about a deity, the after-life etc.

Religion and belief is a protected characteristic under the Equality Act 2010.

Religion & Belief and Discrimination

Discrimination with a focus on religious belief and religious difference is not a new phenomenon. For many years the West of Scotland has been characterised by sectarianism which continues today. Religious discrimination, and suspicion of religions, has come to the fore again due to a rise in Islamophobia – particularly after September 11th in America and the July 7th bombings in London.

In the past there was no specific protection against discrimination for most religious groups. There was, however, protection for people from Sikh and Jewish communities who were protected under the Race Relations Amendment Act as an ethnic group. Religion is often woven in with race and culture to form personal or group identity. Black/Minority ethnic communities, who can be on the outskirts of society, have often used religion to express and to sustain their identity.

There is now greater protection from religious discrimination through the Equality Action 2010. Religion & belief is a protected characteristic and everyone who is protected under law from discrimination, harassment or victimisation is afforded the same level of protection.

For some people, their religion is important to their health yet often the cultural and practical dimensions of religion are not assessed and taken account of when individuals attend for health care. This can be considered as a form of discrimination, can cause distress and as a result can have a negative impact on the effectiveness of diagnosis and treatment.

In the same way that other examples of equality categories often remain invisible to health care organisations and therefore in the way that services are planned, there is lack of data on patients for whom religion is significant to their wellbeing. In addition, strong views on any particular form of religion can lead to prejudice and discrimination against other beliefs – often referred to as sectarianism. This too can have an impact on the physical and psychological wellbeing of individuals. There can also be assumptions that everyone has a faith of some description despite a large percentage of people who consider themselves to be atheist. Any assumptions about faith can lead to experience of discrimination.

Why Religion & Belief Matters to Health

A person’s value system, sense of purpose and inner strength, whether resulting from religious or other sources, has been linked to how they respond to illness and treatment. Our approach in NHS Western Isles focuses on ‘spiritual care’ and ‘spiritual needs’ as outlined in the Spiritual Care Policy. This recognises that all people, whether religious or not, have spiritual needs that may or may not include aspects of formal religion or belief. People will gain comfort and strength to face illness from being allowed to practice their religion while in hospital.

Appropriate recognition of religious practices and preferences, and consideration of the patient’s spiritual needs, are particularly important in the care of the dying and in dealing with the deceased and their family after death. This also has a relevance to the care offered in our Maternity Units at a time of peri-natal or neo-natal death. Consideration of spiritual needs equally applies to people who have a non-religious stance.

Religion and Belief within a health care environment can also impact on

  • gender and choice of staff
  • disclosure of sensitive information
  • attitudes towards illness and health

Religious views may also affect the way in which health promotion messages are received and acted upon. Some religious practices, such as not drinking alcohol or vegetarianism, may have positive links to health. Others may affect whether or not certain medications can be taken due to animal/alcohol by-products.

Religion & Belief & Other Protected Characteristics

There may be examples of poor health resulting from the disharmony between some followers of religion and other equality groups.

For example, people within the LGBT communities who practice or follow a religion may face additional health issues such as mental health problems or feel isolated, perhaps due to discrimination within their faith community.

How We Are Addressing Religion & Belief Issues

NHS Western Isles has a multi-levelled response in tackling inequalities associated within religion and belief.

  • The organisation actively pursues the capture of religion/belief from its staff at recruitment stage as well during the course of employment (SWISS) to ensure that it doesn’t discriminate against one group of
  • We have developed a Spiritual Care Policy outlining the nature of spiritual care, the provision of spiritual care facilities in our hospitals, training and education, the role of all staff in delivering spiritual care and the importance of consultation with faith and belief
  • Healthcare Chaplaincy, as an NHS service, has a key role in responding to the spiritual and religious needs of staff, patients and Healthcare Chaplains function on a ‘generic basis’ whereby their service is for all people, regardless of faith or belief. They are a point of contact to draw in care and support from particular faith and belief groups.
  • The organisation provides mandatory online training to staff at induction level and during the course of employment on equality and diversity which includes religious/ belief Training on subjects such as Loss and Bereavement is under development, including reference to the needs of those from faith communities.
  • Service Providers using our Fairness Assessment can identify whether their services are actively addressing issues associated with religion and belief and put in place necessary actions
  • The production of Culture, Religion and Language practical guide to help staff care for patients from a range of faith groups.
  • The Catering Service provides Halal, Kosher and vegetarian meals upon Work is being undertaken to meet the needs of other religious groups.

Support & Resources

Publications

Websites

Sexual Orientation

What is Sexual Orientation?

Lesbian’, ‘gay’, ‘bisexual’ and ‘heterosexual’ are better described as ‘sexual orientation towards people’, rather than ‘sexual attraction to’. This reflects the fact that people build committed, stable relationships and it is not purely a focus on sexual activity.

Everyone has a sexual orientation. Sexual orientation is a combination of emotional, romantic, sexual or affectionate attraction to another person.

In other words, it's about who you are attracted to, fall in love with and want to live your life with.

For the purposes of this sexual orientation webpage, we have looked at lesbian, gay, bi-sexual and heterosexual issues only, as the term transgender does not relate to sexual orientation but rather the gendered identity of an individual. For more information transgender issues please see Gender.

Sexual Orientation & Discrimination

Discrimination on the grounds of sexual orientation can take several forms – from blatant abusive behaviour (1 in 3 gay men and 1 in 4 lesbians have experienced violent attacks) to more subtle forms that may go unnoticed by many.

Discrimination on the basis of sexual orientation is a crime under current Scottish Law.

Some examples of discrimination include:

  • Refusing to employ someone because of their sexual orientation. A case previously heard how a gay man was ‘advised’ not to follow a career in paediatrics – based on the belief that gay men are a risk to vulnerable groups. This is at odds with all evidence, which clearly shows that sexual orientation does not influence the likelihood of carrying out sexual abuse or a sexual assault.
  • Refusing accommodation. A recent survey showed that 70% of people living in rural areas of Scotland supported the right to refuse holiday accommodation on the grounds of sexual orientation.

Why Sexual Orientation Matters to Health

Examples of how sexual orientation can affect health include:

  • Research looking at mental health suggests gay men and lesbians report more psychological distress than heterosexuals. This can often be associated with a lifelong exposure to bullying and abuse. Surveys have shown extremely high percentages of young lesbian, gay and bisexual (LGB) people reporting verbal and physical abuse. It has also been found that young LGB people are up to six times more likely to attempt suicide that heterosexual youth.
  • Drug use amongst gay men has been found to be significantly higher than for heterosexual men. Research suggests that drug use is in part due to low self-esteem, and also due to the attitudes of society towards this group.
  • Lesbians have specific health issues relating to fertility, pregnancy, sexual health and mental health. However, there is evidence that lesbians are afraid to tell their GP of their sexual orientation in case they experience discrimination.
  • Figures show that gay men and men who have sex with men are generally at higher risk of contracting HIV/AIDS than heterosexual In 2006, 38% of all new cases of HIV/AIDS were found within this population group.Gay men and men who have sex with men are also at higher risk of contracting Gonorrhea, with 81% of all new cases diagnosed in 2006 found within this group.

Sexual Orientation & Other Protected Characteristics

Any sexual orientation other than heterosexual often receives negative responses from parts of our society and this can be made worse when combined with other equality issues.

Disabled lesbians and gay men face the same challenges experienced by many disabled people who live in poverty or on very low income. In addition, lack of money means that many disabled lesbians, gay men and bisexuals are excluded from the LGB social scene, often based in pubs and clubs, which can result in increased isolation. Even if money were not an issue, many venues would be inaccessible to some disabled people.

There may be tensions between sexual orientation and other protected characteristics. For instance, someone who identifies as being LGB but also belongs to a particular faith group may experience negative attitudes from other members of that faith group. It may be that some members of a faith group act in a way that might discriminate against LGB people. Recent high profile media coverage has centred on people with faith beliefs refusing to provide goods and services to LGB people in terms of holiday/leisure accommodation.

How We Are Addressing Sexual Orientation Issues

It is an offence to discriminate against someone on the grounds of their sexual orientation.

NHS Western Isles wants to get better at understanding both its workforce and the people who use our services. We know that sexual orientation affects health. We routinely collect information on sexual orientation from the people who use our services. Without this, it is difficult to deliver services that meet everyone’s needs. We are working towards introducing a collection of routine information relating to sexual orientation supported via a Sexual Orientation E-Learning module for all staff.

Staff training on ‘Getting it Right for LGBT+ People' has been made available through an annual Equality & Diversity event, alongside specific LGBT training. This practical learning session offers the opportunity to find out more about sexual orientation and gender identity and why it’s so important for health professionals to respond confidently to LGBT+ people’s specific needs and build trust in service delivery.

NHS Western Isles Diversity & Equality Steering Group is established has a zero tolerance approach to homophobia. A good practice guide is to be developed to encourage staff and patients to recognise and challenge discrimination on the grounds of sexual orientation.

Support & Resources

Publications

Websites

Pregnancy and Maternity

The law covering discrimination on the grounds of pregnancy and maternity is largely unchanged by the Equality Act 2010. It remains unlawful to exclude a job applicant on the grounds of pregnancy or maternity and to remove opportunities for training, promotion or other workplace benefits (unless there are clear and demonstrable health and safety issues).

However, female employees now have added protection during and shortly after the pregnancy term – referred to as the ‘protected period’. This means that when an employer is addressing time away from work relating to pregnancy, they don’t have to make a comparison with how other staff members would be treated.

For example, Lydia is pregnant and works at a call centre. The manager knows Lydia is pregnant but still disciplines her for taking too many toilet breaks as the manager would for any other member of staff. This is discrimination because o pregnancy and maternity as this characteristic doesn’t require the normal comparison of treatment with other employees.

Activities

Additional Support & Communication

Imagine your child is sick. You take them to hospital but you can’t find a way to let the staff there know what is wrong. They ask you questions, but you don't understand what they are saying.

This is just one of the frightening scenarios which people can find themselves in if they have difficulties with the types of communication many of us take for granted. There are many reasons why someone might find themselves in this situation:

  • English is not their first language
  • They have a visual impairment, are deaf or hard of hearing
  • A condition such as a stroke or having learning difficulties makes communication or other cognitive impairment hard
  • They have difficulty reading

Health staff not being able to communicate effectively with patients can have real consequences for their health and the services they receive.  Many patients miss appointments or are unable to access services because of the language barrier. It is also frustrating for staff who find themselves unable to communicate with their patients.

The NHS Western Isles Equality and Diversity Team aims to ensure that our health service is providing effective communication support for all those who need it.

If you feel that you, or a relative who we are caring for, would benefit from some additional support to make their stay more comfortable, or to help them communicate, please ask a member of staff.  We offer:

  • Communication tools through Speech & Language, such as Boardmaker
  • Playlist for Life, the personalised music playlist
  • What Matters To You, highlighting the most important things to you
  • Alternative support (such as hearing loops)
  • Languageline Solutions, for those who need support in other languages (link to Languageline info section above)
  • Signposting to other support groups.

For further information please contact Rev. T.K. Shadakshari, Head of Spiritual Care Department, Western Isles Hospital, tel. (01851) 704704 ext. 2408 or email: tk.shadakshari@nhs.net

Gender Based Violence

Domestic abuse, sexual violence, child sexual abuse and other forms of gender based violence cause immense pain and suffering and are a major public health issue.

The physical, emotional and psychological consequences of gender-based violence can be profound and include injury, anxiety, depression, addictions, self harm and suicide.

Many people affected by gender-based violence are reluctant to come forward to other agencies, often through fear or shame, but do present across the whole range of primary and acute health settings.

Consequently, health workers are in a unique position to provide help and support. Ignoring or not responding to gender-based violence means that you cannot treat the presenting health issue properly and, at worst, could increase the risk of long-term and chronic ill-health and even death.

For example, Gender-based violence programme and Female Genital Mutilation (FGM) programme to develop the practice of sensitively asking service users about their experience of abuse.

Useful links

Welfare Reform

NHS Western Isles has a number of programmes of work which aim to ensure that our  services understand how to recognise and respond to the life circumstances that are affecting someone's health. Evidence shows that if these issues are not taken into account by the health service, opportunities are missed to improve health and reduce health inequalities.

Recent changes to the welfare benefits system are the biggest for 60 years and are having aprofound impact on the people of Scotland and NHS Western Isles. These changes are likely to have a profound effect on NHS Western Isles patients. There is likely to be an increase in diseases relating to poverty and we can expect increased demand for mental health and primary care services and a negative impact on carers.

The changes come at the same time as the UK economy is experiencing low economic growth, rising unemployment and increasing levels of personal debt. The combination is likely to widen the health inequality gap, increase poverty and have a negative impact on the local economy. Click here to see reference document.

Welfare reform affects both people who are unemployed and people in work. Over 50% of people who are considered to be living in poverty are in work and often claim benefits such as working tax credit.

The Scottish Government published the consultation document A New Future for Social Security for Scotland to seek views on the devolved powers over disability benefits and some other elements of the social security system.

Your Right to Social Security in Scotland is a short film clip about Scotland's new social security powers, produced by the Scottish Human Rights Commission.

Welfare Reform and the NHS

Health practitioners are already reporting increased demand for services as a consequence of financial worries. There is also likely to be:

  • an increase in diseases relating to poverty
  • increased demand for mental health and primary care services
  • a negative impact on carers

Further information on what NHS Western Isles is doing to mitigate the impact on patients can be viewed with the Health Promotion Department's Health Inequalities webpage.

NHS Documents

GPs at the Deep End

General Information

Patient Involvement

NHS Western Isles wants to work in partnership with patients, service users, carers, support groups and other stakeholders in the planning of our services.  We want to learn from peoples’ experiences to improve our services.

We want to give everyone in the Western Isles the opportunity to have their say. Our patient involvement activities specifically engage with people representing the interests of all the protected characteristics and other groups that experience discrimination.

People’s experience of inequalities impact upon their health, how they engage with health services and manage their health problems.

Through our patient involvement work, we want to ensure that patients have equal access to and a better experience of our health services. It is important to us to obtain your comments and feedback on the variety of initiatives, proposals and service changes we offer and provide.

How can I get involved?

You can help us to develop NHS services that are right for you by telling us what you think and getting your voice heard.

There are more ways than ever before to get involved including:

Patient Panel

NHS Western Isles Patient Panel is a voluntary group of group of people who are patients or have been patients in the past, or who are carers of patients.

The aim of the Patient Panel is to work with NHS Western Isles to improve the service provided to patients, relatives and carers, as well as assisting staff in providing the highest level and quality of care.

The group assist NHS Western Isles in providing improved communication and information between patients, relatives and carers, staff and members of the board to help improve service provision. Members review and make suggestions for ways and means of improving accessibility to services.

Patient Panel members will raise issues relating to both satisfaction and concerns with service provision, to ensure the patient voice is heard. Patient Panel members will promote patient and public partnership within NHS Western Isles, providing the patient perspective on issues of discussion both within the Panel and in wider NHS groups on which Panel members serve.

Members may also be asked to make comment/observations on policies that influence patient care, safety and service provision.

To achieve these aims, Patient Panel members are invited to take up any vacant positions as they arise for lay representatives on Committees. Members may also be invited to participate in audits for example; nutrition, access etc. In addition there is a commitment to ensure that patients are involved in providing feedback on any changes that will improve the general hospital environment

If you are interested in being involved in hospital services and quality of care to patients, why not find out more about the Patient Panel? You will be invited to meet some existing members and decide if it may be something you wish to become part of. You would then be supported to complete an NHS Volunteer recruitment process.

For further information please contact the Patient Focus Public Involvement team, tel. 01851 708041 or email: wi.PFPI@nhs.scot

Face to Face

  • Become a member of one of the five Integration Joint Board Locality Planning Groups.
  • Find out more about the North Uist Patient Participation Group at the North Uist Medical Practice
  • Find out more about the South Uist Patient Participation Group at the South Uist Medical Practice and Benbecula Medical Practice
  • Become a public representative on an NHS group or committee
  • Take part in our Annual Review
  • Join the Managed Clinical Networks

Online or in writing

  • Use the Care Opinion website to share your experience (which can be done anonymously if you wish) and get feedback directly from NHS Western Isles staff.
  • Follow NHS Western Isles on Twitter @nhswi
  • Like our NHS Western Isles Facebook page to hear about news and events to hear about news and events at NHS Western Isles.
  • Give your response to our Public Consultations
  • Contact the Patient Advice and Support Service Advisor based at the Citizen's Advice Bureau Stornoway on Freephone 0800 917 2127 for free, confidential and independent advice and support.

Public meetings and events

  • Attend our Board meetings
  • Attend meetings of the Outer Hebrides Community Planning Partnership

To get involved or find out more please contact the Patient Focus Involvement team by emailing: wi.PFPI@nhs.scot or phoning 01851 708041.

For further information please contact:

Rev. T.K. Shadakshari
Lead Chaplain
Department of Spiritual Care
Western Isles Hospital
Macaulay Road
Stornoway
Isle of Lewis  HS1 2AF

Tel. (01851) 704704 ext 2408
Email: tk.shadakshari@nhs.scot