About Us: Equality and Human Rights

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.

View the short film by the the Equality & Human Rights Commission titled ‘What is Age Discrimination? Equality law: discrimination explained’.

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.

Increased protection for adults at risk of harm or neglect is in place through the Adult Support and Protection (Scotland) Act 2007. While the Act defines adults at risk as those aged 16 years and over, it provides protection to many older people with cognitive impairments such as dementia.

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.

The United Nations Convention on the Rights of the Child (UNCRC) is the base standard for children’s rights and sets out the fundamental rights of all children. On 16 March 2021, the Scottish Parliament unanimously passed the United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill (‘the UNCRC Bill’). The UNCRC Bill is a landmark piece of legislation that aims to incorporate the UNCRC into Scots law to the maximum extent of the Scottish Parliament’s powers.

We already use the UNCRC as a framework to ensure that we consider children’s rights whenever we take decisions, and to help provide every child with a good start in life and a safe, healthy and happy childhood. It forms the basis of our national approach for supporting children, called Getting it right for every child (GIRFEC). Fulfilling children’s rights is also critical to our commitment to #KeepThePromise that all care experienced children and young people will grow up loved, safe and respected.

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. 74.25% 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. anxiety, depression and feeling suicidal.
• 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 women 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 40 years, particularly among males.
• Emergency hospital admissions as a result of unintentional injuries are 40% 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

Support & Resources

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

Publications

• ACAS – Age Discrimination: Key points for the workplace
• Age UK – Later Life in the UK
• Centre for Ageing Better – Health Inequalities in Later Life
• NHS Federation – Delivering Dignity: Securing dignity in care for older people in hospital and care homes
• Scottish Government – A Fairer Scotland for Older People: A Framework for Action
• Scottish Government – Children's rights: Human rights
• Scottish Public Health Observatory: Older People
• The Calouste Gulbenkian Foundation – That Age Old Question: Ageing and Social Cohesion

Websites

• Age Positive, UK government site for age legislation.
• Age Scotland
• Citizens Advice Scotland
• Equality Scotland
• Generations Working Together
• NHS Western Isles – Public Health Protection Team
• Policy Research Institute on Ageing and Ethnicity (PRIAE)
• Progressing Age Equality (NHS Health Scotland)
• Public Health Scotland
• ReMind UK – We're getting ahead of dementia
• Scottish Government – Children's Rights
• Scottish Public Health Observatory
• Silver Line Scotland – free national helpline
• UN Convention on the Rights of the Child

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 dementia
• 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.

Also, not all disabilities are immediately apparent and may be described as “hidden disabilities”. These could include long-term conditions such as epilepsy, Autism, some sensory impairments and mental health conditions.

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.

The lived experience Model of disability
The Lived Experience Model of disability recognises that each individual experience may be different but that there will be commonalities too and it is these commonalities which should inform policy and services etc. Many people see this type of model as a development of the social model.

• Click here to go to our Mental Health & Learning Disability website

Disability & Discrimination

The Equality Act is designed to ensure that large public organisations like NHS Western Isles promote disability equality and challenge discrimination on the grounds of disability.

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.

The following is a short film by the Equality & Human Rights Commission titled ‘What is Disability discrimination?’

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
• how we plan our services does not take account of the needs of disabled people e.g. the need for quiet space
• 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 Protected Characteristics

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.
• In the UK Black people are more likely to be detained under the Mental Health Act.
• Women are more likely to become disabled throughout the course of their lives.
• More than one third of LGBTQ+ identify as having a disability.
• 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.
• Identifying as a disabled person does not mean that a person does not also identify in some other way in relation to. For example. Their religion, sexuality or social class. Such intersecting identities need to be considered when promoting disability equality and when ensuring equal access to services across NHS Western Isles.

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 in any hospital redesign proposals.

Staff Support

Development of a short-life 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.

Deaf People & Health Services

A range of work 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 Staff training in BSL is also available on request.

Support & Resources

NHS Western Isles Easy-Read Publications

Local Support

• Autism Eileanan Siar, tel. 07555 632 044. 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

• British Sign Language (BSL)  National Plan 2023-2029
• A Fairer Scotland for disabled People: Our Delivery Plan to 2021 for the UN Convention on the Rights of Persons with Disabilities
• A Fairer Scotland for Disabled People: Working for Change
• A Fairer Scotland for Disabled People (Easy Read Summary)
• Disability discrimination: the law on disability discrimination

Websites

• Accessible Travel Hub
• Alliance – Health and Social Care Alliance Scotland People at the Centre
• Carers Scotland
• Citizens Advice Bureau
• Disability Equality Scotland
• Disability Information Scotland
• Disability Safety Hub
• ENABLE Scotland
• Equality and Human Rights Commission
• Inclusion Scotland
• Inclusive Communication
• NHS Western Isles Mental Health & Learning Disability Service
• National Autistic Society 
• Scottish Commission for People with Learning Disability

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.

In terms of gender, some people describe themselves as gender fluid or non- binary The difference between gender fluidity and non-binary people is the fact that gender fluidity is one aspect of the non-binary spectrum. A range of people on the gender identity spectrum do not see themselves as male or female. They could be agendered, trans or simply identify as non-binary

The following short film by the Equality & Human Rights Commission is titled ‘What is sex discrimination?’.

 

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

Sex and 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 lower.

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

• Gender Pay Gap Information
• NHS Western Isles Bi-annual Equality & Diversity Mainstreaming Progress Report 2021-22 & Equality Act Statutory Report 2023

Publications

• Older Women & Work – Looking to the Future
• Everyday Terrorism – How Fear Works in Domestic Abuse
• Human Trafficking – Making the Links

Websites

• Equally Safe 2023: Preventing and eradicating violence against women and girls: strategy 
• Women’s Support Project
• Men's Health Forum
• Rape Crisis
• Sexual Health Scotland
• Violence Against Women Prevention Scotland

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.  “Trans” is an umbrella term to describe people whose gender is not the same ass, or does not sit comfortably with, their birth.

In the Equality Act the process through which we can move from one gender to another is called gender reassignment. All transsexual people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one.  You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

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. To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one. You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.
• The Equality Act says that you must not be discriminated against because of your gender reassignment as a transsexual. You may prefer the description transgender person or trans male or female. A wide range of people are included in the terms ‘trans’ or ‘transgender’ but you are not protected as transgender unless you propose to change your gender or have done so. For example, a group of men on a stag do who put on fancy dress as women are turned away from a restaurant. They are not transsexual so not protected from discrimination.
• 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.
• Intersex people (the term used to describe a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male) are not explicitly protected from discrimination by the Equality Act, but you must not be discriminated against because of your gender or perceived gender. For example, if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination or disability discrimination.
• The following is a short film by the Equality & Human Rights Commission titled ‘What is gender reassignment discrimination?’.

 

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

• Getting Equalities Monitoring Right– Stonewall
• NHS Scotland Gender Reassignment Protocol
• Engaging All Staff in Trans Inclusion– Stonewall
• Transgender Equality– House of Commons Women & Equality Committee
• Homophobic and Transphobic Hate Crime
• Changing for the Better(employer's guide) – Stonewall

Websites

• Scottish Transgender Alliance
• Press for Change
• The Sandyford Initiative
• LGBT Youth Scotland
• Gender Identity Research & Education Society (GIRES)

 

 

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

• Getting Equalities Monitoring Right – Stonewall
• NHS Scotland Gender Reassignment Protocol
• Engaging All Staff in Trans Inclusion – Stonewall
• Transgender Equality – House of Commons Women & Equality Committee
• Homophobic and Transphobic Hate Crime
• Changing for the Better (employer's guide) – Stonewall

Websites

• Scottish Transgender Alliance
• Press for Change
• The Sandyford Initiative
• LGBT Youth Scotland
• Gender Identity Research & Education Society (GIRES)

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

• Citizens Advice Scotland, tel. 0808 800 9060
• Eilean Siar Foodbank (Facebook page), tel. 01851 706650. Email: eileansiarfoodbank@gmail.com
• Tighean Innse Gall, tel. 01851 706121. Email: info@tighean.co.uk

Publications

• The Role of Health & Social Care Partnerships in Reducing Health Inequalities (2018)
• The Fairer Scotland Duty: Interim Guidance for Public Bodies (March 2018)
• Scotland's Equality Evidence Strategy 2017-2021
• Community Empowerment (Scotland) Action 2015
• A Connected Scotland: Tackling social isolation and loneliness and building stronger social connections
• Shifting the Curve – Independent Advisor on Poverty & Inequality
• Welfare Reform (link to Resources/Welfare Reform section further below)
• Impact of Austerity – BHA newsletter Nov 2012
• Scottish Government consultation document on Poverty, Inequality and Deprivation

Websites

• NHS Inform – other languages and formats 
• Scottish Government Poverty in Scotland
• Benefits Uptake Campaign – Scottish Government
• Poverty Alliance
• Child Poverty Action Group
• Scottish Community Development Centre

Asylum Seekers and Refugees

For some groups of people, a combination of factors such as discrimination, prejudice, stigma and life circumstances, steadily increase their risk of poor health.

Some of these people are protected by equality laws. Many of them use health services where their additional needs can be met through Inequalities Sensitive Practice.

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.

While it is relatively easy to account for the number of people seeking asylum living in Glasgow, it is more challenging to establish the number of refugees. There are no reliable figures available on the number of refugees in the UK, Scotland or Glasgow.

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 in 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.

Ex Service Personnel

Data from a range of support organisations indicate that many ex-service personnel can be vulnerable to a range of health and social inequalities, for example homelessness or mental health problems such as depression and stress. They can have difficulty finding employment, claiming benefits and with social isolation.

Health Concerns regarding ex-service personnel

Research has found that depression is a more common mental health condition than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, mainly from their GP. Only a small number of individuals seek help from specialists.

A considerable number of people leaving the forces or finishing a posting find it difficult reintegrating into their communities and to civilian life in general. In Glasgow, research showed that armed forces veterans made up more than 1 in 10 of the homeless population in the city.

Key Resources

A number of national organisations provide a range of information, advice and practical support including the Ministry of Defence, Soldiers, Sailors, Airmen and Families Association and Veterans Scotland. Local councils will provide housing support and advice.  A wide number of national and local charities also offer specialist support.

• ‘Goodbye and good luck’: the mental health needs and treatment experiences of British ex-service personnel
• A Scottish housing guide for people leaving the armed forces
• Veterans Scotland Home Page

Gypsy Travellers

How many Scottish Gypsy Travellers are there?

Organisations that work with Gypsy/Travellers believe Scotland’s community comprises 15,000 to 20,000 people. Numbers are uncertain because people are reluctant to self-identify as a Gypsy for fear of prejudice or official interference.

Who are Gypsy Travellers?

Gypsy Travellers refers to all travelling communities who regard ‘travelling’ as an important aspect of their ethnic/cultural identity. They come from Scotland, other parts of the UK and other parts of Europe. Other groups of travellers include new travellers (previously new age travellers) or occupational travellers (show or fairground). Gypsy Travellers are the only one of these groups to be protected by equalities legislation.

Discrimination and Prejudice

Gypsy Travellers experience discrimination in health, housing, education, work and from settled communities. This is due to negative stereotypes and prejudice towards Gypsy Travellers. Many Gypsy Travellers face harassment and verbal and physical hostility from local communities.

The following points highlight a few key areas of concern from among the severe, wide-ranging inequalities and problems faced.

• Gypsies and Travellers die earlier than the rest of the population.
• They experience worse health, yet are less likely to receive effective, continuous healthcare.
• Children’s educational achievements are worse, and declining still further (contrary to the national trend).
• Participation in secondary education is extremely low: discrimination and abusive behaviour on the part of school staff and other students are frequently cited as reasons for children and young people leaving education at an early age.
• There is a lack of access to pre-school, out-of-school and leisure services for children and young people.
• There is substantial negative psychological impact on children who experience repeated brutal evictions, family tensions associated with insecure lifestyles, and an unending stream of extreme hostility from the wider population.
• Employment rates are low, and poverty high.
• There is an increasing problem of substance abuse among unemployed and disaffected young people.
• There are high suicide rates among the communities.
• Within the criminal justice system there is a process of accelerated criminalisation at a young age, leading rapidly to custody.
• Policy initiatives and political systems that are designed to promote inclusion and equality frequently exclude Gypsies and Travellers.
• There is a lack of access to culturally appropriate support services for people in the most vulnerable situations, such as women experiencing domestic violence.
• Gypsies’ and Travellers’ culture and identity receive little or no recognition, with consequent and considerable damage to their self-esteem.
• The lack of systematic ethnic monitoring of Gypsies and Travellers who use public services.

Health Impact

Although little Scottish specific data exists on the health of Gypsy Travellers, wider UK studies consistently show that Gypsy Travellers have significantly poorer health even when compared to other economically disadvantaged UK residents from minority populations.

Homeless People

Why do people become homeless?

The reasons why people become homeless can be varied and complicated, however some of the most common factors might be:

• A person losing their job and the resulting financial and personal health problems
• Relationship problems
• Harassment by neighbours
• A disaster such as fire or flooding

Some groups of people are more likely to become homeless because they have fewer rights, have particular needs or are less able to cope by themselves. These include:

• young people
• old people
• people with children
• people with physical or mental health problems
• people on benefits or low incomes
• people leaving care
• ex-armed forces personnel
• ex-prisoners
• asylum seekers and refugees.

How many Scottish homeless people are there?

The Scottish Government has published the latest round of homelessness statistics covering 1st April 2020 to 31st March 2021, available here: Homelessness in Scotland: 2020 to 2021 

Health and Homelessness

Poor health is not only a consequence of homelessness but can also contribute to someone becoming homeless. More generally there is a greater risk of ill health and of premature death amongst the homeless population than amongst the population at large. There are a wide range of health problems which are more common amongst homeless people. These include persistent conditions as well as anxiety, stress, self-harm, other mental health problems and infectious diseases.

Homelessness and other forms of inequality

As well as being associated with homelessness, certain forms of inequality such as poverty and unemployment, gender based violence, disability, mental health and addictions can also be the main cause of a person becoming homeless. Homeless people can feel that there is a stigma attached to being homeless. This perception of social stigma is something that is common to a number of marginalised groups.

• Shelter Scotland
• Simon Community Scotland

People Involved in Prostitution

What is prostitution?

Prostitution is the act of sexual activity in exchange for some form of payment such as: money, drink, drugs, consumer goods or a bed or roof over the person’s head for a night. This may take place in a variety of settings including private accommodation, brothels or on the street. Prostitution is a form of commercial sexual exploitation which is created by demand and is harmful to the person involved.

The Scottish Government, CoSLA and key partners including NHS Scotland are committed to preventing and eradicating all forms of violence against women and girls, as detailed in the Equally Safe strategy. Prostitution in Scotland is predominantly caused by men’s demand to purchase sex from women. In Scotland, prostitution is also caused by men’s demand to purchase sex from men. Men’s privilege to purchase sex is a form of structural inequality, which primarily takes advantage of gender inequality, and is further compounded by various life circumstances and vulnerabilities including poverty, homelessness and experience of other forms of gender-based violence.

Health Impact of Prostitution

The physical, emotional and psychological consequences of prostitution can be profound and include rape and sexual assault, addiction, anxiety and depression, post-traumatic stress disorder, self harm and suicide.

Poor health consequences also impact on vulnerable young people, the families of the individuals involved, on the men who purchase sex, their partners and on the social health of the wider community.

Many individuals involved in prostitution have reported experiences of emotional abuse, physical violence, sexual abuse and rape and sexual assault perpetrated by men purchasing sex. The core harm of being involved in prostitution is the psychological trauma of having to repeatedly submit to unwanted sex. Given this, the health consequences of involvement in prostitution are significant and enduring.

Women and men involved in prostitution are denied positive experiences of sexual health as defined by the World Health Organisation, namely “The possibility of having pleasurable and safe sex experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”

Prostitution and other marginalised groups and protected characteristics

Many individuals are criminalized as a result of their involvement in prostitution and this makes it more difficult for them to exit prostitution and to access the labour market. There is also a correlation with other marginalised groups such as prisoners and ex- offenders.

Resources

• Equally Safe – Scotland’s strategy to eradicate violence against women 
• Equally Safe – challenging men’s demand for prostitution: consultation analysis
• Scottish Social Attitudes Survey 2019  – violence against women key findings

 

People with literacy issues

Adult literacy issues have a direct impact on access to health information and to the quality of patient experiences of using NHS and other healthcare services.

Literacy is defined in Scotland as “the ability to read and write and use numeracy, to handle information, to express ideas and opinions, to make decisions and solve problems, as family members, workers, citizens and lifelong learners.”

The Adult Literacy and Numeracy in Scotland report published back in 2001 estimated that 23% of the Scottish population have significant difficulties with reading, writing and numbers. The report also estimated that up to 40% experience some difficulties.

The latest research on Literacy in Scotland found that one of the key factors linked to lower literacy capabilities is poverty, with adults living in 15% of the most deprived areas in Scotland more likely to have literacies capabilities at the lower end of the scale.

Literacy issues are therefore linked to socio-economic inequality and social class inequality. This can be due to poor experiences at school and lack of opportunity or other barriers early in life.

Other groups such as asylum seekers or refugees may have additional needs in relation to literacy. Also, some disabled people may have support requirement in relation to literacy, such as someone with a learning disability.

Why does literacy matter to health?

The way the health service produces information and the way practitioners communicate with their patient’s needs to take literacy issues into account. Otherwise this might impact on people’s health by-

• Reducing access to health services or limiting people’s health choices;
• Leading to poorer health outcomes by not giving appropriate information on screening, prevention, medication or treatment.
• People with limited literacy skills may find it difficult to:
• Understand and use health information such as instructions for medication, food labels and safety warnings;
• Access services which support their health needs;
• Keep appointments;
• Find their way through complicated health systems;
• Interact with health care providers;
• Seek appropriate medical attention. Some people with limited literacy skills may use health services more frequently, while others often wait until their health problems reach crisis point.

Most research shows that adults with lower literacy capabilities are also more likely to have health problems, including problems with sight, speech, hearing and learning, as well as other disabilities or health problems lasting more than six months.

Key Resources

• Education Scotland – Adult Literacy Resources
• Health information in different languages and formats – NHS Inform
• Accessing and how to use the NHS in Scotland – NHS Inform

 

Prisoners

Prisons in Scotland

There are 15 prisons in Scotland – . Greater Glasgow & Clyde currently has three prisons – HMP Barlinnie and HMP Greenock and HMP Low Moss.

Prisoners in Scotland

During the year 2019-2020 there were 8600 prisoners in Scotland. Of this total 8198 were male and 402 female.

Prisoners and Health

People in prison have poorer health than the population at large. Many will have had little or no regular contact with health services before coming into prison, and research within prison populations reveals strong evidence of health inequalities and social exclusion.

• The majority of prisoners are male with an average of 35.9. The proportion of prisoners aged over 55 has doubled in the last 10 years. In Scotland males account for around 95% of the prison population.
• Most prisoners are in custody for periods of weeks or months, rather than years.
• Prisoners are six times more likely to have been a young father.
• A high percentage of prisoners will have experienced physical or sexual abuse in younger years.
• 34 per cent of male prisoners and 30 per cent of female prisoners had previously been in care.
• In 2019, black, Asian and minority ethnic (BME) offenders represented 4 per cent of the Scottish prison population.
• Approximately 80 per cent of prisoners in Scotland have some kind of mental disorder with 14 per cent having a history of psychiatric disorder
• Between 20 and 30 per cent of offenders have learning disabilities or difficulties that interfere with their ability to cope with the criminal justice system.
• The majority of people (70 per cent) received into prison test positive for illegal drugs.
• People aged 60 and over are now the fastest growing age group in the prison population.

Links to other Inequalities

Scotland’s prisoners, like prisoners everywhere, are more likely to come from the most deprived areas. In fact a prisoner is 3 times more likely to come from the most deprived 10 per cent of areas. It almost invariably follows that the communities which suffer most from crime are the poorest communities, and that the people who are most likely to be victims of crime are poor people. Those who are released from prison will be, almost invariably, released into poverty, inequality and social exclusion. Against this backdrop it is perhaps unsurprising that for many, prison offers respite care from their experiences in the community.

Though female offending rates had gone through a period of growth, the fact that men account for 95% of the prison population must be considered as an issue in its own right. The key messages that are given to young boys around what it means to be a boy or a man appear to be failing significant numbers if this is the result.

Access to primary health care

Access to coordinated health services within prison and on leaving prison can significantly impact the likelihood of re-offending and further imprisonment. Half of those sentenced to custody are not registered with a GP prior to being sent to prison.

Re-offending

Prison can exacerbate the factors that affect re-offending. Mental and physical health can deteriorate. A third of prisoners lose their house. Two-thirds lose their job. More than a fifth experience increased financial problems and over two-fifths lose contact with their family.

People serving a year or less make up 60 per cent of those received into prison under sentence. Forty-seven per cent of adults are re-convicted within one year of being released. For those serving sentences of less than 12 months this increases to 66 per cent.

Into the community

Many ex-offenders and offenders suffer from many complicated, interrelated problems and require input from a wide range of agencies. These include housing, addictions, mental health, health and social care, and benefits services. Many prisoners will be in prison for short periods of time. They return to their communities as residents with repeated and often disjointed contact with local agencies.

Around 30 per cent of people released from prison will have nowhere to live. Those with sentences less than 12 months frequently have no planned care management plan and are prone to falling through the ‘gaps’ in care provision.

Links

• Offender Health Research Network
• Scottish Prison Service
• World Health Organisation

 

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 Equality Act 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 race.

The following is a short film by the Equality & Human Rights Commission titled ‘What is race discrimination?’ – view at: www.youtube.com/watch?v=NFhPNz_PaZ0

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.
• Black and Minority Ethnic Scots are much more likely to live in poverty, with a poverty rate of 38% for  Mixed, Black or Black British people and 34% for the Asian or Asian British community, compared to 18% for White British people. Poverty is a key factor in poor physical and mental health and creates barriers to accessing health & social care services
• One third of black and minority ethnic people in Scotland report experiencing racial discrimination. Racially motivated hate crimes are the most reported type of hate crime.

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.

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.

Key Resources

• Health Rights and Entitlements of Asylum Seekers & Refugees in Scotland
• Tell It Like It Is – busting the myths about Asylum Seekers and Refugees
• Asylum Seekers and Refugees Useful Web Addresses
• Equality Act 2010 – a Briefing for Refugee and Migrant Community Organisations

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:

• Gaelic Signage Database
• “I am sick" Fun Gaelic Learning Game
• STaG (Speech Therapy and Gaelic)

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

• Race Equality Framework for Scotland 2016-2030
• Impact of Austerity on Black & Minority Ethnic Women in the UK
• Changing the Race Paradigm – Coalition for Race Equality & Rights
• Promoting Good Relations – Coalition for Racial Equality & Rights
• Black & Ethnic Minority Infrastructure Scotland (BEMIS) Publications
• Communications Guidelines for the Introduction of Ethnic Monitoring in Health Boards in Scotland
• Healthier Lifestyle Programme – Working with South Asian Groups,
• Review of Health Interventions in Pakistani, Chinese and Indian Communities

Websites

• Amnesty International
• Asylum Aid
• Black & Ethnic Minority Infrastructure in Scotland (BEMIS)
• Scottish Refugee Council
• NHS Western Isles (About Us section)

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.

The following is a short film by the Equality & Human Rights Commission titled ‘What is religion and belief discrimination?’ – view at: www.youtube.com/watch?v=Aj__3wH1Mew 

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

• NHSWI Code of Conduct for Faith Community Leaders
• Religion or Belief in the Workplace – A Guide for Employers
• NES-A Multi-Faith Resource for Healthcare Staff
• Values in Harmony
• Ramadan Health Guide
• Seen & Not Heard: Voices of Young British Muslims

Websites

• Nil By Mouth
• Calendar of Religious Festivals

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.
• The following is a short film by the Equality & Human Rights Commission titled ‘What is sexual orientation discrimination?’ – view at: www.youtube.com/watch?v=GktlFUgMbNo

 

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 people. 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 Gonorrhoea, 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.

NHS Scotland Pride Badge

The NHS Scotland Pride Badge promotes inclusion for LGBTQ+ people and makes a statement that there’s no place for discrimination in NHS Scotland.

Staff Training

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 Equality and Human Rights Operational Group

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

Support & Resources

Publications

• ACAS – Guide on age discrimination
• Centre for Ageing Better – Inequalities in Later Life: The issue and the implications for policy and practice
• Don't Look Back?
• Fair For All – The Wider Challenge (Good LGBT Practice in the NHS)
• Gay and Bisexual Men's Health Survey Scotland
• Getting Equalities Monitoring Right
• Gov UK – Implementing a Ban on Age Discrimination in the NHS
• Halt Hate Crime
• Hate Crime – What You Need To Know
• Health Improvement Scotland – Equality Mainstreaming Report
• Hidden Lives
• HPV Vaccine for men who have sex with men (MSM)
• Inclusive Language in the NHS
• King's Fund – Age Discrimination in Health and Social Care
• LGBT In Scotland – Health Report
• Later Life UK Factsheet
• Life in Scotland for LGBT Young People
• National LGBT+ Health Needs Assessment 2022 – short film
• Not Just A Friend
• Protecting Patients – Your rights as LGB people
• Social context of LGBT people’s drinking in Scotland

Websites

• Age Scotland
• Equality Network
• LGBT Health and Wellbeing
• LGBT Helpline Scotland
• LGBT Youth Scotland
• The Sandyford Initiative
• NHS Inform – Sexual and Reproductive Health
• Silver Line Scotland – free national helpline
• Stonewall Scotland
• UN Convention on the Rights of the Child

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.

The following is a short film by the Equality & Human Rights Commission titled ‘What is pregnancy and maternity discrimination?’

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 or email: tk.shadakshari@nhs.scot

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

• Scottish Government – Preventing and Responding to Gender Based Violence; A whole school framework
• Domestic Abuse: Support
• Western Isles Women's Aid
• Rape Crisis
• Abused Men in Scotland
• Stonewall
• Domestic Abuse: RCN guide for nurses and midwives to support those affected by domestic abuse
• The multi-agency response to children living with domestic abuse: prevent, protect and repair
• Equally Safe: A delivery plan for Scotland's strategy to prevent and eradicate violence against women and girls 2017-2021

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 a profound 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 section.

NHS Documents

• Personal Independence Payment
• Mitigating the Impact of Welfare Reform on Health & NHS Health Services – Chief Medical Officer's Letter
• The Scottish Deep End Project (GPs at the Deep End)

General Information

• Knowing Your Rights Regarding Sanctions
• Impact of Austerity on Black & Minority Ethnic Women in the UK
• Pulling In Different Directions? – the impact of economic recovery and changes to social security on health and health inequalities in Scotland
• Financial Help if You're Disabled (GOV UK)
• Impact of Welfare Reform on people with HIV and Hepatitis
• Early Impacts of Welfare Reform on Rent Arrears
• Welfare Reform: Housing and Social Security (2nd follow-up paper)
• Confronting Myths About The Benefits System
• Scottish Campaign on Welfare Reform
• Preparing for Universal Credit Implementation: Key questions and answers for Local Authorities
• Gender & Welfare Reform in Scotland: A joint position paper

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 one of our 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.

NHS Western Isles documents (download to view):

• (DRAFT) NHS Western Isles Equality Outcomes 2025-29
• NHS Western Isles Bi-annual Equality & Diversity Mainstreaming Progress Report 2023-24 & Equality Act Statutory Report 2025