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NHS Highland Race Equality Scheme 2008 - 2011

Appendices

Appendix 1 NHS Highland Action Plan 2008 – 2011 Page 2

Appendix 2 Background information: ThePopulation of the NHS area

Page 29

Appendix 3 Race Equality in the Highlands: Survey Results

Page 41

Appendix 4 NHS Highland’s Progress against previous action plan

Page 50

Appendix 5 NHS Highland EQIAs Page 74

Appendix 6 Workforce Monitoring Statistics Page 77

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Appendix 12008 – 2011 action plan

For all new actions an EQIA will be carried out to ensure that the specific pieces of work are free from any negative impact upon BME individuals or any other group in the community who may experience discrimination, and do all they can to promote good relations and equality.

Action 1 - Responding to the needs of our community

Every action in this RES can only be successfully achieved if there is an understanding that the views of patients, their families, carers, staff and any other person in the community are heard and responded to. This requires us to have an understanding of our community and have effective channels of communication and consultation that reach BME individuals in our community. To support this, it is imperative that we work in partnership with other public agencies and organisations across Highlands to share key information and best practice, avoid over consultation with community groups and share work load. This is the foundation of making sure the work contained within this RES is delivered appropriately, fairly and sensitively.

Linked to previous action: 2 and 21 (appendix 4)

Supports: Duties: Eliminate unlawful discriminationPromote equality of opportunity Promote good relations between people of different racial groupsPolicy and Service Delivery

Our roles: Improving healthPlanning and providing health careEmployer rolePublic sector organisation and partner

Involve patients and carers and the design and delivery of services.

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Action Status Expected outcome Responsibility Achieved by1.1 Collect the views and opinions of service users and staff and react to the feedback received. There are 4 levels at which this will be sought:

1.1a Staff and patients will be encouraged to give ongoing feedback at any point in the service.

1.1b Patient satisfaction audits and surveys developed in house are implemented with cultural competence to make sure that the opinion and feedback of the diverse population is heard

1.1c National patient surveys are used and implemented with cultural competence in NHSH - to make sure that the opinion and feedback of the diverse population is heard

Ongoing BME populations feel able to report any issues with health care in the highlands.

The organisation can provide evidence to show that services have changed and developed as a result of feedback from BME individuals and groups

Monitoring data shows that the BME individuals have been involved (or invited to be involved) in any consultation process.

The Patient Experience questionnaire and Staff surveys show that individuals feel that opinions and views are valued and reacted to.

Gill Keel

All staff

Gill Keel

Ongoing

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Action Status Expected outcome Responsibility Achieved by1.1d Effective communication channels are maintained with BME individuals and groups to ensure that the delivery of health care is appropriate and that BME individuals are provided with accessible information about the services we provide.

NHSH services respond to feedback from BME individuals and communities and can evidence change in practice as a result.

Gill KeelEsther Dickinson

Ongoing

1.2 Continue to work in partnership with voluntary and public agencies across Highland

Ongoing Work is co-ordinated between partners to achieve efficiencies, avoid duplication and reduce work load. Evidenced by a yearly list of outputs driven by community need and delivered in partnership with Highland organisations.

Moira Paton Ongoing

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Action 2: Increasing access and removing barriers to all NHSH services

This action concentrates upon 5 key areas that staff from all service areas can develop in order to remove any barriers to services experienced by any individual. These areas include: developing systems for monitoring patient ethnicity, carrying out EQIAs, providing an interpreting service, providing a translation service and training our staff.

Linked to previous Action 2,3 ,7,20 ( appendix 4)


Our roles: Improving healthPlanning and providing health care

Action Status Expected outcome Responsibility Achieved by

2.1 Patient monitoring

Equality Profiling of all service users is carried out at point of entry into service and analysed by NHSH

NHSH patient assessment protocols include clear guidance for staff and information for patients about meeting patient support needs

ongoing

New action

Targeted work can be undertaken where it is identified that our patient profile does not fit what we know of our population We can provide examples of positive

action based on equalities profiling undertaken by NHSH

Patients and staff report that care delivery is adapted appropriately to individual need.

Natalie Morel

Data Information and Implementation network

2010

2009

5


2.2 EQIAEQIA training is delivered across Highland to develop staff skills in carrying out assessments

40 staff a year receive training in EQIA delivery

New EQIAs completed: 35 new EQIAs are signed off

and published each year All EQIAs are quality assured

and published online

Ongoing All work relating to the EQIA can provide examples to highlight existing good practice and/or to show where changes have improved services for staff and/or patients.

Natalie Morel Ongoing

2.3 Interpreting A partnership contract for the provision of an interpreting service is signed and agreed.

All services across Highland receive information in how to effectively work with interpreters via a revised guidance document, supporting materials and training.

Ongoing

Ongoing

Any patient that needs an interpreter is offered one for every appointment evidenced by: An increase in usage following the

launch of the new guidelines and information.

Positive feedback from the Polish and Chinese association members and other BME groups

A decrease in problems fed to the team arising as a result of interpreting booking and usage.

An evaluation of the service shows positive feedback from both staff and

Esther Dickinson March2009(Ongoing monitoring)

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patients.

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A system is put in place to track any patient with accessibility needs (including interpreting) through the whole service

Any patient who requires an interpreter is recognised within the system and an interpreter is provided along with any appointment.

Esther Dickinson and Natalie Morel

2010

BME individuals have access to ‘interpreting cards’ that they can hand to any member of staff to inform them of the need to book an interpreter and the language required.

Patients are supported to request an interpreter whenever one is needed.

Feedback from staff members that the cards are being used by their patients

Feedback from the Polish and Chinese association members and other BME groups that they have found them useful

A decrease in problems fed to the team taking forward the E&D agenda, arising as a result of interpreting booking and usage.

Esther Dickinson March 2009

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2.4 Translation

A partnership contract for the provision of translated information across NHSH is signed and agreed – this ensures NHS staff have one company to approach when they are producing translated information.

New action Staff are able to supply existing translated materials or produce new materials for any patient who needs it. Evidenced by: The number of new translated

materials held in the data base. Community feedback shows that

information is being offered in appropriate formats.

Esther Dickinson Translation organisation

July 2009

The company awarded the contract manages one central data base of materials translated over the period of the contract - accessible by partnership agencies in Highland

The number of ‘hits’ on the webpage holding translated information increases.

Esther Dickinson Translation organisation

An online resource is developed within NHSH holding both old and new translated information – accessible to both staff and patients.(Other mechanisms to access this information will also be developed for anyone not in the intranet)

Community feedback shows that information is being offered in appropriate formats.

Staff feedback indicates that translated information is easy to find and relevant to their work

Niall HendersonShirley Noble Esther Dickinson

Dec 2009

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2.5 Training

A comprehensive timetable of training is offered and evaluated throughout the year in NHS Highland. This will be delivered at a variety of times and in different formats to suit staff need. Training will cover:

Core Principles of E&D Accessibility Interpreting best practice EQIA training E&D for Trainers E&D for HR Inequalities in health and its

relationship to Equality and Diversity

100 members of staff per year complete training from each area in Highland (Raigmore, North CHP, Mid CHP, SE CHP, A&B CHP and pan Highland Staff).

Ongoing

Evidence of application of theory to practice is gathered via post training feedback.

Staff choose to access training and development opportunities in creative ways across NHS Highland.

Staff feed their work back to the community and Health Improvement planning team for upload to the staff Equality and Diversity page to share good practice.

CHP and Raigmore managers can report areas of good practice within their services

Lead Esther Dickinson

Raigmore Andrew Ward

North CHPSheena Craig

Mid CHPGill McVicar

SE CHPNigel Small

A&B CHP Caroline Champion

Pan Highland StaffEsther Dickinson

Ongoing

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A framework to support staff to take ownership of their own development around the E&D agenda is developed. Guiding staff towards training, resources and best practice to encourage change in work place practice.

An E&D checklist for all staff delivering any training across NHSH is developed and agreed organisation wide.

Work with the Learning and Development team to develop a system to evaluate the effectiveness of training delivery Highland wide

All training is designed and delivered in a culturally sensitive and supportive way

Staff will receive training which is culturally sensitive and supportive.

Feedback/evaluation at all levels showing how learning has been applied in the workplace to improve experiences for patients and staff from BME communities and is integrated throughout all training opportunities.

Esther Dickinson

Judith Mackelvie

Paul Maber Michelle Williams

June 2009

Jan 2009

Sept 2009

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2.6 Focused pilot One service (the Chemotherapy Unit at Raigmore Hospital) has been chosen to focus upon all activities covered above (2.1 – 2.5).

The chemotherapy unit has been identified due to staff commitment and the discrete nature of the unit

Within the unit staff will be supported to identify how Equality and Diversity can be embedded into their practice in relation to:

Monitoring, EQIAs, InterpretingTranslation and training

Lessons will be learned from this piece of work. From this we will identify strategies to introduce sound E&D practice to all services

Improvements to the service and best practice will be identified. This will be shared with the management team in Raigmore Hospital to encourage other units to see the benefit of this work.

Learning points will be shared; online, via word of mouth, at presentations and in articles.

Best practice will be drawn up and a second area will be identified to take on this work.

Andrew WardNichola Summers

Dec 2009

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Action 3: Achieving our duties as an employer

Delivering fair and sensitive services is not only about supporting patients but also about supporting employees. For this action we have promised to address any inequalities as they arise from analysis of our staff monitoring data. This includes data for potential employees and employees leaving NHS Highland, in addition to data relating to significant events that can happen while at work, such as grievances or training. We also need to ensure that all of our policies and processes are written and applied in such a way as to support employees in all ethnic groups. This action is designed to assure ourselves that the way in which we advertise jobs, select, recruit and support our staff to fulfill their potential is fair and sensitive.

Linked to previous actions 18,19 (Appendix 4) Supporting data for these actions are attached in appendix 5.

Supports: Duties: Eliminate unlawful discriminationPromote equality of opportunity Promote good relations between people of different racial groupsEmployment

Our roles: Employer role

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3.1 Equality and diversity employment action plan:

Data –staff in postThe data is used to inform investigation into specific job families and work units. To increase the return rate, promotional materials are being prepared in advance of the next mail out.

3.2 Applications for employment and promotionApplications are analysed and entered on to a local database.

3.3 Applications for and participation in learning and developmentAT Learning system (AT-L) allows adequate monitoring of applications. Before AT-L is fully functional attendance sheets are being used for monitoring. (This links to the training section in action 2)

Ongoing 100% of staff will have returned their SWISS monitoring data

There will be a better understanding of the distribution and levels of staff from different ethnic groups. NHSH will be able to ensure that there is a diversity of staff, reflective of the local community in different job families and units.

A complete dataset will allow NHSH to better use different and varied channels of advertisement, ensuring that under represented groups can access vacancies.

Analysis at present shows that study leave forms broadly fall in line with what is shown on SWISS returns. The response rate for SWISS is actually much lower so achieving better SWISS response rates and standardizing returns will support future analysis.

For all actions 3.1 – 3.13)

Anne Gent, Director of HR

Workforce E&D subgroup (Highland Partnership forum)

Next Mail out Dec 2009

Ongoing thereafter

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3.4 Performance assessment proceduresSenior manager staff groups and executive cohort data has been analysed and incomplete returns will now be targeted

3.5 PIN policies: Grievance and disciplineAnnual analysis of the grievance and discipline ethnicity data. Most recent data shows that staff subject to disciplinary procedures are far more likely not to have their ethnic background data held.

3.6 Staff who leave NHS Highland employmentMonitoring data is in place and is published annually, which informs positive action to increase retention rates.

Ongoing A full dataset will allow some analysis of this small staff group to inform understanding about access to these roles from equality groups.

From targeting low return areas, we can better analyse and address grievance issues.

The exit interview process also provides qualitative data to improve retention and identify and problem areas in the organisation.




Ongoing

Ongoing

Ongoing

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3.7 PIN policies: Equal opportunities policy

The Equal opportunities policy was to be re-launched with a different heading, but this outcome will now follow on from the national review and impact assessment.

3.8 Promoting equality and diversity in our role as an employerEnsuring all employees can access and provide pertinent information through appropriate use of interpretation and translation

3.9 Reporting and monitoring arrangementsData is analysed and published on a quarterly basis and positive action publicized

Ongoing

All employees are aware of NHS Highland’s commitment to Equality and Diversity and know how this affects them as employees.

Employment rights and responsibilities are embedded in our Equality and Diversity work.

Employees are aware of the importance of gathering data and can see how positive change can impact on them as a result of data analysis.




TBC – awaiting national guidance

Ongoing

Ongoing

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3.10 Governance arrangementsClear governance arrangements are already in place for reporting through the Highland Partnership Forum network. These will be maintained and improved to ensure adequate publicity for action

Ongoing All employees are well informed and involved in decisions affecting them




Ongoing

3.11 Recruitment and selection

To achieve this targeted advertising will be explored, following the example set by Diversity Champions model with support from Stonewall.

To achieve an inclusive interview process, managers will be trained in interview skills and equality and diversity

Diversity of the workforce reflects the ethnic diversity of our community

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3.12 PIN policies

PIN policies are being reviewed and impact assessed nationally. Locally NHS Highland will follow up this process to ensure that they meet the requirements of local impact assessment procedures and thus can deliver our employment duties adequately.

Ongoing PIN policies will support all staff adequately and awareness of PIN policies will be raised for all staff.



TBC – awaiting national guidance

3.13 Other HR policies

All new policies and policies for review that reach the HR sub group are being impact assessed. All existing employment policies and practices have been impact assessed and are race sensitive. Monitoring is in place to ensure all policies are applied equitably.

All of our employee policies are equipped to support all members of staff. Monitoring shows that there is equitable uptake of HR policies.

Ongoing

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Action 4: Procure goods and services equitably

This action involves ensuring that the organisations (including commercial companies and voluntary organisations) that we procure services from can assure us that they manage their business in a fair and sensitive way.

Linked to previous action 4 (appendix 4)

Mapped to: Duties: Eliminate unlawful discriminationPromote equality of opportunity Promote good relations between people of different racial groupsPolicy and Service Delivery

Our roles: Planning and providing health carePublic sector organisation and partner

Action Status Expected outcome Responsibility Achieved by 4.1 TrainingAll key staff involved in procurement receive E&D training

Ongoing Staff are able to incorporate appropriate specifications in tender and contract documents

Esther Dickinson Gordon Tait

June 2009

4.2 Contracts

Procurement, contracting and commissioning processes are impact assessed.

Ongoing All contracts in NHS Highland conform with our Race Equality duties.

Specifications covering duties are included in all contracts

Gordon Tait June 2009

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Action Status Expected outcome Responsibility Achieved by Guidance is developed that ensures specifications with regards to E&D are included in all tenders and subsequent contracts for both commercial companies and voluntary organisations.

4.3 Monitoring Procurement staff develop a framework to monitor contracts and ensure that they are compliant with our duties.

All contracted work is awarded to companies who are committed to eliminating unlawful discrimination, promote equality of opportunity and promoting good relations between people of different racial groups,

Evidenced by monitoring as laid out in 5.3

We are able to assess quality of a contractor in relation to meeting our duties.

Gordon Tait Dec 2009

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Action 5: Sharing good practice among staff

This action is designed to ensure that staff have a way of sharing information between themselves, Equality and Diversity leads in the organisation are able to update staff with new developments and best practice can be replicated throughout the organisation.

Linked to previous actions 2 (appendix 4)

Mapped to: Duties: Eliminate unlawful discriminationPromote equality of opportunity Promote good relations between people of different racial groupsPolicy and Service Delivery Employment


Action Status Expected outcome Responsibility Achieved by 5.1 Publications

Regular articles in staff magazines and on staff intranet

Ongoing NHS Highland staff feel that they work for an organisation that openly supports and encourages good relations between people of different racial groups.

Evidenced by anecdotal feedback during any staff event indicating that there is interest in the information published.

Direct contact from staff who wish to follow up on information contained in articles.

Joanna Taylor Ongoing

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Action Status Expected outcome Responsibility Achieved by 5.2 Road show Visits across NHSH are planned to deliver updated resources and information to staff working in more remote and rural areas. Update will include:

Fair for all Documents Interpretation and translation

guidance NHSH resource

New action Staff feel supported and encouraged to deliver a service that is accessible to the BME community it serves and promotes equality of opportunity among the staff it employs.

Esther DickinsonAll PDMs

Dec 2009

5.3 Webpages

Create an up to date staff webpage holding resources such as:

New information GuidanceEquality SchemesBest practiceEtc

Ongoing Staff can access material online to support their practice evidenced by feedback from staff giving information about best practice they are involved in.

Change in practice is shared between staff on the Equality and Diversity website.

Esther DickinsonMarie Gilbert

Ongoing

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Action 6: Specific projects and initiatives

The individual projects in this action are either ongoing projects with a finite time frame that are currently in progress and their progress requires monitoring for this scheme or they are new projects to take forward this year. It is expected that over the three years of the scheme, as projects and initiatives are completed, new ones will be identified.


Our roles: Improving healthPlanning and providing health carePublic sector organisation and partner

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Action Status Expected outcome Responsibility Achieved by 6.1 Mental Health Including Suicide

NHS Highland has been successful in a funding bid to the Scottish Government Equalities Unit. Funding has been granted to carry out an investigation of the support that people who have mild mental health problems might receive. We want to make sure basic support through reading and talking that we currently use is actually helpful for people who come from Eastern Europe and also for Gypsy Travellers.

Develop and deliver Race and Mental Health Project The project will see if the approaches we have for helping people with mild mental health issues are equally helpful for people from Eastern Europe and for Gypsy Travellers.

Agree process for impact assessment as part of development of mental health integrated care pathways (MH ICP)

2 year project

Culturally appropriate resources and information available to people from BME communities experiencing mild mental health issues

(When we use the term “mild mental health problems” it means issues such as everyday stresses and bereavement, phobias and anxiety disorders. ) Specific training for primary care staff

to support people from BME communities experiencing mild mental health issues

Provide training specifically to MH ICP development groups

Facilitate EQIA process for MH ICPs

Provide feedback for individual MH ICP impact assessments

Natalie Morel Cameron Stark

Natalie Morel

2008 – 2010

2009

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Action Status Expected outcome Responsibility Achieved by 6.2 GP practices

GP services are approached to highlight their key role in gathering patient profiles leading to a robust system of monitoring at the point of service entry.

GP services gather patient profile data sensitively from their patients.

A system is developed to process this data to inform practice highland wide.

Ongoing

The profile of patients can be produced and used to identify any areas where the patient profile does not represent that of the community, leading to positive actions being taken.

Natalie Morel 2010

6.3 Work with Gypsy/Travellers

A network of staff are identified to ensure that any Gypsy /Travellers, either in permanent sites or “on the move” receives the support they require (from NHSH staff and partners)

To support the work of the network:

A training and planning day for all staff in the network will be arranged

Ongoing The health needs of Gypsy /Travellers are met. Evidenced by:

Increased numbers of Gypsy /Travellers accessing dental services GP practices. screening programmes Immunisation Antenatal care health Improvement work (eg well

man services, smoking cessation advice)

Co-ordination Esther Dickinson

Leads:SE CHPJo SmithNorth CHPSusan BellMid CHPSusan Russel A&B CHPAnn Campbell

Dec 2009

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Action Status Expected outcome Responsibility Achieved by Resources to support work

with Gypsy /Travellers will be made accessible, or developed if necessary for all network members

Hand held records are used across NHS Highland

Once established this will become an ongoing aspect of NHSH service delivery

Health Care professionals are aware of the health care history of the GT they work with resulting in improved health care.

Dec 2009(Ongoing thereafter)

6.4 Service redesign

A review of the tools used in service redesign is carried out to identify areas where barriers to services, and possible discrimination can be identified and addressed. And to identify where public consultation can be carried out.

As service redesign work is carried out issues relating to removing barriers, tackling discrimination and involving patients and the public in service design is integrated into the process.

New action Documentation related to service redesign shows how issues relating to BME needs are highlighted and addressed.

Stuart Caldwell June 2009

Ongoing thereafter

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Action Status Expected outcome Responsibility Achieved by 6.5 Hate incident reporting

In partnership launch a hate incident reporting campaign and website.

Ongoing The Highland area is made aware of hate incidents occurring in the community and take action to reduce this.

Moira Paton March 2009

6.6 Supporting the development of an Inter-Faith Council for Inverness and District

Ongoing Better dialogue and understanding between the various faith communities; which, in turn, will be of benefit in the work of spiritual care in NHS Highland.

Michael Hickford Autumn 2008

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Action 7: Fostering sound leadership and management

Support from high level managers is vital to the work of this action plan. This action has been identified to ensure that all decisions made by the Board reflect the commitment to this RES.

Linked to previous action 1,8 & 9 (appendix 4)

Mapped to: Duties: Eliminate unlawful discriminationPromote equality of opportunity Promote good relations between people of different racial groupsPolicy and Service Delivery Employment



7.1 E&D governance The board create a sub group to oversee the governance of E&D.

New action The organisation develops a framework for the governance of Equality and Diversity actions throughout the organisation.

The framework is implemented and used to monitor how E&D is becoming embedded throughout the organisation

Roger Gibbins/Garry Coutts

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7.2 EQIA All staff submitting papers to the board are accompanied by a signed off EQIA ready for publishing.

Ongoing The EQIA process is integrated into the development of new policies/guidelines and new pieces of work.

Evidenced by 80% of papers that are identified as requiring an EQIA are submitted accompanied by a signed off EQIA ready for publishing.

Chris Meecham Natalie Morel

2011

7.3 Levels of awareness

All board members attend E&D training yearly

Ongoing Board members more fully aware of Equality accountabilities and more likely to question this during Board discussions

Lorraine Powers Yearly

7.4 Financial commitment

The organisation will continue to buy interpreting to support need

There is a dedicated £10,000 budget to support all Equality and Diversity Activities.

Ongoing

Ongoing

Patients and staff can access an interpreting service to ensure that all conversations are understood.

The actions within equality schemes are well managed and shown to be achieved at each review.

Roger Gibbins

Roger Gibbins

Ongoing

Ongoing

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Appendix 2Background information: The Population of the NHS area

NHS Highland demographic contextThe context for race equality has altered significantly in recent years with the increase in arrival of migrant workers brought about by the expansion of the European Union impacting on communities and services across the country. There is evidence that this social and economic phenomena has resulted in considerable numbers of new people from white minority ethnic groups arriving in the NHS Highland area.

The available data to illuminate changes in both national and local demography is limited and there is also a continued deficit in our understanding of the population health needs and health and social care requirements of resident minority ethnic groups. There remains a paucity of data relating to patterns of health and access and use of health services across Scotland. Information about mortality, morbidity, health related lifestyles and service use remains inadequately collected in terms of ethnic coding. The 2001 Census therefore remains the most comprehensive source to understand in particular our Black Minority Ethnic (BME) Groups and still provides key information on age structures, gender and socio-economic status. Routinely collected administrative data provides little evidence to what extent more recent flows of people represent a transient phenomenon or whether such trends will be longer-term. Equally it is difficult to quantify these changes or establish what proportions of economically driven migrants are committed to permanent residency in the area.

Population structure Map 1: NHS Highland

NHS Highland in 2008 serves a population of over 308 thousand people, six percent of the national population in an area that is over 40 percent of the landmass of Scotland.

The expanded NHS Highland encompasses the local authority areas of Highland and Argyll and Bute. Four Community Health Partnerships (CHPs) serve local populations in North Highland, Mid Highland, South East Highland and Argyll and Bute.

The geographical area covered is diverse; including the expanding population of Inverness and the Inner Moray Firth, part of the commuter zone of Glasgow in the Helensburgh and Lomond area, as well as the most remote and fragile communities in both island and mainland locations

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Figures from the Census 2001 showed that the NHS Highland population is predominantly white Scottish with a relatively low proportion of minority ethnic groups (Table 1). 97.1% of the population identified themselves as white Scottish (83.3%) or white British (13.8%). This is higher than the total figure of 95.5% for Scotland. Minority ethnic groups included white other (1.5%) and white Irish (0.5%). Black Minority Ethnic Groups accounted for 0.8 percent of residents. Although small in absolute numbers this population is diverse in terms of place of birth, ethnic identities, language and culture.

NHS Highland’s white minority groups will now include newly arrived communities of European nationals, mainly, Polish, Latvian, Czech, Lithuanian and Slovakian nationals, as well as the Gypsy and Traveller community.

Table 1: Ethnicity in Scotland and NHS Highland at Census 2001NHS Highland Scotland

Percentage of total population

Percentage of black minority ethnic group Base

Percentage of total population

Percentage of black minority ethnic group Base

ALL PEOPLE 100 - 300220 100 - 5062011

White Scottish 83.27 - 249985 88.09 - 4459071

Other White British 13.84 - 41559 7.38 - 373685

White Irish 0.64 - 1908 0.98 - 49428

Other White 1.46 - 4372 1.54 - 78150

Indian 0.07 9.3 224 0.30 14.8 15037

Pakistani 0.07 8.7 209 0.63 31.3 31793

Bangladeshi 0.05 5.9 142 0.04 1.9 1981

Other South Asian 0.05 6.6 158 0.12 6.1 6196

Chinese 0.13 16.6 398 0.32 16.0 16310

Caribbean 0.04 5.0 119 0.04 1.7 1778

African 0.04 4.7 112 0.10 5.0 5118

Black Scottish or Other Black 0.02 2.3 55 0.02 1.1 1129

Any Mixed Background 0.23 28.2 676 0.25 12.6 12764

Other Ethnic Group 0.10 12.6 303 0.19 9.4 9571

All black minority ethnic groups 0.80 2396 2396 2.01 101677 101677

Data Source Census 2001 © Crown Copyright (Table UV10)

Black minority ethnic groups made up less than one percent of the population in all CHP areas at the last Census. (table 2).

Table 2: Ethnicity in NHS Highland CHPs at Census 2001Argyll & Bute Mid Highland North Highland South East Highland

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ALL PEOPLE 91306 87215 38462 83237

White Scottish 80.36 82.71 85.43 86.04

Other White British 16.52 14.30 12.57 11.02

White Irish 0.80 0.61 0.41 0.59

Other White 1.53 1.66 1.00 1.37

White 99.21 99.28 99.41 99.02

Indian 0.06 0.06 0.05 0.11

Pakistani 0.08 0.06 0.06 0.07

Bangladeshi 0.02 0.08 0.00 0.07

Other South Asian 0.03 0.04 0.06 0.09

Chinese 0.14 0.11 0.07 0.17

Caribbean 0.03 0.06 0.02 0.04

African 0.04 0.03 0.03 0.06

Black Scottish or Other Black 0.02 0.01 0.01 0.02

Any Mixed Background 0.27 0.19 0.19 0.23

Other Ethnic Group 0.10 0.08 0.09 0.13

All Black Minority Ethnic Groups 0.79 0.72 0.59 0.98

Data Source Census 2001 © Crown Copyright (Table UV10)

The small NHS Highland BME population is widely spatially distributed. (table 3) There are no co-ethnic localised communities as found more typically in large urban environments and many people are living as individuals or nuclear families in remote areas.

Table 3: NHS Highland NHS Highland All black minority ethnic groups

Other Urban Areas 20.5 32.6Accessible Small Towns 2.6 3.6Remote Small Towns 26.6 27.7Accessible Rural 9.9 9.0Remote Rural 40.4 27.2Total 300220 2396

Data Source Census 2001 © Crown Copyright (Table UV10) and Scottish Government 6-Fold Urban Rural Classification (2008)

There is little evidence that minority ethnic communities live in what would be recognised as our deprived communities as defined by the Scottish Index of Multiple Deprivation (SIMD 06). Considering areas defined as in the most deprived 15 percent of national deprivation 8 percent of the BME population lived in one of the 27 deprived datazones compared with 7 percent of the population of NHS Highland overall. This difference is not statistically significant. It should be recognised that SIMD was not designed to identify deprivation at an individual or household level.

A conclusion from the Census settlement pattern would be that many have been attracted to the area for individual or family reasons rather than as the result of any communal pull. The pattern of more recent settlement resulting from the arrival of accession state white ethnic minorities cannot be documented with any accuracy and beyond the simple pull of economic opportunity is

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not understood. The influence of any communal factor in encouraging particular groups from the enlarged European Union to locate in the NHS Highland area would be of particular interest

Ethnicity and age structureNHS Highland population structure has an ageing profile and it is now well recognised that the population will continue to age as the number of older individuals make up proportionately larger shares of the total population over time. The black minority ethnic population has a younger age distribution that the rest of the population. 76 percent of the BME population in NHS Highland is under the age of 45 years compared with 56 percent of the population as a whole.

Figure 1: Sex and age by ethnic group in NHS Highland

0 20 40 60 80 100

White Scottish

Other white British

White Irish

Other White

Indian

Pakistani

Bangladeshi

Other South Asian

Chinese

Caribbean

African

Black Scottish or other Black

Any Mixed Background

Other Ethnic Group

All Persons

00-15 16-24 25-44 45-64 65-74 75+

Data Source Census 2001 © Crown Copyright (Table S235)

Table 4: Sex and age by ethnic group in NHS Highland

All people White IndianPakistani and other South Asian Chinese Other

Male population 147174 146025 117 282 183 567

Percentage in age group

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00-15 20.4 20.3 17.9 31.9 24.0 40.016-24 10.0 10.0 12.0 10.6 16.9 16.925-44 27.5 27.5 34.2 34.4 25.7 26.545-64 27.4 27.5 26.5 16.7 25.7 10.965-74 9.0 9.1 6.0 5.7 4.4 2.575+ 5.6 5.6 3.4 0.7 3.3 3.2

Female population 153046 151799 107 227 215 698

Percentage in age group00-15 18.4 18.3 20.6 31.7 24.7 34.016-24 8.3 8.3 3.7 11.0 12.6 7.625-44 27.0 26.9 43.0 36.1 39.1 30.845-64 26.8 26.9 26.2 15.0 18.6 19.965-74 10.0 10.0 5.6 3.5 1.9 4.4

75+ 9.6 9.6 0.9 2.6 3.3 3.3

Male to Female ratio

1.0 1.0 1.1 1.2 0.9 0.8

Data Source Census 2001 © Crown Copyright (Table S235) Figure 2: Population pyramid – percentage of population by age and sex


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12 9 6 3 0 3 6 9 12

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Percentage of population

male femaleNHS Highland

BME groups

Ethnicity and healthThe health status and health needs of different minority ethnic communities vary due to the interaction of a number of factors - with some of these groups experiencing better health and some poorer health than the general population. These factors include: a genetic predisposition to particular illnesses, the impact of culture on individual behaviour, greater exposure to risk factors from their country of origin, differences in educational attainment and in socio-economic status. Social exclusion and low socio-economic status has by far the greatest adverse impact on population health and discrimination can affect the health of minority ethnic communities indirectly through lack of employment opportunities, lack of career progression and poor living and working conditions. Racial discrimination also can have a directly adverse impact on both physical and mental health.

The Census provided information on perceived levels of morbidity in the population in terms of limiting illness and general health. Limiting long-tem illness (LLTI) is a self assessed measure of the limitation of carrying out normal daily activities. Compared to Scotland, the proportion of the NHS Highland population at Census with a LLTI was smaller (table 5). The proportions of minority ethnic populations with an LLTI were generally lower than the overall level in NHS Highland. However, interpretation is confounded by both the direct influence of age and by indirect cultural perceptions of health. As in the general population LLTI is age dependent (figure 3). The average age of most minority ethnic groups is younger than the general population and therefore the proportion of the population reporting a LLTI would be expected to be lower as a direct result. The 2001 Census also introduced a general health question that asked respondents to assess their own health as ‘good’, ‘fairly good’ or ‘not good’ over the twelve months prior to Census day. The question is again obviously open to the respondent’s interpretation and people with the same health experience may assess their health differently. Equally age is again a factor in any interpretation but the evidence suggests that minority groups are relatively healthy.

Table 5: Self reported health status in NHS Highland from the Census by ethnic group Scotland NHS Highland

All people All people White Indian

Pakistani and other South Asian Chinese Other

BME Groups

Percentage of population LLTI 20.3 18.9 18.9 14.7 12.4 11.1 13.7 13.2

Good/fairly good health 89.8 91.8 91.8 91.1 93.9 95.0 92.6 93.0


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Figure 3: Limiting long-term illness by age band and ethnicity

0 10 20 30 40 50 60

00-15

16-24

25-34

35-59

60-64

65+

Total

Age

Gro

up

Percentage with a LLTI

White Indian Pakistani and other South Asian Chinese Other


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Ethnicity and religionThe 2001 Census collected information about ethnicity and religious identity. Combining these results shows that the population is more culturally diverse than ever before. Just over two-thirds (69%) of the NHS Highland population reported having a religion. White Christians remain the largest single group. The Indian group was religiously diverse; 27 per cent of Indians were Hindu, 10 per cent Sikh, a further 9 per cent Muslim and 15 percent Christian. By contrast the Pakistani and Southern Asian grouping were more homogenous, Muslims accounting for 64 per cent. Overall, 26 per cent of the NHS Highland population reported having no religion although variation by ethnicity was marked. Nearly 60 percent of all Chinese people stated they had no religion. Pakistani and the South Asian grouping were least likely to have no religious affiliation

Figure 4: Ethnicity by current religion in NHS Highland

0 10 20 30 40 50 60 70 80 90 100

White

Indian

Pakistani and otherSouthern Asian

Chinese

Other

Percentage

None Church of Scotland Roman Catholic Other ChristianBuddhist Hindu Jewish MuslimSikh Another religion Not answered

Data Source Census 2001 © Crown Copyright (Table T25)

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Developments since the 2001 CensusThe pattern of migration resulting from enlargement of the European Union has been the most obvious demographic change in the post Census period (table 6). Contacts between overseas nationals and government agencies regulating access to the labour market provide the limited quantitative evidence for the numbers who may have arrived in the NHS Highland area. The principal source of information on all overseas nationals who want to work in the UK is through National Insurance Number Registrations (NINOs). These records collect date of registration, country of origin, gender, age and address of first residence in the UK. The tracing of subsequent movement within the UK is unknown and there is no requirement to de-register prior to returning home or leaving the country. Management systems primarily for regulating employment are unable to provide any substantial details about family or other dependents of registered workers.

The distribution of post-enlargement migrants around the UK differs significantly from that of previous large scale immigration and the NHS Highland area has attracted considerable numbers of new people from the white ethnic minorities of the Accession States (A8)1. In common with the rest of the country the majority of these migrants come from Poland. In 2007-2008, 53 percent of all National Insurance Registrations in NHS Highland were made by people from Poland. The employment rate amongst these migrants is high and many have taken lower skilled/paid jobs that have been difficult to fill with indigenous labour. In contrast to historic cohorts of migrants it is financially and logistically possible for EU migrants to come to the UK on a temporary basis and regularly or permanently return home. It is simply unknown how many people have chosen to settle within any area. Collectively little is known about the health of these groups and the most significant barrier to accessing care and improving job prospects for these groups is the linguistic barrier.

Table 6: National Insurance Registrations by world region in NHS Highland*

TotalEuropean Union

EU Accession States

Other European Africa

Asia and Middle East

The Americas

Australasia and Oceania

2002-03 800 310 50 30 70 100 90 1402003-04 980 320 110 50 100 140 110 1402004-05 2000 280 1130 70 100 180 110 1302005-06 3310 300 2260 80 170 200 130 1602006-07 3440 280 2550 30 140 200 120 1302007-08 3440 250 2590 60 100 150 130 160Total 13970 1740 8690 320 680 970 690 860

Data Source: National Insurance Number Registrations, Department of Work and Pensions

Male registrations have exceeded female over this period – for every one hundred female workers there were 112 male registrations. 80 percent of all registrations were made by workers between the ages of 18 and 34 years of age (figure 5).

1On 1 May 2004, ten countries – Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland,Slovakia and Slovenia – joined the European Union (EU). From that date, nationals of Malta and Cyprus have had full free movement rights and rights to work throughout the EU. The A2 countries are Bulgaria and Romania who joined the EU on the 1st January 2007

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Figure 5: Age of workers from National Insurance Registrations in NHS Highland*

0.6%

43.5%

36.7%

11.0%6.8%

1.1%

0.4%

Less than 18 18-24 25-34 35-44

45-54 55-59 60 and over

Data Source: National Insurance Number Registrations, Department of Work and Pensions * Based on cumulative registrations in NHS Highland local authorities from January 2002 – April 2008

The Workers Registration Scheme (WRS) provides some additional demographic data specifically about workers from the A8 when they first start employment and for any subsequent changes during the first 12 months of residency. Access to and publication of this data is restricted but it is known from this source that the majority of these workers are employed in hospitality and catering; administration business and managerial services; and SBS sectors (agricultural processing). The types of job attracting these workers over time have been consistent and the majority continue to be employed in low skill jobs such as processing of food, kitchen and catering assistants, waiting staff, cleaning and labouring.

The Institute for Public Policy Research paper of April 2008 Floodgates or Turnstiles2

used data from the WRS to estimate the ‘current stock’ of A8 workers who had registered and remained within local authority areas across the UK between May 2004 and the end of 20073 The numbers can only be considered indicative but would suggest that Highland in particular has attracted and maintained many workers from the A8 (table 7). Only Perth and Kinross (29) and Angus (21) authorities have a higher rate of A8 ‘stock’ than Highland.

Table 7: WRS registrations and IPPR estimate of A8 worker ‘stock’ in Argyll & Bute and Highland

Approved Numbe Rank of

2 3 This estimate of the current A8 stock is based on the assumptions that the WRS underestimates the actual level of worker registration by 33 per cent; and that 50 per cent of A8 migrants who have arrived since May 2004 are no longer in the UK

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WRS applications May 2004-December 2007

r of A8 workers per 1,000 residents based on IPPR estimate of current A8 stock

Local Authority area in UK (N=434)

Highland 5290 16 39Argyll & Bute 1140 8 133

Data Source: IPPR

Additional indirect evidence suggests that considerable numbers of workers from the Accession States may be committing to a long-term future in the NHS Highland area. Evidence from Highland drawn from WRS shows that the number of dependents declared at first worker registration in the area expanded significantly during 2007-2008 and the numbers of children in local schools whose first language is not English has again increased.

Evidence also shows that the percentage of births to women from outside the UK has increased in NHS Highland (table 8). This general pattern is evident in Scotland and the rest of the UK There will also be differences in fertility patterns between ethnic groups but analysis is limited to country of birth because ethnicity is not collected at birth registration.

Table 8: Live births, by country of birth of mother in NHS Highland2007 2005 2002

All countries of birth 3073 3006 2732UK, Isle of Man, Channel Islands 2759 2791 2567Irish Republic 21 14 12Other EU (Poland in brackets) 150(117) 68(35) 45(1)Commonwealth total 78 84 66

Australia, Canada, New Zealand 28 32 27India, Bangladesh, Sri Lanka and Pakistan 19 19 7West Indies, Belize, Guyana 1 3 0Africa 25 19 16Other Commonwealth 5 11 16

Other countries 65 49 42Not stated 0 0 0

Data Source: GRO(S) Annual Vital Event Tables

In Scotland in 2007 1 in 9 births were to non-UK born mothers and in NHS Highland this figure was 1 in 10. However, in England this figure is about 1 in 5. The relatively small size of Asian communities in both Scotland and Highland will partly explain the difference in the proportion of births to mothers from non-UK countries from that in England and WalesInternational migration patterns and evidence from worker registration shows that recently arrived groups include many women of child bearing age. Women born outside the UK are a diverse group and fertility will vary across a range, but it is

39

known that migrant fertility may be particularly high in the years following arrival in a new country. There are obviously many different reasons for migration, and family building as a process will be inter-related to that experience. Some individuals will stay for only a short period; others arrive with families, or form such relationships and stay. There is currently little information available to understand this complex picture and it is only possible to tentatively suggest that the recent pattern of births to overseas mothers may indicate some degree of longer term commitment from recent migrants to remaining in the area.

Ian DouglasHealth Intelligence Specialist NHS Highland October 2008

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Appendix 3

Race Equality in the Highlands

Survey Results

1 October 2008

Introduction

Each of the public bodies listed below is obliged to produce a Race Equality Scheme which sets out how it tackles racial discrimination, promotes equality of opportunity and promotes good relations between racial groups. The Race Equality survey was designed to feed into this process.

The partners involved in the survey were:

The Highland Council; NHS Highland; Northern Constabulary; Highlands & Islands Fire & Rescue Service; Highlands & Islands Enterprise; Scottish Natural Heritage; University of the Highlands and Islands

Survey Response

There was a total response of 145 to the survey, 44 of which were from the online version of the questionnaire. 101 provided responses via a paper questionnaire.

The survey ran over a six-week period during August and September 2008.

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Profile of Respondents

Gender

69% of respondents were female, 31% male.

Disability

9% of respondents described themselves as having a disability.

Age

%Under 16 -16-25 1226-39 1840-60 5161-74 1575+ 4Total 100

Sexual Orientation

All of the 113 respondents to the question apart from one individual were heterosexual.

Faith / Religion

Number of Responses

Christian (undefined) 23None 20

Church of Scotland 15

Church of England 7

Roman Catholic 9

Protestant 5

Muslim 2

Other* 8

Total 89

* Others included Atheist, Buddhist, Spiritual, Jewish, Episcopal, Humanist, Presbyterian and Jehovah’s Witness

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Ethnic Group

93% of the survey respondents described themselves as white. A full breakdown is provided in the table below.

Number of Responses

White 113Asian 2

Black 1

Mixed 1

Other* 5

Total 122

* Others included (four respondents provided details): Hispanic (2), Scandinavian (1) and “Gaelic speaking community of the Highlands and Islands” (1).

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Main Survey Findings

Responses to each of the survey questions is reported below. Totals may not sum to 100% because percentages are rounded to the nearest whole percentage point.

Question 1

Since you have been living in the Highlands do you think the levels of racism or racial discrimination have:

%Increased 20

Decreased 11

Stayed the same 36

Can’t say 34

Total 100

Base: 124 respondents

The large majority of respondents (70%) were either unsure, or thought that the levels of racism or racial discrimination had remained the same.

Among those who thought that levels had changed, almost twice as many respondents thought the levels of racism or racial discrimination had increased compared with those who thought levels had decreased.

Young people (aged 16-25) were more likely than average to think the level of racism or racial discrimination had increased (47%).

There were no further notable differences in the pattern of response by gender, disability or ethnic group.

Question 2

Have any of the following organisations treated you, or your family, less fairly because of your ethnic group?

Number %No response 133 92

Local school 7 5

Police 5 3

Council Housing Service or Housing 4 3

44

AssociationLocal college or university 3 2

Business advice agencies 3 2

Local GP 2 1

Local hospital 1 1

Other Emergency Services 1 1Base: 145 respondents

Note: respondents could tick more than one option.

92% of respondents chose none of the options. Among the organisations listed, local schools were most likely to be identified (by 5% of respondents) as having treated the respondent or their family less fairly because of their ethnic group.

Owing to the small numbers involved, no further analysis by ethnic group, age or gender is tenable.

Seven other responses to the question were received:

Local people (2 mentions) Council (2 mentions) Job Centre Sheriff Court Amenities Association

Question 3

Have you been treated less fairly when applying for a job because of your ethnic group?

%All the time 1

Sometimes 11

Never 44

Does not apply to me 45

Total 100Base: 121 respondents

There were no notable differences in the pattern of response by age, gender, disability or ethnic group for Questions 3-7.

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Question 4

Have you been treated less fairly when applying for promotion or training because of your ethnic group?

%All the time 3Sometimes 3Never 47

Does not apply to me 48Total 100

Base: 118 respondents

Question 5

If you need an interpreter do you get offered one by the public services you use?

%All the time -

Sometimes 2

Never 5

Does not apply to me 93

Total 100Base: 117 respondentsQuestion 6

Do you agree that people from different backgrounds get on well in your local community?

%All the time 29

Sometimes 65

Never 7


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Question 7

Do you feel your community is welcoming of people coming to live here from outside the Highlands?

%All the time 30

Sometimes 68

Never 2


Question 8

Do you think the following service providers meet the needs of people from all ethnic groups?

Yes%

No%

Other Emergency Services 95 5

Local GP 88 12

Local hospital 88 12

Local college or university 81 19

Local school 78 22

Police 78 22

Business advice agencies 78 22Council Housing Service or Housing Association 76 24

Base: respondents range from 51 to 77

Overall, the response level to the question was lower than most other questions.

Respondents were most likely to regard “other emergency services” as most likely to meet the needs of people from all ethnic minorities (95%), whereas Council Housing Service or Housing Association were regarded as least likely to do so (76%).

Only one other response was stated, namely “other council services”, which received a “yes” response.

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Question 9

If you would like to give any examples to support your answers, or make any comments, please use the space below.

Nineteen comments were received which are presented below.

A little annoying to find that people from ethnic groups have equal priority on our housing lists. They quickly learn how our system works and before you know it you'll have a new breed of home owners.

This survey does not seem to be well put together. All those 'Does not apply to me' options; we all HAVE an ethnic group, so the question must apply to everyone, but it seems you are using 'ethnic group' as a -say it without saying it- shorthand for 'minority ethnic group'. Also, what really is the point of asking how you think services are provided to all ethnic groups? Surely most people can only answer that with confidence for their own grouping.

There is always likely to be one bad apple in the box!

Many people still seem to react with caution if they deal with someone with a foreign name or a non-white face. I would apportion some of what I/my family have experienced down to lack of training or awareness, not malice.

With an American/Swiss passport fluent in German and paying uk taxes it seems impossible to find a house to live in therefore staying in a tent.

I think that the attitude of some Highland Councillors towards the Gaelic community is discriminatory and inflammatory. The Council has a duty under the Gaelic Language Act to provide for the Gaelic community and its members should adhere to this.

This survey is a good example. Your question about needing an interpreter - if people did how would they be reading an English survey! You should have supplied the survey in a number of languages. It is limited to English speaking respondents.

Communication in other languages

Lack of language skills

I know of a housing situation in Lochaber where Travellers are treated less fairly, in my opinion

If you were truly anti-discriminatory, you would not ask for ethnic/racial/religious/sexual background.

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There is sometimes anti-English feeling and sometimes poor understanding of non-Christian religions.

As a white British full-time worker with no family, I have no rating for housing.

Working in education I have found children from other ethnic groups have been welcomed and adapt well, but more resources should be available to help in initial stages. Parents sometimes feel isolated if English is not their first language.

Travelling people bring themselves into conflict with the resident population by illegal camping in lay-byes and other places and creating health hazards by their behaviour. Failure of the appropriate authorities to move these people to approved sites inevitably leads to friction and discrimination.

Many Scots are still backward thinking with regard to the English (taking our jobs, houses etc). We have welcomed the influx of Poles, who have relieved us of some of this racism.

Ongoing anti-English comments in the workplace.

There is still a strong sense of "outsiders" coming to the Highlands and local people not coping with this. Scottish people seem to be entrenched in history and can't let go of the past. They are very personal and feel directly affected by history.

People in the Highlands, especially in villages, do not want anyone apart from Scots. I receive various racist remarks being English even married to a local. God help anyone coming here with a different colour skin.

Further Involvement

Respondents were asked if they would like to come to a meeting to discuss the issues in the questionnaire before the race equality schemes are finalised. Only two people provided contact details for this to be done.

Fewer than 10 people indicated that they would like to receive a draft copy of a Race Equality Scheme before it is finalised, only four of whom provided contact details.

Respondents were asked if they would like to give their opinions about any other similar work in the future. Three respondents provided contact details for this to be done.

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Appendix 4NHS Highland’s Progress against previous action plan Action 1

Ensure regular review of Action Plan

Action Achievements - examples of good practice Further actions needed

a) Exception reporting at Equality and diversity group meetings

Comments √ Green

The NHS Board have received annual detailed progress reports on Equality & Diversity, including race equality, supplemented by regular brief written updates

Training in Equality & Diversity, patient sensitive services and Equality Impact Assessment has been provided to the Board

A policy has been put in place to require all Board and Committee papers to reflect evidence of equality impact assessment

The need to undertake Equality Impact Assessment has been written in to the Management of Policies Guidance and the Clinical Policies ratification group guidelines

There has been an annual increase in the spend on interpretation & translation

An Equality & diversity Steering Group has met every 6 weeks to progress the agenda and a workforce subgroup has been established

Two new posts to support the Equalities agenda have been established

An Equalities Impact Assessment of the way the Board operates

See objective 7 in the new action plan for actions carried forward

E&D meetings continue

Ensuring sound governance of the E&D agenda could still be further strengthened at board level.

A new governance ‘committee’ has been formally agreed. This will be carried forward

b) Bi- annual (twice yearly) reporting to corporate team.

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Action 2

Provide regular updates to staff and Public about Fair for All activity nationally and in NHS Highland


a) 1 Staff Policy Briefing Comments: √ Green

This action has evolved beyond simply developing a policy briefing. Policy briefings were developed in the first year and have been superseded by informing staff in the following varied formats:

Fair for All activity is included in training resources; Numbers of staff trained : 700

Resources distributed to all GP practices and all hospital wards and services

An equality and Diversity webpage has been designed Relevant staff are regularly forwarded relevant

information Articles appear in staff magazines

See objective 1, 2 & 5 in the new action plan for actions carried forward

Continue to incorporate national work throughout the work of the organisation such as training,

b) 2 Articles in local Unison Magazine

Comments: √ Green

Articles were published as agreed

Productions of articles for a range of publications is ongoing

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c) 2 Team Update articles Comments: √ Green

Tangible outcomes: Articles published included Staff experience of Ramadan, How to use the Interpreting service and coverage of the Staff ESOL lessons.

Productions of articles for a range of publications is ongoing

d) 2 Organised Press Eventse)4 Community Open Events

Comments: √ Green

This work has expanded and includes a variety of community engagement activities.

Tangible outcomes:Such events include:

Show racism the red card football event Health education event with an international women’s

walking group Discussions in the Chinese association regarding

interpreting Health Checks with the Gypsy Traveller community Participation in Council for Ethnic Minority Voluntary

organisations (CEMVO) events to encourage participation in the decision making process.

Publications include:Community Planning partnership newsletter: E&D Highland A section within the “Multicultural Inverness” calendarAn article in the local Polish newspaper Gazeta Highland about the interpreting service

Continue to promote and become involved in community events.

f) 2 Community publications

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Action 3Raise Awareness with Practice Staff (staff working at GP surgeries) about Equality and Diversity Issues and the Race Relations Amendment Act (RRAA) as services procured on behalf of NHS Highland


a) Attend clinical area forum to discuss role of equality anddiversity in practice and agree approach to awarenessraising

Comments O Amber

This has evolved from the initial actions stated here. Awareness raising and training for practice staff has included a variety of actions as follows.

Tangible outcomesRepresentatives attended area medical committees in 2007

NHS Highland now has a rolling programme of Equality and Diversity training


Continue to develop and deliver a variety of Equality and Diversity training across Highland.

Identify way to further engage GPs and practice staff.

b) Pilot and evaluate sessions in CHP area

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c) Agree action required to expand training takinglessons learned from pilot

Community Health Partnership (CHP)specific work

All practice managers and a number of staff across North Community Health Partnership (CHP) have attended Equality and Diversity sessions.

Equality and Diversity training is a standing event at Protected Learning Time for all GP practices in Mid and South East CHP

Argyll and Bute CHP have an action plan to roll out training to all staff.

Examples of outcomes from training: Increased usage of the interpreting service EQIAs carried out on various areas of practice Gained ongoing funding for ESOL lessons for NHSH staff Supported the development of E&D guidelines for staff

delivering any training in NHSH

Further work to fully engage practice staff is needed.

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Action 4Agree protocol for ensuring equality and diversity issues are addressed within procurement arrangements


a)Set up one off meeting with all relevant staff toagree manageable and achievable actions

Comments: O Amber

Tangible outcomes Equality and Diversity Terms and conditions of contract along with guidance have been agreed. Staff have been informed that this must now be included in all contracts

Equality and Diversity training (specific to procurement issues) has been delivered.


A working group will develop a framework to specifically monitor the Equality and Diversity elements of any contracts awarded.

b) Progress agreed actions

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Action 5 Set up process for ensuring that Rapid Impact Assessment (RIA) recommendations are implemented (before review dates)


a) Include clearer recording of responsibility against actions within RIA

Comments: √ Green

RIA and full EQIA tools have been merged into one process supported by one document and set of guidance. This was done to minimise duplication and encourage more effective completion and follow up of EQIA

Tangible outcomes: New EQIA process available to all staff including electronic

guidance and forms. EQIA training available for all NHSH staff 61 EQIAs have been undertaken


Put in place systems to ensure continued review and monitoring of recommendations from EQIA and the embedding EQIA in organisation’s functions.

b) Review all completed RIAS and agree with leadstimetables for implementation.Include in exception reporting with E&D Group.

c) Use process of implementation of recommendationsre Spiritual Care, Advocacy and Food, Fluid &NutritionFunctions as focus for Staff Policy Briefing

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Action 6

Develop and Action RIA Delivery Timetable according to prioritisation


a) Review Prioritisation exercise in light of limitations ofthe tool and draw up timetable according to existingprioritisation exercise

Comments: √ Green

In light of review of the EQIA process and developments in the system for carrying out an EQIA actions a and c have been superseded.

Tangible outcomes Clear guidance for NHSH staff submitting papers to the

Board about carrying out EQIA. All Board papers must now include a statement about EQIA

status in order to be accepted. All NHSH policy and guidance passed to the Clinical policy

ratification group can only be ratified when an EQIA has been undertaken.

Corporate Team and Board have been provided with EQIA awareness raising sessions and as a result continue to develop approaches to embedding E and D in delivery of Board functions


No further actions in relation to now defunct RIA will be included in the EQIA future actions.

b) Seek Corporate Team Support to lead on prioritisingRIA / Appoint Non Exec Lead

c) Deliver on RIA Timetable including communityconsultation

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Action 7

Develop Champions Network


a) Recruit 12 more Champions in 2006-2007

Comments: √ GreenThis objective has been revised and outcome has been reached via alternative approaches.

During the course of the training staff that were particularly interested and skilled in E&D issues were identified. Although the aim had been to develop champions in this area the staff fed back that they would prefer not to be identified as this. However such staff have now become key contacts across various departments some of which include: Facilities, HR, Raigmore, each CHP area. These contacts are working towards taking various E&D issues forward thus embedding the agenda across the organisation. Race is a key area of work for this and is embedded into the Equality and Diversity training delivered

Tangible outcomesStaff have supported among other things:

A focus group among Polish women using the maternity service

Providing English for speakers of Other languages (ESOL) classes to facilities staff

The production of multilingual health improvement information Increased usage of the interpreting service

See objective 2 and 5 in the new action plan for actions carried forward

Continue to make links onto NHSH departments.

Identify pieces of work across the organisation that can be supported.

b) Provide 3 follow up training sessions

c) Develop support resource for Champions

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Action 8 Develop and embed policy and function monitoring, including key outcomes as agreed from Checking for Change national performance monitoring toolkit.


a)Review risk assessment tool and make recommendations to Planning and PrioritisationProcess (PPP) Group

Comments: √ Green

The purpose and content of the Checking for Change tool is being reviewed nationally in light of new drivers to build links across equality strands. NHSH had therefore used the tool as a guide but has not followed it precisely.

Tangible outcomes: EQIA of PPP carried out and recommendations proposed. The policy for the management of Policies has had an EQIA All NHSH policy and guidance passed to the Clinical policy

ratification group can only be ratified when an EQIA has been undertaken.

If a recommendation within an EQIA is not taken forward this is recorded and published.

See objective 2 & 7 in the new action plan for actions carried forward

Include EQIA in future review of risk assessment procedures

Ensure EQIA is embedded within broader performance management and monitoring systems in NHSH

Review Argyll and Bute action plan April 09 as several risks associated with E&D are identified

b) Include EQIA process and Equality and Diversity Stamp within Management of PoliciesPolicy

c) Include EQIA in clinical policy review

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Action 9

Ensure that all elements of FFA/RES are appropriately resourced


a) Quarterly budget/resource reporting to E&DGroup

Comments: √ Green

Tangible outcomesDuring 07/08, £28K was allocated to support roll out of training, £3000 for ESOL training of NHSH staff.

In addition, a bid to Scottish Government for £35k to support the development of a Hate Incidents Reporting System across the Highland Partnership was successful. Work on that continues and it will be launched in late 2008.

Partnership monies used to support community engagement activities.

Investment in interpretation support has grown from around £10kpa in 2004/05 to over £80k pa in 07/08


Continued support at board level is required.

b) Provide costings/risk assessment at Corporate Team Meetings

Progress reports highlight financial issues and risks

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Action 10 Launch Health Needs Assessment and Plan for implementing recommendations


a) Recommendations and actions approved byCorporate Team and Board

Comments: √ Green

Tangible outcomes: Board approved actions within the plan. Ongoing work with community groups have ensured discussion of findings, along with other emerging research, has been carried out across Highland.

Health inequalities and specific health needs have been incorporated into other organisational performance management systems thus embedding such work across the organisation and removing the need to produce a separate document.

Recommendations made have been merged into the new Race Equality scheme so that the organisation is working from one document.


Continue to incorporate specific health needs monitoring and assessment in organisational performance management systems.

b) 3 Community led events to be held promoting anddiscussing findings of HNA and proposed actions

c) As part of action agree ongoing review andassessments required over each 12 month period.

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Action 11

Develop response to Gaelic Culture issues within Fair For All


a) Set up appropriate meetings with local authorityrepresentatives developing Gaelic Culture Strategies

Comments: √ Green

An NHS Gaelic Language Plan implementation group has been set up and met several times to date. This group are taking forward actions to meet our duties under the Gaelic Language Act (2005) which requires us to produce a plan outlining how we intend to promote and provide equal status to the Gaelic Language.

Tangible outcomes: Funding gained from Gaelic Implementation Fund from Bord Na Gaidhlig allowing us to:

Equip a new Health Centre in Kyle with fully bilingual signage Produce a promotional NHS Highland promotional banner in both English and Gaelic Develop health promoting school information to all pupils attending Gaelic Medium education in Gaelic and English.

This has been incorporated into other work in the organisation. No further actions required in the RES.

b) Agree NHS specific response to support andmaintain Gaelic Culture appropriately within the context of equality and diversity

s

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Action 12

Implement Patient Held Records System for Gypsy/Travellers within Highland


a) Agree group membership and set up implementation group

Comment: O AmberThe actions have altered since the publication of this scheme Nationally the hand held records were not rolled out.

Tangible outcomes: A Joint Gypsy/Travellers action plan has been agreed and a network of staff have been brought together to implement this.

Links between the Gypsy/Travellers and health workers on the permanent site in Inverness are strong. Hand held records are used here. However, work is patchy across Highland and this needs to be strengthened.

Initial meetings to identify key health staff across Highland has commenced.


A group will be set up across Highland to ensure the health needs of Gypsy Travellers are met across the whole Highland area.

This group will co-ordinate the roll out of the hand held records

b) Group to report to E&D Group and WBA onprogress. Implementation by December 2006

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Action 13

Improve Pan Highland Recording of Ethnicity (patients)


a) Present business case to all CHPs and SSU and include requirement for local monitoring of progress

Comments O AmberPolicy Development Managers are aligned to CHPs to support embedding of Equality and Diversity. This includes improved monitoring data. Tangible Outcomes Training provided to NHSH staff on asking equalities

monitoring questions Monitoring awareness raising sessions made available to all

staff Process mapping approach highlighted to Board and

referenced in staff training

Systems still need much development to ensure that Pan Highland reporting is achieved.


Work with eHealth, Medical Records and SCi Implementation teams through the Information Governance Team to continue to develop equality monitoring tools and electronic systems

b) Host one day event on whole system approach and process map patient journey to highlight benefits of recording ethnicity (and other E&D strands andhighlight purpose of EQIA)

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Action 14

Develop recording and monitoring of data on new Sexual Health Services System


a) Include Equality and Diversity issues within system training

Comments: O AmberThis Sexual Health project was not progressed past the pilot stage and so the data was not gathered. This we has been picked up by more generally data recording and monitoring work both locally and nationally.

Tangible Outcomes Ethnicity monitoring awareness raising sessions carried out

in service. System in place to receive local data from Information and

Statistics Division (ISD) through Equality and Diversity Information programme (EDIP) project and Diversity Information and Implementation network (DIIN)

No specific actions to take forward in relation to Sexual Health Services

b) Set up process with Information and Statistics Division (ISD) to ensure local data re ethnicity is made available

c) Meet quarterly with Sexual Health Services Team to review progress

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Action 15Implement and Monitor Short Term Interpretation Service


a) Produce literature explaining how to access service for staff. Also to be available electronically

Comments: O Amber

Tangible outcomes These outcomes reflect the work of North Highland. Interpretation services need to be made widely available in Argyll and Bute and we working towards this as a priority.

A partnership (with Highland Council) interpretation contract has been signed ensuring that standardised interpretation is available across Highland. This has been in operation for 3 years.

Guidance for staff was produced and circulated among staff.

An audit has been carried out on the service.

The usage of the service is monitored

In partnership with agencies across highland this contract is being re-tendered.

Although not in the 2005 RES, we have also set up English for speakers of other languages lessons for staff working in NHS Highland. This now received main stream funding form our facilities department.


Complete new tender and award contract.

Continue to work in partnership to manage the contract

Ensure service provided for Argyll and Bute area

b) Produce literature explaining how to access service for public in a range of languages. Also to be available electronically

c) Monthly multi agency meetings to review service use and compare with use of telephone service

d) Produce report of activity andlearning present to Corporate Team

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Action 16 Oversee Feasibility Study re options for long term Interpretation Services


a) Set up multi agency steering group

Comments: O Amber

The performance interpreting service is managed reviewed and In partnership with the Highland Council. Multi agency meetings are held monthly where issues surrounding interpretation are discussed. The new contract has been drawn up following multi agency consultation and in partnership with community planning partners.

Tangible outcomes An increased number of partners have joined the

contract. This means that the BME community will received a

standardised service across these partners.


As above b) Report on findings

c) Agree plan for implementation ofagreed service mode

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Action 17

Agree Process for Translations of NHS literature


a) Agree key health information to be translatedb) Agree process for one offtranslations of material and promote process to organisation

Comments: O Amber

Guidance on translation was produced and circulated to staff.

Known translated information has been made available on our website


Complete tender process and award contract to a translation agency.

c) Present clear picture of use and potential cost risks to corporate team

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Action 18

Carry out a staff led staff data gathering exercise(see appendix 5 for staff data to date)


a) Set up Project group by advertising in house for interested staff and including HR, Union/Partnership Forum, Health Intelligence Team Representation in group

Comments: O AmberScottish Workforce Information Standard System (SWISS) data monitoring has superseded this action.

Tangible outcomes Over 72% of staff have filed returns for SWISS. On

three occasions target follow up letters have been sent out to encourage returns. Further action is ongoing to contribute to achieving 100% returns.

Findings are being promoted through the Highland Partnership Forum arrangements.

The Workforce Equality and Diversity Action Plan details the responsibilities for all staff monitoring, for example in terms of learning and development and promotion.

Publicity and information related to Dignity at Work is being disseminated through a series of road shows, within which Equality and Diversity is a core component.


Continue to build upon this work in the coming years.

b) Agree format of delivery of information request and promote exercise and its purpose including equal opportunities policy and dignity at work policy.

c) Deliver exercise

d) Gather data and promote findings

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Action 19

Set up manageable staff data monitoring process(see appendix 5 for staff data to date)


a) Quarterly meetings with Human Resourcesto ensure data is gathered and accessible and toundertake action required by specific patternsand trends

Comments: O Amber

These actions have been superseded by the establishment of the Workforce Equality and Diversity sub group of the Highland Partnership Forum. This group is overseeing actions in place to address adequate staff data monitoring. The monitoring data collected will be used to identify patterns and trends. Actions put in place are informed by the data findings.


Continue to build upon this work in the coming years.

b) Set up and agree pan organisation development of a Positive Action Programme

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Action 20

Take forward results of training model consultation


a) Finalise date for close of consultationperiod

Comments: √ Green

These actions have not been worked through systematically however the outcomes achieved have led to a full programme of training in NHS Highland

Tangible outcomes £28 000 was awarded to develop a sustainable programme of training.

Ongoing training is now available for all staff across all areas of NHS Highland.

Equality and Diversity training is an integral part of NHS Highland learning plan

An online training package is available called the Same Difference.


Continue to offer training for all staff.

Develop a range of training opportunities including , face to face, distance learning and team learning

b) Include specific reference to equality anddiversity in NHS Highland training plan

c) Produce project outline and costings for corporate team

d) Agree resource for setting up cross organisation ad hoc and timetabled training

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Action 21

Develop a Communication Gateway between BME Communities and NHS Highland


a) Review complaints procedures with Victim Support and EQIA tool andimplement recommendations

Victim Support Project with BME communities ended. This has been superseded by work on hate crime

No further actions needed.

b) Set up meetings with community leaders and Senior NHS Staff

Comments: √ Green

These actions have been achieved in various ways and in some cases alternative routes have been taken to achieve the same end.

Tangible outcomes

In partnership with organisations across Highland we have: Carried out a formal consultation with all known equalities

groups Remained in constant (yet not formalised) contact with

groups in the community representing BME individuals, and have responded to specific needs (eg offering the Chinese community Health Checks, producing interpreting cards so support the use of interpreters in the community, highlighted the need for the Chaplaincy to support staff to plan care for a Muslim who is expected to die )


c) Agree with community leaders clear process for participation includingfeedback and commitment to action from NHS Highlandd) Agree programme of activity to propose to community groups re ad hoc discussion and community led projects and formalised consultations onNHS led agendas including EQIA prioritisation.

e) Agree range of single and multi community meetings

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f) Work with PFPI to increase awareness of BME communities inHighland, the benefits of diversity and importance of equality.

Community consultation was carried with all equality groups to identify common areas of work.

Developed a network of known groups and individuals that we can communicate with regarding heath related matters.

We work closely with the PFPI team to deliver E&D training, work with our patient forum representatives and ensure that public consolations invite individuals from BME communities.

Continue to develop our relationship with BME communities across Highland.

g) Work with other public sector partners to co-ordinate delivery as far as possible to prevent duplication

h) Engage staff through promotion of activities and involvement incommunity led information requests and activities

i) Set up NHS Highland BME Communities staff network

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Appendix 5

List of all Equality and Diversity Impact Assessments (EQIAs) carried out up to and including September 2008. All EQIAs listed below will be available on line by January 2009

1. Bedrail Protocol

2. Bowel Cancer Screening Programme

3. Breastfeeding Guidelines

4. Business Case For Older People’s Services – Migdale Hospital.

5. Cambusavie Unit Patient Information Leaflet

6. Camhs Framework Proposal

7. Camhs Framework Update

8. Commissioning Sexual Health Services In Argyll And Bute – Terrence Higgins Trust Proposal

9. Communications Action Plans

10. Communications And Engagement Plan

11. Condition Management Service

12. Delayed Discharge Procedures

13. Diabetes Strategy

14. Directorate Of Public Health Annual Report 2007-2008

15. Fixed Term Contract Pin Policy

16. Food, Fluid & Nutrition In Hospital Care Policy

17. Function Of Board Meetings

18. Gender Based Violence Employee Policy

19. Guided Self Help Programme

20. Hate Crime Campaign

21. Healthy Weight Strategy

22. Heart Failure Service

23. Highland Sexual Health Strategy

24. Incident Policy And Procedural Guidance

25. Induction Policy

26. Infant Feeding Strategy

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27. Infection Control Policy

28. Integrated Care Pathways (Mental Health Communications Stakeholder Involvement Strategy

29. Learning And Development Strategy

30. Learning Gateway Policy

31. Leased car scheme

32. Occupational Therapy Guidance

33. Older People Service Change Proposal

34. Patient Access Policy

35. Patient information Leaflets Dental Services

36. Patient Information Policy

37. Patient Partnership Forum Proposal Argyll And Bute

38. Peg Feeding Guidelines

39. Planning And Prioritisation

40. Policy And Practice Guidance On People With Learning Disabilities

41. Policy and Protocol for Verification of Patient Death in Hospital and Community by an RGN

42. Policy On Management Of Policies And Procedures

43. Practitioners With Specialist Interest Proposals

44. Prevention Of Excessive Weight Loss In The Breastfed Neonate Policy And Guidelines

45. Procedures For Developing Service Level Agreements On Patient Care

46. Promoting Attendance Pin Policy

47. Property Strategy

48. Proposal for Self Referral Pathway to Physiotherapy Services

49. Protocol for management of sex offenders on admission to hospital

50. Redeployment Pin Policy

51. Relationships And Sexuality

52. Review Of Nursing In The Community Public Information Leaflets

53. Safer pre & post employment checks PIN

54. Secondment Pin Policy

55. Smoking Cessation Action Plan

56. Tobacco Policy

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57. Tobacco Policy – Managers’ Guidance

58. Transferring Skills Across NHS Highland For Nurses, Midwives And Allied Health Professionals Policy

59. Violence Against Women Strategy

60. Volunteering Policy

61. Workforce Strategy

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Appendix 6

1. All Staff in Post

The pie chart below shows the ethnicity data for the whole of NHS Highland workforce at July 2008. Although the return rate has steadily been increasing, there remains over 20% of staff for whom data is not held. Targeted mail shots and promotional activities over the coming months will address these staff groups.

Compared to the data held for the local population, it can be seen that NHS Highland employ a higher percentage of BME individuals compared to the known demographics of the population. As the data for staff becomes complete, this situation will be monitored.

2. Senior managers

The pie chart below shows the monitoring data that is held for senior managers (the group subject to performance assessment procedures).

The figures for the senior managers are to some extent in line with the figures returned for all staff. Asian and Black groups however, are not represented in this group. This group of staff are so small though that a single new member of staff or a newly completed monitoring form could bring the statistics in line with all staff.

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ETHNICITY

Any Other0.11%

Black (inc British)0.33%

Blank20.88%

Asian (inc British)1.55%

Prefer Not To Answer3.11%

Mixed0.26%

White73.76%

The next round of publicity and mail outs will facilitate increased returns for this group and so allow a more complete analysis.

Other British 2329%

Prefer Not To Answer 7

9%

White Scottish 3950%

Blank 79%

Irish <51%

Any Other White <51%

Mixed <51%

3. Applications for Learning and Development

The pie chart below shows the reported ethnic group of those employees who have applied for study leave through the learning and development team from 1st April to 31st July 2008. The chart provides a snap shot of ethnicity data for this period and is indicative of those applying for study leave through the year.

Compared to the data held for the whole workforce, this chart shows a much higher completion rate of the submission of ethnicity data. The data provided for most ethnic groups seems to be broadly in line with the data for all staff (notwithstanding the difficulty of using <5 figures).

The figures for white ethnic groups are higher in this chart, which could mean that some people who left the standard monitoring forms blank are identifying themselves as white for the Learning and Development forms. When the data is complete in the whole workforce figures, these figures will be compared again and appropriate action taken if needed.

The new AT Learning system will improve this information by monitoring ethnicity of all participants in and applicants for registered

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courses. This system is currently in development and should be able to provide us with data from 2009-2010.

Ethnic Group

Declined3%

White British24%

White Scottish62%

White Irish<5

Any mixed background<5

African<5

Indian1%

Other Asian<5

Other White3%

No Response7%

No ResponseAfricanAny mixed backgroundDeclinedIndianOther AsianOther WhiteWhite BritishWhite IrishWhite Scottish

4. Disciplinaries and Grievances

The table below shows disciplinaries against and grievances raised by NHS Highland employees from 31st August 2007 to 31st August 2008.

We have not had monitoring data supplied by most of those who have faced disciplinary action and those who have raised grievances. As the <5 figures represent at least one, then no data is held for over half of those involved in disciplinaries.

A possible explanation of this is that those people who are involved in disciplinary procedures are less likely to complete monitoring data, because they have less confidence in the organisation. Activities to promote monitoring and the reputation of the organisation as a diversity champion are underway to support increased returns. Increased returns will allow more meaningful comparison.

Qualitative data is needed to understand whether there is any significance to the cases in the <5 groups.

Disciplinaries & Employee Concerns12 months to 31 August 2008

Disciplinary Employee ConcernsEthnic Background

Raised Closed Raised Closed

Blank 15 13 18 11

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Declined <5 <5 <5

African <5

Any Mixed <5 <5 <5

White British <5 <5 10 7

White Irish <5 <5

White Scottish 11 8 30 23

5. Staff applying for and leaving NHS Highland employment

Monitoring of applications was taking place and being entered on a local database up to 2007, and some beyond. This was put on hold because a national online application system (Marje) was then introduced. It was hoped that this new system would allow data collection at the time of application. Due to ‘functionality issues’ this system has very recently been withdrawn. NHS Highland will be putting in place alternative arrangements to ensure future reporting of this data.

A new exit interview process is being developed, which will link to workforce monitoring data. This will ensure up to date returns on those leaving NHS Highland employment.

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