The NHS, shoes, ships and sealing wax, but not equality

I recall a few years ago being in the company of a bunch of reprobates and denizens of Leith on a wet Friday night, and the crack limped on to wondering what to do with what promised to be a miserably dreich Saturday.  The discussion lasted forever, starting off in the Malt Shovel at the foot of Cockburn Street and lasting well into the small hours of Saturday itself when a decision was finally reached [amongst those still standing and whose lips could still form words] in the bowels of the Pelican Club in the Cowgate, that we would all go searching for the fabled magic mushrooms.  I recall that Saturday afternoon, being driven out in the back of an ancient van and arriving in the middle of endless moorland in central Scotland.  The rain was horizontal, the sheep and sheep droppings everywhere, inadequately clothed and shod for our adventure, the temperature just shy of zero, and yet we harvested sufficient of nature’s free gifts to ensure that our mushroom virgins would swear later at night that the walls of the bar were pulsing, the pool table was really a large tortoise that spoke in tongues, and that they had been served at the bar by a Walrus who kept asking them if pigs had wings.

Magic mushrooms can have that effect.

So why is it, you wonder, I have dragged you down this seedy and disreputable memory lane of my dissolute past? 

Because our government is treating us, people who dare to be different, like mushrooms.  Deliberately keeping us in the dark and, on those rare occasions when we squeeze open a crack of daylight in the doorway of accountability, we find ourselves covered in generous servings of the shit of duplicity, mendacity and half-truth that is now standard government reaction when challenged on why equality is not being experienced by Scotland’s citizens.

In July of this year, the Equality & Human Rights Commission published a report on how well the NHS in England had performed in meeting the previous general equality duties on race, disability and gender.  Some of the key findings from the report were seriously disturbing :

q On the basis of the evidence made available to the assessment team, no authority or trust included in the sample was likely to be fully performing on all the three duties, and most were likely to have significant failings in performance.

q The assessment suggested that performance against the duties was regarded by the majority of authorities and trusts as a ‘box ticking’ exercise and only rarely encompassed the achievement of equality outcomes in practice. 

q Much greater attention needs to be paid to leadership, commissioning, and employment than the assessment suggests has been the case up to this point.

q Performance on the Disability Equality Duty (DED) was strongest, followed by the Gender Equality Duty (GED) and Race Equality Duty (RED) in equal measure.

q Several common causes were found for potentially inadequate performance. A key problem was the lack of equality planning and reporting in mainstream materials such as strategic, employment, and commissioning plans. It was therefore often unclear how the general duties were being delivered.

q It was not clear whether priorities, objectives, and actions were based on adequate needs assessment. Typically, transgender, transsexual and Gypsy and Traveller communities were overlooked.

q The quality of actions and reporting on the equality duties in mainstream plans and documents was very poor. This included action resulting from and reporting of achievements in equality schemes.

q A clear and urgent problem was identified with regards to a lack of action orientated priorities and objectives with real and tangible outcomes. The current state of play suggests that few mechanisms exist by which aims and improvements for equality groups can be defined and achieved.

q Twenty-four of the twenty-eight authorities assessed had failed to: set clear gender objectives; set clear means of effectively promoting equal pay through objectives; and addressing causes of inequality (see Table 3 for more information in Section 2 of the report). Equally, under-representation and gendered occupational segregation in employment was frequently unaddressed, as were health inequalities stemming from gender differences.

In short, the NHS in England has been failing big time on delivering equality under previous legal duties.  The EHRC hopes that these findings will ensure improved performance under the new Equality Act 2010.

Hmmmmm.  So would prodding NHS Chief Executives with a taser cranked all the way up to ‘Max’.

That said, the report did have the effect of providing another brief, illuminating crack of light on just how bad the NHS is in providing equal access to services for all people, and not just for the ‘people like us’ who plan and design NHS services.

Being a reasonable kind of person, I assumed Nicola Sturgeon would want to have the same kind of performance analysis on our NHS in Scotland.  Especially since she carries the bag for government work on equalities in Scotland.  It would really help her, I suggested in a recent missive, draft the specific equality duties required to help public bodies, like NHS Boards, meet the new Equality Act 2010 and provide health services equally accessible to all of the diverse people living in Scotland, and so ensure that they would get the same quality of health service as the ‘people like us’ who run it.  I added that I presumed she would not want Scotland’s citizens to be disadvantaged compared to those in England, as they now had this information and could hold their NHS to account.

government has decided, very deliberately, not to 

check if the last 30 or so years of work on such as 

race equality in our NHS has really made a difference

 This triggered a dialogue with government officials, speaking on behalf of Nicola, which became increasingly surreal as they strained every sinew to frame answers in such a way as avoided my direct questions.  It was as if I had stumbled into that scene where Tweedledum and Tweedledee recite for Alice :

The time has come," the Walrus said,

"To talk of many things:
Of shoes—and ships—and sealing-wax—
Of cabbages—and kings—
And why the sea is boiling hot—
And whether pigs have wings."

The conclusion was that our NHS is not to have its performance checked in a way similar to that already undertaken in England. 

We are about to witness some major changes in how government will work on delivering equality.  Before setting out, government has decided, very deliberately, not to check if the last 30 or so years of work on such as race equality in our NHS has really made a difference.  In Scotland’s NHS, pigs do indeed have wings.