Has NHS become a no-go area for compliance with equality laws?

Over this last 12 months, the performance of the NHS in Scotland has been so shambolic it is difficult to conceive that there is a government minister in charge.

Nicola Sturgeon, former Cabinet 
Secretary for Health & Equality

The fiddling of waiting times by NHS Lothian, first revealed early last year, just won't go away.  Just days ago, yet another error in the waiting list figures given to the Lothian Board was found.  Given the previous Cabinet Secretary for Health, Nicola Sturgeon, did not replace either the entire senior management cohort or the members of the Lothian Board itself but instead asked them to clear up their own mess, suggests a naive belief that the resignation of the previous NHS Lothian chief executive was a sufficient catalyst for change.

If the Laurel & Hardy waiting times act were confined to NHS Lothian, there might be some small comfort in that.  Not so.  An investigation by Audit Scotland revealed : 

"The management and scrutiny of the waiting-list systems have not been good enough.  During the period we reviewed, the Scottish government and boards were focussed on making sure waiting times targets were being met but not giving enough attention to how this was being done."

The complete reveal of the shambles across Scotland is in this report from Audit Scotland.  The slings and arrows at NHS Lothian show no signs of abating, with a report last month revealing complaints from Lothian patients surging upwards by 20%.    

One of the many elephants in the room which houses the NHS in Scotland has to be if management and scrutiny of waiting lists has not been good enough, how can we be confident the management and scrutiny in other areas, such as meeting the equality duties, has been good enough?  We can't.  Successive government ministers have refused to build central performance management data systems which would allow government to track, in real time, health board performance on a range of critical areas.

In the last few months, research has been published which shows the performance of health boards on meeting the equality duties begs the question that the same malaise found in performance on waiting  times may also be affecting performance in the NHS on equality.

In delivering Equal Pay, health boards seem determined to break the law and ignore promises made by the Cabinet Secretary for Health in 2009.  In October 2009, Nicola Sturgeon responded to a question from the Scottish Parliament's Equal Opportunities Committee :

'It was indicated [at a previous Committee round-table discussion on equal pay reviews] that advice had been given to NHS boards not to perform equal pay reviews to ensure that agenda for change remains equal-pay-proofed. I want to clarify that that is not the case. There remains an issue about the extent to which such reviews can be carried out while agenda for change reviews are under way, but there is a clear expectation that all boards will get on and complete those reviews as quickly as they can, and that they will go beyond the letter of the law to ensure that they are exemplary employers that live up to all the duties required of them.' [6^th October 2009]

In 2012 I conducted research across all of Scotland's councils and health boards to clarify just what the equal pay gap is in Scotland's public sector currently.  Three years on from that very clear and unequivocal assurance given by Nicola Sturgeon to the Scottish Parliament, I have found that across the NHS in Scotland’s 22 Boards, just 2 [9.09%] of the Boards were able to provide data on the gender pay gap. This shows a gender pay gap of either 4.3% at NHS 24 or 12.9% at the NHS State Hospital. 

This means that just 1 Scottish NHS Board has a gender pay gap which comes within the 5% criteria set by the EHRC.

I shared that research with government.  No reaction.  No plan to shake the health boards out of their almost pathological aversion to meeting the law and stopping the theft from the pay packets of women.  Not only are health boards not going beyond the letter of the law as Nicola Sturgeon said they would, they are ignoring it and have been ignoring it for some time.

More recent research into Equality Impact Assessment of health board budgets, shows how deep the equality crisis is in the NHS.  Just 1 of the 22 health boards offered an EQIA of their budget, with the other 21 Boards unable to offer a consistent reason for not checking their budgets for discrimination and adverse impact on people from the equality communities.

 NHS Lothian claimed that a single EQIA of its big [£1.4 billion] budget would be "meaningless".  Another health board said they did not do an EQIA as they were "not withdrawing services".  The health board which hosts a dedicated equality unit supposed to assist all other health boards with equalities work, NHS Health Scotland, said simply "NHS Health Scotland has not conducted an impact assessment of the budget".  

Our NHS is spending £multi-billions a year and has no credible system in place for checking that the equality bang from each and every pound spent is squeezed to the max.  It has for too many years been complicit in stealing from the pay packets from women as it avoided its legal duties on equal pay.  Its record on race equality and disability equality is threadbare, with a track record of producing equality schemes consuming several hundred pages of print from which emerged little measurable difference in the life experiences for black minority ethnic or disabled people when accessing and using the NHS.

Alex Neil, Cabinet Secretary for 
Health & Equality

The NHS is in deep trouble.  Audit Scotland has found performance management and scrutiny to be not good enough.  Evidence is piling up that health boards are breaking the law on equality.  It is as if health has become a no-go area for equality in Scotland.  Government and the EHRC need to enforce compliance by all health boards with all equality law and fast.