Thousands of Scotland's disabled people will be born, live a life and die before they can claim equality of employment opportunity

Just a few weeks ago Nicola Sturgeon was heckled by service users at a homelessness project when she launched yet another initiative to end rough sleeping and homelessness.  John Swinney will, in the next few days on 9th December, join thousands of people in a sleep out in Princes Street Gardens organised by Social Bite and aimed at ending homelessness within the next 5 years.

International Day of People with a Disability [IDPD] was on 3rd December, just a couple of days ago.  In Scotland, the government reports that 20% of the population [over 1 million people] has a disability.  Use Google to search for IDPD linked to Scottish Government and you discover that there were no events at which Nicola Sturgeon promised new money or fresh action to end discrimination against disabled people in Scotland.  John Swinney appears to have slept in his own bed that day since there was no media coverage of him raising the public's awareness of the discrimination encountered by disabled people and showing how this could be ended.  None of the organisations claiming to work for disabled people have launched plans or strategies to end disability discrimination within the next 50 years, never mind the next 5 years.

The only mention I was able to find of IDPD linked to government was on Twitter, where the head of the civil service in Scotland tweeted a picture of St Andrews House.

It might have been more useful if the Permanent Secretary had shone a light - of any colour - on the equality employment data of her own employer, Scottish Government.  The most recent 2017 report on employment data from government as an employer shows that just 5.8% of the workforce identifies as disabled, quite some way short of the 20% of the population identifying as disabled.  The rest of the public sector has an equally abysmal record when it comes to delivering equality of employment opportunity for disabled people.  The NHS in Scotland in 2017 has just 0.85% of its whole workforce identifying as disabled.  Scotland's universities report that 3.3% of their collective workforce identifies as disabled.  In 2015, Scotland's local authorities were reporting that 1.96% of council employees across Scotland identified as disabled.

At this rate of progress towards delivering equality of opportunity for all disabled people in Scotland, it is more than likely that thousands of Scotland's disabled people will be born, live a life and die before they can claim equality of employment opportunity has arrived for them.

Is government inaction on the Equal Pay Gap in NHS Scotland part of the causes of period poverty ?

Recent campaigning has drawn attention to the impact of poverty on some women, with 'period poverty' being used as a shorthand to highlight just one of the multiple realities of how poverty can impact on the lives of those who struggle with low or erratic incomes.  A draft Bill is being worked on by one MSP to ensure universal free access to sanitary products.

picture from the Scotsman newspaper

I had recently completed research into the Equal Pay Gap in the NHS in Scotland.  This found that, using data published by NHS Boards themselves, the Equal Pay Gap in the NHS is 19.9%, an increase on the 18.85% being reported by the same Boards two years ago.

The research into the Equal Pay Gap covers more than just the headline figures of what the gap is.

One of the major revelations is in how there is an almost total lack of planning by Boards to identify and remove the significant amount of gender segregation in the NHS, and which is a major factor in the size of Equal Pay Gap.  The NHS insists that the pay system is fair.  What it does not want to talk about are the hugely disproportionate number of women who work part-time or who work in lower paid jobs in the NHS.  Men, generally, work full-time and tend to occupy disproportionately more of the higher paid jobs in the NHS.

It is this unequal distribution of part-time and low-paid jobs which contributes to much of what is the Equal Pay Gap of 19.9%.  And it is this which almost all Boards refuse to even engage with.  To illustrate.  In the report published by NHS 24, it was said :

NHS 24 is a part of NHS Scotland, the major employer of nurses in Scotland, and as such has a significant influence on the various elements of the supply chain which creates the nursing pool.  To suggest the occupational segregation in nursing is “outwith the control or influence of NHS 24” is more than a tad disingenuous. 

It is obvious that the NHS in Scotland struggles with devising strategic ideas for tackling occupational segregation and so tends to leave it in the box marked 'too difficult'.  Government Ministers, and the NHS Scotland Chief Executive, have been made aware of this in previous research into the NHS Equal Pay Gap.  They deliberately choose to take a hands-off approach to the performance of Boards in this area of complying with the law on equality, even though the consequences of their inaction will mean women continue to be discriminated against, and earn less than men, in the employment culture of the NHS.  I do believe that if Ministers can set waiting times targets which Boards must comply with, then setting a legally binding waiting time for women to achieve equal pay is just as critical to the health of the population.

 

if Ministers can set waiting times targets which Boards must comply with, then setting a legally binding waiting time for women to achieve equal pay is just as critical to the health of the population

Looked at another way, government failure to provide real leverage on closing the equal pay gap contributes in no small way to the continuing poverty experienced by many people and which government seeks to ameliorate – ignoring its own contribution to sustaining that same poverty.

The campaign which seeks to introduce a Bill providing for universal free access to sanitary products cites the crucial issue of dignity, and how 'period poverty' often crushes any sense of dignity.  

By closing the Equal Pay Gap in the NHS and in the wider public sector, government could restore dignity to women in multiple ways - through the ability to earn more and being able to make their own choices and priorities on what that increased income can be used for.  Period poverty and all other forms and manifestations of poverty will not be fixed by government making choices for people.  Poverty and the attendant indignities will only be eliminated when people are enabled and empowered through such as employment and equal pay to make their own choices and secure their own dignity.  Government action to close the Equal Pay Gap in the public sector would be a powerful first step in creating exactly that for women.

 

Who is responsible for keeping Scotland's NHS workforce a refuge for white male privilege ?

In recent months, research has shown that Scotland's NHS is struggling to shake off decades of institutional discrimination as an employer, especially when it comes to recruiting and retaining people who are Black Minority Ethnic [BME], who are disabled, or who are Catholic.  The research was shared with the Cabinet Secretary for Health, Shona Robison, and she was asked to indicate if she would :

"be looking at undertaking very clear and specific actions by government to ensure that the next time public sector employers are required to report on employment data, in 2019, the NHS at least complies fully with the letter and the spirit of the specific equality duties ?"

The response was the usual civil service waffle, including empty phrases such as :

The Scottish Government is determined to lead in advancing race equality across Scotland.

A pedant would ask what it has been doing for the last 10 years.  Another pedant would query exactly what 'advancing' means.  It does not convey a sense that government will, within the next 10 years say, ensure that the NHS workforce includes an agreed in advance percentage of BME people.  That would be leadership, and it is leadership that government is failing to give.

Another part of the response points out :

NHS Boards, as employers, have fully delegated responsibilities in relation to the recruitment and retention of staff including compliance with the public sector equality duty.

Put another way, the government's Cabinet Secretary for Health has no power to direct any or all of the Health Boards in Scotland to shred their racist, pointy-headed, KKK employment culture and practices.  

Cabinet Secretary for Health has no power to direct any or all of the Health Boards in Scotland to shred their racist, pointy-headed, KKK employment culture and practices.

Another part of the response points to data gathering by NHS Scotland which shows, the letter claims, that the proportion of the NHS workforce identifying as BME is 3.2%.  No attempt is made to reconcile this centrally gathered figure with the 2.44% established by the research which has used data published by Boards themselves.  If the data being published by Boards every two years is crap, Boards need to be called out for publishing crap data.

No attempt was made in the response to deal with other major findings in the research.

That Boards are gathering data of varying quality at recruitment stage, but not using it to identify discrimination or to change how they recruit and so improve the rate at which they employ BME people, disabled people and Catholic people.

That while Boards are gathering data on workers in post, none of the Boards has built an understanding of what the ethnic profile of their workforce would look like with discrimination removed, meaning that working towards eliminating racial discrimination is being conducted in the absence of a clearly articulated and evidenced goal.

That while Boards are gathering varying qualities of data on people leaving NHS employment, there was a lack of evidence that Boards were using data on people leaving their employment to find out if racial discrimination was a factor in the reason to leave and using this to identify areas of institutional discrimination in the culture and practices of NHS Boards as employers.

Boards left entirely to their own resorts will
 continue to sustain a workforce employment culture
which provides a well-paid and comfortable workforce
 for white, non-disabled, non-Catholic people

Put simply, the Cabinet Secretary for Health has no plan to direct Health Boards to improve their performance on equality and, research shows, Boards left entirely to their own resorts will continue to sustain a workforce employment culture which provides a well-paid and comfortable workforce for white, non-disabled, non-Catholic people.

NHS Scotland performance on employment equality reveals hidden structural inequalities

Recent research reports into who has what jobs in Scotland's NHS suggest that institutional discrimination continues to prevent Black Minority Ethnic people, disabled people and Catholic people from getting equal access to jobs and careers with the NHS.  

Copies of these reports have been sent to NHS Board Chief Executives, Board Chairpersons, the Chief Executive of NHS Scotland and the Cabinet Secretaries for Health and for Equality.  None of them have offered any mea maxima culpa for the state of equality in the NHS, and no promises are on offer to start demolition of institutional discrimination.  And yet why should they?  As journalist Hugh Muir put it so well in a recent Guardian piece on equality :

"We say we want equality because that fits with the way we like to see ourselves. It’s an article of faith that politicians promise to deliver. But how much do we really want it? Not nearly enough. Not enough to embark on the sort of root-and-branch reform that would make it possible. Certainly not enough to reset the default position that leaves white, middle-class men to dispense or withhold fairness and equality on their whim and at their discretion." [I would add to Hugh's definition of the apparatchik - white, middle-class, non-disabled, Protestant, men]

And then we turn to the last protected characteristic, the last group of people commonly discriminated against, in what is a quartet of research reports, Lesbian, Gay and Bisexual [LGB] people in the NHS workforce.

This report shows that NHS Scotland has, on average and across all 22 Boards, 1.00% of the workforce identifying as LGB.  And that is with 6 of the 22 Boards being unable to provide data on the sexual orientation of their workforce.  A context for the 1.0% figure is provided by the Scottish government's own equality evidence finder which cites the Integrated Household Survey 2014 as showing the LGB population in Scotland at 1.1%.  Expressed as a ratio where 1.1 = 100%, performance on LGB employment in the NHS is at 90.9/100.  This suggests the NHS in Scotland is doing very well in delivering employment equality for LGB people.  

That being the case, why then is the NHS so obviously incapable of delivering employment equality to the same extent for BME people, disabled people and for Catholic people ?  For BME people, the average employment rate across NHS Scotland is 2.44%.  The government's equality evidence finder tells us that the national population has 4% of BME people.  Expressed as a ratio where 4 = 100%, this puts NHS performance on BME employment equality at 61/100

For Catholic people, the average employment rate is 6.9%.  With the equality evidence finder showing a population with 15% Catholics, the NHS performance on employment of Catholics is at 46/100.  The performance on employing disabled people is even worse.  An NHS employment rate of 0.85% sits poorly alongside the equality evidence finder data showing 23% of the population have a disability.  Expressed as a ratio, this means the NHS performance in employment equality for disabled people is 3.7/100.

While the performance of the NHS on making employment equality happen for LGB people is very welcome, the same data analysis used to reveal that success has also revealed an unacceptable performance by the NHS on employment equality for BME people, for Catholic people and for disabled people.  Anything other than a root and branch reform of NHS employment cultures and practices will leave the NHS and Scottish government open to the charge that they actively favour a hierarchy of equality within the NHS.

Will the talent of Scotland's Catholics ever be free of the cold clammy chokehold of Calvinist privilege ?

Scotland has, particularly after 10 years of SNP-style government, achieved a vast conceit of itself in relation to equality.  Simply by declaiming, loudly and often, that Scotland is a hugely 'tolerant' country, Scottish government ministers trade heavily on a mythology rooted deeply in some Brigadoonian myth that Scottish people are but a hair's breadth away from some tartan Nirvana where all can quote extensively, and in the approved accent, from the government-sponsored poet Laureates such as the sexually incontinent Burns and fascist-loving MacDiarmird.

Tolerating difference is a dangerous, misleading, and Trumpian, forked-tongue concept.  Tolerance puts up with difference, as long as the source of the difference accords respect to the established nature of things - like the elevation of deep-fried Mars bars to haute-cuisine.  Tolerance does not embrace difference.  Instead, tolerance points to difference as an amusingly, sometimes quaint, folksy and even eccentric way of living - this from a country where men fetishise a form of national dress invented for her amusement by an English queen in the 19th century.

What Scotland's political cadre seem incapable of understanding is that the status quo, the management class which runs Scotland, has zero interest in changing how things have been in Scotland for some generations.  It would appear that the Scottish public sector management apparatchik is genetically incapable of operating in any way than the default, where white, protestant, middle-class men run things for 'people like us'.  They have become adept at creating a sense of industry and activity suggesting discrimination is being uncovered and uprooted on a daily basis and equality of opportunity is to be ushered in for all within the almost graspable future. 

Why then does the biggest public sector employer in Scotland, NHS Scotland, have just 2.44% of its workforce identifying as Black Minority Ethnic [BME] ?  Statistics show that at 2014, 3.4% of the adult population was BME.

NHS Scotland shows no evidence that it accepts the reality that it is institutionally racist and lacks the courage to even recognise the concept as a possibility.  The same NHS workforce data published earlier this year also shows that disabled people account for just 0.85% of all who work in the NHS.  This at a time when the government's own equality evidence finder reveals that in 2014 23% of adults living in Scotland had a disability, in 2010 12.5% of degrees were held by disabled people, and that 8.6% of people starting in the 2016/17 Modern Apprenticeships identified as disabled 

When it comes to the historical marginalisation of Catholic people in Scotland and the discrimination they face in areas such as employment, the cold, clammy Calvinist heart which beats in the white, protestant, middle-class management cadres continues to ensure Catholics remain at the margins in the workforce of the NHS.  With a national population where 15% are Catholic people, the NHS in Scotland employs just 6.9% of staff identifying as Catholic.

These figures act as a stark reminder that simply asking those who currently hold positions of privilege, such as the ranking well-paid jobs in the public sector, and wield power and influence, to cede this to the have nots is up there with simply asking men to stop abusing women.  Legal penalties for abuse of privilege and sustaining institutional discrimination, strictly enforced, alongside lengthy interventions at schools, colleges and universities to embed, over several decades, concepts of equality in tomorrow's adults is a must do for Scotland's all too many 'sans culottes'.

NHS in Scotland part of the problem when it comes to disability equality in work

For a political party whose whole purpose is the cause of independence, one would have expected the SNP to be gleefully trashing the barriers to independence commonly encountered by disabled people - especially in those areas under direct control of the SNP government, such as in strategic policy in the jobs market of the public sector.

Recent research into data published earlier this year by Scotland's 22 Health Boards would suggest the SNP in government has, like many others before it, become the establishment which finds it quite likes how the status quo works and confines reform to some very modest shop window dressing.  

The Scottish government’s own equality evidence finder reveals that 23% of adults living in Scotland in 2014 had a disability.  In 2010, 12.5% of degrees were held by disabled people, and 8.6% of starts in the 2016/17 Modern Apprenticeships identified as disabled people.  Yet the proportion of the NHS Scotland workforce in 2017 identifying as disabled people is 0.85%.

Getting into a job in the NHS is clearly not barrier-free for disabled people.  On the basis of an analysis of the employment data reports published by NHS Boards in 2017, there is an almost total lack of evidence that active and positive use is being made of the employment data gathered on recruitment to show that Boards are creating discrimination-free gateways to equality of opportunity for disabled people in getting and sustaining employment within the NHS.  

When it comes to what the employment data reports say about those people currently working in the NHS, not one of the 22 Health Boards has even worked out just how many disabled people would be employed once disability discrimination was eliminated from workplace cultures and practices.

In any analysis of why disabled people are leaving work with the NHS, the extent to which Boards are failing to gather and use data is astonishing.  Not one of the Boards has opted to aggregate leaving data over several years [the obligation to gather data on disability has a long legal history pre-dating the Equality Act 2010] as an aid to uncovering deep structural trends and patterns in disabled people and non-disabled people joining, staying in and leaving the workforce.  What appears to be an almost casual disregard amongst Boards for undertaking proper scrutiny, as set out in the specific equality duties, of why disabled people are leaving employment inevitably means the potential for disability discrimination being the trigger for people deciding to leave employment will continue to remain hidden by poor data gathering systems and organisations cultures.

The totality of the data published by Health Boards suggests a culture that can't be bothered making the effort to deliver disability equality at work, reinforced by the lack of any legal action being taken by the Equality & Human Rights Commission to enforce full compliance with the equality legislation.  Independence, through equality of opportunity to earn a living, is being institutionally denied to disabled people in Scotland.  It has been denied for over 10 years by a political party in power for whom independence is said to transcend all - but not, it would appear, being disabled.  

Roots of institutional racism remain deep and undisturbed across much of the NHS in Scotland

500 years ago one Niccolo Machiavelli wrote [I paraphrase] that the status quo will defend itself, and all its many privileges, with great vigour against change to how things are.  When it comes to making race equality in employment happen in NHS Scotland as opposed to working towards it, then not a lot has changed in the last 50 years.

In 2012, Scotland patted itself on the back with the adoption of what was described as a better set of regulations on making equality happen than were put in place in other parts of the UK.  Some 5 years on and several thousands of pages in multiple equality reports published by Scotland's NHS Boards under the Scottish equality regulations, and the data suggests those charged with enforcing the regulations had not studied or read Machiavelli at university.  Or maybe they just thought he was Liza Minnelli's grandfather ? 

In the 3 cycles of employment equality data reports published by Scotland's 22 NHS Boards, their own figures show that the proportion of Black Minority Ethnic [BME] people employed in the NHS has fallen from forming 2.77% of the workforce in 2013 to 2.44% in 2017.

To get and keep a job anywhere, you first have to succeed in what is often termed the recruitment stage.  Research in recent years has shown this is not a place where equality flourishes, and certainly not for BME people.  In 2016, the Scottish Parliament's Equal Opportunities Committee found that there was a disproportionate failure of BME people at interview stage.
 

With that in the background to NHS Boards preparing their 2017 employment equality data reports, one could have been forgiven for presuming this area of their culture and practice would feature heavily in their 2017 reports.  On the basis of an analysis of the employment data reports published by NHS Boards in 2017, there is an almost total lack of evidence that active and positive use is being made of the employment data gathered on recruitment to show that Boards are creating discrimination-free gateways to equality of opportunity for BME people in getting and sustaining employment within the NHS.  

an almost total lack of evidence ... Boards are creating discrimination-free gateways to equality of opportunity for BME people

It would not be unreasonable to conclude that on the basis of what has been published, the recruitment systems and cultures in the NHS have changed little if at all since the Equality Act 2010 and that they act as a bulwark to the status-quo of a predominantly non-BME workforce.

It gets no better when looking at the other end of what comprises a job with Scotland's NHS these days - that point where you walk away.  The intention behind the equality regulations was that employers would gather data on people who had left, find out why they had left, compare the patterns of BME people with non-BME people and use that to find out if there were underlying discrimination which triggered resignations from BME people.  

The extent to which Boards are failing to gather and use data on BME people leaving employment, and why, is astonishing

The extent to which Boards are failing to gather and use data on BME people leaving employment, and why, is astonishing.  It must also be viewed as deeply worrying as none of the Boards provides any rationale for taking what is often a minimalist approach to gathering and using data to understand why BME people are leaving employment.  Not one of the Boards has opted to aggregate leaving data over several years [the obligation to gather data on ethnicity has a long legal history pre-dating the Equality Act 2010] as an aid to uncovering deep structural trends and patterns in BME and non-BME people joining, staying in and leaving the workforce. 

What appears to be an almost casual disregard amongst Boards for undertaking proper scrutiny, as set out in the specific equality duties, of why BME people are leaving employment inevitably means the potential for racial discrimination being the trigger for people deciding to leave employment will continue to remain hidden by poor data gathering systems and organisation cultures.  

the potential for racial discrimination being the trigger for people deciding to leave employment will continue to remain hidden by poor data gathering systems and organisation cultures

This latest examination of employment data published by Scotland’s 22 NHS Boards suggests little has changed since the Equality Act 2010 and that if anything the roots of institutional racism remain deep and undisturbed across much of the NHS.  What has emerged in this particular research report is growing evidence that the NHS in Scotland is reluctant to willingly and comprehensively embrace all that the specific equality duties requires as this would more than likely unearth practices and cultures which are racist and which would require institutional change.

NHS in Scotland has hung a 'DNR' on the too-long neglected concept of human rights

At any given time, the majority of US citizens are able to identify some of their rights as enshrined in their revered constitution.  Amendment 2 relates to the right to 'keep and bear arms'.  Some would argue that knowledge of this right is almost world-wide, such is the cultural impact of the US and of Holywood on the rest of the world.  



In similar terms, many people across the world are as familiar with the 5th Amendment as are most US citizens - the right to refuse to answer a question on the grounds of self-incrimination.

The nearest equivalent here in the UK is the 1998 Human Rights Act.  Sadly, the knowledge of UK citizens of their human rights is markedly less widespread than that of US citizens of their constitutional rights.  It may be of course that tabloid press coverage of human rights cases has tended to sensationalise the use of human rights laws to the extent that they are commonly, and negatively, associated in that part of the public mind informed by the tabloid press with refugees and prisoners.

It is not enough to blame the red-tops for the jaundiced view many have of human rights. 

Age UK published research in 2011 on Equality & Human Rights in Practice.  On Human Rights it found : 

Human rights are basic rights that belong to everyone simply because we are human. They are an important means of protection for people in later life, especially those who face abuse, neglect and isolation, and can be empowering tools for older people to advocate for their own rights. The Human Rights Act (1998) is, however, absent from much of government policy-making in relation to older people. Within many parts of government, human rights are so little understood that conversations using human rights ‘language’ are ineffective.

In 2010, NHS Health Scotland published a report which found that :

The overall theme within NHS Scotland was that few health boards had taken action on human rights as they were unclear about what is expected of them or wanted guidance on this. However, there was recognition of the need to comply with human rights law and good practice and a willingness to do so.

Translation ?  Senior, well-paid, staff running the 22 NHS Boards knew they should be doing something on human rights.   But because politicians and civil servants had not told them what they should do, they did nothing.  Because politicians and civil servants have mot been holding them to account on what they should be doing on human rights [like empowering service users to know their human rights], they have got away with doing nothing for the best part of 17 years. 

The Working Group behind the NHS Health Scotland report recommended Boards in Scotland should use a Human Rights Based Approach.  A critical part of this approach was commended to NHS Scotland :

NHS Scotland will take steps to ensure that everyone within the NHS (including staff, volunteers, patients, carers and families) is aware of and empowered to claim and enforce their rights.

Recent research on how much use the NHS in Scotland makes of a Human Rights Based Approach revealed that for all the claims to 'do' human rights, there is precious little evidence that Scotland's NHS service users even know what their human rights are.

Scotland's 22 NHS Boards were asked via a Freedom of Information request to provide a count of exactly how many service users they had helped empower with a knowledge of their human rights and the capacity to claim them.  Once the fluff, jargon, double-speak, confusions and digressions had been stripped from the 22 responses, the count revealed that over the last 3 financial years, Scotland's 22 NHS Boards had manged to empower exactly 0, zero, zilch service users with a knowledge of what their human rights are.

Boards were also asked to provide a count, over the same 3 years, of how many claims had been submitted to them by service users of cases where their human rights had been ignored or breached.  Keep in mind that the NHS in Scotland has at least 26 million interactions with service users each year.  Over the last 3 years once can reasonably assume that the number of interactions would have been in excess of 78 million.  During that whole time, not a single one of those 78+ million interactions was carried out in such a way as to cause a service user to claim that their human rights had been ignored or breached.

The submissions received from all 22 NHS Boards early in 2017 suggests little has changed from the findings of the 2010 NHS Health Scotland report.  It seems that since the 1998 Human Rights Act took effect in 2000, the NHS in Scotland has been keeping the concept of human rights in the NHS on the barest minimum of life support systems.  Starving service users of the oxygen of knowledge that they have human rights in a health setting is clear evidence that the NHS in Scotland has hung a 'DNR' on the too-long neglected concept of human rights, which has been dumped on a trolley and pushed out of the way and into some long-forgotten dusty NHS policy corridor leading nowhere.