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'.