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.