Time to topple the statues to structural racism in Scotland's public sector ?

For several decades now - starting in the 1960's - there have been a variety of legal obligations on public sector bodies to find and eliminate race discrimination in how they operate.  The most recent re-visit to legislation on race equality was in the Equality Act 2010.

After more than 50 years of effort, one would imagine that the public sector in Scotland would have undertaken the bulk of the work required to identify and eliminate the shameful practices, systems and cultures which provided the foundation to racism in how they delivered services and how they recruited as employers.

If these 50+ years of effort have revealed anything, it is that simply bringing laws into being will not change the structural nature of racism.

At or around 2019, the NHS in Scotland was reporting that 3.32% of their 168,194 workforce were identifying as Black Minority Ethnic [BME] people.  Scotland's Councils were reporting that 1.29% of that 258,680 workforce identified as BME, while Scotland's universities reported 6.03% of the 48,933 workforce identified as BME.  Scotland's other public bodies, not in any of these other major sectors, reported 1.57% of the aggregated 33,429 workforce identified as BME.  Scottish government itself, expected to act as a beacon and flag-bearer towards race equality, reported that 2.1% of its workforce identified as BME.  These figures were being reported against a demographic backdrop in the form of the Scottish government's Equality Evidence Finder which reveals that BME people formed 4.6% of the adult population in Scotland in 2018.

The level of employment of BME people in Scotland’s universities is obviously underpinned by recruitment from abroad. That being the case, any benchmarking of performance on BME employment equality cannot use, for example, Scotland’s BME population [4% at the 2011 census] as a key indicator [as is done by St Andrews University] . 

The poverty in performance of the public sector, after over 50 years of effort, in delivering race equality in employment is pitiful, especially at a time when the ‘Black Lives Matter’ movement has been pushing hard for a faster pace to the dismantling, sometimes literally, of structural racism across the UK.  The toppling of slave trader Edward Colston’s statue earlier this year helped trigger a serious questioning of the sloth-like progress towards race equality in the UK.  It appears that public sector employers in Scotland need to urgently review their own monuments to organisational systems, practices and cultures which clearly continue to chain them to structural discrimination on the grounds of race.

Whether those who lead in the public sector have the desire or willingness to recognise their white privilege and unpick the lock they have on jobs and power is a question to which there is no clear or obvious answer.  Just part of the obstacle to race equality is the busted flush that is accountability in the running of the public sector.  Each of the 20-odd NHS Boards in Scotland has a group of Board members appointed by Jeane Freeman, Cabinet Secretary for Health, with the main remit for them being to hold the senior paid staff in each NHS Board to account.  These Board members know how their paid staff are performing poorly on race equality [they get reports which show this] - and do nothing to change that poor performance.  Jeane Freeman and her senior civil servants know how poorly all NHS Boards are performing on race equality [she gets reports which show this] - and do nothing to end that poor performance and speed up the delivery of race equality in Scotland's NHS.  In both these scenarios, the general public/electorate has no tools with which to hold each NHS Board or the Cabinet Secretary to account.  Until such times as politicians build in effective and independent enforcement to such as the Equality Act 2010, racism in employment [and services] in the public sector in Scotland will continue to be an inevitable consequence of unchallenged white privilege.

  

Scotland's public sector offers a thin dry toast of excuses for doing nothing on disability equality

 It is now over 10 years since the Equality Act 2010 promised a bold new world order in making equality happen across the UK.  It had been intended to be the freshest policy offspring of Gordon Brown's premiership, and would have marked the start of his new term of office, this time as an elected Prime Minister.  Instead, the Equality Act 2010 became the unwanted and unloved orphan inherited by David Cameron, propped up by Nick Clegg.

In Scotland, government accepted that in the years prior to the Act, work on equality had become bogged down in the process of compliance with the then equality legislation and reporting on progress had become an end in itself instead of a vehicle for tracking and driving real change.  New 'local' regulations on how the Act would be applied in Scotland were drafted by Scottish government with the aim of dislodging the stasis which had gripped public sector progress with delivering real equality which changed the lived experiences of people.

In 2015, Equality Here, Now looked at the performance on the delivery of employment equality of public sector organisations beyond the usual suspects of NHS, Councils and Universities.  Research from then found that diverse organisations such as Visit Scotland to the Scottish Qualifications Authority were employing disabled people to the extent that they formed 2.98% of the sector workforce.  At that time, Scottish government's Equality Evidence finder resource was flagging that the proportion of the adult population identifying as disabled was 20%.

The research in 2015 concluded that - 

the employment data published by public bodies provides no evidence that there is any awareness that there could be even the remotest prospect of institutional discrimination in the sector’s employment of disabled people.  There is also no evidence that disability discrimination in employment in the sector is to be eliminated in a coherent, planned manner based on gathering good quality evidence and analysis, and linked to measurable targeted changes in the lived experiences of disabled people.  This failure of public bodies in Scotland to act decisively on institutional discrimination on the grounds of disability means that for a lot of young disabled people alive today, they will live out their lives and die before demonstrable and evidenced equality of employment opportunity is available to them.

In 2020 Equality Here, Now revisited the 2015 research, with new findings revealed that the employment rate of disabled people across this part of the public sector was 3.81% while Scottish government's Equality Evidence Finder was flagging an adult population where 32% of people identified as disabled people in 2017.

 The research concluded - the Mainstreaming Equality reports published by these public bodies offer varying promises of a ‘jam’ that purports to be the elimination of discrimination in employment, with that ‘jam’ always scheduled to arrive tomorrow.  The tomorrows promised seem never to arrive in the todays being lived now by disabled people looking for equality of opportunity in getting access to work.  When the nature of the ‘jam’ is examined closely, it is in fact often found to be the thinnest of syrups, with many of the planned Outcomes on equality taking the form of improving systems for gathering data.  This seems to be the 21^st century equivalent in Scotland’s public sector’s grappling with the delivery of equality, to the medieval scholasticism of such as Thomas Aquinas and his Summa Theologica grappling with questions such as ‘can several angels be in the same place’.

This research, carried out in the midst of the Covid-19 pandemic in 2020, finds that the 5 years which have slipped past since previous research in 2015 have been stuffed so full of lost opportunities to deliver employment equality for disabled people as to produce an obscenely rich foie gras of discrimination and which requires any independent observer to apply a deep and unappetisingly ableist layer on the public sector’s usual thin dry toast of excuses for doing nothing.

Scotland's Councils as employers being run by and for WASPs with privilege - government and EHRC decline to intervene

Ten years ago, in the dying days of Gordon Brown's government, the Equality Act 2010 as rushed through the last stages of parliamentary scrutiny and scrambled on the the statute book.  Over the period of time that followed, David Cameron's government ripped sections out of the Act, watered down other sections, and performed crude dentistry on the powers of the Equality and Human Rights Commission [EHRC].

As with any law, valuable time could be wasted in picking over the mistakes in drafting the Bill, mourning the opportunities lost in Cameron's filleting of the Act, and denouncing the massive funding cuts to the EHRC budget.  Or we could look at what public bodies have actually done in a decade of work focused on delivering the core aim of the Act - to eliminate discrimination - and decide whether the Act is delivering for the people it aimed to help - those discriminated against on an almost daily basis.

Over the intervening decade since the Equality Act 2010, 'Equality Here, Now' has carried out regular research into what Scotland's public bodies have been doing to rise to the challenges of the Act and eliminate discrimination through change in the polices, practices and cultures of how they deliver services and operate as employers.  Most recently, this has involved scrutiny of what Scotland's 32 local authorities [Councils] published in their function as employers on the workforce profile of people employed by them, and by the protected characteristics of disability, ethnicity, sexual orientation and religion.

What that research found was that the fundamental flaws in how Councils are gathering and using employment data are unchanging from what data they published in previous years and that the often marginal movements/improvements in percentages reported against each protected characteristic are simply a result of modest improvements in data gathering and reporting.  Put simply.  There has been for some years and continues to be today a complete lack of evidence that Scotland's Councils are actively seeking out discrimination within their cultures, practices and systems and eliminating the root causes of that discrimination.  For these reasons, the research report published in May 2020 offered no analysis of why discrimination continues to be evidenced, sometimes conspicuously, in the 32 workplace data profiling reports published by Scotland’s Councils in 2019.  It has all been said before in previous research reports since 2013 and nothing in what Councils are still doing – and still not doing – has changed in any meaningful way.

At the most basic level of scrutiny, we know that Scotland’s Councils have 2.16% of all workers identifying as disabled.  The Scottish government’s equality evidence finder reveals that Scotland, at 2018, has a national average of adult people identifying as disabled at 32% of the population.  

Glasgow Centre for Population Health estimates, in a study from 2017, that Scotland would have, by 2020, an average of over 5% of the population identifying as Black Minority Ethnic [BME] and increasing to 7% by 2031.  Councils in Scotland are reporting an average across all Councils of 1.29% of the workforce identifying as BME.

Councils also reveal that in 2019 the proportion of the Scotland-wide workforce identifying as Lesbian, Gay and Bisexual [LGB] is 0.69%.  The government’s equality evidence finder reports that the proportion of the Scottish adult population identifying as LGB as at 2017 is 2%.  The final protected characteristic tracked in the research report was religion or belief and with a particular focus on the employment of people who identify as Catholic.  Data published by the 32 Councils reveal that 6.54% of their workforce identify as Catholic people.  The equality evidence finder on government’s web site provides the wider context that in Scotland 14.3% of the adult population identifies as Catholic people.

These basic numbers reveal all too clearly that Scotland’s Councils are light years away from being even close to delivering employment equality, after having had 10 years of opportunity to make the aims of the Equality Act 2010 a reality for people looking to escape discrimination and gain equal access to employment.  There are no obvious reasons why this should be the case.  Applying Occam’s razor would suggest the most likely reason for the complete and sustained failure is that there is a marked lack of appetite in local government for changing a status quo in a Scotland which is largely run by and for WASP [White Anglo Saxon Protestant] privilege.

For Scottish government and the Equality & Human Rights Commission [EHRC] to be aware of this and not to actively intervene and drive the real change required, suggests WASP privilege is similarly indulged by government and the EHRC.

Rainbow flags no substitute for hard data evidence of LGB employment equality - flags offer nothing but a feeble flapping at the relentless orthodoxy of discriminating against anything which is different

One of the many changes in virtue signalling common in the UK in the 21st century is that the rainbow flag has been hi-jacked in 2020 by the movement to celebrate the NHS and those who work in it, leaving the LGB community uncertain whether their version of the rainbow flag can retain brand distinction.

Scotland's universities were not slow in climbing on the Stonewall-driven bandwagon of the early rainbow flag waving as a high-vis message that of course they were fully paid-up members of the Stonewall bus and very active in support of LGB rights for students and for staff and would, just as soon as possible, eliminate discrimination wherever it was unearthed.

Between 2010-2012, legislation on equality required a bit more than getting on the right bus and waving the right flag during the right month.  Employers were required to gather data on the people who worked for them, by protected characteristic, and publish the information, in an accessible form.  As well as this they were required to publish what they had learned from gathering the data and to report on how they would use what they had learned to improve their performance in eliminating discrimination as an employer.  Easy-peasy, one would think.  Especially at universities which take the finest minds and polish them into even finer minds.  Identifying and eliminating discrimination can be done by mid-morning coffee while solving Fermat's Theorem might take them until late-lunch.  

And yet, in 2016, Fermat's Theorem was solved, while in 2020, Scotland's universities have still not managed to identify and eliminate discrimination against employees who identify as LBG.  It does not help universities achieve their goal on eliminating discrimination when half of the workforce [49.73%] on average across the sector refuses to identify their sexual orientation to their employer.  Two of Scotland's universities do not even publish data on the sexual orientation of their workforce.  From that sort of baseline it can be no real surprise to find that, on close inspection, the colours in the rainbow flag of LGB solidarity have been washed out by the rain of distrust expressed by staff and instead reveals a sector which has surrendered, waving the white flag of apathy and indifference on LGB equality.

We do know that in 2019, Scotland's universities employed 1,378 people identifying as LGB, just over 2.8% of the sector workforce total of 48,933 people.  

What we don't know is whether Scotland's universities think 2.8% of the workforce is evidence that LGB equality exists or that it has not yet been achieved.  Not one of the universities provides a reasoning for what their workforce would look like if discrimination against LGB people were eliminated.  In brief, universities don't know where they are [half the workforce don't trust them enough to identify their sexual orientation] and don't know where they are going [none of them have worked out their optimum profile in terms of people identifying as LGB].  

Most of Scotland's universities have got on the rainbow bus and paid their fare to Stonewall [free flag included].  Trouble is, no one bothered to check the destination board before buying the ticket and grabbing a seat up the back of the bus.  The lack of data on half of the university workforce means the bus tires on one side are almost flat, pulling the bus off the straight line to eliminating discrimination and into a circular journey where universities simply keep arriving back to where they started out from.  Flag waving - a favourite hobby of nationalists across the world - may look pretty, but in the face of the relentless orthodoxy which discriminates against anything which is different, it tends to obscure the reality that nothing has changed.

Happy to provide numbers of Jewish, Hindu, Muslim or Church of England people, but not Catholic - Scotland's universities

Aside from being places where the bulk of tomorrow's middle-class public sector management apparatchiks are created, Scotland's universities are also major employers.  In 2019 and based on reports they themselves have published, Scotland's universities employ almost 50,000 people.

Like all other employers across Scotland's public sector, universities are struggling to evidence that discrimination has been eliminated and that equality of employment opportunity is being allowed to flourish unhindered by the weeds of prejudice and bigotry.  Recent research into data published by all universities on the religion or belief identity of their workforce revealed that 'Scotland's Shame', so eloquently described by James MacMillan in 1999, continues to cringe even in Scotland's ivory towers, helped not a little by the fact that almost half of Scotland's universities refuse to turn on the light and let the world see the data on Catholic and Protestant people employed by them. 

This reluctance stands in contrast to the willingness of all the other universities to gather and publish data sets providing a rich granularity on the religion and belief identify of their workforce, whether it be Jewish people representing 0.1% of the Napier University workforce, the 4 Hindu people in the Stirling University workforce, the 2 Church of England people employed at Queen Margaret University, and the 59 Muslim people on the workforce at Aberdeen University.  Just don't ask about Catholics and Protestants.

In fairness to universities, Scottish government is also guilty of refusing to shine a light on the Catholic and Protestant cohorts within their workforce.  Their most recent employment equality report from 2019 rolls up the uncomfortable reality of sectarianism by aggregating the troubling data sets into an anonymised, unembarrassing and uninformative catch-all of 'Christian', amounting to 25.7% of government's workforce.  Curiously, the benchmark government chooses to check performance reveals that Scotland has 44% of the population identifying as Christian.  Government doesn't comment on this disparity or inequality.

Strathclyde University is one of a number of universities unable to evidence employment equality for people identifying as Catholic. Page 25 of the Strathclyde University workforce profiling report reveals : 

At Strathclyde, information from staff on gender reassignment, religion and belief, sexual orientation, marital and civil partnership status was sought in September 2013 for the first time. The disclosure rates for gender reassignment (improved by 4%), and parental (improved by 2%) have increased since 2017. All other rates have slightly decreased since 2017. We will monitor this and consider initiatives to improve the disclosure rate for reporting purposes. 

What Strathclyde University fails to address is that it is unable – and has been unable for some time – to identify and eliminate discrimination on the grounds of a person identifying as Catholic. 

Almost half of Scotland’s universities have failed to gather and publish data sets which evidence [or fail to evidence] employment equality for people identifying as Catholic.  All of Scotland’s universities have failed to provide a benchmark against which to judge current performance on delivering religious equality in employment and not one of them has offered up any clear sense of what their destination [the elimination of religious discrimination] will look like if and when it is reached.

The silence of so many of Scotland’s universities on the Catholic and Protestant profiles of their workforce simply acts as a shout which draws attention to another fertile layer of the cultural landscape in Scotland which enables the continued growth of intolerance and which continues to provide discreet sustenance to the sectarianism long recognised as ‘Scotland’s shame’, as discussed and illustrated more recently in 2018.

Not everything that is faced can be changed, but nothing can be changed until it is faced - racism in Scotland's universities

One of the clear measures of equality is to be found in the profile, by protected characteristic, of those people in employment.  Being in employment can bring multiple, potentially positive, impacts on the lived experiences of many people who share particular protected characteristics.  It can reduce dependence on the less than generous state welfare system and the increasing stigma attached to what little support is provided to people who are jobless for whatever reason.  Being in work provides the opportunities for those previously excluded from key areas of society to be able to influence change and the future shape of societal structures from within.  

In order for Black Minority Ethnic [BME] people to get into work, race discrimination needs to be eliminated.  For that to even begin happen requires an explicit acknowledgement by all public sector bodies that institutional discrimination is alive and well and exists within and across the structures, policies and cultures which create each organisation.  No such acknowledgment has been made by any of Scotland’s universities in the employment data reports they have published over the course of 2019 and which have recently been the subject of research and a report.

Any reading of the workforce data reports published by Scotland's universities reveals that the accessibility to and in them - a key factor in regulations surrounding what should be published - is poor.  Each of Scotland’s universities have managed to produce reports on workforce equality data which are entirely different from the reports of all the other universities.  The university sector in Scotland, taken as a whole, fails spectacularly to reach pass marks in any test against standards of transparency, accessibility and accountability in how they report workforce data.

Reading the published reports also reveals that for universities, publishing the report itself is the end result, instead of the report being an intermediate point on the journey which ends only with the elimination of racism in employment.  This may of course relate to the reports revealing yet another flaw in offering a route map towards the elimination of racism.  None of the universities offers a sense, an understanding, a data picture of what their workforce would look like once racism in employment had been eliminated.  

The level of employment of Black Minority Ethnic [BME] people in Scotland’s universities is obviously underpinned by recruitment from abroad.  St Andrews University reports that over a quarter of their staff have a non-UK nationality.  That being the case, any bench-marking of performance on BME employment equality cannot use, for example, Scotland’s BME population [4% at the 2011 census] as a key indicator, although St Andrews University does try.  

WASPs [White Anglo-Saxon Protestant] people have held the monopoly on positions of power and privilege within Scotland’s universities as employers for decades, if not centuries in some cases.  Legislation in the latter part of the 20^th century and early 21^st century aimed at eliminating race discrimination has failed to break the monopoly that WASPs hold.  The requirements of the Equality Act 2010 and specific equality duties in Scotland have found universities locked into a sterile two-year cycle of gathering workforce data and publishing often inaccessible and ineffective workforce profile reports – while the baseline evidence they reluctantly disgorge tells us that nothing is changing.  Evidence of race equality – or race discrimination - remains shrouded behind an opaque curtain of unexplored and disconnected silos of employment data on ethnicity and nationality.

Many decades ago, James Baldwin offered the view that nothing can be changed until it is faced.  Evidence published by Scotland's universities themselves suggest that racism in Scotland's universities will not be eliminated for some decades yet, as Scotland's universities are still not ready, able or willing to face the institutional racism embedded in the sector.

Scotland's universities not learning ......... how to eliminate disability discrimination as employers

Whenever the question is asked - 'what are universities for ?' - it is impossible to find a universal truth which provides a clear answer in a short paragraph [just try 'Googling' the question].  There does appear to be a consensus that in the UK universities offer some of the best minds [in terms of passing exams] from secondary schools the opportunity to develop and stretch their minds to another level and to then embark on a life from which society anticipates it will gain, and be shaped and re-shaped, in various ways.  

In some senses, one could reasonably conclude that a number of the leaders society needs for tomorrow are currently attending university today.  In political terms that is certainly true, for good or bad.

From that perspective, the close examination and scrutiny of how universities are performing in relation to equality and the legal framework which seeks to eliminate discrimination, becomes even more important.  Part of the context in which tomorrow's leaders are formed is the culture and practices of our universities as employers.  Students as they pass through the system will encounter the rough and sharp edges of the university employment culture in the shape of the employment profile of each university and will in turn take away a sense of what is the prevailing culture of what is equality in the workplace.

When it comes to employment equality for disabled people, Scotland's universities are teaching the leaders of tomorrow that disabled people are expendable when it comes to making employment equality a reality.  From reports published in 2019 by all the universities, the proportion of people identifying as disabled across the sector was found in recent research to be 3.69%.  Scottish government claims the average employment rate of disabled people across the public sector is 11.7%.  At the same time, Scottish government's own report on employment equality from 2019 explains that their rate of employment of disabled people is at 7.6% against a benchmark of 19%.  

No matter which way the data published by Scotland's universities is stacked up, the result - 3.69% of the workforce identifying as disabled is simply unacceptable and represents hard evidence of institutional discrimination against disabled people.

Non-disabled people have held the monopoly on positions of power and privilege within Scotland’s universities as employers for decades, if not centuries in some cases.  Legislation in the latter part of the 20^th century and early 21^st century aimed at eliminating disability discrimination has failed to break the monopoly that non-disabled people hold.  The requirements of the Equality Act 2010 and specific equality duties in Scotland have found universities locked into a sterile two-year cycle of gathering workforce data and publishing often inaccessible and ineffective workforce profile reports – while the baseline evidence they reluctantly disgorge tells us that nothing is changing.  Disability discrimination remains in place across the university employment sector.

There is a well-known quotation defining insanity [and often mis-attributed to Einstein]  :

“doing the same thing over and over and expecting a different outcome.”

Scotland’s most recent attempts in the 21^st century at framing equality legislation and regulations to eliminate discrimination are insane.  Scotland's universities have displayed a lack of intellectual rigour in attempting to observe and comply with regulations which, each year, demonstrate clearly that the goal - the elimination of discrimination - is not going to be reached.  The insanity of the system for delivering equality is widespread and deep-rooted.

When is enough, enough, in LGBO equality in Scotland ?

In the Scottish Government's most recent mainstreaming equality report published in 2019, the reader will find her/himself overwhelmed by data sets and tables spread over 233 pages which makes nonsense of the concept of accessibility and buries in the mud of apathy any semblance of accountability between government and citizens.

Some of the pages provide stark insights as to how equality is not happening in Scotland's government as an employer.  On page 114 of the report data is offered on the ethnicity of the government's workforce.  For 2018 [the most recent year for which data has been gathered] just 2.1% of the workforce identified as what Scottish government calls 'minority ethnic'.  The report helpfully provides another line of data sets which provide the reader with a benchmark against which to judge performance.  This line advises that the benchmark for 'minority ethnic' staff in the workforce should be 4%.  Any sense that this has triggered alarm bells in government quickly vanishes on a reading of the other 232 pages of the report.  There are no real, significant, coherent plans to dismantle the discrimination in the employment culture and practices of government which act as barriers to Black Minority Ethnic [BME] people working in government.

When looking at the government's record as an employer in relation to disabled people, the sense of just how ineffectual government is in eliminating discrimination is hardened on a reading of the report's page 115.  The benchmark for employing disabled people is 19%.  The actual rate of people who identify as disabled in the government's workforce is 7.6% at 2018.

One area of the report where this trend of failure is reversed relates to what government describes as 'LGBO' - Lesbian, Gay, Bisexual or Other [see page 38].  The benchmark used by government to assess performance on employment equality is 2%.  The actual figure recorded for all employees identifying as LGBO in 2018 within government is 3.6%.  Heterosexual employees make up 62.3% of the workforce, against the benchmark of 96%.  The remaining 34.1% of the workforce are logged as either 'prefer not to say' or 'unknown'.

Please sir, who decides
when enough is enough ?

When asked what government would be doing to remedy an imbalance between LGBO and heterosexual employees, according to their own benchmark, it was explained that the 34.1% of employees logged as 'unknown' prevented government from having 'sufficient data' to make policy decisions about over- or under-representation.  Such a take - and position - is clearly indefensible.  No matter which way one allocates the 34.1% of 'unknowns' between the cohorts of LGBO or Heterosexual, the percentage of the Scottish government workforce identifying as LGBO will be, at absolute minimum, 3.6% - well in excess of the benchmark of 2%.  Put another way, the number of LGBO people working at Scottish government would, if the benchmark translated into actual reality, give a count of 185 people.  There are in fact 335 people identifying as LGBO in government's workforce.

In isolation, this could be said to be a good thing.  But the data sets presented by Scottish government - and all other employers - cannot and should not be looked at in isolation.  

If, instead of just 2.1% of the government workforce identified as BME, this figure increased to 8.1%, in that scenario, non-BME people would have a strong claim to being discriminated against in the employment practices and cultures of Scottish government.  If the figure of 7.6% of the workforce identifying as disabled people increased to 27.6% [against a benchmark of 19%], non-disabled people would have a strong claim to being discriminated against by government.

Nicola Sturgeon - unable to answer,
when  is enough, enough ?

Ducking difficult decisions is something government's do, especially when they have been in power too long.  On this issue - the employment of LGBO people - Nicola Sturgeon as First Minister is failing to offer a lead to employers across the public and private sectors on how to answer the question - when is enough, enough ?

NHS in Scotland not listening to deaf and hearing impaired people

When you call the NHS, you expect and believe that the service you get over the phone will be the same as if you were there in person.  The same high standards will apply.

That is fine if your hearing is good enough to hear what the person on the other end is saying and asking.  If you are one of the hundreds of thousands of deaf and hearing impaired people [not using BSL] who struggle with telephone based conversations, the NHS in Scotland struggles to offer you the same quality of service which hearing people get when they phone the NHS

In 2019 Scotland's NHS Boards were asked to provide data on all telephone calls received over the last 3 full financial years, with the telephone being the most common method of contacting the wide range of services provided by the NHS.  From that baseline data, Boards were then invited to release data which showed how they were quality assuring telephone calls to them made by deaf and hearing impaired people not using BSL and where the contact would most likely be made via Minicom or Next Generation Text Relay.

The questions were focused to reveal what quality assurance systems were in place in each Board to check the accuracy of the call enabled and the accuracy of medical advice offered in such calls.   Boards were also asked what systems were in place for regular sampling of these calls to gauge user satisfaction and to reveal what levels of satisfaction were being reached.  To provide a wider context to the study, Boards were also asked to provide similar data sets for people contacting them by phone and for whom English was not their first language and who would need communication support in the shape of Language Line or Big Word interpreting services.

On the basis of the data supplied by the minority of NHS Boards in Scotland, incoming calls to NHS Scotland exceeded 52,100,000 over the last three calendar years.  Given the number of Boards unable to find and supply the data, the true figure is likely to be well in excess of that total.  On a daily basis, 9 of the 22 NHS Boards in Scotland are receiving, on average, 47,600+ telephone calls per day.  The other 13 NHS Boards in Scotland don’t know how many calls they are receiving each day.

We are now well established in the 21^st century and yet large parts of the NHS in Scotland are unable to access and assemble basic data on telephone traffic which should be an essential and key feature of the strategic management of service development today and well into the future.  If this data gap were revealed to be the case with a large private sector organisation such as British Airways or Marks and Spencer, the share price would plummet as a direct result.

In 2018, the average daily calls in to the NHS across all of Scotland by people using language interpreting support was 41 calls per day – when the average daily rate of all incoming calls to NHS Boards was over 47,700 per day.    

While evidence of equality of access to the NHS for people whose first language is not English is limited to just a few parts of the NHS, evidence on equality of access to the NHS for deaf and hearing impaired people not using British Sign Language [BSL] is even more difficult to find.  Just two of Scotland’s 22 NHS Boards [NHS24 and NHS Fife] revealed details of the volume of calls received and enabled by such as Minicom, Next Generation Text Relay or other systems.  According to the data supplied by all Boards it is revealed that the number of calls made to the NHS across Scotland by deaf or hearing impaired people and enabled by Minicom, NGTR or similar averaged 1 per week.  This compares to the total incoming calls across NHS Scotland of an average of over 47,600 calls per day.  

When it came to quality assurance of the calls, and from the responses received from the 5 Boards who had logged the over 43,000 calls received over 3 years and enabled via Language Line or similar, it was revealed that not one of the 43,000+ calls was selected for audit and quality assured for accuracy of content or of the medical advice offered.

Given just 2 of the 22 NHS Boards in Scotland [NHS 24 and NHS Fife] have been gathering data on calls received from deaf or hearing impaired people using Minicom, NGTR or similar, it was not expected that much data on quality assurance would be available.  The response from both NHS 24 and NHS Fife to this particular part of the FoI was to indicate that none of the calls received via Minicom, NGTR or similar had been quality assured, either for accuracy of the call content or for the accuracy of the medical advice offered in the call.

In the last 3 complete calendar years, Scotland’s 22 NHS Boards received well in excess of 52,188,408 telephones calls [just 9 of the 22 NHS Boards provided call data – the rest not gathering or unable to gather the data].  Of the 52+ million calls received by the NHS in Scotland over the last 3 years, just 43,162 [0.09%] calls were received from people whose first language is not English and were enabled by Language Line or similar.  Calls from people who are deaf or hearing impaired and not using BSL and enabled by NGTR or similar totalled 181 [0.0004%].

NHS Boards reported that none of the calls made possible via the different forms of communication support are routinely subject to audit by them for quality assurance purposes in relation to the accuracy of call content or accuracy of the medical advice offered.  Similarly, none of the calls were subject to user satisfaction surveys on experiences of accessing and using health services by phone.

Given the Equality Act 2010 places a clear duty on NHS Boards to provide health services free of discrimination, the realities revealed by this research note suggest that NHS Boards in Scotland are unable to offer robust evidence that equality of access to health services by phone is being delivered for people with different communication support needs.  

Access beyond the ghettos of accessible housing

From time to time, the media, business, governments, elected members and charities acknowledge how inaccessible most of the traditional high streets are across the UK for disabled people with particular mobility and access needs.  Real equality means that disabled people who, say, use wheelchairs and are visiting a place like Dalkeith in Midlothian should be able to know that they can visit, for example, Ladbrokes in South Street and place a bet [they can – it has ramped access].

While dropping in to the High Street is often an unthinking event for non-disabled people, so too is the decision to drop in unannounced on a friend or relative who lives, say, just a few miles away and whose company you enjoy.  Such is the stuff of life for non-disabled people.  Place a bet on the Grand National at Ladbrokes, grab a few beers from Lidl, and then zip round to watch your horse come in last on the large-screen tv at your friend’s house.

We know that all can gain equal access to Ladbrokes and bet the house on the 3.30 race at Newmarket.  What we also know is that the vast majority of houses built across Midlothian [old and new] and the rest of the UK are not visitable by disabled people who use a wheelchair.  Too many, way too many, still have stepped access, even when the building site was relatively flat [architects and developers like to make statements at entrances to homes and steps can be part of such ‘statements’].  Too many still have inadequate door opening widths, meaning entrance over the few which have level, no-step, access, can mean anything from getting stuck, grazed knuckles, or getting marooned in the hallway because there is no turning space and the doors leading into the rest of the house open the wrong way.

Even if a person is lucky enough to get into the lounge of their friend’s house, all the while making sure the blood from their knuckles is not dripping on the on-trend off-white fitted carpet, the space standards used in building most homes are so minimalist that while you have been lucky enough to get into their lounge, you can’t move around the lounge. 

We could go on and on, describing how it is most unlikely that you can get into the kitchen to raid his or her fridge for more beers once the Lidl shop has drowned the sorrows of the horse coming in last.  Even in those rare occasions where you have been lucky enough to obliterate the memory of that rash bet, being able to get to and use the toilet is likely to take as long as your horse did to get round Aintree, and with no guarantee that you will get over the last hurdle and into the toilet.

How did we get here ?

Two basic approaches used by governments for decades now explain where we are and why.

Firstly, governments have focused on the homes disabled people live in and trying to improve basic standards of accessibility to and in them.  Current standards while not perfect work after a fashion for most disabled people.

Secondly, when it comes to housing built for the majority of the population who are non-disabled people, builders and developers have been encouraged – rarely forced – through regulations and guidance to ensure that all new homes built since the 1990’s are visitable by disabled people.  Given the majority of housing built since 1979 has been private sector for the owner-occupied market, the consequence of these approaches is that we have created ghettos in terms of where disabled people can expect to live and, by default, exclude disabled people from not only being able to live in the vast bulk of housing built, but also excluded from being able to visit and socialise with people living in the vast bulk of housing built.

Excluding disabled people from being able to visit and engage socially with friends, family and neighbours through enabling the building of unvisitable housing is a breach of human rights.  Government needs to recognise this and start to work with disabled people in getting planners, builders and developers to stop ghettoising the lives of disabled people.

If the people with particular housing needs were people of colour [POC] and housing policy led to POC only being able to visit other POC, society would erupt in a storm of protest at such racist, segregationist and discriminatory policies.  If the people with particular housing needs were Catholics and housing policy led to Catholics only being able to visit other Catholic people while Protestant people could visit any and all other people, society would rightly storm Parliament and demand an end to sectarianism in housing policy and discrimination against Catholic people because of their particular faith.