How long before First Minister Sturgeon held to account on 6 year-old equal pay promise for the NHS ?

Almost 6 years ago, Nicola Sturgeon was being given an easy time at a meeting with the Scottish Parliament's Equal Opportunities Committee.  They were pressing her, gently, on the slow progress the NHS in Scotland was making with publishing equal pay reviews.  Sturgeon clearly felt some visionary statement was required to reassure the government-dominated Committee that all was well and that the sunlit uplands of Scotland's Brigadoon 2 were soon to be open to us all.  She declared that, from the government's point of view, there is [at October 2009] :

"a clear expectation that all boards will get on and complete those reviews as quickly as they can, and that they will go beyond the letter of the law to ensure that they are exemplary employers that live up to all the duties required of them." 

Fast forward 6 years, pausing briefly in 2014 to wonder just how government managed to lose a two year long referendum campaign aimed at selling Brigadoon 2 to the Scottish people, and the data published by Scotland's health boards on equal pay gaps suggest that while she may expect, few of them will deliver.  

'.......... she may expect, few of them will deliver'

The table below, based on the most recent equal pay gap data published by health boards themselves, shows that just 2 health boards manage to get their pay gap to come below the 5% boundary set by the Equality & Human Rights Commission.  The full research report which shows just how much health boards pay attention to what government ministers promise of their performance can be found here.



























Maybe it is time for the Parliamentary Equal Opportunities Committee to invite the First Minister back and ask her just how just long she thinks it will take for the NHS to not only, as she put it, comply with the letter of the law on equal pay, but go beyond it and become exemplary employers that live up to all the duties required of them ?  Another 6 years ?  Another 26 years ?

how long she thinks it will take
for the NHS to not only, as she
put it, comply with the letter of the law
on equal pay, but go beyond it and
become exemplary employers that
live up to all the duties required of them ?
Another 6 years ?
Another 26 years ?
How long, Nicola, how long ?

It is not just a bed blocking crisis in the NHS in Scotland, blocking of equality is revealed in workforce profiling

One of the clear measures of equality is to be found in the profile, by protected characteristic, of those 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.  It 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.  Being in work instead of being marginalised, excluded and discriminated against can also help start to slowly foster good relations between those who erect barriers and discriminate, and those who are discriminated against.

Scotland’s specific equality duties, adopted in May 2012, recognised this and set a clear goal for public bodies in Scotland.  Amongst other things, the duties required that public bodies gather data on their workforce by protected characteristic and use it to help them better perform their general equality duty to eliminate discrimination, advance equality of opportunity, and foster good relations.  April 30^th 2013 was the first date by which public bodies were required to publish a report on their efforts in meeting this particular part of the specific equality duties.  Research reports providing data on that baseline can be read here.

In June 2015, new research captured data from Scotland's 22 health boards on what had changed in the 2 years since the baseline was published.

In 2013, the NHS in Scotland employed 12,079 Catholic people, representing 7.63% of the whole workforce.  In 2015, the figure had increased, to 16,198 Catholics working in the NHS, representing 9.89% of the NHS workforce.  Government data resources tell us there are 841,000 Catholic people in Scotland, representing 15.9% of the population.

The good, the bad and the indifferent health boards when it comes to the employment, or non-employment, of Catholic people can be seen in this table on the right.  One can only guess as to the extent to which sectarianism plays a part of the reality that these data sets reveal.  But then Scotland does not like talking about it, or even accepting that sectarianism has a reach beyond the football terraces on a Saturday afternoon.

You can read the full research report from which this table is extracted here.

While Catholics are clearly discriminated against in accessing employment opportunities within the NHS, disabled people seem equally blocked from getting into work with the NHS.  In 2013 the number of disabled people employed across the NHS was 1,365, or 0.86% of the whole workforce.  By 2015 the number had increased to 1,550, or 0.95% of the workforce.  Government data resources tell us that almost 20% of the population has a disability.

The best, the indifferent and the downright ugly NHS boards when it comes to unblocking access to employment equality for disabled people can be seen in the table on the left.  

You can read the full research report from which this table is extracted here.

Former First Minister Alex Salmond was fond of proclaiming Scotland as a tolerant country.  Many who bought what he was selling in that ambiguous phrase also believe that racism is an English disease.  As with Catholics and sectarianism, there is a lot of denial in Scotland on racism in employment.  In 2013, Scotland's health boards reported employing a total of 4,378 Black Minority Ethnic [BME] people - 2.77% of the entire workforce.  By 2015 this had fallen, to 3,923 BME people - 2.39% of the workforce.  Government data reveals that Scotland has over 200,000 people identifying as BME, 4.00% of the population.

The great, the good and the awful of NHS boards when it comes to unblocking the racism which prevents BME people from accessing employment equality in the NHS can be seen in the table on the right.

The full research report from which this table is an extract can be read here.

Since Scotland put in place legislation on same-sex marriage, there are many who believe that Scotland has become some sort of Nirvana for people who identify as lesbian, gay or bi-sexual [LGB].  As with people from the protected characteristics already  covered in this blog, the reality as defined by the employment data published by NHS boards themselves would suggest this is naught but a pipe-dream worthy of the Brigadoon 2 the former First Minister scribbled on the back of a fag packet and tried to get backing for in September 2014.  

In 2013, Scotland's NHS boards reported employing 1,502 people who identified as LGB, representing 0.95% of the workforce.  By 2015, this had increased to 1,998 LGB people, or 1.22% of the workforce.  The context for these figures can be found on the Stonewall web site where they back government estimates that 5-7% of the population is LGB.

The sparkling, the dim and the downright dull when it comes to unblocking the path to employment equality in the NHS for LGB people can be seen in the table below left.  The full report on LGB employment data from which this table is an extract can be found here.

NHS Scotland's failure to deliver employment equality for disabled people, BME people, LGB people and Catholics is as much a crisis as the blocking of beds is to the ability of the NHS to deliver clinical services to all.  It is also right to point out that very little evidence is being gathered and published by the NHS in Scotland on whether discrimination is encountered in access to effective clinical services as much as it is clearly encountered in the recruitment culture and practices of the NHS.

How much equality of employment opportunity is there in Scotland's Councils?

One of the clear measures of equality is to be found in the profile, by protected characteristic, of those 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.  It 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.  Being in work instead of being marginalised, excluded and discriminated against can also help start to slowly foster good relations between those who erect barriers and discriminate, and those who are discriminated against.

Scotland’s specific equality duties, adopted in May 2012, recognised this and set a clear goal for public bodies in Scotland.  Amongst other things, the duties required that public bodies gather data on their workforce by protected characteristic and use it to help them better perform their general equality duty to eliminate discrimination, advance equality of opportunity, and foster good relations.  April 30^th 2013 was the first date by which public bodies were required to publish a report on their efforts in meeting this particular part of the specific equality duties.  Research reports providing data on that baseline are available here.

In July 2015, new research captured data from Scotland's Councils on what had changed in the 2 years since the baseline data was published.  

 In 2013, Councils in Scotland employed 4,826 Catholic people, representing 1.9% of the entire Council workforce.  In 2015, the figure had increased - there are now 9,661 Catholic people employed, representing 3.86% of the Council workforce across Scotland.  Government data resources tell us there are 841,000 Catholic people in Scotland, representing 15.9% of the population.  

The best, and worst, performing Councils when it comes to the employment, or non-employment, of Catholic people can be seen in this table on the right.  One can only guess as to the extent that sectarianism plays in the reality these data sets reveal.  But then Scotland does not like talking about, or even accepting that sectarianism is an issue beyond the football terraces on a Saturday afternoon.

You can read the full research report from which this table is extracted here.

When it comes to the record of Councils in employing disabled people, the good news is equally thin on the ground.  In 2013, the total number of disabled people employed in Councils was 4,819, representing 1.9% of the total number of people employed across all Councils.  By 2015, the number had increased to 4,901, representing 1.96% of the entire workforce.  Government data resources tell us that almost 20% of Scotland's population has a disability.

The best, the worst and the downright ugly Councils when it comes to the employment of disabled people can be seen in the table on the left.

You can read the full research from which this table is extracted here.

There are many in Scotland who believe that we are a 'tolerant' country, and that racism is an English disease.  As with Catholics and sectarianism, there is a lot of denial in Scotland on racism when it comes to employment.  In 2013, Scotland's Councils reported 2,447 Black Minority Ethnic [BME] people employed, making up 0.96% of the entire workforce.  In 2015, this had increased to 2,632 BME people, and making up 1.05% of the entire workforce. Government data reveals that Scotland has over 200,000 people identifying as BME, 4% of the population.  

The great, the good and the awful Councils, when it comes to employment of BME people can be seen in the table on the right.

The full research report, from which this table is an extract, can be found here.

Since the Scottish legislation on same-sex marriage, there are many who believe that Scotland has become some sort of Nirvana for people who identify as lesbian, gay or bi-sexual [LGB].  As with people from the protected characteristics covered already in this blog, the reality as defined by the employment data published by Councils themselves would suggest this is naught but a pipe-dream worthy of Brigadoon 2.  In 2013, Scotland's Councils reported employing 402 people who identified as LGB, representing 0.16% of the entire workforce.  In 2015, Councils reported this had increased, to 906 people identifying as LGB and making up 0.36% of the total Council workforce.  The context for these figures is found on the Stonewalll web pages where they back government estimates that 5-7% of the population is LGB.

The poor, the bad and the awful performing Council when it comes to employment equality for LGB people can be seen in the table on the left.

The full report on LGB employment in Councils, from which this table is an extract, can be found here.

On the basis that these figures suggest there is a serious problem with institutional discrimination in the employment practices and cultures of Scotland's Councils, the reports were sent to the Chief Executive of COSLA, Rory Mair, with the offer of a meeting to consider how performance on equality could be improved and so better serve the interests of people from the protected characteristics covered by the research.  Mr Mair's response was :

"I entirely disagree with your proposition that Scotland’s local authorities’ performance is poor with regard to employment practice"

Does Scotland's NHS have a burning desire for equality ............ for Catholics ?

We may have stopped killing Catholics because they are Catholics and instead confine ourselves to celebrating the death of Catholic who have rebelled against the status quo by burning Guido Fawkes in effigy, but it is not clear that the five centuries since have really changed attitudes towards employing Catholic people in the public sector.

Not too long ago, the Glasgow Herald reported that Tom Devine had claimed that Catholics in Scotland aged below 55 had reached equality in work with other Scots in the 1990s.

In 2013, public bodies published profiling data on their workforce which suggested that things have either changed radically since the 1990s or that the data used then by Devine was less than robust.

In 2013, Scotland's 32 Councils published data which showed that just 1.69% of Scotland's local authority workforce identified as Catholic.  This at a time when the 2011 census was revealing Scotland's Catholics as making up 15.9% of the population.

In the NHS, at 2013 the proportion of people identifying as Catholic and working across the 22 health boards was 7.63%.  Two years later it has crept up to 10.00%.

Scotland's universities in 2013 offered similar dismal evidence of discrimination against Catholics.  Just 0.97% of workers in all universities identified as Catholic.  Edinburgh University, where Tom Devine worked until last year, offered a miserly 1.77% of the workforce as being Catholic.

Since devolution, Scotland's senior public sector apparatchiks have managed to convince themselves sectarianism and discrimination against Catholics is somehow magically confined to the week-ends when some football clubs play each other.  This is the same kind of lazy, arrogant, Wasp-like analysis which informed the work of Visit Scotland in 2013.  

When challenged over the fact that they employed just 1 Catholic out of a workforce of 763 workers, they could not accept there might be sectarianism in their corporate culture.  This was the same organisation which a few years previously were caught out airbrushing in a black face to what was originally an all-white Homecoming poster.

Not only did Visit Scotland fail to accept the potential of sectarianism in their employment culture then, they reported earlier this year that the proportion of Catholics in the workforce has increased, massively, from just 1 in 2013 to 2 in 2015 [see page 39 of the report].  

In carrying out the research for the 2015 report into Catholics and employment in the NHS, it was observed that few if any Boards appear to have systems in place for gathering evidence on patients/service users cross-referenced to their identity by protected characteristic and checking whether their experience of access to, experience in and outcome from health services has been free from discrimination.

A health board delivering services where Catholic people experience barriers, discrimination or sectarianism is unlikely to be an employer where Catholic people find they are free from discrimination, sectarianism or have equality of opportunity – and vice versa

In the same way that it is possible to conclude that the prevailing culture in the NHS on meeting the specific equality duties on employment is one focused on the process rather than on change to the lived experiences of people from the protected characteristics as employees or would-be employees, so too can the absence of joined up work/evidence gathering between NHS Board functions as employers and service providers be regarded as a fundamental and fatal flaw in work to deliver equality.  Such an attitude and approach ignores the ineluctable synergy between the two functions and the cultures of organisations where discrimination exists.  A health board delivering services where Catholic people experience barriers, discrimination or sectarianism is unlikely to be an employer where Catholic people find they are free from discrimination, sectarianism or have equality of opportunity – and vice versa.

Mirror, mirror on the wall, who is most racist of them all............... in Scotland's NHS ?

Just two years ago, Scotland's 22 Health Boards published their first reports on workforce equality profiling, as required to meet Scotland's then shiny new specific equality duties.

It was not a time for celebration.  No corks were popped for equality in April 2013.  It was hard for the NHS, collectively, to look in the mirror then and see the prejudice and bigotry 

It was hard for the NHS, collectively, to look in the mirror then and see the
prejudice and bigotry which stared back  as the data stacked up

which stared back as the data stacked up, Board by Board, to show that employment equality in the NHS for people sharing protected characteristics is as likely as the KKK is to stop flying the Confederate battle flag.  You can find the research reports which piled up the data sets on the protected characteristics of ethnicity, disability, sexual orientation and religion across our NHS in the Equality Here, Now website.

On race, the research in 2013 found that not one of the Boards managed to exceed the standard set by the BBC [then employing 12.3% of a Black Minority Ethnic (BME) workforce].  NHS NES was closest at 12.28%.  Only 1 other Board managed to report a BME employment rate into double figures, NHS Golden Jubilee at 11.39%.    If all 22 Boards had achieved the same employment levels reached by the BBC, there would have been 15,310 more BME people working in the NHS in Scotland.    If Boards had managed to mirror the national UK average of 8% BME people, this would mean an extra 8,502 BME people working in the NHS.  This is roughly equivalent to the population of Haddington and provided a graphic illustration of the number of BME people missing in 2013 from the workforce of the NHS.

Based on these figures, it was concluded that the NHS in Scotland appeared to have significant problems with institutional discrimination^[1] in the employment of BME people.  The research was shared with all 22 Board Chief Executives and with the Cabinet Secretary for Health, along with an invitation to discuss what the data revealed and to meet and discuss how performance on employment equality could be improved.  Not one of the poorly performing 20 Chief Executives believed they needed help.

Just last month, June 2015, more workforce equality profiling reports needed to be published to meet the now not so shiny new specific equality duties in Scotland.  For the 20 poorly performing Chief Executives, the mirror of independent research will have triggered a considerable and involuntary release of the trapped winds of denial.  Across the whole NHS in Scotland, the employment rate of BME people has fallen in the last 2 years, from the already dismal levels of 2.77% in 2013 to 2.44% in 2015.

Stephen Lawrence :
1974-1993

Alongside that dire figure, the proportion of the NHS workforce which refuses to provide their employer with their ethnic identity remains stubbornly stuck at close to 30%.  

While the Metropolitan Police force has been under intense and righteous scrutiny since the murder of Stephen Lawrence in 1993 and the Inquiry report from Sir William Macpherson in 1999, the Met has managed to admit to being racist in its function as a force and as an employer, and undertaken considerable work to eradicate that racism, all in the intense glare of public scrutiny and accountability.  

Scotland's NHS, the Board Chief Executives and the Cabinet Secretary for Health are curiously reluctant to take that crucial first step in eliminating racism.

[1] Institutional discrimination has been and will be defined in a range of ways.  The following definitions relate to race in the UK but can be amended to equally apply to all other protected characteristics.

"The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people."
The Macpherson report

"If racist consequences accrue to institutional laws, customs or practices, that institution is racist whether or not the individuals maintaining those practices have racial intentions."
The Commission for Racial Equality

Two Ticks ? More like Two Fingers from Scotland's NHS to disability equality in employment

Two years ago in 2013, public bodies in Scotland published their first workforce profiling reports, required by Scotland's then new specific equality duties.

In a series of research reports Equality Here, Now looked at what this revealed.

Two things emerged.  An ultra-casual approach on the part of many in the public sector to meeting the duties, either in the letter or in the spirit of the law.  Secondly, that institutional discrimination remains very much alive and flourishing in what is often described in political double-speak as a 'fairer Scotland'.

When looking at the NHS, the research found that the NHS in Scotland appeared to have significant problems with institutional discrimination in the employment of disabled people.  

Just 0.86% of the whole NHS workforce across Scotland identified as disabled.  This at a time when the census revealed Scotland has 20% of the population identifying as disabled.

Two years on, research - based on data published by NHS Boards themselves - reveals that across the whole workforce and after another two years of working on disability equality, the NHS can now conjure up 0.95% workers identifying as disabled.  

Look at the table on page 14, providing some detail and texture to the bald but embarrassing and shameful figure of 0.95%.  Out of the 22 NHS Boards serving [not very well, it has to be said] the population of Scotland, just 1 comes anywhere near employing the proportion of disabled people in Scotland's population.  NHS 24 has 20.27% of its workforce identifying as disabled.  

The performance of the rest of the 21 Boards looks dismal in comparison.  Keep in mind that this is not about percentages, this is about disabled people being given the opportunity to work, or not in the case of most of the NHS.  That opportunity is being denied them by the shockingly bad performance of most NHS Boards in meeting their specific and general equality duties.  There can only be one of two possible reasons for this.  Either most NHS Boards are led by a Chief Executive not competent in complying with the law on equality, or the institutional discrimination against disabled people in employment is deep and ingrained across most of the NHS in Scotland.  

In the many questions on performance which Chief Executives need to answer and be held to account for, an obvious one is just why is it that NHS 24 can achieve a reasonable level of employment of disabled people while they in their own Board can't ?

Do they not work together, learn from each other ?  Share insights to what works and what doesn't work ?  There is even a dedicated Equality Directorate for the whole NHS and based in NHS Health Scotland.  Why is it that Directorate is unable to ensure that progress with disability equality in employment is part of a coherent national strategy for the whole of the NHS ?  The Cabinet Secretary for Health in Scotland needs to get a grip of Chief Executives failing to do their job.  She would smack them hard enough and quick enough if they fell behind on waiting times.

As well as the Cabinet Secretary putting 21 Chief Executives on the seriously naughty step for awful performance on disability equality, the Equality & Human Rights Commission should also be holding the Cabinet Secretary, Boards and Chief Executives to account, given the obvious and continuing failings in tackling disability discrimination in employment.  It is a fundamental part of the reason the EHRC exists.

The clue to their failure to wave the big stick of legal action on compliance is to be found in the Official Record of an evidence session involving 2 senior officials from the EHRC and the Scottish Parliament's Equal Opportunities Committee last year, just after the referendum vote on independence.  During some occasionally tough questioning, the Scotland Director, Mr Pringle, was asked how many public bodies had the EHRC taken to court for non-compliance with the equality duties.  The eventual and clearly reluctant answer was :

We have never taken a public authority in Scotland to court. We have never had to.

The NHS is in trouble on disability equality and those responsible seem unwilling or unable to get out of the inequality jail they have created with their lack of meaningful efforts over a number of years.  As a single measure of just how deep that trouble is, a look at the NHS Grampian workforce report for 2013/14 and published in January 2015 tells the reader, on page 15, that :

NHS Grampian has been given the right to display the “Disability Symbol” on our literature. This is in recognition of our commitment to employing disabled people and our assurance to interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities.

Yet, just a few lines on and the report notes :

The number of disabled staff employed by NHS Grampian has shown a decrease in 2013/14. 73 staff considered themselves disabled in 2012/13.

This represents a stunningly eloquent illustration of the bankrupt nature of the 2-ticks symbol sponsored by Job Centre Plus and exposes it as the sham window dressing it really is  It also illuminates the bankruptcy in the capacity of the NHS to analyse its own data and deal with the stark realities which it conveys.  That Scotland's NHS is, for the most part, institutionally discriminatory in its employment of disabled people.

Scotland's NHS is, for the most part,
institutionally discriminatory in its
 employment of disabled people

Scotland's public sector executives paid in full by government- even when failing to make race equality happen

It is now some 50 years since the Race Relations Act of 1965 first outlawed discrimination on the grounds of colour, race, ethnicity or national origin.  It was extended in the 1968 Act to include a remit in the spheres of employment and housing.  In the Race Relations Act of 1976, almost 40 years ago, the Commission for Racial Equality was created to make sure the even more robust provisions of that Act on racism and discrimination were implemented.  More legislation on race equality followed in 2000, 2003, 2006, and in the Equality Act 2010.

You would think that Parliament has been sending a clear enough message, particularly to public bodies, that racism and discrimination needs to be eliminated.

And yet, 50 years on, current data tells us that the NHS in Scotland is unable to identify the ethnicity of over 29% of their workforce and does not yet routinely monitor the patient experience by ethnic identity and so provide us with evidence of the presence/absence of racism in service provision.  Councils in Scotland are little better.  Almost 40% of Scotland's total council workforce remains unidentified in terms of ethnicity, and very few Councils routinely gather data on service user by ethnic identity and so offer us evidence of the presence/absence of racism in council service provision.

Elsewhere, the Cabinet Secretary for Culture, Fiona Hyslop, recently appointed Richard Findlay as Board Chairperson of Creative Scotland.  Looked at another way, the body charged with the strategic development of culture in Scotland is led by an all-white Board, with no Visible Minority Ethnic people on the Board at all. 

There is clearly a need for fundamental change to doing the same old, same old, in Scotland on race equality.  The evidence shows that approach is not working and that institutional discrimination on the basis of race remains embedded and ingrained in how Scotland is run.  It is this embedded racism which finds just a few years ago Visit Scotland having to rush out a hastily air-brushed revision of a tourist poster for a government-backed Gathering in which all faces in the crowd were white.

Racism remains a huge challenge for all, 50 years on.  Channel 4 recognised just how big that was when in January this year it published a fairly radical 360° Diversity Strategy.  As Channel 4 puts it :

"In the past, some elements of diversity have been put in the 'too difficult' box.  Our 360° Diversity Charter sets out to smash that box, by using all the talent available - both inside and outside our industry"

They have  set ambitious targets on employment and on how Channel 4 makes and commissions programmes, and links delivery of those goals by 2020 to the pay of senior executives.

I recently asked First Minister, Nicola Sturgeon, if government would give serious consideration to a similar strategic approach [to that of Channel 4] and if not, why not ?.

"government is not considering adopting
an approach linking equality targets
and the performance pay of senior staff"

What I got was "government is not considering adopting an approach linking equality targets and the performance pay of senior staff".  No 'why not'.  That was clearly something for the 'too difficult' box.

Looked at another way, our First Minister is happy to go on paying Chief Executives of Scotland's 22 health boards and 32 councils all of their basic pay and any performance bonuses, even though they are failing to deliver race equality in any measurable sense after 50 years of being told they needed to make it happen.  Yet another way to look at the First Minister's refusal is to conclude that, unlike Channel 4, she does not want the best talent available in running Scotland's NHS or Councils.