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EQUALITY AND DIVERSITY IMPACT ASSESSMENT TOOLKIT

SECTION 1: BACKGROUND

Legislative and Policy Framework

Introduction to Equality and Diversity Impact Assessment

Tips and General Guidance

LEGISLATIVE AND POLICY FRAMEWORK

1. Equality and Diversity offers an approach which forms part of the wider cultural change agenda within SEHD/NHSScotland as it is instrumental in developing responsive, patient-focused policy and practice. Both the overall approach and the Equality and Diversity Impact Assessment Toolkit should be considered in the context of the following policy/guidance:

• Patient Focus and Public Involvement⁷
• Informing, Engaging and Consulting the Public in Developing Health and Community Care Policies⁸

2. At the Scottish Executive level this work also relates to the Race Equality Scheme, the Policy Gateway and Mainstreaming Equality Web Site ( detailed links).

3. The equality and diversity agenda within SEHD/NHSScotland addresses equal opportunities as defined in Schedule 5 of the Scotland Act 1998: ⁹ 'the prevention, elimination or regulation of discrimination between persons on the grounds of sex or marital status, on racial grounds or on grounds of disability, age, sexual orientation, language or social origin or of other personal attributes, including beliefs or opinions, such as religious beliefs or political beliefs'.

4. The Health White Paper, Partnership for Care¹⁰ has committed the Scottish Executive Health Department to extending 'the principles set out in Fair for All¹¹ across the NHS to ensure that 'our health services recognise and respond sensitively to the individual needs, background and circumstances of people's lives'.

5. In order to achieve this and work within the current policy and legislative requirements it is essential that all policy and service developments and implementation within SEHD/NHSScotland do not disadvantage people from the following equality target groups, wherever appropriate:

• Black and Minority Ethnic Communities (including Gypsy/Travellers and Refugees & Asylum Seekers)
• Women and Men
• Religious/Faith Groups
• Disabled People
• Older People
• Children and Young People
• The Lesbian, Gay, Bisexual and Transgender Community

6. Given the policy context for Health in Scotland it is essential that cross cutting issues are also considered as core to the EQIA process including:

• Poverty
• Mental Health
• Homelessness
• Involvement in the Criminal Justice System
• Marital Status
• Language or Social Origins

7. The Equality and Diversity Impact Assessment Tool (EQIA) should also be considered in relation to the requirements which will be placed on NHS Boards through the enactment of the National Health Service Reform (Scotland) Act, ¹² namely: the duty to involve the public; the duty to promote equal opportunities; and the development of Community Health Partnerships.

8. The Race Relations Act 1976 (Statutory Duties) (Scotland) Order 2002 ¹³ places a legal obligation on the Scottish Executive to actively promote race equality in all of its work.

9. The Race Relations (Amendment) Act 2000 (RRAA) ¹⁴ adds to this duty and requires SEHD and NHS Boards to ensure that they comply with the general duty to:

• Eliminate unlawful racial discrimination
• Promote equality of opportunity
• Promote good race relations

10. Specific Duties under the RRAA further require that NHS Boards assess their functions for relevance to race equality, and where relevance is established, set out their plans to:

• Assess and consult on the policy's likely impact
• Monitor the policy for adverse impact on race equality
• Publish the results of the above
• Ensure public access to information and services
• Train all staff in their new duties under the RRAA

11. It should be noted that, at the time of writing, there is a proposal for a positive duty to be developed as part of the new Disabled Persons' legislation and early discussions regarding the development of a Public Duty for Gender.

12. The work of SEHD and NHSScotland must also comply with other relevant legislation which forms the UK Equality legislative framework as at August 2004:

• Equal Pay Act 1970
• Sex Discrimination Act 1975
• Disability Discrimination Act 1995
• Human Rights Act 1998¹⁵
• Employment Equality (Sexual Orientation) Regulations 2003
• Employment Equality (Religion or Belief) Regulations 2003
• Gender Recognition Act 2005
• Age Discrimination Directive 2006 (proposed timescale)

13. NHSScotland also has specific duties under the Human Rights Act (1998) to act compatibly with the European Convention on Human Rights. In addition, a Scottish Human Rights Commission is being established and it will be in a position to spotlight areas of non-compliance, hold public investigations and make recommendations.

14. The UK Government ratified the United Nations Convention on the Rights of the Child¹⁶ in December 1991. The Scottish Executive is committed to implement the articles of the Convention in all its policies (subject to interpretation and reservations made to the convention). The UN Convention provides a set of minimum standards relating to children's civic, political, economic, social and cultural rights. The Convention should be considered in parallel with the requirements of the Children (Scotland) Act 1995. ¹⁷

15. Partnership for Care has further committed us to develop an integrated equality and diversity approach within SEHD and NHSScotland. This Equality and Diversity Impact Assessment Toolkit will form a core element of this approach and is designed to ensure that a commitment to equality of opportunity and anti-discriminatory policies and practices become part of our day-to-day work within the wider Community Planning context.

16. The EQIA is designed to ensure that we are taking into consideration and where reasonable meeting the needs of individuals from all parts of Scottish society within the context of the current legislative framework. This applies equally to the Scottish Executive Health Department and NHS Boards in policy development, service provision and employment. The EQIA must be applied to both new and existing policies and functions.

17. The SEHD is committed to tackling health inequalities more generally and is currently developing a Framework for Action for the implementation of Closing the Opportunity Gap (CTOG) and Spending Review 2004 targets in relation to health inequalities.

18. One of the high level CTOG objectives is 'to increase the rate of health improvement for people living in the most deprived communities to improve their quality of life, including their employability prospects'. The EQIA will be useful to Boards in this context.

19. Boards and their partners should also consider its use in planning to tackle health inequalities generally as well as for the various equality groups and should attempt to integrate the various strands of work. Boards should be able to identify the impact of policies and services, including uptake and access issues, on the most deprived communities and groups which have poor health outcomes. This is essential to identifying effective interventions to bring about change.

20. NHS Health Scotland has already carried out considerable work around Health Impact Assessment and SEHD hopes to further develop this area of work with NHS Health Scotland in the coming year. What follows in the guidance is as applicable to health inequalities generally as it is to the various equality groups.

21. In compliance with the Freedom of Information Act 2000, the SEHD and NHS Boards must include EQIA reports and relevant documentation within their Publications Scheme.

22. The Gaelic Language Bill is due to become law in July 2005. This Toolkit will be of use to Boards in considering the impact this new legislation will have especially in the preparation of Gaelic Language Action Plans.

INTRODUCTION TO EQUALITY AND DIVERSITY IMPACT ASSESSMENT (EQIA)

1. The purpose of the EQIA is to improve the way in which the SEHD and NHS Boards develop their policies ¹⁸ and functions ¹⁹ by making sure there is no discrimination in the way that they are designed, developed or delivered and that, wherever possible, equality is promoted.

2. It provides a means to assess the potential or actual impact of our work on patients, carers, members of the public or members of staff who currently experience disadvantage in their dealings with SEHD/NHSScotland.

3. It is a way to make sure that we think carefully about the likely impact of our work on the people of Scotland and take action to improve the way we work.

4. The EQIA therefore focuses on assessing and recording the likely equalities impact of any policy or function in relation to this statement. There is a focus on assessing the impact on certain groups of people known as equality target groups.

5. In line with the legislative framework and current good practice, the SEHD/NHSScotland have defined the equality strands as:

• Age
• Disability
• Gender
• Race/Ethnicity
• Religion/Faith
• Sexual orientation

The Equality Target Groups are:

• Women and Men
• Black and Minority Ethnic People (including Gypsy/Travellers and Refugees & Asylum Seekers)
• Children and Young People
• Older People
• Disabled People (including those who are learning and/or physically disabled)
• Lesbians
• Gay Men
• Bisexuals
• Transgender People
• People from different faiths and religious backgrounds.

The cross-cutting issues include:

• Poverty
• Mental Health
• Homelessness
• Involvement in the Criminal Justice System
• Marital Status
• Language or Social Origins

6. Many Public Health Departments within NHS Boards and Public Health Practitioners at LHCC/Community Health Partnership level are already developing Health Impact Assessment processes to assist decision making and policy development.

7. This Toolkit aims to build on these existing processes and offers the opportunity to integrate the Equality and Diversity Impact Assessment with Health Impact Assessment processes.

8. A Rapid Impact Checkilst ²⁰ process has been included as Step 3 of the overall EQIA and this should be used to indicate which policies, functions and services may impact on equality groups and other relevant groups. This can help identify changes that would improve the policy, function or service; and indicate where more detailed assessment is required.

9. This screening process helps NHS Boards to achieve a multi-agency approach to EQIA. It affords the opportunity to integrate common overarching themes on the health and wellbeing of all our communities.

10. The Equality and Diversity Impact Assessment Toolkit involves anticipating the consequences of policies or functions on relevant groups and making sure that, as far as possible, any negative consequences are eliminated or minimised and opportunities for promoting equality are maximised, by:

• taking account of the needs, circumstances and experiences of those who are affected
• identifying actual and potential inequalities in outcomes, including unlawful discrimination
• considering other ways of achieving the aims of your policy in order to minimise or remove any possible adverse impact.

11. The EQIA has been developed from a number of existing models. All follow the same principles.

12. All new or revised policies or functions must be impact assessed as they are developed.

13. All existing policies or functions must be prioritised for relevance and impact assessed by March 31 2007.

14. It is essential that everyone involved in policy development and implementation is aware of the need to undertake EQIA as a core and ongoing part of their work. Doing nothing with regard to the impact of policies or functions on people who face discrimination and marginalisation is not acceptable and may be unlawful.

15. Within SEHD, this means that a comprehensive EQIA report will need to be provided before decisions on policy or new initiatives can be taken.

16. We would expect that NHS Boards will require assurances that a comprehensive EQIA has been undertaken before authority is given to proceed with a policy, function or service change.

17. The EQIA is a decision-making tool. The benefits accruing from carrying out impact assessments and consultations include:

• Improvement in the quality of patient care.
• Making sure that policies are targeted effectively.
• Encouraging greater openness about policy making.
• Encouraging SEHD/NHSScotland to anticipate problems and make informed decisions.
• Improving SEHD and NHSScotland's ability to deliver suitable and accessible services that meet varied needs.
• Increasing confidence in health services, especially amongst individuals from the equality communities.
• Helping to develop good practice.
• Helping to avoid claims of unlawful discrimination.

18. Impact assessments and consultations should be seen as an integral part of the policy and service development processes rather than an add-on or extra burden on SEHD/NHSScotland. This process offers an important opportunity to promote inclusive and fair service delivery and employment practice.

19. This Toolkit is designed to assist you in undertaking effective impact assessments and inclusive consultations.

20. The EQIA is carried out by completing a form, see Impact Assessment Tool.

WHAT IS AN 'IMPACT'?

21. There are two possible impacts to consider in the EQIA:

22. If a negative or adverse impact is judged to be unlawful (would result in either direct or indirect discrimination) action must be taken immediately to either abandon the policy development or change it to make it lawful.

For Example: An NHS Board which has a policy to use only in house catering when that catering service cannot or does not meet different dietary needs (e.g. on account of religion, cultural preference, choice (vegetarian/vegan), health (gluten-free etc.)). This policy would prevent appropriate provision as there is no choice of provider and no opportunity to require it as part of a contract with appropriate sanctions. The Board could be acting unlawfully on grounds of race or religion and belief (where the function includes employees).

WHEN TO CARRY OUT AN EQIA?

23. An EQIA must be carried out on:

• all new/reviewed policies and strategies
• all existing policies and strategies
• all service plans
• all best value reviews and service re-design processes

that:

24. You should start the impact assessment at the point of deciding on aims and objectives.
This will ensure that you are thinking from the outset about the potential impact on different equality target groups.

25. Everything proposed should at the very least be screened for potential relevance to race equality. This refers to all the formal and informal decisions about how an organisation carries out its duties and uses its powers.

26. Given that the principles of relevance and proportionality²³ apply, the time and resources given to impact assessment and consultation will differ according to the relevance of the function and proposed policy to equality. For example, the level of relevance will inform decisions about the extent of data collection and analysis around a proposed policy, and/or how much consultation is undertaken.

27. All managers are responsible for incorporating equality and diversity into their policy areas, strategies and services, and for assessing the equalities impacts. This should be a continuous process, starting at the very beginning of the project/review of service.

TRAINING

28. As part of the support mechanisms for the implementation of the Equality and Diversity Impact Assessment Toolkit (including the Rapid Impact Checklist process, see Step 3), NHS Education Scotland intend to provide training in partnership with the SEHD and National Resource Centre for Ethnic Minority Health. This will necessarily be multi-disciplinary training and would aim to attract staff from the following areas of work:

TIPS AND GENERAL GUIDANCE

1. Equality Impact Assessments are designed to be a positive but challenging process. It is not an exact science and a common-sense approach is required.

2. All plans should include the time to make changes to a project, strategy or policy as identified by the EQIA. It should not be a last-minute check.

3. The aim should be to take the perspective of someone outside of the organisation/project, such as a patient or member of the public, when carrying out an EQIA.

4. The EQIA should be undertaken in partnership with stakeholders and is unlikely to be completed immediately.

5. Completing the EQIA form is similar to undertaking a risk assessment. It involves predicting and assessing what the implications of a policy, function or strategy will be on a wide range of people with different and varied life circumstances. This can be a difficult thing to do and it is best done with the involvement, support and advice of staff in the project, divisions etc and partner organisations. Completing the EQIA form with colleagues, who can provide a different perspective, will help.

6. It is particularly important that managers understand that they have a legal duty to assess the impact of the strategy, policy or service on black and minority ethnic communities and to consider the promotion of race equality and the elimination of race discrimination.

7. If the likely impact on the different equality target groups is not known, then action needs to be taken to acquire that information.

8. The best way to find out if a policy or service is likely to impact negatively or positively on equality target groups is to find out if research or data already exists or to directly consult representatives of those groups or relevant specialist organisations.

9. As there is likely to be a shortage of relevant data and research in the short-term, it is essential that that those undertaking the EQIA consider both empirical and "action research" based on engagement with communities and individuals.

10. This broad-based approach to research and data collection will enable managers to assess likely impact and identify whether further research is required. It is hoped that this approach will also foster the principles of community planning as envisaged in the evolving Community Health Partnerships.

11. Useful contacts and reference material are listed in the Useful Links and Other Reading section.

12. For a large or significant piece of work you should allow for the cost of assessing the project in the budget. For example, it may be appropriate to pay for a consultant or representative of a voluntary sector organisation to carry out the EQIA with you or to support the process.

13. For a partnership policy, strategy or function the need to undertake an EQIA remains. The need to assess impact must be discussed as part of the development of the partnership agreement. A decision must be made as to which EQIA model will be used.

For Example: A Health Board and Local Authority working to establish a Community Health Partnership would need to agree that an EQIA should be undertaken on the piece of work and whether to use the local authority's or the NHS Board's EQIA model.

14. Following the completion of an EQIA, the manager responsible should outline any changes required to the policy or project and other actions required. The need for a change in the methods used to collect or obtain data on certain issues could be one such action (such as commissioning research or carrying out monitoring).

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