Gender Equality Scheme 2008-2011

HEALTH AND WELLBEING

PORTFOLIO RESPONSIBILITIES

The Health and Wellbeing portfolio is responsible for developing and running effective policies and programmes that:

protect and improve the health of people in Scotland;
tackle health inequalities;
promote equality, and tackle discrimination, prejudice and disadvantage;
provide high quality health care and social care services, person-centred and close to home;
promote social inclusion and reduce poverty;
increase the supply of good quality, affordable housing and prevent and tackle homelessness;
regenerate communities; and
promote physical activity and participation and success in sport.

These policies and programmes support the achievement of our objective for a healthier Scotland, promoting greater wellbeing among all those living in Scotland. They also underpin the delivery of other programmes across portfolios to promote equality and to tackle poverty, disadvantage, discrimination and prejudice.

GENDER EQUALITY ACTION PLAN

Name of Directorate

Public Health and Wellbeing

Directorate Responsibilities

Public Health & Wellbeing Directorate is made up of 5 divisions each with its own discrete areas of interest:

Social Inclusion
Sport
Equalities
Public Health & Substance Misuse
Health Improvement

Social Inclusion is about helping those parts of the population lacking fair opportunities to lead fulfilling and self sustaining lives. It is about reducing inequalities between the least advantaged groups and communities and the rest of Scottish society.

The Division is responsible for the development of Scottish Government policy on how best to tackle poverty, inequality and deprivation and undertakes cross cutting work to tackle poverty and disadvantage.

Sport interests are about breaking down the barriers that prevent people from participating in sport at all levels. It is about reducing inequalities between the least advantaged groups and communities and their ability to access sporting facilities and opportunities. The Division is responsible for the development of Scottish Government policy on how best to encourage and sustain participation in sport. In November 2007 the Scottish Government helped secure the Commonwealth Games in 2014. From the Games we aim to secure a lasting sports legacy for the whole of Scotland as well as using the Games as a platform from which to encourage and enable regeneration in deprived areas of Glasgow. The Division undertakes cross cutting work to tackle inequalities in sporting provision. This includes the development of policies with colleagues across the Scottish Government, to ensure that all Scots irrespective of age and gender have access to sport and physical recreation and the benefits that can be derived from participation, and that the appropriate facilities are available to do so.

Public Health & Substance Misuse focuses on public health protection, sexual health, smoking and alcohol misuse. (Whilst sexual health has gender specific issues these are not primarily gender equality related). Health Improvement embraces both health improvement and health inequalities as part of its policy interests.

Equalities has overall responsibility for equality policy across the Scottish Government and its range of interests go right across government on issues relating to race, religion, gender equality and disability equality.

Statement of Directorate Commitment to the Promotion of Gender Equality and how this helps to deliver Government's national purpose and outcomes and contributes to progressing the Government's gender equality scheme objectives.

People have different needs.

Poverty, health inequalities, health improvement activities and sport. These all need to consider whether different approaches for men and women are required.
Our aim is to tackle poverty, health improvement and wellbeing among all groups within society.
Our work is entirely consistent with the Government's overarching gender equality objectives. (For example the gender pay gap, eradicating poverty and childcare, caring and flexible working).
Our aim is to tackle inequalities in sporting provision and opportunities among all groups within society.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

We know that employment rates are lower for lone parents and older men, while working part time (most common amongst women) increases the chances of low pay and poverty., We know that the majority of women over 75 live alone and that they face a higher risk of poverty. We also know that significant numbers of women are concentrated in the lowest paying jobs and occupations.
We know that if children experience poverty of income and opportunity then they are more likely to experience poverty and disadvantage in later life - as a young person and adult. We know that children from disadvantaged backgrounds can suffer a range of lasting problems, such as poor educational performance, greater risk of unemployment and poor health in later life. Many poor families are headed by lone parents, the majority of whom are women.
Our financial inclusion work is targeted at those people who are living on low incomes and who cannot access mainstream financial products such as bank accounts and low cost loans, leading to financial strain and unmanageable debt. Analysis suggests that men and women tend to use different financial products and services, have different skills in their understanding and use of such products and are not equally able to access money advice when they face financial problems. Consequently, our financial inclusion policies need to be sensitive to the different needs of men and women.
We know that the experience of poverty can often vary by gender and that we need to take full account of gender issues when developing and implementing policies.
- Scotland's Strategy for Sport - Reaching Higher- clearly states that sport should be widely available to all regardless of gender, age, disability, faith or ethnic origin.
- The percentage of women participating in sport is 60% compared to 70% of men. Women's participation is dominated by four activities - walking (32%), swimming (26%), keep fit/aerobics (13%) and dancing (12%).
- Sportscotland has specific targets to meet in securing greater participation amongst women.
- sportscotland, in partnership with the Women's Sports Foundation, has appointed a Women, Girls and Sport Officer to lead on a programme of positive action for women and girls to encourage participation, leadership and performance and excellence.
- sportscotland has published a good practice guide for local authorities, sports governing bodies and others involved in sports provision. The guide highlights the practical barriers which many women feel prevents them from participating in sport, makes recommendations on how these can be overcome and highlights good practice. For example:
  
  Being imaginative about venues (village halls, schools, and in good weather local parks) given that many women experience transport problems;
  Ensuring that women can have privacy in changing rooms and facilities as well as adequate mirrors and hairdryers;
  Providing single sex activities staffed by women;
  Organising mother and daughter sessions to create a familial culture of support for sport;
  Arranging women and girls coaching sessions and incentives which will encourage participation;
  Securing greater publicity for women's successes.
- There is ongoing investment in the development of Active Schools, a programme to encourage sport and physical activity in and around the school day. A key aspect of Active Schools is to encourage girls to become more physically active. Active School Co-ordinators have actively sought girls' views and preferences and arranged a wide range of activities to meet their aspirations.
- Girls on the Move - a programme for more vulnerable young women aged 16-25, including those with disabilities, mental health issues, young mothers and girls from ethnic minorities.
- Increased participation from women in football and rugby over recent years and this is reflected in sportscotland's funding of both sports to enable the women's games to be further developed.
We know that people in our society can experience particular disadvantages because of their gender but that these can be compounded by other aspects of their identity and lives such as their ethnicity, sexual orientation, disability, marital status or caring responsibilities.
For example, families from minority ethnic communities have higher rates of chronic disease and disability. People in these situations, and especially women, tend to receive less support from extended family and friends, as well as less support from services.
The multiple and complex needs initiative aims to improve public services for those who experience these multiple disadvantages to improve social inclusion and help people out of poverty.
Gender inequality is evident in a number of health improvement policy responsibilities:
- health inequalities - life expectancy and prevalence of CHD in most deprived areas
- physical activity in adolescents
- obesity in adolescent and adults
We know that disabled women and men face barriers which can prevent access to public services, and which can prevent them from participating in public life and the life of their communities.
We know that women are currently under-represented in decision making processes, particularly in politics and business.
We also recognise that there are a number of areas where we could improve our consultation with men.
The evidence for transgender people tends to be based on medical experiences but we know that there are many other issues that need to be addressed to progress transgender equality. Research undertaken by the Scottish Transgender Alliance shows that transgender people often face discrimination and harassment in the workplace, as service users and in our communities.
We know that women represent a large majority of workers in personal services (85%), administrative and secretarial (79%), and sales and customer services occupations (70%). We know that, by contrast, men represent the large majority of workers in the occupational categories of managers and senior officials (67%), process, plant and machine operatives (86%), and skilled trades (92%) ¹⁴. We know that women predominate in key public sector workforces, for example, teaching (92% of primary school teachers and 60% of secondary teachers in 2007) ¹⁵, the NHS (78% in 2007) ¹⁶ and local government (68% in 2007) ¹⁷, but they nonetheless continue to be under-represented in more senior positions.
In Scotland, according to the Annual Survey of Hours and Earnings 2007, the gender pay gap is 15% based on average hourly earnings for full-time staff (and 34% for part-time female staff compared to full-time male staff). We know too that there are gender equality issues in our own pay and rewards structures which have been set out through the process of conducting equal pay audits and which need to be addressed. We know that we need to collect better data on the caring responsibilities and working patterns of our staff if we are to effectively tackle equal pay issues in the longer term.
We know that women are overwhelmingly the victims of domestic abuse perpetrated by male partners and ex-partners (in 2006-7 there were 48,801 reported incidents, a 7% increase on the previous year. In 87% of these cases the recorded victim was female and the perpetrator was male). Similarly female victims of homicide are more likely to have been killed by a partner or ex-partner than male victims (For homicides recorded in the last ten years, 52% of the female victims aged between 16 and 69 were killed by their partner. For male victims aged 16 to 69, only 6% were killed by their partner). We know too that many women experience more than one form of violence during their lives and that there are links between these forms whether domestic abuse, rape and sexual assault or other forms of commercial sexual exploitation. We know that in order to tackle violence against women we need to develop a strategic approach to such violence in all its forms.
The Scottish Government recognises the importance of ensuring that both women and men from Scotland's faith communities are supported. There are particular issues for some women of faith for example Muslim women who can experience abuse as a result of wearing the hijab, which makes them more identifiable as Muslims than their male counterparts.
Refugee and asylum seeking women have additional issues relating to their experiences prior to claiming asylum or subsequently. Many have experienced sexual violence in their home countries and have sought asylum as a result, others have been raped or sexually assaulted on their journey to the UK. A high proportion of asylum seeking and refugee women are lone parents.
Gypsies/Travellers experience extremes of discrimination and disadvantage. Gypsy/Traveller women live 12 years less than women in the settled community, and Gypsy/Traveller men ten years less than men in the settled community, for example. Education outcomes are also considerably poorer for both Gypsy/Traveller women and men than for their counterparts in the settled community.
We know that people from minority ethnic communities, especially women, experience particular disadvantages in the labour market. Labour market segregation affects both women and men from minority ethnic communities.

Public Health and Wellbeing Directorate: Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
Implementation of National Sport Strategy	Identify categories of non-participants and develop and target policies which will stimulate an interest	Local authorities supported by Scottish Government	Ongoing	Increased participation	Yes (4)
Development of Clubgolf programme	One of the 6 Regional Development Officers has a specific remit to increase participation among girls aged 9 -18	Clubgolf partnership	2009	Increase in girls participating from 10 to 20%	Yes (4)
Support for the development of girls and women's football	Financial support towards the provision of posts dedicated to girls' and women's football. The National Plan for Girls' / Women's Football 2006-2011 will be an integral part of the Youth Plan for Football.	SFA in the lead supported by SG through sportscotland	2013	Increased participation among girls.	Yes (4)
Development of youth football in Scotland	Financial support of £12.2m over 10 years made available by Scottish Government	SFA in lead directed by Youth Action Plan Steering Group	2013	Stronger infrastructure within youth football to encourage and sustain greater participation among boys and girls	Yes (4)
Active Schools	Development of opportunities for boys and girls to become more active by involving them in the development of activities	Active School Co-ordinators	Ongoing	Increased participation among boys and girls.	Yes (4)
Consultation paper on tackling poverty, inequality and deprivation in Scotland.	The consultation paper is designed to spark debate and discussion with stakeholders which will help us develop a framework that reflects the views and concerns of partners and constituencies beyond the Scottish Government.	Social Inclusion Division and the anti-poverty arena.	Consultation period ends 30 June 2008.	Publication of a framework pointing to the direction of future Social Inclusion policy and how the Government Economic Strategy Solidarity Target will be delivered.	Yes (3)
As part of the Government's overall approach to tackling poverty and deprivation in Scotland, the Multiple and Complex Needs Initiative will look at how we can improve services for those with multiple and complex needs.	The Government will continue to support 14 demonstration projects until December 2008 to test out and evaluate different approaches to providing services to those with multiple and complex needs, taking into account any needs presented by gender and other equality strands. Three projects are specifically looking at the impact of gender alongside other issues. For example, Aberdeen Carers will receive £66,500 to develop support services for male carers in Aberdeen and Aberdeenshire.	Social Inclusion Division	Project will last until December 2008.	Identification of improved ways of providing services to women and men with multiple and complex needs.	Yes (3)
The 2005 Financial Inclusion Action Plan, which focussed on 3 strands Financial education and capability Money advice Financial products and services ( e.g. bank accounts, savings, affordable credit, insurance products)	The Action Plan committed the Scottish Government to a review in 2007, which is currently nearing completion.	Financial Inclusion Team	Summer 2008	Publication of the review of the Action Plan, followed by an updated policy statement	Yes (3).
The financial inclusion evidence base in the Scottish Household Survey currently provides information at household rather than individual level.	A Financial Inclusion Topic Report published in October 2007 provided more in-depth analysis of the Scottish Household Survey and other sources, including exploring equalities dimensions. The Report included a number of recommendations for improving information. Consultation with stakeholders on proposed changes to the SHS questions ended 30 April 2008.	Financial Inclusion Team/Communities Analytical Services, Social Justice Statistics	Summer 2008	The SHS is enhanced to provide better information on all individuals within a household, improving understanding of gender differences.	Yes (3)
We work with local partners, in particular community planning partners, to ensure that quality money advice services are provided in a way which meets clients differing needs and preferred service delivery channels (face to face, telephone or email)	We continue to provide funding through the local government settlement. We are funding Citizens Advice Direct to extend telephone and email advice to cover all of Scotland. We support the national Standards for Advice and Information Providers in the money advice sector and fund training and consultancy support for advisors.	Financial Inclusion Team/ MATRICS/ Local Government	Ongoing	Individuals can access quality money advice in a way which meets their needs and preferred mode of service delivery, and are able to resolve their debt problems	Yes (3)
Alcohol misuse - The Gender Issues Network on Alcohol ( GINA) is funded by the Scottish Government and sits within Alcohol Focus Scotland	The network aims to raise awareness, disseminate information and engage and communicate with gender and health improving networks and other strategic partners in order to promote equality of access and participate in the development of services for women with alcohol problems.	Alcohol Focus Scotland	Funding has been provided by SG since 2003 and approval has just been given for the year 2008/09	GINA's overall aim is to reduce the level of alcohol related harm for women in Scotland.	No
Alcohol Misuse - recently commissioned an 'audience segmentation' research project	In order to tailor specific messages on alcohol to specific groups we commissioned a qualitative research project. This identified women as a key group for alcohol communications and allowed the development of specific messages and channels most appropriate to reaching women.	Alcohol Misuse Team	Completed January 2008	This research will inform future public health campaigns in relation to women and alcohol.	No
Equality + Diversity Impact Assessment	Task Force recommendation on integrated impact assessment	Scottish Government to ensure guidance and support.	Continuing	Gender aspects of health inequalities incorporated in impact assessment of public policies and programmes at national and local levels.	Yes (8)
Occupational Segregation	We will continue to take forward the recommendations of the Women and Work Commission as they pertain to Scotland. We intend to publish the report of the cross-directorate working group later in 2008.	Equality Unit in partnership with colleagues across directorates.	Report published by end 2008	Interventions identified to tackle occupational segregation and amendments made to policy as appropriate.	Yes (2-5)
Equal pay	We will continue to work with the Close the Gap Partnership, which aims to tackle stereotyping and job segregation, and raise awareness amongst employers and employees about their rights and responsibilities.	Equality Unit	Ongoing	The gender pay gap continues to narrow in Scotland.	Yes (2-4)
Equality Proofing the Budget	The Government will work in partnership with the Equality Budget Proofing and Policy Advisory Group ( EPBPAG) to develop work to: improve the presentation of information about equalities issues in the Government's budget documents raise awareness about the need to mainstream equalities into both policies and budgets investigate ways of monitoring Government expenditure on different equality groups.	Equality Unit	Ongoing	Budget processes take equality issues into account.	Yes (2, 3, 8)
Consultation with women	We will continue to support a range of women's organisations so as to facilitate the involvement of women with different experiences, perspectives and knowledge, in Scottish Government policy and decision making process.	Equality Unit	Continuing	Continued improvement in the involvement of women and women's organisations in the policy and decision making process.	Yes (1-5)
Promoting the involvement of women's organisations to other public authorities	We will continue to promote the involvement of women's organisations to other public authorities, so as to better support women's involvement in the production of gender equality schemes, policy development, service development and gender impact assessment.	Equality Unit	Continuing	Decision taking and policy making is better informed of gender equality issues.	Yes (1-5, 8-10)
Consultation with men	We will improve our consultation networks with men and explore options for establishing an effective network.	Equality Unit	September 2008	An increase in the understanding of gender equality within the relevant policy areas and improved outcomes for men as a result.	Yes (6)
Transgender women and men	We will continue funding the Transgender Alliance, for a development worker, to ensure that transgender equality is integrated into national and local programmes to promote equality, until March 2011 as part of a wider programme of work to promote transgender equality.	Equality Unit	Funding continued until March 2011	Issues for transgender women and men in Scotland are heard and work is taken forward to positively address those issues.	Yes (7)
Transgender women and men	We intend to hold a lunchtime seminar (June 2008) to bring together analysts, researchers and policy officials with an interest in transgender issues, to hear more about the transgender research and to discuss recommendations from the LGBT hearts and minds agenda group relating to developing a more comprehensive evidence base on the experiences of transgender people.	Equality Unit	June 2008		Yes (7)
Engagement with Lesbian, Gay and Bisexual communities	We will consider the recommendations of the hearts and minds agenda group's report 'Challenging Prejudice' which includes recommendations on changing attitudes towards the lesbian, gay and bisexual community. The Scottish Government will issue a formal response later this year.	Equality Unit, working with colleagues across Directorates	End 2008	Better and more informed policy making as a result of understanding the differential experiences of men and women in Lesbian, Gay and Bisexual communities.	Yes (6)
Involvement of disabled people in Scottish Government policy making	Our work on involvement of disabled people will ensure that gender issues are considered and will ensure that both women and men are able to participate.	Equality Unit, working with colleagues across Directorates	Ongoing	Disabled men and women's needs are better understood and reflected in policy making and decision taking.	Yes (6, 8, 10)
Violence against women	We will continue to ensure support for women who experience gender-based violence and develop a strategic approach to tackling it, building on the National Strategy on Domestic Abuse which we are reviewing.	Equality Unit	Review published by end 2008	A reduction in the numbers of women experiencing men's violence and a change in attitudes towards violence against women. An increase in women's confidence in reporting violence and the quality of the support that those coming forward receive.	Yes (1)
	We will continue to raise awareness of violence against women through campaigns and consider how to challenge and change attitudes to prevent its occurrence.		Media campaign runs during Christmas & New Year period.
	We will ensure the needs of children and young people experiencing domestic abuse are addressed and will be publishing shortly the National Delivery Plan for Children and Young People containing the recommendations of the National Domestic Abuse Delivery Group.		Delivery Plan published in June 2008
Ethnic Minorities in the Labour Market	We will continue to promote action which takes a gendered view of the labour market issues for women and men from minority ethnic communities. This will be embedded in our Race and Faith Equality Statement which will be published Summer 2008.	Equality Unit	Ongoing	Improved labour market outcomes for men and women from minority ethnic communities; increased employment in wider range of jobs.	Yes (2-4)
Religion / Faith	We will continue to support women's faith organisations to ensure that women are supported and enabled to play a full role in ensuring equality of opportunity for faith communities in Scotland.	Equality Unit	Ongoing	The particular needs of women and men of faith are addressed appropriately through policy development and service provision.	Yes
Refugees and Asylum Seekers	We will continue to support specific work targeted at the needs of asylum seeking and refugee women.	Equality Unit	Ongoing	Refugee and asylum seeking women's needs are taken into account in service planning and delivery.	Yes
Gypsies/Travellers	The Government will continue to support work to tackle the health deficit of Gypsies/Travellers, and address the specific needs of Gypsy/Traveller women, such as access to female health professionals. Training will be provided for front line service providers in awareness of Gypsy/Travellers' cultural needs. An education strategy for Gypsies/Travellers, including both formal and informal learning pre, during and post school age will be developed as part of the Race and FaithEquality Statement.	Equality Unit, working with colleagues across Directorates	Ongoing	Gypsy/Traveller women's and men's specific cultural needs are reflected in service delivery. Health and education outcomes for Gypsy/Traveller women and men are improved.	Yes
	A £2m (£1m per year for 2008-09 and 2009-10) site improvement fund provided by the Government will enable significant up-grades to facilities at many local authority Gypsy/Traveller sites, some of which will benefit Gypsy/Traveller women, who have the main burden of caring/cleaning responsibilities.			Improved facilities at sites make life easier for Gypsy/Traveller women.

Key actions to take into account gender equality across main responsibilities, if not already covered above.
Policy	Actions to take forward gender equality	By whom	By when	Expected Outcome
Healthy weight, food + health	Priority for joint action plan for antenatal and infant nutrition, including free fruit for pregnant women.	Govt/health boards		Fewer low birth weight babies Improved health outcomes for Scottish populations and reductions in health inequalities.
Physical Activity	Funding for programmes targeting adolescent girls - Y Dance, Girls on the Move and Fit for Girls	Govt/health boards	Funding over 2008-2011	More teenage girls participating in physical activity and realising the health benefits of this
Keep Well	Particular focus on men as more at risk of CHD	Health boards/community health partnerships	Funding over 2008-2011	Engaging with men at most risk of preventable ill health and CHD. Improved health outcomes for Scottish populations and reductions in health inequalities

GENDER EQUALITY ACTION PLAN

Name of Directorate

Healthcare Policy and Strategy

Directorate Responsibilities

The Directorate covers a broad range of patient facing responsibilities including; child health; maternal health; healthcare quality and patient safety; palliative care; NHS complaints; equality & diversity policy; public involvement; patient rights; patient information; sponsorship of the Scottish Health Council; cancer & genetics; long-term conditions and healthcare planning.

The Directorate also has responsibility for the e-Health strategy and for Group Finance

Healthcare Policy & Strategy has a significant role to play in tackling discrimination and disadvantage and in promoting gender equality. Men and women, transsexuals, boys and girls, staff and service users, have different needs and uses of the health service in Scotland, which was traditionally based on a 'one size fits all' model.

By taking into account these different needs, the quality of health services will improve for everyone. Our evidence base in health is already good in terms of sex and gender and we are able to analyse much of our analytical data by sex. Tackling health inequalities is a key part of the work of the directorate, along with other health inequalities issues, and understanding and tackling gender equality issues form a central part of our work.

We recognise that men, women and transsexuals experience different and sometimes unequal access to our services and unequal health outcomes that are a result of their needs not being considered in the design, development and delivery of our services. We are committed to tackling these issues by involving men, women and transsexuals in our processes at an early stage and by measuring progress through improved outcomes.

We aim to ensure that men, women and transsexuals are involved in the design, development and delivery of health services to ensure they recognise and respond sensitively to the individual needs and circumstances of their lives, in an NHS that is free from prejudice, harassment and discrimination.

Fair for All - Gender, the Directorate's national initiative to support NHS Scotland understand and respond to gender issues, has worked with men, women and transsexuals and NHS staff to develop a shared vision that improved access to health provision cannot be led by legislation alone. As Fair for All moves to a new integrated Directorate of Equalities & Planning within NHS Health Scotland, we will monitor progress to ensure men, women and transsexuals's needs are met.

While each NHS Board publish their own Gender Equality Schemes, in recognition of the relationship between the Health Directorates' strategic role and NHS Boards' role in the delivery of services, we are implementing a 'whole system' approach to equality, including gender equality, across our key clinical priorities of Cancer, CHD/Stroke and Mental Health. This is being developed in collaboration with Better Together, our national Patient Experience Programme.

The development of our e-Health strategy also provides an opportunity to improve services for men, women and transsexuals, through developing systems where information on patients' individual needs and circumstances can be effectively communicated across different parts of the health system, ensuring smooth transitions between services that provide appropriate and accessible healthcare.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

We know that men and women's mortality rates vary across a range of diseases, with cancer and heart disease taking the lives of more men than women on an annual basis.

Other issues such as mental health, alcohol consumption, smoking rates and obesity are also markedly gendered. We know that women are more likely than men to suffer from anxiety and depression, while men are more likely than women to complete suicide.

We know there are some health differences between women and men which are biological:

Men typically develop heart disease 10 years earlier than women
Man to woman infection with HIV is more than twice as efficient as woman to man infection
Women are around 2.7 times more likely than men to develop an auto immune disease such as diabetes.

And some which are a result of socialisation or gender:

Men are more likely than women to complete suicide
Boys are twice as likely as girls to be killed or seriously injured in pedestrian road accidents
Life expectancy for women in Scotland is the lowest in the EU and for men, the second lowest
Men are more likely than women to die of injuries, but women are more likely to die of injuries sustained in the home
Women are more likely to suffer from anxiety or depression
The gap between women's and men's smoking rates is changing, with more young girls taking up the habit than boys.

We also know that there are specific issues that transsexual people face in relation to health and health services that need to be considered in policy and planning:

Transsexual people can experience difficulties because of people making assumptions about sexuality and sexual expression.
Transsexual people can experience difficulties because in general people have very fixed ideas about what a man / woman should be like, i.e. 'not a real man'.
Some of the most significant health related issues for Male-to-Female ( MTF) transsexuals included alcohol abuse, suicidal feelings, constantly feeling stressed about gender and disgust with body parts.
Some of the most significant health related issues for Female-to-Male ( FTM) transexuals included anxiety, fear of what people would think / say, suicidal feelings and distress about body parts.
Self-harm and depression were also significant for MTF and FTM transexuals.
Some of the most significant issues with health services for MTF transsexuals included GPs with no knowledge of transgender issues, psychiatrists with no understanding of transgenders and having to pay for electrolysis.

Some of the most significant issues with health services for FTM transsexuals included difficulties getting good chest surgery, a psychiatrist giving the wrong information and a complete lack of information in health centres and for GPs.

Directorate of Healthcare Policy and Strategy Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).

Policy

Action

By whom

By when

Expected Outcome

Contribute to GEPO (Yes/No)

Gender Based Violence

NHSScotland is committed to making tangible, sustainable progress in tackling this issue. To do so we intend to adopt an incremental approach, concentrating on the areas and settings where presentations of people affected by gender-based violence are highest, and which work closely with the most vulnerable people within our communities. The priority areas for attention will therefore be primary care, mental health, sexual & reproductive health, A&E, community health, addictions, and maternity services.

To achieve our aim of an NHS that fully recognises and responds to its responsibilities around gender-based violence, as a service provider, employer and partner agency, each NHS health board will develop and deliver a 3 year action plan focussing on the implementation of routine enquiry of domestic abuse within these priority settings, supported by a national team that will produce guidance, training and ensure multi-agency collaboration.

Patients & Quality Division, Child & Maternal Health Division, NHS Boards, NHS Gender Based Violence Team

2008 - 2011

Implementation of Routine Enquiry of abuse within priority settings, which will result in identifying and providing coordinated support for more women who have experienced domestic abuse

Dissemination of revised guidance on abuse for staff, to support them to enquire about abuse and be skilled in dealing with the response.

Production of an employee policy on gender-based violence.

Multi-agency collaboration.

Yes (1)

Key actions to take into account gender equality across main responsibilities, if not already covered above.
Policy	Actions to take forward gender equality	By whom	By when	Expected Outcome
Cancer / Better Together In 2006 we began planning for a 'whole systems' approach to our work on equalities that would assess all stages of healthcare, from policy and planning to frontline delivery of services, starting with Cancer, then rolling out across clinical priority areas. In 2007 work began separately to develop Better Together, a national patient experience programme that would survey c _ § million patients per year on their experience of health services (disaggregated by diversity categories), supported by an improvement programme to improve services based on these findings. To ensure our improvement work on cancer and Better Together was joined up we have been working to update our plans and will be ready to commence activity in Summer 2008. This programme is based on a wide range of evidence, including patient stories, of the inequalities faced by different groups in epidemiology; accessing services; services delivery and outcomes in relation to the design, development and delivery of health services	A research project is drawing together the evidence on gender inequalities in relation to Cancer services.	Patients and Quality Division; Staff Governance Unit, Healthcare Planning Division, NHS Greater Glasgow & Clyde, NHS Lothian, NHS Grampian, Better Together Co-ordination Centre, Delivery Directorate's Improvement & Support Team, Health ASD	Summer 2008	Men, Women and Transsexuals's experiences of specific cancer services are recorded and used to improve services. Evidence collated nationally of gender inequalities in cancer services Equality Impact Assessed Policy sets expectation for the equitable and fair delivery of cancer services for men, women and transsexuals Share/develop best practice/learning Shared ownership of approach to improving men, women and transsexuals's access to, and experience of cancer services. A range of patient experience improvement tools that take explicit account of gender
	3 NHS Boards are currently recruiting co-ordinators to take this programme forward - this will include development of validated case studies of inequalities sensitive practice based on patient experience, including men, women and transsexuals experiences, that will be disseminated across all Cancer services, then rolled out across CHD / Stroke & Mental Health.		Summer 2008 - Mar 2010
	The national Cancer Strategy, Better Cancer Care is currently being revised and Equality Impact Assessed		Summer 2008
	The Better Together patient surveys (qualitative and quantitative) will be disaggregated by equality strand, including men, women and transsexuals, which will tell us if our actions are having improved outcomes in relation to patient experience for these groups		November 2008
Patient Monitoring Monitoring men, women and transgender patients' access to health services and their health outcomes is central to understanding and responding to their needs and to ensuring that our actions are having an impact on outcomes.	Supported by the Equality & Diversity Information Project at NHSNSS (funded by Patients & Quality Division) We will establish new levers to ensure we embed equalities patient monitoring across NHS Scotland, including establishing targets for Boards A 5 countries meeting in April 2008 brought together leads with responsibility for strategy and operational leads to agree a 3 year action plan and targets for achieving this All NHS Boards are currently piloting the routine collection of equalities data from NHS Complaints to test out this approach This will include roll out of an equalities dataset, staff training, communication with patients and revised patient information collection	Patient & Quality Division, NHSNSS Equality & Diversity Information Project, NHS Boards	Ongoing	Ability to monitor service use and health outcomes for men, women and transsexuals and to be able to use this information in a systematic way to identify, understand and address any inequalities
Patient Focus Public Involvement ( PFPI) launched Fair for All - Gender, a partnership with the Equal Opportunities Commission, to support NHS Scotland mainstream gender issues across their activities and to develop ambitious gender equality targets for their first Gender Equality Schemes. 'Gender Equality Duty - Guidance for NHS Scotland' Fair for All - Gender's guidance on mainstreaming gender equality was launched in 2007.	Work will be undertaken to join up approaches nationally to ensure national / special NHS Boards and Health Directorates engage with men, women and transsexuals in the design, development and delivery of their services and functions. Following the review of Gender Equality Schemes, the Directorate of Equalities & Planning will support NHS Boards to: progress the mainstreaming of gender equality into their work; share good practice and provide targeted support to NHS Boards	Patients and Quality Division and NHS Health Scotland Directorate of Equalities & Planning	ongoing	Improved access to healthcare for men, women and transsexuals Improved patient experience Gender equality built into all aspects of NHS

GENDER EQUALITY ACTION PLAN

Name of Directorate

Primary and Community Care Directorate
Adult Care and Support Division

Directorate Responsibilities

In 2005, the Scottish Government launched the National Strategy for Survivors of Childhood Sexual Abuse which is now being taken forward by the Adult Care and Support Division together with a National Reference Group and 2 lead professionals. This sets out a strategic way forward to improve services for survivors, to ensure greater priority and joined-up working in national and local mainstream services, and improve the lives of all who have suffered childhood trauma. It also aims to raise public awareness, improve knowledge and develop training and skills for frontline workers.

We are funding services which address the needs of both male and female survivors. As part of the National Strategy, we are progressing further work on the needs of male survivors. There is work underway in the field on mixed gender information based groups which will provide an opportunity for clients (who have experienced childhood sexual abuse, sexual assault/rape or domestic violence) to experience a group for the first time, where the focus is on support and recovery in general. This will allow clients the experiencing of mixing (often for the first time) in a safe and containing environment.

Primary and Community Care Directorate (Adult Care & Support Division) Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
SurvivorScotland - National Strategy for Adult Survivors of Childhood Sexual Abuse	Funding services which address the needs of both male and female survivors. As part of the National Strategy, we are progressing further work on the needs of male survivors.	SurvivorScotland	Ongoing	Improved support services for both men and women.	Yes
	Work to ensure all professionals, support services and the public more generally become more aware of the issues around sexual abuse and adopt behaviours which support and embrace the agenda around promoting gender equality, non-discrimination, social inclusion and equal rights.	SurvivorScotland- communication strategy and website.	Ongoing	Dimininsing of discrimination and lack of awareness in Scottish society that impacts on health and other services more widely. Better addressing of behaviours and attitudes.	Yes
	Training for staff and peer workers to recognise and respond to inequalities, including gender equality. To also include work around educational programmes for perpetrators for those likely to offend.		Ongoing	Improvement in experience of services. Diminishing of discrimination and prejudice in Scottish society. Better addressing of behaviours and attitudes.	Yes

GENDER EQUALITY ACTION PLAN

Name of Directorate

Housing and Regeneration

Directorate Responsibilities

Housing and Regeneration Directorate ( HAR) is responsible for developing and delivering the Scottish Government's policies for housing and regeneration. The expenditure programmes for which the Directorate is responsible contribute to the Government's Purpose and Strategic Objectives by increasing the supply of good quality, sustainable housing and by supporting large-scale projects to achieve the comprehensive regeneration of targeted areas. In addition, the Directorate works with local government and other partners to prevent and tackle homelessness; provide housing support services to enable vulnerable people to live independently in their own homes; and to provide targeted regeneration action to tackle poverty in the most disadvantaged communities. On this occasion the HAR directorate action plan includes the newly formed agency, The Scottish Housing Regulator ( SHR). The agency was launched on April 1 2008 and regulates registered social landlords and the landlord and homelessness functions of local authorities. The SHR's purpose is to regulate to: protect the interests of current and future tenants, and other service users; ensure the continuing provision of good quality social housing, in terms of decent homes, good services, value for money, and financial viability; and maintain the confidence of funders.

Because much of our work involves working with and for communities that are likely to experience disproportionate levels of disadvantage, we are committed to ensuring we do all we can to promote equality and respect diversity.

We are committed to making sure that the policies, procedures and services that we lead or influence make a positive contribution to improving the experiences that men and women, including transgender men and transgender women face. This will involve staff awareness and training and highlighting to the organisations we work with that they too have statutory duties to promote gender equality. We will take positive action to eliminate discrimination and inequality in our policies. We will use evidence to help us to understand the needs and experiences of men and women.

We are committed to undertaking Equality Impact Assessments for all new and developing policy, and involving when appropriate. Where Equality Impact Assessments identify the need for specific actions to be taken to ensure the needs of men and women are met, we will put these in place. We are also undertaking work to ensure all staff are aware of their responsibilities under the equality duties.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities

The proportion of households which either owned their home outright or were buying it with a mortgage or loan had increased by 2005. By 2005, 74% of male highest income householder ( HIH) households were homeowners compared to 68% in 1999, while 55% of female HIH households were homeowners compared to 50% in 1999.
Single parents were least likely to be homeowners, with 68% being in rented accommodation in 2005.
In 2005 single men were more likely to be in rented accommodation than women. 50% compared with 43%.
Of households in high and middle income areas, the HIH is more likely to be male than female - 29% compared to 19%.
In 2005, households where women were the highest income earners were more likely to be in rented accommodation than households where men were the highest income earners, 43% compared to 25%.
Female HIH households are more likely than male HIH households to rent in disadvantaged council estates (12% compared to 10%), or to head families in council flats (12% compared to 7%).
Female HIH households also make up a higher proportion of renting singles than male HIH households (13% compared to 8%), a category which includes flats for older people and sheltered accommodation.
In 2005, around half of single pensioners owned their homes outright, 51% of men and 48% of women.
There are similar numbers of male and female pensioners in rented accommodation.
Of all applications to local authorities under homeless persons legislation in 2005/06, the biggest group was single males (43% of all applications). This was followed by single females (21%) and female single parents (20%). Single parents as a category (male and female together) were, however, the second biggest group at 25% of all applications.
Though gender has an impact on the quality of housing to which people have access, there are few gender differences in how people rate their neighbourhood, or in which aspects of their neighbourhood they like or dislike.

Housing and Regeneration Directorate Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
National Accommodation Strategy for Sex Offenders	The review of Strategy and Guidance will be subject to an EQIA	Housing & Regeneration/ Social Housing Division	To commence by end 2008	A National strategy which takes into account the different needs of men and women.	Yes (1)
The National Group to address Violence Against Women established the Domestic Abuse Accommodation and Support Provision Implementation Working Group to take forward recommendations in the research report: Refuges for Women, Children and Young People in Scotland (2003)	Technical sub-group established to develop design guidance for refuge accommodation and good practice	Housing Investment Division represented on both the Implementation Working Group and the technical sub-group.	To be confirmed	Design guidance and good practice	Yes (1)
Collect performance and statistical information on Registered Social Landlords to inform our risk based assessment and determine the level of regulatory engagement we will have with individual organisations	Collect information on the gender of staff and governing body members of all RSLs.	The Scottish Housing Regulator Head of Business Analysis Branch	Annually	Provides up to date contextual information on the gender balance of staff and governing body members in RSLs.	Yes (4)

Key actions to take into account gender equality across main responsibilities, if not already covered above.
Policy	Actions to take forward gender equality	By whom	By when	Expected Outcome
Review of social housing allocations policy	We will review current allocations requirements to ensure they are working as well as possible and deliver fair outcomes for the vulnerable groups that depend upon them. Reflecting equality considerations will be a key part of the review and we will undertake an EQIA during it, and will ensure that we gather the views of men and women. The review may lead to new guidance on allocations, in which case this would include equalities requirements.	Housing & Regeneration/ Social Housing Division	By end 2009	Ensure that social housing allocations promote equality of opportunity between men and women.
Development of policy on value of social housing. The housing discussion document Firm Foundations outlined a series of proposals for improving the value that social landlords provide for their tenants and taxpayers.	Proposals include modernising the regulation of social housing and securing better value for public investment in new social housing. As options for taking forward these policies are developed, they will be subject to EQIA scrutiny.	Housing & Regeneration/ Social Housing Division	Continuing	Policies that define value for tenants and that have been developed with the interests of men and women in mind.
Fuel Poverty, including Central Heating and Warm Deal programmes	Existing programmes are being reviewed. We will review current and proposed delivery mechanisms to ensure equalities and diversity issues are considered and dealt with appropriately.	Housing & Regeneration/ Housing Access & Support - Fuel Poverty Team	Late 2008	EQIA report will identify any issues which impact unfairly on gender. These will be addressed wherever possible.
Information and Advice Standards Unit The Scottish National Standards for information and Advice Services explicitly adhere to all equalities issues.	We equality proof our main policies, documents and publications and web based resources. We ensure that gender issues are included in local authority information and advice strategies. We have produced good practice guidance for older LGBT people. We also compiled and published information on Relationship Breakdown and Housing Rights for all.	Housing & Regeneration/ Housing Access & Support /Advice And Standards	Ongoing	Ensure the needs of both men and women are firmly kept in focus.
Supporting People is a funding framework for people in supported accommodation or in receipt of floating housing support. The programme was introduced throughout Great Britain in April 2003 in order to support vulnerable people in different types of accommodation and tenure in ways responsive to their needs.	Supporting People budget absorbed into local government settlement from April 2008. Local authorities continue to be responsible for the delivery of services from this now un-ring fenced budget. Final guidance will remind local authorities of the need to ensure compliance with the equalities agenda.	Housing & Regeneration/ Housing Access & Support /Advice And Standards	Each year	Continuing similar services for men and women as for other groups.
Strategic planning for housing	Build equalities requirements into new guidance on local housing strategies.	Housing and Regeneration/ Housing Markets and Supply:	End 2008.	Improved strategic planning, ensuring provision of suitable housing for men,
Implementation of Parts 1 & 2 of the Housing (Scotland) Act 2006 .	This guidance will be subject to an equalities impact assessment after the end of the consultation period	HAR/ Housing Markets and Supply	End 2008	The Equalities Impact Assessment will identify any gender equalities implications.
Low-cost Initiative for First Time buyers ( LIFT) The New Supply Shared Equity Scheme and the pilot Open Market Shared Equity Scheme both aim to support first time buyers. Both schemes are demand-led.	Registered Social Landlords are asked to provide information on the gender composition of the households under the schemes. Monitoring information will be examined in more detail to identify any gender imbalance in applications. Gender equality issues will also be considered when the shared equity schemes are evaluated in 2010.	Housing Investment Division/Housing Markets and Supply	Impacts will be monitored on an ongoing basis.	Both men and woman being supported as first time buyers.
Community Voices Network - for community activists and volunteers working to regenerate disadvantaged areas of Scotland	Actively promote the Network to all equalities groups, including balanced representation of men and women. Ensure all events take into account gender issues, including the provision of child care and separate prayer rooms for men and women. Complete an EQIA to ensure that the Network is inclusive for all community activists and volunteers	Housing & Regeneration/ Regeneration/ Community Engagement Team	Ongoing	Increased skills, knowledge and expertise on community regeneration through participation in the Community Voices Network
Empowering Communities	Policy development is accompanied by EQIA. Focus groups have taken place as part of dialogue in December 2007, with both men and women well represented. The dialogue showed that empowerment and equality of opportunity go hand in hand. Gender groups will continue to be consulted during policy development. We will continue to improve monitoring participation at meetings by gender and other equality groups.	Housing & Regeneration/ Regeneration/ Community Engagement Team	On going	Both men and women are involved in policy development processes. Improving evidence of how community empowerment includes minority groups.
Fairer Scotland Fund ( FSF)	This catalyst fund is offered to community planning partnerships ( CPPS) in order that they can make accelerated progress for the most disadvantaged areas and vulnerable groups, with a view to regenerating communities, tackling poverty and improving employability. In the guidance for the Fund, CPPs have been informed that as part of an 'agreement' with the Scottish Government they should demonstrate that communities of place and interest have been consulted on strategic deployment of the Fund. In the terms and conditions governing investment of the grant, Partnerships are reminded of their statutory duties in relation to all equalities legislation. In conjunction with local authority and CPP contacts on the proposed use of FSF funding, SG officials will ensure that equalities issues are raised and will seek assurances that such issues have been considered in drawing up the relevant proposals.	Housing & Regeneration/ Regeneration Division/ in conjunction with Social Inclusion, Workforce Plus and More Choices More Chances teams.	CPPFSF proposals due by June 2008 Ongoing contact with CPPs on FSF issues. Annual progress report on FSF from each CPP	As above -with emphasis on strategic deployment of the Fund
Pathfinder Urban Regeneration Companies ( URC) being supported by the Scottish Government	URCs are required to report to the Scottish Government annually on the progress of their business plan. This includes a specific section on how equalities are being considered. Architecture and Design Scotland are undertaking a project with the URCs to raise the level of their design ambition. Their definition of good design includes considering how design can affect equalities groups. The longer-term monitoring and evaluation of the Pathfinder URC programme will include some indicators broken down by gender where appropriate.	Housing & Regeneration/ Regeneration Division	Ongoing	Increased awareness amongst the URCs of equalities issues, including more effective consultation and community engagement. Better quality of design aspiration and consideration of a community's needs. Creation of a statistical picture of how the areas are changing over time and ability to consider the gender impact.
Affordable Housing Investment Programme	Ensure the organisations we fund demonstrate their commitment to equal opportunities.	Housing & Regeneration/ Housing Investment Division	Ongoing	Improvements in the consideration of equalities issues and in service delivery to equality groups.
Strategic Housing Investment Framework	Ensure the assessment processes for strategies of our partners include an assessment of their commitment to equalities.	Housing & Regeneration/ Housing Investment Division	Ongoing	Improvements in the consideration of equalities issues and in service delivery to equality groups.
Mainstream our scrutiny of equality issues in the inspection of social landlords	All published inspection reports to include a range of appropriate assessments on equality issues including, where relevant, gender.	The Scottish Housing Regulator, Head of Inspection Branch	Throughout inspection programme for 2008/09	Holding landlords to account for the services they provide to men and women
Continue to provide landlords with easy access to up-to-date and relevant information on broader equalities duties including gender.	Self-assessment information on equalities duties is published on the website and kept up to date.	The Scottish Housing Regulator, Heads of Policy & Corporate Services Branch and of Inspection Branch	Information published 1 April 2008. To be reviewed during 2008-09.	Landlords have access to information that helps them to continuously improve their services to men and women.
Collect and report on equalities information about our staff	As an executive agency of the Scottish Government we will ensure that we are able to report on equalities groups, including gender. We are looking at options available to us to understand the make up of our workforce.	The Scottish Housing Regulator, Head of Policy & Corporate Services Branch	Systems established by end June 2008	Effective equalities monitoring systems.

GENDER EQUALITY ACTION PLAN

Name of Directorate

eHealth Directorate

Directorate Responsibilities

To help NHS Scotland to meet the improvement objectives set by Ministers by: enabling the sharing of information to improve patient safety and clinical outcomes: improving the Information and Communication Technology Support for processes and business change, ensuring that systems are designed to support change and reflect the needs of patients, clinicians, managers and other users

eHealth is defined as the use of computers and telecommunications to work with information in health. It is about harnessing the power of these technologies to support a wide range of activity within NHS Scotland to improve the patient experience, improve outcomes for patients, improve patient safety and to improve the efficiency of the services we provide.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

The strategic agenda of eHealth is set by the Better Health Better Care Action Plan.

ehealth uses that as a framework for setting its direction. Inclusion and access to all is at the centre of the action plan

eHealth Directorate Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).

Policy

Action

By whom

By when

Expected Outcome

Contribute to GEPO (Yes/No)

The eHealth team are responsible for investment decisions around a variety of national projects and programmes

Ensure that programme and project boards address any gender equality issues in their EQIA

The appropriate project/programme

board

ongoing

Policies and systems that address any potential areas of gender inequality

Yes (all)

The eHealth strategy will be published in June 2008

We will carry on an EQIA on the eHealth strategy

eHealth Strategy

June 2008

Identify strengths and weakness in areas of gender inequality as it affects the formulation of our strategy

Yes (all)

Key actions to take into account gender equality across main responsibilities, if not already covered above.

Policy

Actions to take forward gender equality

By whom

By when

Expected Outcome

Provision of NHS Wigs

Users have consistently raised concerns over the service, in particular regarding they variation in procedures across the country.

In the light of users' concerns, the cost of the basic modacrylic wig was reduced to bring it in line with the prescription charge for other items as from 1 April 2006. Also, a short life working group, the Supply of Wigs Investigation Group Scotland ( SWIGS) was established to research the position regarding other types of wigs and to make recommendations.

The effects of chemotherapy/radiotherapy treatment and alopecia on women were specifically included in the group's discussions. The group's recommendations, however, related to patients generally, have been approved and work is ongoing on their implementation to include annual monitoring returns from boards.

The recommendations were based on input from patients representatives and suppliers to ensure equity of treatment for all patients and it is proposed to introduce standard practices across the country

The NHS (Charges for Drugs and Appliances) (Scotland) Regulations 2008, were accompanied by guidance on the provision of wigs (and fabric supports). These guidelines included forms for the recording of provision, including by age and gender, and will be used by Boards to report to the Scottish Government on an annual basis.

Patients and Quality Division; Primary Care Division; NHSScotland Boards

Ongoing.

The development of national guidelines with the aim of eliminating of variations in services for the benefit of all patients.

Much more accurate, and readily available, data will be produced to enable officials to report to Ministers on provision. This will also enable responses to Parliamentary Questions, which have been known previously to seek gender-related information on this subject.

GENDER EQUALITY ACTION PLAN

Name of Directorate or Agency

Health Delivery Directorate

Directorate Responsibilities

Performance management of NHS Scotland; ensuring delivery of access targets; and supporting continuous improvement in health services.

The Health Delivery Directorate is committed to promoting gender equality through its NHS performance management function and in its work to support the delivery of improved NHS services and to improve access to those services. The Directorate ensures that the NHS performance management system supports the National Performance Framework by directly supporting the achievement of the Scottish Government's Purpose and National Outcomes, including through the HEAT targets and NHS Boards' Local Delivery Plans.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

We have access to a strong evidence base in relation to the health of men and women. Mortality rates vary by gender across a range of diseases, including cancer and heart disease (which disproportionately affects men), alcohol consumption, smoking and obesity rates. Women are more likely than men to suffer from anxiety and depression, while men are more likely than women to complete suicide. Tackling health inequalities - including those relating to gender - is a key priority for the Scottish Government, and the forthcoming report of the Ministerial Task Force on Health Inequalities will provide further guidance in this area.

The Health Delivery Directorate's role is primarily to support, guide and encourage the activities of NHS Boards in ensuring that NHS services promote gender equality, in the light of the evidence and data available.

Health Delivery Directorate Gender Equality Action Plan

Key actions to take into account gender equality across main responsibilities.
Policy	Actions to take forward gender equality	By whom	By when	Expected Outcome
Approval of NHS Boards' Local Delivery Plans ( LDPs).	Ensure that LDPs' trajectories take account of differential impact of disease and poor health on gender.	NHS performance management teams.	Approval of LDPs in Spring.	NHS Boards focus actions in areas which make greatest impact on gender inequalities in health.
NHS Performance Management and accountability process	Ensure that Boards have appropriate gender equality plans in place.	NHS performance management teams	Ongoing	NHS Boards focus actions in areas which make greatest impact on gender inequalities in health.
Continuous business improvement within the NHS	Take account of gender differential impacts in service-specific business improvement work and NHS work which we influence such as the patient experience programme.	Improvement and Support Team	Ongoing	Awareness of gender inequality is increased and good practice is promoted.
18 Weeks Referral to Treatment ( RTT) Programme	An Equality Impact Assessment ( EQIA) will be undertaken as part of the 18 Weeks RTT Programme. This will assess how access to NHS services can be improved for disadvantaged populations through the reduction in waiting times. It will also lead to more effective assessment of NHS Boards' delivery plans to improve patient access.	Access Support Team working with the Programme Board and NHS Board programme teams.	EQIA to be completed by September 2008. Action plan to be implemented by December 2008	Programme Board and NHS Boards focus actions in areas which make greatest impact on gender (and other) inequalities in access to health services.

GENDER EQUALITY ACTION PLAN

Name of Directorate or Agency

Health Finance Directorate

Directorate Responsibilities

The Directorate consists of three divisions - Health Finance Division, Capital and Property Planning Division, and Health Analytical Services.

Key functions of Health Finance Division are:

Financial Report and Control, covering financial data analysis, accounting processes and financial reporting as well as technical accounting guidance, audit and governance issues;
Financial Performance Assurance, covering financial management advice and assurance to the Delivery Directorate, all Health Boards and the health programme budget holders within the Health Directorates;
Financial Planning and Development, covering planning and project management, policy and quality assurance, leads on efficient government and best value and on developing performance measurement and benchmarking.

Key functions of Health Analytical Services are:

Supporting policy development, implementation and evaluation by providing appropriate and relevant evidence, advice and analysis through an integrated analytical approach; and
Providing analytical support in the measurement and reporting of the performance of health and community care services;
To work closely with ISD, other NHS organisations, and local authorities to ensure the availability and application of high quality information.

The Capital and Property Planning Division has responsibility for those policies relating to the physical assets (property, medical equipment and IT) from which healthcare services are delivered and for allocating and managing the capital resources made available to NHSScotland to invest in modern, fit for purpose assets. This includes lead responsibility for the Health Directorates' Capital Investment Group which approves and monitors delivery of major investment projects developed by NHSScotland Boards.

This directorate is committed to delivering gender equality for its staff and to ensuring that the actions listed in part 2 of this document are taken forward.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

Health Analytical Services has developed an evidence base around equalities/ inequalities through the commissioning of social research, work with ISD, the regular data collections which ASD undertake, our work with the Health Inequalities Task Force and our work with Patients and Quality / Fair for All (which has now become part of Health Scotland). Health Analytical Services knows that the issues for different genders also depend on their disability status, sexual orientation, ethnic group, level of deprivation and religion/ belief

Life expectancy ( LE) and healthy life expectancy ( HLE; an estimate of the number of years a person can expect to live in good health) are often used as indicators of the overall health of the population - and of inequalities between different sections of the population. Key inequalities observed are:

Male LE in the 10% most deprived areas in Scotland is 13 years lower than that in the 10% least deprived areas. For females the gap in LE between the most and least deprived is 8 years. This inequality gap appears to be widening over time, particularly for males ( GRO(S) figures for 2004/06);
HLE for males in the most deprived 15% of Scotland is around 10.6 years lower than in Scotland overall. For females, the gap is around 10.0 years (Scot PHO - comparing Scotland figures for 2006 with SIMD breakdowns for 2005/06);
LE for women is 5.0 years higher than for men (79.6 years compared to 74.6 years). This gap is however narrowing over time, dropping from over 6 years in the early 1980s ( GRO(S) figures for 2004/06);
HLE for females is 1.1 years higher than that for males (Scot PHO figure for 2006).

Significant inequalities are observed in the incidence and prevalence of and mortality from Scotland's biggest killers. For example:

South Asian men have a 45% higher incidence of heart attack, and south Asian women have an 80% higher incidence than the rest of the Scottish population. However, south Asian men and women have 40% better survival rates than the rest of the Scottish population (Fischbacher et al);
Following adjustments for socio-economic circumstances, male cancer mortality (particularly lung) is significantly higher in West Central Scotland than the rest of Scotland ( GCPH).

The mental health and wellbeing of particular groups also appears to be worse amongst some specific groups. For example:

Mental health problems affect more women than men. Specifically, women experience higher rates of depressive disorders than men, however, men are more likely to complete suicide and experience earlier onset of schizophrenia with poorer clinical outcomes than women ( SDCMH);
Comparison of teenage and older mothers showed that teenage mother suffer from poorer mental health in the first three years after their child's birth ( BHPS);

Inequalities in the prevalence of lifestyle choices associated with health are also evident, but relationships are sometimes unclear. For example:

Binge drinking is more common amongst men than amongst women and appears to increase with increasing deprivation, but weekly consumption of alcohol does not follow the same pattern ( SHeS);
Males are more likely than females to be meeting the recommended levels of physical activity, but there is no clear relationship between physical activity and deprivation for adults or children ( SHeS);
Consumption of 5+ portions of fruit & vegetables a day is slightly higher for females than males, increasing with age and decreasing with increasing deprivation for adults. There are no clear patterns for children ( SHeS);
Rates of obesity increase with increasing deprivation for adult women, but not for men or children. A slightly higher proportion of adult males than females are overweight, but within this a slightly higher proportion of females than males are obese ( SHeS).

There is increasing policy interest in inequalities in the early years of life and the impact this might have on future population health. For example:

In the most deprived fifth of areas in Scotland, the rate of teenage delivery amongst girls aged under 16 years is more than ten times higher than that observed in the least deprived fifth of areas - and the abortion rate amongst the under 16s is around three times higher than that observed in the least deprived fifth of areas ( ISD figures for 2005);
Rates of smoking during pregnancy in the most deprived fifth of areas are almost five times higher than those in the least deprived areas (38% compared with 8%) ( ISD figures for 2005);
Only 12% of younger mothers (< 20 age group) in the most deprived fifth of areas are breastfeeding at the health visitor's first visit. This compares with 73% of mothers aged 40+ years in the least deprived fifth of areas at first visit ( ISD figures for 2006).

There is also evidence of inequalities in access to and use of health services. For example:

In some areas, more than 75% of sexual health screens for men having sex with men are provided outwith the NHS Board area ( HPS).

References

BHPS British Household Panel Survey

Fischbacher et al; Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians; BMC Public Health 2007, 7:142 GCPH Glasgow Centre for Population Health Comparisons of health-related behaviours and health measures between Glasgow and the rest of Scotland; 2007

GRO(S) General Register Office for Scotland

HPS Health Protection Scotland

ISD Information Services Division of the NHS

Scot PHO Scottish Public Health Observatory

SDCMH Scottish Development Centre for Mental health; Equal Minds - Addressing Mental Health Inequalities in Scotland, 2005.

Health Finance Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
Scottish Health Survey	To include the collection of equality strand information including gender	Health ASD	Ongoing	Data available on gender as part of the Scottish Health Survey	Yes (2, 3, 5, 6)
NHS Resource Allocation Formula (Arbuthnott and NRAC)	The Arbuthnott Formula includes an explicit adjustment for the effects of sex on the cost of providing healthcare to patients. The formula included age-sex cost weights which reflect the national average costs of healthcare resource use per head per year, split by age and sex categories. The differing needs of males and females in different age groups are reflected via the differing costs of treating these groups ( e.g. costs of childbirth for women, lower life expectancy of males). NRAC reviewed the age sex adjustments and proposed a refined and extended set of weights that uses more disaggregated groupings and takes account of the ageing population. Looking ahead NRAC also recommended that issues of equality and diversity are considered in any future review of the Formula, ascertaining whether robust evidence is available and consulting on proposed recommendations with equality groups	Health ASD	Yearly from 2009/10	To ensure allocations are adjusted	Yes (1, 3, 6, 7)
Statistics Review	To ensure that ISD and other data collections provide data by equality group, including gender where appropriate.	Health ASD	Ongoing	More data available on gender	Yes
Community Care Data Collections	To ensure that the collection of data made by ASD across community care includes gender where appropriate	Health ASD	Ongoing	High quality data available on gender	Yes (5)
Supporting Health Directorates in using high quality evidence across the equality strands, including gender	Any entry from the Health Directorates which has an evidence need will be supported in some way by Health ASD. These items have not been duplicated under the Health Finance entry as they are lead by other part of the Health Directorates.	Health ASD	Ongoing	Data and evidence needs are addressed across the Health Directorates with attention to equality groups including gender.	Yes
Pre-Expenditure Delivery Assessment	To include equalities within the Pre-Expenditure Delivery Assessment form submission process	Health ASD	Ongoing	Equalities are addressed as part of pre expenditure assessments within the Health Directorates	Yes

GENDER EQUALITY ACTION PLAN

Name of Directorate

Health Workforce Directorate

Directorate Responsibilities

The Health Workforce Directorate is here to protect, promote and improve the health, quality of life and wellbeing of people in Scotland by working with NHSScotland to build a world class workforce for NHSScotland. We work closely with Ministers, NHSScotland employers, NHSScotland employees and their representatives, as well as the wider public, to develop policy and practice that will help achieve this.

The Health Workforce Directorate is committed to establishing a workforce that reflects the population it serves at all levels and in so doing help reduce or close the gender pay gap, end occupational segregation and provide appropriate flexible working arrangements that meet the needs of the service and individuals.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

Based on 2005 figures

45.7% of the GP workforce were women
44% of all medical staff were women

Health Workforce Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
Agenda for Change One of the major change programmes within NHS which modernised pay structures, helped service delivery and patient care, aided recruitment and retention and allowed for personal development of staff	Implementation of Agenda For Change to ensure that staff received equal pay for work of equal value	Pay and Pensions team	Ongoing	Gender equality proofed pay structure	Yes (2)
Diversity in Leadership	Establish a resource tool to promote diversity in leadership and increase knowledge across NHS Scotland	Workforce Planning Team	Ongoing	Improved gender balance within senior levels in NHS Scotland	Yes (4)
Reputation Recruitment and Attraction	Improve reputation of NHSScotland as an employer - measured by increased/more diverse range of applicants and translation into appointments Adopt more efficient recruitment processes for NHS Scotland Increased recruitment from non traditional groups	Employee experience team	Ongoing	Improved awareness of job roles within NHS Scotland to wider talent pool	Yes (4, 7)
Consultant appointment process	Review and improve recruitment policy to improve Health Boards capacity to reduce consultant vacancy levels and improve proportion of women securing senior appointments	Employee experience team	June 2008	Improved higher level opportunities within NHS Scotland	Yes (4)

GENDER EQUALITY ACTION PLAN

Name of Directorate

Chief Medical Officer Directorate

Directorate Responsibilities

To work with Ministers, our delivery partners and other stakeholders to protect and improve public health, to prevent disease and to oversee the clinical effectiveness of healthcare services in Scotland.

The Chief Medical Officer's Directorate commitment to protecting and improving health includes a major commitment to reducing inequalities in health in the Scottish population. These include inequalities based on social and economic factors, ethnicity and membership of excluded groups. The Directorate takes a population-based approach in continually reviewing trends in health and disease. In doing so, the Directorate consistently considers the health of the male and female populations within the Scottish population and considers the reasons for, and potential action to address, gender inequality in disease and health.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

Disease and health demonstrate a mixed pattern in the male and female populations. The key data are well set out in "A Gender Audit of Statistics: Comparing the Position of Women and Men in Scotland". Some diseases such as breast, cervical, uterine, prostate and testicular cancer are gender specific. Other disease and health problems such as coronary heart disease, depressive illness, multiple sclerosis and accident and injury are experienced by both sexes but the incidence shows a gender imbalance. The challenge is to ascertain the proportion of the imbalance that is based on the genetic gender and that which is about the different health experience of the different genders. For example, coronary heart disease and lung cancer has been higher in men due to higher rates of smoking but the gender difference is declining due to increasing rates of smoking in women. However death and illness due to injury is higher in males due to higher occupational risk, higher levels of violence and higher levels of alcohol use.

Chief Medical Officer Directorate Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).

Policy

Action

By whom

By when

Expected Outcome

Contribute to GEPO (Yes/No)

Reducing inequality in premature mortality between male and female populations

The Chief Medical Officer's Annual report for 2007 will focus on amenable mortality and will highlight and consider the gender differences. The report will aim to link behaviour risk in the population to disease.

Chief Medical Officer

The Annual report will be published in November 2008

Dissemination and discussion of the report findings with key stakeholders

Yes

Reducing inequality in premature mortality between male and female populations

Collaboration with WHO Euro Regional Office in Venice on Social Determinants of Health and Reduction of Health Inequalities. Will provide European comparators of gender inequalities

Chief Medical Officer,

DCMO,

NHS Health Scotland

This work will be progressing across 2008-2009.

Dissemination and discussion of the collaboration findings. Potential highlighting of Scottish differences.

Yes

GENDER EQUALITY ACTION PLAN

Name of Directorate

Chief Nursing Officer Directorate ( CNO)

Directorate Responsibilities

CNO Directorate provides policy and professional practice advice on all issues relating to nursing, midwifery, Allied Health Professions ( AHP) and Health Care Scientists. It develops, implements and evaluates policy on education and training, regulation, modernising careers, leadership, recruitment and retention, patient experience, eHealth, mental health, children's and midwifery services. It also provides professional leadership to the Nursing, Midwifery and Allied Health Professions and Healthcare Scientists professions in Scotland working closely with the professional bodies and NHS managers.

The Directorate is also responsible for (1) Clean Hospitals including Healthcare Acquired Infection, (2) The National Programme for Patience Experience and (3) the provision of advice to Ministers on cross-professional regulation and workforce standards for both the regulated and unregulated workforce. It also ensures an effective contribution to the international fora including the Scotland/Malawi Initiative.

The Chief Nursing Officer Directorate is committed to developing and implementing policy to ensure the recruitment of and training of a nursing, midwifery, allied health professions and health care scientist workforce that provides opportunities for all, reduces or closes the gender pay gap, ends occupational segregation and provides appropriate flexible working arrangements that meet the needs of the service and individuals.

What is known about the experiences of, and issues for, women and men affected by the Directorate Responsibilities.

Based on 2005 figures

90% of midwifery and nursing staff were women
64% of healthcare science staff were women

Chief Nursing Officer Directorate Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
Pre-registration nursing and midwifery education	Monitor student gender balance, through annual review, and work with Higher Education Institutions to reduce attrition levels. Developing a marketing strategy on the Image of Nurses targeted, for example, at men.	Chief Nursing Officer Directorate	Ongoing	Improved gender balance within student cohort	Yes (4)
Modernising Nursing and Allied Health Professions Careers & Career Framework	Develop a strategy for the nursing and Allied Health Professions workforce of the present and the future which has currency across the 4 UK countries, and a process for the development of staff in hard to fill posts or who have high potential. Develop a national framework for advanced nursing practice.	Chief Nursing Officer Directorate	December 2008	Improved gender balance within nursing staff	Yes (4)
Healthcare Science	Obtain an accurate profile of the healthcare science workforce in NHS Scotland - gather statistical information of the numbers and genders of healthcare scientists for each of the 50 disciplines within the 'life, physiological and physics and engineering sciences streams', by NHS Board. Publish an Action Plan for Healthcare Science which makes key recommendations around the priorities identified by healthcare scientists themselves.	Chief Nursing Officer Directorate	July 2008	Improved gender balance within healthcare science staff	Yes (4)

GENDER EQUALITY ACTION PLAN

Name of Agency

Mental Health Tribunal for Scotland.

Agency Responsibilities.

The Administration of the Mental Health Tribunal for Scotland was established as an Executive Agency on 1 April 2005 and commenced live operations on 5 October 2005 when the Mental Health (Care and Treatment) (Scotland) Act 2003 came into force.

The Administration is responsible for providing case management and hearing support to ensure that the Tribunal can, through the panels sitting across Scotland, determine the applications and referrals made to it under the Act. We work closely with all stakeholders to ensure that the administrative processes not only comply with the requirements of legislation but run as smoothly as possible to provide the best service to the people of Scotland.

Statement of Agency Commitment to the Promotion of Gender Equality and how this helps to deliver Government's national purpose and outcomes and contributes to progressing the Government's gender equality scheme objectives.

The Agency will ensure that staff are aware of their responsibilities in relation to gender equality, including the need to involve women, men and transgender people in policy making.

We aim to ensure that women, men and transsexual people are involved in the development of the Mental Health Tribunal for Scotland and in the design, development and delivery of our services to ensure they recognise and respond sensitively to the individual needs and circumstances of people's lives and that they are free from prejudice, harassment and discrimination.

The Mental Health Tribunal for Scotland will

Consider the implications of gender equality legislation
Review all areas of MHTS' work to make sure gender equality issues are addressed
Demonstrate good practice in all areas of gender equality.

Mental Health Tribunal for Scotland Gender Equality Action Plan

Key actions which are designed to address gender equality issues identified from evidence and actions which contribute to progressing the Government's gender equality policy objectives ( GEPO).
Policy	Action	By whom	By when	Expected Outcome	Contribute to GEPO (Yes/No)
Training	Staff and members will have gender awareness training delivered by the Scottish Government's Diversity Team. It is crucial that our staff are fully aware of gender equality issues given the gendered nature of experiences of mental ill-health.	MHTS	Ongoing	All staff aware of gender equalities information and their responsibilities.	Yes (1, 2)
Recruitment Policy	We will ensure that our recruitment processes pay due regard to the Scottish Government's gender equality policy.	MHTS	Ongoing	Recruitment processes pay due regard to gender equality.	Yes (1, 2)
Flexible Working	Continue to promote the Agency's flexible working opportunities.	MHTS	Ongoing	Increased awareness and use of flexible working. Achieve a better work / life balance.	Yes (1, 2)

Key actions to take into account gender equality across main responsibilities, if not already covered above.
Policy	Actions to take forward gender equality	By whom	By when	Expected Outcome
User consultation	We will ensure that our tribunal processes take full account of the differing needs of women, men and transgender people.	MHTS	Ongoing	Tribunal processes and format are fully accessible to both women and men.
Communications	We will promote positive images of all people in our publications and on our website.	MHTS	Ongoing	Positive images of all people in our publications to reflect a positive view of gender equality and to address gender stereotyping.

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