A number of key Scottish Government policies drive the work to tackle discrimination, promote the equalities agenda and reduce health inequalities. These are:
The summaries below highlight key aspects relevant to equalities and inequalities.
Commission on the future delivery of public services ('Christie Commission')
The Commission was established by the Scottish Government in November 2010 to develop recommendations for the future delivery of public services.
There are a number of recommendations in the final report published in June 2011 relevant to NHS Scotland’s work to improve the health of individuals and communities, promote equality and reduce health inequalities. For example, it states that public authorities should:
- prioritise preventative measures, to reduce demand and lessen inequalities
- identify and target the underlying causes of inter-generational deprivation and low aspiration
- demonstrate greater transparency around major budget decisions
- recognise that effective services must be designed with and for people and communities.
The commission heard evidence from a wide variety of sources, including the Equality and Human Rights Commission and the Scottish Human Rights Commission. The Commission shares the EHRC’s view that 'no progress towards positive outcomes can or will be achieved without addressing the issue of inequality' (p.56).
The report recognises that there are a disproportionate number of people in Scotland, experiencing poor outcomes, who are vulnerable to discrimination because of their identity or status (p.59). It notes that public bodies do not currently collect sufficient data to meet their equality duties and recommended, amidst a suite of other recommendations, that the Scottish Government supports the public sector deliver its equality duty by working with the EHRC and SHRC (and others) to:
- identify the key equality gaps in Scotland and address these gaps through further development of outcomes and indicators contained within the National Performance Framework, and
- produce guidance on how best the public sector equality duty can best be expressed in the context of partnership working. (p.59)
The Government published a response to the Christie Commission report which outlines some of the actions and measures in place to respond to the recommendations.
NHS Healthcare Quality Strategy for NHSScotland
The Quality Strategy aims to deliver the highest quality healthcare services to people in Scotland through achieving the following quality ambitions:
- Person-centred: 'Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making'
- Safe: 'There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times'
- Effective: 'The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated'.
In particular the person-centred and clinical effectiveness drivers, specifically through supporting people with long-term conditions, have the potential to address the health problems of many of those who carry a disproportionate burden of ill-health in our communities.
The strategy states that 'Each of the aligned and integrated national programmes, initiatives and interventions pursued in support of achieving the three Quality Ambitions will require to be fully assessed in terms of their impact on equalities through a Health Inequalities Impact Assessment (HIIA), which includes mandatory Equalities Impact Assessment (EQIA). Through this we will ensure that the Quality Strategy optimises its impact on reducing inequality across Scotland' (p.24)
The 2011 report 'Variations in the Experiences of Inpatients in Scotland: Analysis of the 2010 Scottish Inpatient Survey' shows that people do not have an equal experience of health services, across a range of personal factors. This reinforces the need to take into account individual needs, preferences and personal characteristics (e.g. age, disability, gender) when providing individualised and holistic, person-centred care.
Equally Well is the report of the Ministerial Task Force on Health Inequalities. The report outlines what needs to be done by national and local government, NHSScotland and the third sector to tackle health inequalities and the underlying reasons for health inequalities.
The report sets out 78 recommendations within six key areas:
- early years and young people
- tackling poverty and increasing employment
- physical environments and transport
- harms to health and wellbeing: alcohol, drugs and violence
- health and wellbeing
- delivering change.
The main focus of action in the recommendations is on tackling inequalities that result from socioeconomic circumstances. However the report recognises that the causes of health inequalities are complex and that a person's health may also vary because of their age, disability, gender, race or ethnicity, religion or belief and sexual orientation as well as other life circumstances such as homelessness or history of offending.
Particular groups of recommendations to highlight include:
- Ten recommendations within the health and wellbeing section are specific to improving access to NHS services for vulnerable groups, particularly those with disabilities and offenders (Recommendations 52-61, p.40).
- There should be a review of health needs data and targets should be set to support work on patient monitoring and collection of equalities data (recommendations 74, 75 p. 54-55).
- Equally Well also supports the public sector Equality Duty specifically through recommendations advocating the need to promote good relations within communities (recommendation 62, p.41), promoting the need to equality impact assess actions taken to implement any of the recommendations (recommendation 2, p.16) and develop an integrated assessment process (recommendation 77, p. 55).
For further information, see our Health Inequalities Impact Assessment pages.
Since the publication of Equally Well in June 2008 the Scottish Government has published the Equally Well Implementation Plan (December 2008) and the Equally Well Review (June 2010).
In 2012, the Ministerial Task Force on Health Inequalities was reconvened in order to review new evidence, look at lessons learned so far and highlight any new areas for attention. NHS Health Scotland produced a policy review to provide evidence to the reconvened task force about what works to reduce inequalities and to make recommendations for future strategy.
Updated November 2015