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Martin is a Deaf man whose first language is British Sign Language. A smoker for many years, Martin finally decided to take the plunge and quit. After looking at the various options available to help him, he decided that he would like the support of a group. On enquiring, however, Martin was told that he could not attend a smoking cessation group because there was no budget for an interpreter.

This is a real example of discrimination which happened in NHSGGC. It was our responsibility to ensure Martin could use this service. To meet our patient commitment, and by law, a BSL interpreter should have been made available.

This section provides real examples of how people have been affected by discrimination within NHSGGC. It highlights the training and resources available to staff to help us treat people fairly. It also looks at what’s being done to ensure a working environment for staff which is free from harassment or discrimination of any nature.

What is Discrimination?

We discriminate when we treat people as if they are all the same even when they have different needs. We also discriminate if we treat people differently in a negative way based on their gender, age, social class, sexual orientation, race, faith & belief or disability.

Every one of us has to be aware of and tackle discrimination. Not only should we want to ensure that patients get the services they need, we should be aware that by law we must not discriminate either against patients or staff members.

People’s Experiences

Jelina

Jelina is an older Pakistani woman who cannot speak English or read in any language. Jelina was admitted to hospital for a stay of several weeks.

During this time, staff did not communicate with her and she was left completely isolated in her already vulnerable state. Jelina’s family had to draw pictures for her to use to make very simple requests.

What should have happened?

Jelina’s communication needs should have been assessed immediately so that support could have been provided for both her and the staff. This support may have taken the form of an interpreter and/or language assistance materials.

Julie

Julie is a 34 year old gay woman whose partner is terminally ill. During a hospital visit, Julie was asked not to show affection to her partner because it was making the other patients feel uncomfortable.

What should have happened?

It was wrong to discriminate against this couple on the basis of their sexual orientation. Julie and her partner obviously wanted to be able to comfort each other at this difficult time in their lives and should have been treated as any other couple.

Tina

Tina Watson is a transgender woman. She visited an NHS clinic, and when called from the waiting room was referred to as Stephen Watson – her former name. Tina approached the desk and explained that her name was not Stephen and that she should be referred to as Tina or Ms. Watson. The receptionist stated that they would continue to use the name on his records until he presented a new passport.

What should have happened?

Tina should have been treated in the same way as any other patient amending their personal details. For transgender people this is particularly sensitive and it is our responsibility to ensure records are amended. In this case, where there had clearly been a breakdown in communication, the receptionist should have apologised for the mistake, addressed the patient as requested and ensured that the paperwork was updated.

Charlotte

Charlotte and her husband are asylum seekers from Africa. Pregnant with her 4th child, Charlotte attended the maternity services in her local hospital.

After a smooth pregnancy, Charlotte gave birth to a healthy baby boy. Prior to discharge from the hospital, Charlotte was given information about contraception. This is common practice. However, the midwife introduced the subject by saying, “We don’t want you coming back here every year – you need to do something about this.” Charlotte at first thought that she was joking but quickly realised she was serious. Shocked, she described the approach of the midwife as ‘provocative’.

What should have happened?

The comment made to Charlotte was clearly based on the midwife’s own assumptions about her circumstances. The implication that Charlotte’s family was the result of thoughtlessness or ignorance, or that Charlotte and her husband would not want more children, was presumptuous and insulting. The contraception advice should have been offered in a friendly, informative manner. An open approach would have allowed the patient to disclose any particular concerns.

John

John is both visually and hearing impaired. He faces a range of obstacles every time he attends services. Firstly, he finds it difficult to read the correspondence he receives about appointments. This means he has to rely on someone else reading what can often be personal, private information. When attending an appointment, he can’t hear when his name is called out and, on one occasion, despite alerting staff to his situation, missed his appointment completely.

John uses the support of a guide/communicator for any regular appointments or hospital stays. However, during a recent admission, staff went ahead with a procedure after his communicator had been asked to leave. With no way of knowing what was happening or why, John was extremely distressed by this traumatic situation.

What should have happened?

John should have been asked what could be done to make written information accessible to him. Letters should then have been sent to him in an appropriate format, e.g. large print. Noting John’s communication needs in his file would have informed staff of the right steps to take. Similarly, if staff had been aware of his hearing impairment, then they would have understood the need to go and get John in the waiting room, rather than calling out.

Everyone is different, and by talking to John through his communicator his communication needs could have been assessed and acted on. For example, staff may have been able to communicate with him in an emergency by learning the deafblind alphabet and putting a poster behind his bed.

What is the Health Hap?

We can see differences in people’s health across NHS Greater Glasgow and Clyde and there is a widening gap in health between the richest and poorest. Men in the least deprived areas can expect to live 13-14 years longer than those in the most deprived areas of the city. The gap for women is 8-9 years.

Social class is a major cause of these differences in health, or ‘health inequality’. Discrimination because of someone’s sex, race, disability, age and sexual orientation, combined with a person’s social class can have a harmful effect on health. People also experience a decrease in health as their social position decreases. This is called the health gradient.

What can the NHS do to tackle the Health Gap?

NHSGGC has an important role to play in reducing health inequalities by the way that it provides its services and gives out its resources. The NHS has worked in communities with the worst health and helped people find ways to become healthier. However, this has not affected the size of the health gap because more wealthy communities have been improving their health as quickly, or more quickly than poorer communities.

Those who need health care the most often have the least access to it (sometimes called the ‘Inverse Care Law’).In Glasgow, GP practices are evenly spread throughout the city – which does not reflect the distribution of poor health. Also, the way health care is organised favours people who:

  • have knowledge of the health care system and the confidence and assertiveness to use it;
  • can communicate and can be communicated with at several levels i.e. have spoken English as their first language, who can read and who have no sensory impairments such as blindness;
  • can travel easily to hospitals, health centres etc or for whom there are no physical barriers (such as difficulties walking); and
     
    have health problems which are largely unrelated to their life circumstances or discrimination 

NHSGGC’s work on inequalities is designed to deal with these issues and find ways of sharing resources in a fairer manner. It also works with its partners to improve the underlying causes of differences in health, such as education, employment, housing, transport and other public services.

Useful resources

Linked pages 

Addressing Income Inequality, Poverty & Social Issues

Welfare Reform

Poverty & Human Rights

Other Useful Links

World Health Organisation Commission on Social Determinants of Health

Scottish Public Health Observatory-Health Inequalities

Scottish Child Payment is now open for applications

Scottish Child Payment is a new payment for families on tax credits or certain benefits to help towards the costs of looking after a child. It is £40 paid every four weeks for each child under six.

The payment starts on Monday 15 February 2021, with first payments made from the end of February onwards, but Social Security Scotland is taking applications now to help manage demand.

You can apply if your child will be under six on 15 February 2021.

The qualifying benefits are:

* Child Tax Credit
* Income Support
* Pension Credit
* Working Tax Credit
* Universal Credit
* Income-based Jobseeker’s Allowance (JSA)
* Income-related Employment and Support Allowance (ESA)

Social Security Scotland will ask for evidence that the person applying is responsible for a child under six, usually through the child being named on a benefit claim form.
If more than one person applies for the same child, there’s a process for deciding who gets the payment – prioritising the person who the child lives with most of the time.

Scottish Child Payment will not be taken into account for UK benefit and tax credit assessments and there is no cap on the amount of children this payment can support.

First payments will be made from late February onwards. When someone gets paid will depend on how many applications we get and the process each individual application goes through.
If someone applied before Monday 15 February 2021, this will be the date that their
payment will be calculated from. If they apply after this date, it will be calculated from the date that they applied.

Payments will be made every four weeks following the first payment.

Find out more information and apply at mygov.scot/scottish-child-payment or call Social Security Scotland on 0800 182 2222.

PIP is a new benefit for people aged 16-64 who have a disability, physical impairment or mental health condition.

It will replace Disability Living Allowance (DLA) but more people will qualify for PIP than DLA.

PIP aims to support people that are experiencing difficulties with daily activities and mobility that are likely to last for 12 months or more.

We want to ensure that patients who have problems with daily living, such as eating or preparing food, taking medication, moving around or managing money, are aware of this benefit and how to claim it.

Posters and leaflets promoting PIP have been produced by NHSGGC and are being distributed throughout our services.

Get In Touch for more information.

NHS Greater Glasgow & Clyde have put in place a range of initiatives on money worries and employment which can make a substantial difference to vulnerable patients and families. For more information click here.

The COVID-19 pandemic, Brexit, welfare reform, austerity and the recession have created extreme poverty in Scotland and the UK. The Scottish Social Renewal Advisory Board and the Marmot Build Back Fairer reports argue for radical action to tackle the long term humanitarian crisis.

People’s human rights to food, fuel, income and shelter are often breached in the humanitarian crisis that has arisen. Poverty, child poverty, stress and social isolation with the long term associated impacts on mental and physical health are public health emergencies. This is due to low economic growth rising unemployment levels; stagnant wages; social security cuts; higher food and fuel prices.

Over 50% of people living in poverty are in work and often claim benefits such a working tax credits. However, often people are unaware of what is their right to social security with around £20 billion unclaimed in the UK every year. In 2020, the Scottish Human Rights Commission developed this short film clip about right to Scotland’s devolved social security powers.

Even before the pandemic, the UN rapporteur on human rights had two visits to Scotland – one on extreme poverty and one on the right to food. The reports cited the UK governments economic and welfare reform policies as a key factor in why these are live public health emergency issues in Scotland (see Human Rights page).

NHSGGC Public Health Strategy post pandemic firmly sets out to tackle poverty, child poverty and mental wellbeing with NHSGGC a partner in the legally required Local Child Poverty Action Plans.

Useful Resources

Addressing Income Inequality and Social Issues

The Fairer Scotland Duty

The Fairer Scotland Duty came into force in April 2018 with the aim of ensuring that public sector bodies consider how they can reduce socio-economic disadvantage when making key strategic decisions.

‘Socio-Economic Requirements’ – Equality & Human Rights Commission Summary Report

Addressing socio-economic issues in NHSGGC

NHS Greater Glasgow and Clyde is involved in a range of work to tackle inequality as a result of income inequality, poverty and social issues. 

Child Poverty

Welfare Reform

Money Advice Referrals

Food Insecurity/Poverty –  NHSGGC’s hospital based services assess for malnutrition and diet on admission. Our Financial Inclusion Group shares information on good practice around food poverty issues,  highlighting the negative impact on health and stress and promoting community food initiatives.

Staff Money Worries

Home Energy Advice – NHSGGC has a partnership with Home Energy Scotland.  This means patient and staff struggling to pay with for fuel and requiring improvements to equipment receive the support they need.  The service is promoted in hospitals and communities. 

NHS Credit Union

Linked Pages
Healthier Wealthier Children

More information coming soon…

Person centred care is at the heart of the National Quality Strategy and aims to deliver effective, safe, non-discriminatory and efficient health and social care. 

Being sensitive to inequalities and human rights within person-centred care means working in a way which responds to the life circumstances that affect people’s health. Evidence shows that if these issues are not taken into account by the health service, opportunities are missed to improve health and to reduce health inequalities.

Developing Person Centred Care that is Sensitive to Inequalities

NHSGGC has a number of programmes of work which aim to ensure that our services understand how to recognise and respond to the life circumstances that are affecting someone’s health.

For example, the Healthier Wealthier Children Project focuses on identifying and responding to the needs of people who have worries about money. While the Gender-based Violence Programme is developing the practice of sensitively asking service users about their experience of abuse.

Actions such as providing communication support, routinely asking about social issues such as money worries and stress and referring on as appropriate are key to delivering inequalities sensitive person centred care.

The current issues around Extreme Poverty and Destitution are likely to have a profound effect on NHSGGC patients. We are anticipating an increase in diseases relating to poverty and we can expect increased demand for mental health and primary care services and a negative impact on carers.

There are also a number of initiatives around workforce training and development.

NHSGGC wants to work in partnership with patients, learning from patients’ lived experiences.

We want to ensure that all voices are heard. The Equalities & Human Rights Team’s patient involvement activities therefore specifically engage with people with protected characteristics and other groups that experience discrimination.

People’s experience of inequalities and discrimination impact upon their health, how they engage with health services and manage their health problems. By engaging with communities and responding to feedback we can improve everyone’s experience of NHSGGC services. This work will also inform our equality outcomes and actions for the future.
The Equality and Human Rights Team also work closely with the Patient Experience Public Involvement Team to help reach and engage with all our communities.

Involving Patients and Members of the Public

We consult with a variety of patient groups depending on the area of work. For example –

Disability Access – our Disability Access Patient Group, made up help us investigate and audit the factors affecting disabled people’s access to our buildings and services

Learning Disability – we work in partnership with a number of organisations supporting people with a learning disability and are members of The Life I Want Health Group, a partnership forum made up of 3rd sector services.

Black and Minority Ethnic Communities – our engagement is constantly being developed and delivered with a range of 3rd sector organisations working with BME communities. This has informed our work to ensure communities have access to health information and that our services are delivered in ways which ensure access for all communities.

The Deaf Community – feedback is sought from the deaf community on a range of issues, including the BSL National Plan, our Interpreting services and access to NHSGGC services. The BSL Health Champions – volunteers from the Deaf BSL community – work with us to achieve this and group meetings are open to any Deaf BSL user who lives in the NHSGGC area. The group also has a Facebook page which is used to share information and to get feedback from the BSL community.

Engagement as a consequence of COVID-19

Engaging with specific patient groups has been crucial in helping us understand the barriers communities can face when trying to access the necessary advice and information regarding Covid-19.

Feedback from these communities has helped us target our communications and identify the most effective ways to reach people.

Examples of this work include –

  • From October 2020 – March 2021, twenty-three separate COVID-19 information sessions were held to address identified issues for the Black & Minority Ethnic communities
  • In February/March 2021 twenty-five COVID-19 Vaccination community group sessions were run
  • Information on the COVID-19 vaccines was shared via targeted social media channels, including religious organisations and sent to all Mosques in the Greater Glasgow and Clyde area.
  • Person-Centred Virtual Visiting (PCVV) was introduced across all NHSGGC hospitals in March 2020 to allow all patients access to technology specially set up to enable them to see and talk to the people who matter to them during COVID-19 visiting restrictions.
  • We disseminated easy read COVID-19 information to all learning disability organisations and generic disability organisations.

Useful Resources

The Fairer Scotland Duty

The Fairer Scotland Duty came into force on 1 April 2018. It places a legal responsibility on named public bodies in Scotland to actively consider how they can reduce inequalities caused by socio-economic disadvantage when making strategic decisions.

Scottish Government guidance (2021) Fairer Scotland Duty: guidance for public bodies provides a comprehensive explanation of the Duty together with useful tools to assess decision making processes.

Addressing socio-economic issues in NHSGGC

NHS Greater Glasgow and Clyde is involved in a range of work to tackle inequality as a result of income inequality, poverty and social issues. 

Food Insecurity/Poverty

NHSGGC’s hospital based services assess for malnutrition and diet on admission. Our Financial Inclusion Group shares information on good practice around food poverty issues,  highlighting the negative impact on health and stress and promoting community food initiatives.

Food insecurity – worrying about accessing enough food, making compromises to quality or quantity or just going without – is becoming much more of an issue for our communities.

People experiencing food insecurity face not only a lack of sufficient food, but also negative impacts on their health and the stress of being able to feed their family from one day to the next. This can also come with feelings of shame and helplessness, social stigma and isolation. Community food initiatives have a really important role to play here, as they can provide emotional and practical support as well as places for people to access food.

Find your local foodbank

For more information on how to access a foodbank, donate or help out, click on the links below.

Donating to your local foodbank

Any non-perishable goods are welcome. A typical food parcel includes – Breakfast cereals

  • Soup
  • Pasta
  • Rice
  • Pasta sauce
  • Tinned beans
  • Tinned meat
  • Tinned vegetables
  • Tinned fruit
  • Tea or coffee
  • Sugar
  • Biscuits
  • Snacks

Your local foodbank may also highlight what’s particularly needed that month. See the websites above.

Domestic abuse, rape and sexual assault, prostitution, child sexual abuse and other forms of gender-based violence cause immense pain and suffering and are a major public health issue. The emotional, psychological and physical consequences of gender-based violence can be profound and include fatal injury, physical health problems, chronic conditions, mental health problems and negative health behaviours.

Many people affected by gender-based violence are reluctant to disclose this experience, often through fear or shame. However, they do present across the whole range of primary and acute health settings. Health workers are therefore in a unique position to provide help and support. If we do not ask about or respond to gender-based violence there is a danger that the health issue won’t be treated properly and could increase the risk of long-term and chronic ill-health and even death.

Health workers across the whole of the health service need to know about gender-based violence, what to look for and how to respond. This is fundamental to our duty of care to patients and part of our role to promote gender equality.

The prevention of gender-based violence and the care of people experiencing it is a key priority for public protection within NHS Greater Glasgow and Clyde.

Key NHSGGC Documents

Other Publications

Public Protection

Commercial Sexual Exploitation

Domestic Abuse

Prevention Campaigns

FGM and Forced Marriage

Rape & Sexual Assault

Stalking

Trafficking for sexual exploitation

Homelessness

Imagine your child is sick. You take them to hospital but you can’t find a way to let the staff there know what is wrong.They ask you questions, but you don’t understand what they are saying.

This is just one of the frightening scenarios which people can find themselves in if they have difficulties with the types of communication many of us take for granted. There are many reasons why someone might find themselves in this situation:

  • English is not their first language
  • They have a visual impairment, are deaf or hard of hearing
  • A condition such as a stroke or having learning difficulties makes communication hard
  • They have difficulty reading

Health staff not being able to communicate effectively with patients can have real consequences for their health and the services they receive. Many patients miss appointments or are unable to access services because of the language barrier. It is also frustrating for staff who find themselves unable to communicate with their patients.

NHSGGC aims to ensure that we providing effective communication support for all those who need it.

Accessible Information Policy

Interpreting Service

Providing interpreting services is a vital part of the ongoing work to ensure that everyone receives the best possible care. NHSGGC now has an in-house interpreting service. Find out more about the Interpreting Service.

For a range of language resources currently available for NHS staff, please go to Staff Resources.