Equalities in Health

Within Greater Glasgow & Clyde there are approx. 5700 adults with learning disabilities. A learning disability is a significant, lifelong, condition that starts before adulthood. It affects a person’s development and means they need help to:

• Understand information
• Learn skills
• Cope independently

Learning difficulties, such as dyslexia, ADHD, dyspraxia and speech & language difficulties are not defined as a learning disability due to the specific nature of their developmental delay.

People with learning disabilities represent a diverse group. Historically, people with learning disabilities lived in hospitals. Then, in 2000, policies were introduced which advocated that people with learning disabilities should be supported to live in their local communities and have equal access to employment opportunities & health services. Despite this shift towards independent community living, people with learning disabilities are one of the most disadvantaged groups within Scotland.

90% of people with a learning disability have described an experience of bullying or harassment, with 32% experiencing this daily.

65% of people with a learning disability would like a job. In 2010/2011, 6.6% of people with a learning disability were in paid employment, the majority of whom worked less than 16 hours a week. This is significantly less than in the working age population (77.3 %) and the disabled population (47.4 %), NHSGGC is one of the partners involved in running an award winning learning disability employability programme called Project Search.

People with learning disabilities die younger than the general population – on average 13 (for females) or 20 (for males) years younger, with many of these deaths being from preventable causes.

People with a learning disability will also possess other protected characteristics and their experience of inequality will be made worse as a result.

Protected characteristics – characteristics that are protected by law, such as Disability – are listed on our home page and include sex, age and race.

Gender-based Violence & Women with Learning Disabilities

Research tells us that disabled women and girls are more susceptible to gender-based violence than non-disabled women and girls. Women with a learning disability are at greater risk of sexual abuse and are more likely to experience violence from perpetrators that are not partners, most notably other service users and men with learning disabilities.

Dependency on care, attitudes of staff and carers, poverty and isolation can make women more vulnerable or make it more difficult for them to disclose abuse. Poor availability of services such as day care centres also make it difficult for women to find help and support. As a result, the abuse often goes undetected and unreported.

To tackle gender based violence and support women with learning disabilities, services need to remove barriers to disclosure and provide better access to information and health and support services. Within NHSGGC, a programme of work is underway to raise awareness about the experience of gender-based violence amongst people with learning disabilities and to build staff confidence and competence in knowing how to identify and respond to this.

Learning Disability & Human Rights

When the behaviour of people with learning disabilities challenges carers and services, complex and competing human rights issues may emerge.

A Human Rights impact assessment was carried out in Netherton Learning Disabilities Unit. This initiative looked at human rights in relation to everyday practices in the Unit.

This work, which included workshops and interviews with staff and patients, highlighted a number of issues around the patients’ rights. For example, some residential units allowed free access to kitchen areas whereas others were much more restrictive. By using human rights guidelines along the PANEL principles set put below, they were able to explore the differences between practices in a patient-centred way.

• Participation – People should be involved in decisions that affect their rights.
• Accountability – There should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong.
• Non-Discrimination – Nobody should be treated unfairly because of their age, gender, ethnicity, disability, religion or belief, sexual orientation or gender identity. People who face the biggest barriers to realising their rights should be prioritised when it comes to taking action.
• Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives.
• Legality – Approaches should be grounded in the legal rights that are set out in domestic and/or international law.

People with learning disabilities experience some of the poorest health outcomes of any group in Scotland and much of their health needs are unrecognised and unmet. In addition to the same everyday health needs as the general population, people with learning disabilities have a different pattern of health needs

People with learning disabilities –

• have differing causes of death (respiratory illness, cardiovascular disease and gut cancers, as opposed to lung cancer, heart disease and strokes in the general Scottish population)
• have more physical health problems
• are more likely to have mental health problems – 40-50% of the learning disability population compared to 1-10% of general population
• on average, have 5 long term health conditions, compared with 1 or 2 in the general population
• are more likely to have a sensory impairment (approximately 60% will have a visual impairment and 40% will have a hearing impairment)
• are more likely to be underweight or obese than the general population.

Poor health can result from social isolation and deprivation. A large majority of people with learning disabilities have endured a lifetime of exclusion resulting from lack of choice and opportunity. People with learning disabilities experience a number of barriers when trying to access appropriate healthcare within the NHS. These include:

Communication – Many people with a learning disability may take longer to express what they want to say and may simply require patience and understanding on behalf of the listener to allow them to do this. Some people with learning disabilities have limited verbal communication skills and difficulties with understanding and processing information which can impact on their ability to understand health information. Health services are reliant on written information for advice, appointments, signs and information and this creates a significant barrier if it is not provided in an easily understood way. NHSGGC’s Clear to All accessible information policy aims to ensure that we provide effective communication for everyone and that information is provided in the format and language required.

Physical access – NHS establishments are required by law to be accessible to those with a disability. However, accessibility and signage is not always clear and navigating health centres and hospitals can be difficult for wheelchairs users or those with poor mobility who also are unable to read.

Attitudes – NHS staff all strive towards person centred care. However, many have not had experience of working with people with learning disabilities or had learning disability awareness training. This can often lead to negative assumptions about a person’s ability, even when it is well intentioned eg, a health care professional may talk to a carer to obtain health information instead of asking the person directly.

Diagnosis overshadowing – This occurs when a behaviour change is attributed to a person’s learning disability when it is in fact due to physical ill health or pain. Unfortunately this is common for people with a learning disability and can lead to delayed treatment and in some cases death.

NHSGGC is working to ensure that the organisation is addressing health inequality experienced by people with learning disabilities.

NHSGGC continues its engagement activity with patients and 3rd sector organisations. This includes our co-production work with The Life I Want partnership forum. This work is a valuable way of sharing information between our own organisation, learning disability support services and patients themselves and is one of the main ways in which we receive up to date feedback from patients regarding their experiences of accessing and using our health services.

We are also planning a new programme of staff training designed to provide a better awareness of how we can provide the best support for patients with a learning disability and improve their experiences of using our services. Patients with a learning disability will be involved in developing and delivering this training.

The Keys to Life (2019) is the Scottish Government strategy to promote inclusion and equality in all areas of life for people with learning disability. NHSGGC is committed to delivering these recommendations which promote a vision and shift towards independent living, employment opportunities, equal access to health services, education that meets the needs of every child and a Scotland with zero tolerance for inequalities.

The Learning Disability Liaison Team supports and enables NHSGGC services to adapt their approaches to meet the needs of people with learning disabilities. The Team supports the system to anticipate and respond to the general medical needs of people with learning disabilities. It also works with local learning disability teams and other agencies to ensure a co-ordinated approach in addressing health inequalities for people with learning disabilities.

For information contact: PCLTAdmin.Generic@ggc.scot.nhs.uk

A Strategy for the Future is NHSGGC’s service redesign for all community based learning disability specialist services. The redesign will enable NHSGGC services to deliver responsive and appropriate healthcare and provide specialist support when required. It aims to give people with learning disabilities more equality and control as well as improving health, wellbeing and safety.

The Scottish Learning Disabilities Observatory has been funded by the Scottish Government to help build understanding of the causes of poor health and health inequalities experienced by people with learning disabilities. The aim of the Observatory is to produce high quality evidence to support learning disability policy and practice and to work in partnership with the NHS, local authorities and Scottish government to improve the information gathered on people with learning disabilities.

Project Search is a targeted programme of employment training and support for young people who have a learning disability (18-24). Participants learn job skills which are transferable and marketable when looking for full time paid work. Students are supported to find work with their job coach either on site with the host business or with another employer. NHSGGC is planning for the 3rd year of this programme following 2 successful years resulting in graduates securing employment within NHSGGC.

As part of A Fairer NHSGGC 2020-24 we have a specific outcome looking at improving service delivery and experience of healthcare appointments for patients with a learning disability. This includes a programme of engagement with patients and third sector organisations to ensure service users are involved in this work.

Edwards’s Story

The video below is from a website featuring people with learning disabilities and their carers, written in collaboration with the Rix Centre. It presents the thoughts and feelings of these individuals in their own words, so that doctors and other health professionals can see what people want and how they wish to be involved in their own healthcare.

NHS Greater Glasgow and Clyde gathers stories and experiences of patient with a learning disability through our ongoing engagement activity. Some of these individual patient experiences will be used to inform our staff training programme.

Publications

• Coming Home – A Report on Out-of-Area Placements and Delayed Discharge for People with Learning Disabilities and Complex Needs
• Death by Indifference
• Health Needs Assessment for People with Learning Disability in Greater Glasgow and Clyde
• Keys to Life
• Learning Disability & Autism
• Project Search
• Specialist Adult Learning Disability Services in NHSGGC – A Strategy for the Future
• The Challenges of Estimating Scotland’s Learning Disabled Population
• The Keys To Life – Scotland’s National Learning Disability Strategy
• Towards Transformation 
• SCLD – Learning Disability Statistics for Scotland
• Learning Disabilities – Learning for NHS Staff

Video Resources

More information coming soon…

Websites

• CIPOLD – Confidential Inquiry into Premature Deaths of People With Learning Disabilities
• Easy Health
• ENABLE
• Epilepsy Scotland
• Keys to Life
• Learning Disability Change Programme
• Mencap
• PAMIS
• People First
• Scottish Consortium for Learning Disability
• Scottish Learning Disability Observatory
• Shaw Trust

What is Gender Reassignment?

In most cases we grow up feeling a sense of comfort or acceptance with our gender but this is not true for all people. Around 1 in 11,500 people will find that as they grow up, they feel less comfortable with the gender prescribed to them at birth, and will instead, find greater comfort and connection to another gender. They may then express the need to live in this different and more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender’ or ‘trans’ people. ‘Trans’  is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, their birth.

In the Equality Act it is known as gender reassignment*. All trans people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one.You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

The Equality Act 2010 says that you must not be discriminated against because you have the protected characteristic of gender reassignment, where your gender identity is different from the gender assigned to you when you were born. For example, a person who was born female decides to spend the rest of his life as a man.

In the Equality Act this is known as gender reassignment. All trans people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change characteristics associated with your sex recorded at birth. This is because changing your physiological or other gender attributes is a personal process rather than a medical one. You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

The Equality Act says that you must not be discriminated against because:

• of your gender reassignment as a trans person. You may prefer the description transgender person or trans male or female. A wide range of people are included in the terms ‘trans’ or ‘transgender’ but you are not protected as transgender unless you propose to change your gender or have done so. For example, a group of men on a stag do who put on fancy dress as women are turned away from a restaurant. They are not trans so not protected from discrimination
• someone thinks you are trans, for example because you occasionally cross-dress or are gender variant (this is known as discrimination by perception)
• you are connected to a trans person, or someone wrongly thought to be trans (this is known as discrimination by association)

Intersex people (the term used to describe a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male) are not explicitly protected from discrimination by the Equality Act, but you must not be discriminated against because of your gender or perceived gender. For example, if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination.

Following is a short film by the Equality & Human Rights Commission titled ‘What is gender reassignment discrimination?’.

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for trans people include:

• Mental health problems including suicide, self harm, anxiety and depression
• Lack of primary care facilities as many GPs have no or little knowledge of trans people’s needs
• Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for trans women
• Lack of awareness and understanding of care providers so that trans people are in appropriately treated in single gender out patient and in patient services.
• Inconsistent funding and access to transitioning services throughout Scotland
• Lack of social work service to support children, young people, adults and families with gender identity issues.
• Social exclusion, violence and abuse and the resulting negative impact on health and well-being

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for trans people include:

• Mental health problems including suicide, self harm, anxiety and depression
• Lack of primary care facilities as many GPs have no or little knowledge of trans people’s needs
• Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for trans women
• Lack of awareness and understanding of care providers so that trans people are in appropriately treated in single gender out patient and in patient services.
• Inconsistent funding and access to transitioning services throughout Scotland
• Lack of social work service to support children, young people, adults and families with gender identity issues.
• Social exclusion, violence and abuse and the resulting negative impact on health and well-being

NHS Greater Glasgow and Clyde were the first NHS Board in Scotland to publish a Gender Reassignment Policy (currently under review in light of the Supreme Court ruling of April 16th 2025) which sets out our commitment to ensure equality of access to services that are both appropriate and sensitive.

We have the busiest trans services in Scotland at the Sandyford Initiative and provide a number of specialist services that are recognised as being amongst the best in the UK. However, there are still barriers experienced by trans people using mainstream NHS services.

It is essential that frontline NHS staff do all they can to remove the stigma of transitioning and play their part in delivering services of the highest standard to trans people. To this end, guidance has been issued to support staff in responding to queries from trans service users.

Fran’s Story

Fran transitioned from male to female 10 years ago. She has spent her life experiencing bullying and harassment because of her gender identity and has been the victim of several hate crime incidents.

Fran was experiencing pain in her right thigh and attended an outpatient appointment.  When Fran entered the waiting area she gave her name and confirmed her appointment time.  The receptionist explained there wasn’t an appointment for a Fran Walker but there was one for a Mr Frank Walker.  Fran explained that she should now be referred to as Fran as she had requested all records be updated to reflect her gender reassignment.  The receptionist explained she was unable to do that until the medical records were updated.  Fran was asked to take a seat in the waiting area.  Fran was in discomfort but before taking a seat explained again it was Fran or Ms Walker, not Frank or Mr Walker.

While Fran was waiting for her appointment she heard a member of staff calling for a Mr Frank Walker.  Fran sat where she was, angry, frustrated and embarrassed that she was still being referred to in the wrong gender.  Eventually after a repeat call she stood and walked into the treatment room.  She was still very upset and asked why, despite explaining she wished to be called by her new name, staff insisted on calling her by her previous name.  The member of staff explained the name on her record was Frank Walker, not Fran, and until they heard otherwise, she would continue to be addressed as Frank or Mr Walker.

Fran tried to remain calm and explained that if she was referred to as Frank again she would make a formal complaint.  The member of staff reiterated the position so Fran explained that staff were in breach of legislation protecting trans people. They were deliberately disclosing her previous birth gender and so could be held liable and receive a significant financial penalty under UK law. Fran stated that if it happened again she would take formal action.

Legislation protects trans people in a number of ways, one of which is to ensure previous birth gender is only disclosed to another party when necessary with appropriate controls in place and then only with the expressed permission of the trans person.

Supreme Court Ruling Update – Thursday 17th April 2025

We are currently reviewing our policies in light of the Supreme Court’s ruling on 16 April 2025 that ‘sex’ in the Equality Act 2010 refers to biological sex.

Publications

• NHSGGC Transitioning in the Workplace – Guidance for Managers Nov 24 (under review)
• Changing Your CHI (under review)
• Gender Reassignment Policy Review 2021 (under review)
• Sharing Trans Information (under review)

Websites

• Gender Identity Research & Education Society (GIRES)
• LGBT Youth Scotland
• Press for Change
• Sandyford Initiative
• Scottish Trans Alliance

A person has a disability that is covered by the Equality Act 2010 if they have a physical or mental impairment that has a substantial and long-term effect on their ability to carry out normal day-to-day activities.

For example:

• Sensory impairments such as being blind or deaf
• Mobility difficulties and other physical disabilities
• Learning disabilities and people who are autistic (go to our Learning Disabilities page)
• Mental health problems
• Facial disfigurements
• Neurodiversity or autism
• Speech impairments
• Memory problems, such as dementia.
• Long-term conditions, such as epilepsy, dyslexia and cancer.

It is important to note that the definition can cover illnesses and conditions which some people may not immediately think of as a disability, such as asthma, depression, heart disease or diabetes. Also, not all disabilities are immediately apparent and may be described as “hidden disabilities” These could include long term conditions such as epilepsy, Autism, some sensory impairments and mental health conditions.

The social model of disability

This model recognises that an individual is disabled not by their impairment or medical condition, but by a society which fails to meet their needs.

For example, if an individual is unable to read information provided at an open day because they have a visual impairment, the social model sees the organisation as the problem because they have not provided suitable material that can be read by someone who is visually impaired, such as Braille or large print documents.

The lived experience Model of disability

The Lived Experience Model of disability recognises that each individual experience may be different but that there will be commonalities too and it is these commonalities which should inform policy and services etc. Many people see this type of model as a development of the social model.

It is the social and, increasingly, the lived experience models of disability that the Equality & Human Rights Team place at the core of its work in relation to disability

The Equality Act is designed to ensure that large public organisations like NHSGGC promote disability equality and challenge discrimination on the grounds of disability.

Discrimination occurs when a person or organisation treats a disabled person less favourably than they would treat others. This discrimination can affect issues such as education, employment, income and health.

For example:

• Disabled people of working age face considerable disadvantage compared to people without an impairment. On average their incomes are about 20 per cent lower than the incomes of non-disabled individuals and their employment rates are half the size
• International evidence shows that people with learning difficulties or long term mental health problems on average die 5-10 years younger than other people, often from preventable illnesses
• 15% of deaf or hard of hearing people say they avoid going to their GP because of communication problems

Following is a short film by the Equality & Human Rights Commission titled ‘What is Disability discrimination?’.

A recent survey of people with disabilities found the following:

• 63% of respondents reported that they were not in work, and 91% of those were not seeking employment – well above national averages.
• Over 30% of respondents stated that they found it difficult or very difficult to manage on their current income.
• In the UK Black people are more likely to be detained under the Mental Health Act
• Women are more likely to become disabled throughout the course of their lives
• More than one third of LGBTQ+ identify as having a disability

Identifying as a disabled person does not mean that a person does not also identify in some other way in relation to, for example, their religion, sexuality or social class. Such intersecting identities need to be considered when promoting disability equality and when ensuring equal access to services across NHSGGC.

In the 2011 census, 22% of NHSGGC’s population declared a disability.

People with disabilities can suffer poorer health for a wide variety of reasons. For example, it may be due to the fact that:

• people can’t get access to services or communicate with service providers
• how we plan our services does not take account of the needs of disabled people e.g. having an adult changing table, quiet space for autistic people
• the health of disabled people is given less priority than that of other patients
• an illness may be wrongly thought to be part of a person’s mental or physical disability
• people with long term disabilities are particularly likely to live in poverty
• some conditions are linked to a higher rate of a particular health problems

NHSGGC promotes the social model of disability, which means that it is up to the organisation and the people in it to ensure that disabled people have the same opportunities to enjoy good health as non-disabled people.

NHSGGC’s The Equality & Human Rights Team works directly with disabled people (patients and staff) and disabled people’s organisations to gain insight and understanding of their lived experience. This insight is then used to inform the work of the team

It is the responsibility of service providers and employers not to discriminate against a person on the grounds of their disability, regardless of how the person may describe themselves. This is important because many people may not regard themselves as ‘disabled’, but they will still have rights under the Equality Act. The law applies to all disabled people who use NHS services. This includes visitors and members of the public, as well as patients and staff

Specific examples of work include:

Sensitising Patient Pathways for Autistic People

Starting with day surgery, the Equality and Human Rights Team are exploring how our patient pathways can be made sensitive to non-neurotypical people and autistic people. Working with staff and the charitable sector we will publish as a learning tool for staff.

Deaf People & Health Services

A range of work currently being undertaken by NHSGGC to promote British Sign Language (BSL) as a language and culture and improve the experience of our Deaf BSL patients. This includes a BSL Online Interpreting Service, a plan to better meet the mental health needs of Deaf and hard of hearing people, staff training in BSL and a BSL Health Champions Group. We are also consulting with our patients regarding NHSGGC’s response to the BSL Act.

Facilities & Estates

The Facilities and Estate Department have a programme of actions to ensure our estate is accessible for disabled people. We work with our disabled patients through the Disability Access Group and our Staff Disability Forum to drive actions for change. For example, a guide for people using mobility scooters to access NHSGGC sites has been produced.

Interpreting Service

Interpreting services address a number of risks for both service users and staff. For example, patients whose first language is British Sign Language or who utilise Deaf Blind communicators must always have interpreters at their out patent appointments and at key times during in-patient stays such as admission, discharge, doctors rounds, significant nurse interventions and to communicate with family members if needed.

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned. In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHSGGC’s in-house interpreting service provides interpreters to our patients on request. BSL user can now also access on line interpreters through our communication support iPads. The iPads also contain a number of support apps including the AVA app which subtitles what staff saying in real time, to help those who have a hearing loss.

Clear to All Accessible Information Policy

Effective information and communication are vital for the provision of high-quality services and care. Many of those who access services have difficulty understanding the information provided. An accessible information policy has been produced to ensure that all information can be made available in the appropriate format to meet the needs of disabled people who may need this e.g. Braille, words and pictures, British Sign Language or audio version.

Details are available on the ‘Clear to All’ Accessible Information Policy web page.

Margaret’s Story

Margaret is Deaf. Her first language is British Sign Language.

Margaret fell at home. She couldn’t move and thought she had broken her leg. She couldn’t call for an ambulance as she couldn’t use a hearing phone so she asked her mother to take her to her local Accident & Emergency.

When Margaret got to A&E she told the person checking her in that she was Deaf. She explained her mother was also Deaf. She said that she would not be able to hear her name being called.

Margaret waited for over an hour and was getting anxious about her appointment, so approached the desk again. She was told she hadn’t been called. She waited again. Eventually after 5 hours and having approached the desk on more than one occasion she was told that she missed her appointment.

Margaret was distressed and frustrated that her needs as a deaf person were not taken into account. She may have had a long wait in A&E if other emergencies had come in but she felt she had waited so long because she was deaf.

NHSGGC’s Communication Support and Language Plan aims to ensure that the communication needs of individual patients are assessed, in order for the right kind of support to be provided.

Publications

• Assistance Dog Policy
• Being Disabled in Britain
• BSL National Plan (2017-2023)
• Disability Perceptions Gap
• Health Needs Assessment – Deafblind and Deaf Communities
• Staff Guidelines for people who are Deaf, have hearing loss or are Deafblind
• NHSGGC Staff Guidelines – Working with people with visual impairment
• Principles of Inclusive Communication

Video

Websites

• Access Panel Network
• Alliance  
• Disability Equality Scotland
• Disability Information Scotland
• Citizens Advice Scotland 
• Glasgow Disability Alliance [GDA] 
• Inclusion Scotland
• Inclusive Communication
• Disability Safety 
• Accessible Travel 

In the Equality Act 2010 ‘sex’ means a woman or a man or a group of women or men. Sometimes it is hard to understand exactly what is meant by the term ‘sex’ , and how it differs from the closely related term ‘gender’.

Our sex is determined by the sexual organs we are born with – men are born with a penis, women a vagina.

Gender relates to the types of behaviours society expects of men and women. We learn these behaviours as we grow through a range of images and messages given to us by parents, schools, friends and the media. For example, young girls might be given dolls to play with and princess outfits to play in, while boys may be given guns and soldier uniforms.

Society has a set of gender expectations of women and men that differ for each sex. Currently, masculine characteristics are more highly valued than feminine characteristics and world-wide, this ascribes more power and wealth to men than to women. This in turn reinforces sets of behaviour, which have significant implications for the pathways into poor health.

In terms of gender, some people describe themselves as gender fluid or non- binary The difference between gender fluidity and non-binary people is the fact that gender fluidity is one aspect of the non-binary spectrum. A range of people on the gender identity spectrum do not see themselves as male or female. They could be agendered, trans or simply identify as non-binary

Sex discrimination exists when a person (man or woman) or group of people (men or women) are treated unfairly solely on the basis of their sex. An understanding of gender is important to understanding inequality between women and men. Discrimination on the basis of gender is both subtle and persistent.

Women are expected to be ‘natural carers’ which has led to a huge imbalance in the types of jobs women do, how much they earn, how much housework/ caring they do and disapproval of society if they do not conform to this stereotype.

Men are expected to be ‘strong’ and unemotional, and they can often experience barriers when seeking jobs that require a degree of caring or empathy. Their masculinity can single them out for additional duties that rely on physical capacity rather than capacity to care.

There is a very serious side to this imposed difference. It means that women consistently earn less than men throughout their lives and often live in poverty when they are older. This lack of economic power has also meant that women have less power in society and less access to positions of power in politics.

In most cases we grow up feeling a sense of comfort or acceptance with our gender (as prescribed by biological sex at birth). However, a small number of us (around 1 in 11,500) find as we grow our prescribed gender is so different from our internal sense of where we exist in relation to being a boy/girl, man/women that we express a wish to live in the opposite, more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender people’ also covered by the Equality Act 2010.

Some people describe themselves as non-binary – not seeing themselves as male or female. In recognition that non-binary people experience extreme levels of discrimination in Scotland, the Scottish Government set up a working grouo in 2021

What is sex discrimination? – a short film by the Equality & Human Rights Commission

Sex differences cut across all the other protected characteristics such as age, race and social class.

For example:

• Male life expectancy is six years lower than for females across NHSGGC
• In NHSGGC, there is a nine-year gap in male life expectancy between East Dunbartonshire (77.7 years) and North Glasgow (68.6 years)
• Asian women aged between 15-35 are two to three times more vulnerable to suicide and self harm than their non-Asian counterparts
• Retired women and lone parents are most at risk of poverty and average incomes of women in work are lower

Other inequality issues can prevent people from receiving health services and treatment appropriate to their sex. For example, some disabled women have been told that they do not need cervical smear tests because of assumptions about their sexual behaviour.

NHS evidence has shown that treating women and men the same, without considering the differences between them, means that underlying sex-related links to health problems are ignored and patients’ health needs are not met. 

There is recognition by the Scottish Government that gender discrimination affects women and their health (Scotland’s Women’s Health Plan 2021-2024 – Health Inequalities) The health and societal differences for women and men are shown in the examples below-

• Women are more likely to live in poverty, be lone parents, experience abuse and  have less access to citizenship opportunities than men, due to historical gender stereotyping in society. This affect health differently during the life course.
• One in four women are likely to experience domestic abuse over their life course and that prevalence rates for child sexual abuse are estimated at around 21% of girls and 7% of boys.
• Men are more likely to participate in risk-taking behaviour which leads to premature mortality and to use their power to commit acts of violence and abuse which affect themselves and women and children of both sexes.
• Men are also less likely than women to participate in health improvement activity or to present to primary care in the early stages of illness.
• Where men have experienced abuse in childhood, this experience can manifest itself in a range of health and social problems in both childhood and adulthood but is often not identified as part of medical presentations.
• Women still tend to have multiple social roles as employees, as carers and as the primary managers of households. This imposes stresses that can have physical and psychological impacts on their health.
• Some diseases have been seen solely as ‘women’s’ or ‘men’s’ diseases due to gendered biases in medical research, leading to delays in diagnosis and treatment (e.g. heart disease – leading cause of mortality in UK women but still seen as a ‘male disease’)

Other examples of where gender expectations affect health are:

• In NHSGGC, like the whole of Scotland, women are between two and two and a half times more likely to report experiencing depression and anxiety than men.
• Suicide rates are almost three times higher in men than in women.
• Men are more likely than women to die of injuries outside the home.
• The gap between women’s and men’s smoking rates is changing, with more young girls taking up the habit than boys.
• Young men aged 16-24 are most at risk of becoming a victim of violent crime

‘A Fairer NHSGGC 2016-20 – Meeting the requirements of Equality Legislation’ sets out what the organisation is doing to ensure it meets its responsibilities to promote gender equality and remove sex discrimination across all its services and functions. Most actions in this document involve addressing issues around sex. In addition, actions on closing the health gap between affluent and deprived communities in NHSGGC take into account the different needs of women and men.

Some examples of actions include:

• Equality Impact Assessments undertaken throughout NHSGGC has a strong gender element
• An NHSGGC Gender-based Violence Action Plan has been in place for a number of years
• Women and child poverty work has gained increasing prominence in NHSGGC, endorsed by the Scottish Government funded Healthier Wealthier Children Project
• Sex issues are key within Human Resources Equality Scheme actions (e.g. Equal Pay Audit,Audit of family friendly policies)
• A gender analysis of our equality scheme, ‘A Fairer NHSGGC’, which sets out how we will meet the needs of equality legislation

John’s Story

John is a survivor of childhood sexual abuse. Now in his 40s, he has struggled to cope throughout adulthood with the experience and knowledge of being abused and has felt that many areas of his life have been negatively affected.

“I’d lost family, friends and jobs – that one major incident was affecting my whole life. I knew I needed help to stop the slide, so I spoke to my GP.

“I was referred to nine different counsellors. None of them specialised in childhood sexual abuse issues. After listening to me talking about my abuse experience, they would pass me on to another counsellor.”

The whole experience left John extremely depressed and contributed to a major breakdown.

John finally contacted Thrive, a counselling service for adult male survivors of childhood sexual abuse which is part of the Sandyford Initiative – NHSGGC’s sexual, reproductive and emotional health service.

“The initial telephone contact was really helpful – the person I spoke to was very supportive and put me at my ease. At my appointment, they explained how the counselling service would be run. They told me that counselling could take a long time and I appreciated that, I didn’t want to be kidded on.

“Hearing those words (‘we can help you’) made such a difference.   When I left I cried all the way to the Underground, I was just so full of relief and happiness.”

Dr Rosie Ilett, Head of Planning and Partnerships at Sandyford, developed the original funding application for Thrive and appreciates the importance of gender sensitivity in services. “Thrive has been developed because we know that many men have real difficulties seeking professional help about sensitive issues – it’s just not considered ‘manly’.   Experience of abuse can test men to breaking point.   Understanding what makes men tick and the barriers that living up to a stereotype of masculinity can impose on them helps our counsellors work effectively with the most challenging cases and start the healing process”.

Thrive is based at the Sandyford Initiative in Glasgow. Men can access the service by calling the direct line on 0141 211 8133 or visit the Sandyford Initiative website at: www.sandyford.scot

Add info here…

Publications

• A Guide to Support Services for Children and Young People Experiencing Domestic Abuse in West Dunbartonshire
• Ethnic Survivors Forum
• Everyday Terrorism: How Fear Works in Domestic Abuse
• Facts for Fathers-to-be
• Human Trafficking – Making the links
• Older Women and Work: Looking to the Future
• Women – Where to go for advice, support and information in the Glasgow area
• Women Living with Domestic Abuse in West Dunbartonshire

Websites

• Scottish Women’s Health Plan 2021-24
• Engender
• Non-Binary Scotland
• Equally Safe
• Women’s Support Project
• Men’s Health Forum
• Rape Crisis
• The Sandyford Initiative
• Violence Against Women Prevention Scotland

Ethnicity refers to a common group identity based on language, culture, religion or other social characteristics. This means that people define their own ethnicity, that everyone (and not just those in minorities) has ethnicity and that a person’s ethnic identity may change over time. For example some people might describe themselves as Scottish Chinese.

Race is the group you belong to, or are perceived to belong to, in the light of a limited range of physical factors. The term ‘race’ should be used in relation to legislation only and not to describe people who belong to an ethnic group.

The term BME is often used within the public sector. It’s an abbreviated term for Black and Minority Ethnic and is often used to describe people from minority ethnic groups, particular those who have suffered racism or are in the minority because of their skin colour and/or ethnicity.

Racism refers to the combined use of power with racial prejudice (the belief that some races are inferior to others) which leads to the oppression or discrimination of specific racial or ethnic groups.

Racism can be detected through attitudes, processes, behaviours and actions which impact on any ethnic group/s and can lead to differences in education and employment opportunities, living conditions and health. We all have an ethnicity.

The Equality Act is designed to ensure that large public organisations like NHSGGC promote race equality and challenge discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origins. We are required to;

1. eliminate unlawful racial discrimination;
2. promote equality of opportunity; and
3. promote good relations between people of different racial groups.

Following is a short film by the Equality & Human Rights Commission titled ‘What is race discrimination?’.

Racism can be intensified by other forms of discrimination, for example on the basis of sex, disability, age and social class.

1. Black African women are six times more likely to die from pregnancy-related causes than white women.
2. Women from the South Asian community are less likely to attend breast cancer screening and only half as likely to accept an invitation to be screened for bowel cancer than members of the non-Asian community.
3. Evidence suggests the health gap between white and black/minority ethnic communities is greater in older people.
4. Over a third of people from minority groups are in poverty after housing costs are taken into account, compared with 17% of the ‘white British’ group

Race and ethnicity affect people’s health in a number of ways. Our ethnic background can affect our susceptibility to certain diseases and conditions. There is also a clear link between discrimination and health and implications for the way in which health services should be provided.

For example:

1. Black and Minority Ethnic Scots are much more likely to live in poverty, with a poverty rate of 38% for  Mixed, Black or Black British people and 34% for the Asian or Asian British community, compared to 18% for White British people. Poverty is a key factor in poor physical and mental health and creates barriers to accessing health & social care services
2. One third of black and minority ethnic people in Scotland report experiencing racial discrimination. Racially motivated hate crimes are the most reported type of hate crime.
3. Gypsy/Travellers are more likely to report long-term health conditions than the general population. They are also twice as likely to report three or more categories of health conditions. 

How we are addressing race issues

Our Fairer NHSGGC reports explain how the organisation is meeting the requirements of equality legislation. This includes demonstrating how we will assess the impact of the measures we have put in place to ensure race equality for service users and staff.

Areas of work include:

Access to Services

National evidence shows the BME community experience additional barriers in accessing health and social care services.

We are currently working intensively with two services – diabetes and pain management/physiotherapy – to improve access for BME patients. The learning from this has helped develop a Equality Sensitive Patient Pathway for NHSGGC as a whole.

Following consultation with staff and patients current actions include –

Review all patient information for readability and accessibility
Develop information routes for those with lower health literacy around pain
Explore how the opt-in service accommodates the needs of those from BME communities specifically
Develop a route for non-English speakers to ask for advice outwith appointment times via direct patient access to telephone interpreting
Understand how therapeutic group work can work best whilst utilising spoken language interpreters.

Perinatal Care

National evidence indicated marginalised groups, in particular, BME pregnant women; women living in poverty and those experiencing gender based violence, fair worse in accessing and using maternity services.

A local baseline research was conducted with patients, maternity and third sector staff to assess current issues for marginalised groups using NHSGGC maternity services. A review of best practice interventions was also carried out. The focus of the work has been to look at the patient journey through maternity and identify any barriers for BME women.

Actions identified so far to address these issues include –

Develop a leaflet in multiple languages to describe each stage of the maternity pathway, how to access support and highlight emergency routes
Explore how to maximise the value of ante natal classes for non-English speakers
Develop training for Maternity Staff on meeting the needs of BME women thnrughout our pathway
Develop a route for non-English speakers to ask for advice outwith appointment times through direct patient access to telephone interpreting.

Interpreting service

Interpreting services address a number of risks for both service users and staff. For example, patients who have a limited understanding of English:

• may not be able to give informed consent
• may not be able to ask questions or seek assistance
• may not be aware of what services are available to them
• may not be able to use medication properly or follow care plans
• may come from cultures with different understandings of health and illness
• may not understand how to use NHS services
• may not understand their rights and responsibilities within the healthcare system

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned.In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHSGGC’s in-house interpreting service provides interpreters to NHS patients on request. The service is available to a wide range of service areas and departments, including hospital wards, outpatient clinics, medical practices, dental surgeries,pharmacies and opticians located throughout the NHSGGC area.

‘Clear to All’ Accessible Information Policy

Effective information and communication are vital for the provision of high-quality services and care. Many of those who access services have difficulty understanding the information provided. An Accessible Information Policy has been produced to ensure that all information can be made available in various languages and formats to meet the needs of our diverse community.

A toolkit for staff has been developed which helps to provide information and support in the development of accessible information for NHS patients, their carers and the public. The toolkit aims to ensure that the material we develop is clear, consistent with NHSGGC guidance, accurate and in everyday language.

Details are available on the ‘Clear to All’ Accessible Information Policy web page.

Stand Against Racism Campaign

Our workplace should be a place where discrimination is unacceptable and where everyone has the chance to thrive, regardless of their background or identity.

Our anti-racism campaign is based on the words of our own staff from their experiences at work. NHSGGC is an inclusive employer and there is no place for racism in our services.

Briony’s Story

Briony is part of the travelling people’s community and has lived in Scotland all her life.

Briony and her family have lived on the caravan site for 8 of the last 10 years. They were there for three years, moved into a flat for two years, and then have been back at the site for the last five years. When they moved into the flat it was mostly due to her health problems, but they also felt like maybe they would want a change and settle in for a little while. But after a couple of years, they wanted to move back to the caravan site because that is who they are and it was where they wanted to be.

She tells about how it was for her and her family to register with the local surgery when they first moved to the caravan site. There was not just one doctor’s surgery for everyone on the site, so all of the people living there were allocated to different surgeries. Briony herself went around to all of the local surgeries to see if she could register with one, but none would take them on. “They kept telling me ‘you aren’t from this area, so we can’t take you. She had to wait to get a letter from NHS telling her which surgery they had been allocated to and where to go before she could register.

When they moved into the flat, they didn’t have any problem registering with a surgery, and everyone was really nice to her. When asked why she thought there were no problems with getting registered and why they were nice, she says, “Oh, I couldn’t speak for them. But it could because I was in a flat at the time and not from the caravan site. This surgery was one of the ones I went around to when we were first at the caravan site and they said they wouldn’t take us on. But when we were in the flat, they would.

“I‘m still with that surgery now, even though we’ve moved back to the site. And they are still nice”.

Publications

• Amina
• Awaz FM
• Black and Ethnic Minority Infrastructure in Scotland (BEMIS) 
• CEMVO Scotland
• Glasgow Helps
• Govanhill HA
• Scottish Refugee Council

Ageism can be very subtle but is common throughout society; it can affect wellbeing, damage confidence and create exclusion. Individuals can be subject to assumptions and different treatment based on their age or perceived age, no matter how old or young they are.

Older people in particular, are subject to stigma, prejudice and social isolation. Older people are often also the poorest in society, and some are vulnerable to abuse. 

Children and young people can also be discriminated against and are viewed with suspicion by society. Their lack of power means that their views are often ignored and they are also vulnerable to abuse.

Discrimination arises either because difference is ignored and therefore people’s needs are not met or difference is recognised but forms the basis of unfavourable treatment or stereotyping.

Age equality means that age should not be used to define or presume anything about the role, value or potential of an individual.

The following video is a short film by the Equality & Human Rights Commission titled ‘What is Age Discrimination’.

Age and Other Protected Characteristics

Age discrimination links to other forms of discrimination- 

• Older people, especially older women are often on low incomes. This is caused by a combination of factors including the state pension not being linked to earnings and women being less likely to have occupational pensions of sufficient level.
• Disability increases with age, especially visual impairment and blindness. 74.25% of those registered blind or partially sighted in Scotland are aged 65 or over.
• Young people may be discriminated from exploring their sexuality and their gender identity by their family, at school or in hospital. LGBTQ+ young people may be less likely to express their sexuality or their gender identity due to fear of discrimination from family, friends and other young people. This can lead to low self-esteem and serious long-term negative health effects e.g. anxiety, depression and feeling suicidal.
• Peer pressure can pressure young people into concealing their religious beliefs or practices, while overt symbols of faith make young people more likely to be victims of religious provocation.
• Ageing may further reduce the ability to communicate for those for whom English is not their first language.
• Teenage women living in areas of highest deprivation are four times more likely to become pregnant than those in the least deprived areas. ; Teenage women from the most deprived areas are more likely to deliver than to terminate their pregnancy. In contrast, those from the least deprived areas are more likely to terminate than to deliver their pregnancy.
• The health of older people in Scotland varies according to social circumstances. The gap in life expectancy between the most affluent and deprived communities has widened significantly in the last 40 years, particularly among males. Life expectancy has either stopped increasing or has decreased in almost all council areas since 2012-2014.
• Emergency hospital admissions as a result of unintentional injury are over 40% higher for children living in the most deprived areas.

Older People

Long life is a sign of good health, and the ageing of the world’s population is an indicator of improving health worldwide. Although there are no specific conditions or illnesses associated with ‘being old’, the older people get the more likely they may be to experience a range of different conditions such as chronic disease, cancer and disability and to experience more than one of these together.

Increased protection for adults at risk of harm or neglect is in place through the Adult Support and Protection (Scotland) Act 2007. While the Act defines adults at risk as those aged 16 years and over, it provides protection to many older people with cognitive impairments such as dementia.

Young People

Healthcare, lifestyle and experience in childhood and adolescence have a significant impact on physical and mental health in later life. Certain conditions particularly affect young people, such as some inherited problems, accidents and injury and sexual and mental health issues, or they may have different experiences of conditions which affect all ages.

The United Nations Convention on the Rights of the Child (UNCRC)  sets out the essential rights of all children. The UNCRC Bill became law in Scotland in 2024 and is used as a framework to ensure that we consider children and young people’s rights whenever we make decisions that may impact on them and to help provide every child with a good start in life and a safe, healthy childhood. It forms the basis of our national approach for supporting children, called Getting it right for every child (GIRFEC). Fulfilling children’s rights is also critical to our commitment to #KeepThePromise that all care experienced children and young people will grow up loved, safe and respected.

All Ages

Traditional assumptions about age related conditions are increasingly being challenged. People with conditions previously associated with childhood, e.g. cystic fibrosis, severe physical disability, are increasingly surviving into adulthood. Similarly, younger people may suffer from conditions previously associated with ‘old age’ such as dementia or the need for social care and support.

Age Discrimination and Health

Age discrimination in health can lead to inappropriate treatment, misdiagnosis or reluctance from patients to get involved with health services. It may take some of the following forms:

• Stereotyping of old age as being automatically linked to ill-health
• Low expectations of older people’s mental capacity, leading to inappropriate behaviour or symptoms not being believed.
• Health or social care support or treatments having upper or lower age limits.
• Lack of support or time for meals, resulting in undernourishment
• Young people being placed in adult wards
• Information not produced with age group in mind
• Judgemental attitudes
• Confidentiality and anonymity not respected
• Abuse or neglect or older or young people, in hospitals, care settings or at home
• Denial of the right to make choices about health and personal affairs

How we are addressing age issues

NHSGGC is working to ensure no-one using our services is discriminated against on grounds of age or any other protected characteristic.

We are also working to raise awareness of the nature of direct and indirect age discrimination and our responsibilities under equalities legislation. We will do this by improving education and training of healthcare professionals on the effects of ageism in clinical care and care settings and by improving patient and carer experience of discharge planning.

Patients aged 81 and older are less likely than younger patients to feel they have been given adequate information about their discharge and what to do about their health if they are worried after leaving hospital. A Fairer NHSGGC 2024-25 highlights our plans to ensure that older people and their carers are routinely involved in discharge planning and decisions as part of person centred care.

This will be supported by the application of the Frontline Equality Assessment Tool (FEAT) which has been designed to assess inequalities sensitive practice within frontline services. This involves checking the patient information collected, how communication support is assessed and knowledge of protected characteristic related issues as well as the impact on discharge planning. Within NHSGGC’s frontline services the use of FEAT will contribute to the recognition and sharing of good practice as well as highlighting where improvements in services can be made.

Overall service planning is increasingly taking account of the changing age profile of the population and the impact this will have on demand for services. Awareness of the need to ensure age equality within our services informs this planning process. However, there are circumstances where a targeted approach to specific age groups is appropriate both when providing services and when consulting and involving individuals. For example, Sandyford sexual health services have been designed to ensure that they are accessible to young people and have the confidence of young people.

The United Nations Convention on the Rights of the Child (UNCRC)  sets out the essential rights of all children. The UNCRC Bill became law in Scotland in 2024 and is used as a framework to ensure that we consider children and young people’s rights whenever we make decisions that may impact on them.   NHSGGC has incorporated the principles of the new law into our Equality Impact Assessments which are used to ensure our services and policies are meeting the requirements of equality law.

Publications

• Age discrimination: key points for the workplace
• Fairer Scotland Older People Framework
• Ethnic Health Inequalities in Later Life
• Later Life UK Factsheet
• That Age Old Question
• UN Convention on Rights of the Child

Websites

• Age Scotland
• Public Health Scotland 
• NHSGGC Public Protection Team
• UNICEF –  Convention on the Rights of the Child
• Research Institute for the Care of Older People (RICE)
• Scottish Public Health Observatory

• Workforce Equality Documents including Equal Pay Statement

A Fairer NHSGGC 2025-29 is available in other formats such as easy read, large print, British Sign Language DVD and alternative languages. Please contact us with your request.  

EQIA is a vital part of NHSGGC’s overall approach to dealing with inequalities and discrimination. It means that services, policies and projects are thought about carefully in terms of their likely impact on different groups of people and on the various aspects of inequality.