NHS Wales Equality Mapping Exercise
Introduction
The NHS Centre for Equality and Human Rights recently undertook an
equality mapping exercise to get a picture of the structures, priorities and
resources Trusts and LHBs in Wales currently have in place to support their
work on equality and human rights. The primary purpose of the exercise was
to:
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
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inform the work of NHS CEHR in supporting the new LHBs with the
development of their new Equality Schemes
identify opportunities for the NHS CEHR to influence relevant WAG
guidance being developed as part of the NHS restructure, for example
in areas such as governance and Board development,
get an understanding of the key equality priorities contained in the
existing Equality Schemes of the legacy bodies and the level of
resources allocated to the Equality function
inform the work of the CEHR towards a more outcome-focused
approach to equality and human rights across the NHS in Wales.
Methodology
A survey questionnaire was developed and distributed to all Trusts and LHBs
through the NHS CEHR Equality Linkworker Network. 24 responses were
received from 6 NHS Trusts and 18 LHBs1.
Findings
All responding organisations currently have an identified lead officer for
equality and in some instances there are additional nominated Equality
Champions. Each of the lead contacts were asked to complete a
questionnaire providing details of their own organisation’s circumstances and
24 responses were returned. Briefly the findings of the exercise are as
follows:

The majority of organisations (18) have equality leads that undertake
the role as part of a wider remit, such as HR, Corporate Services
and/or Corporate Governance, some of whom commented on the
difficulties this represents in terms of their ability to allocate sufficient
time and attention to work on equality and human rights. In particular
comments were made about the difficulty equality leads have
experienced from being based within the operational Human
includes 2 joint responses from Neath Port Talbot and Bridgend LHBs and
Merthyr Tydfil and Rhondda Cynon Taf LHBs
1
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Resources function and in some organisations this has limited their
ability to influence the service delivery agenda that has become a
significant focus of equality and human rights work and legislation over
recent years.

Within the sample, there are more Non-Executive Equality Champions
(19) at Board level than Executive (10) with some Boards having more
than one champion. Organisations have used this role to link into
senior management and the Board and the survey further shows that
progress reports are presented regularly either directly to Boards or in
some instances reporting and discussion takes place at a dedicated
equality steering group. Some organisations also reported equality
work being co-ordinated via the PPI, governance and HR work
streams.

Methods of corporate accountability and reporting on equality vary
considerably between organisations. 14 indicated formal reporting on
progress in respect of their Equality Schemes to the Board. This
should be the minimum standard given the responsibility Boards have
in setting the organisation’s priorities including those set out in the
Equality Schemes and they are ultimately accountable for the delivery
of the action plan. Also, the statutory duties require organisations to
draft and publish annual progress reports and these should be given
the same level of status as other corporate reports received by Boards,
such as the Annual Report and Standing Orders. Some organisations
pointed to alternative practices such as reporting progress to Equality
Forums, HR Steering Groups, PPI groups and Clinical Governance
Committees.

The mapping exercise asked respondents to report on the top equality
priorities for their organisation (as set out in their existing statutory
equality schemes). From the responses provided, the top 6 most
commonly cited priorities are:
o
o
o
o
o
o
Training and Awareness Raising
Monitoring
Engagement,
Equality Impact Assessment
Access to services, and
Mainstreaming.
In the main, these priorities mirror the requirements of the current
Specific Duties set out in the Race, Disability and Gender Equality
Duties and are predominately concentrated on process and building
organisational capacity for equality with a more limited focus on
outcomes for patients. This internal, organisational focus is
undoubtedly necessary if bodies are to ensure they are working
towards legal compliance however, the move to a more outcomefocused approach to tackling inequality will require a shift away from
‘tick-boxes’.
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
All but one organisation reported not having a clear, dedicated source
of funding to promote equality and human rights and support capacitybuilding albeit some individuals state they are able to access other
sources of funding, i.e.: PPI, HR, clinical and corporate governance,
corporate DDA/access resources.

The mapping exercise asked organisations to provide examples of
changes to outcomes for patients as a result of the organisation’s
equality schemes. Some responses did not provide any examples and
where examples were provided, these tended to be output measures
such as more inclusive engagement activity and the use of the ‘twotick’ symbol for disability recruitment, rather than tangible
improvements to health outcomes for patients, or being able to report
whether the inputs/outputs had made a difference to patients over a
period of time.
The overall messages from the mapping exercise are that consideration
needs to be given to:

establishing as a minimum, a Board-level Equality Champion to
ensure sufficient priority and scrutiny is given to equality and
human rights and that all members of the Board are aware of
their roles and responsibilities through development activity and
are held accountable

developing consistent internal governance and reporting
structures in the new organisations so that there are clear lines
of accountability and regular monitoring of progress against the
organisation’s action plan commitments. The profile of equality
and human rights needs to build upon, and not dilute, the good
practice that exsits in the legacy bodies

examining the level of dedicated staffing resources required by
the new LHBs to ensure work on embedding equality and
human rights is improved, the pace of change is increased and
that organisations are more effectively able to focus on
improving patient outcomes.

exploring where the equality and human rights function sits
within the new LHB structures. Equality and human rights need
to be viewed as a corporate responsibility with the scope to
influence the service delivery and modernisation agendas as
well as the other key areas such as governance, procurement
and employment policy for example. The Organisational
Development workstream in the new LHB structures does have
the potential to provide these critical linkages and ensure a
whole-systems approach to the promotion of equality and
human rights as well as working towards compliance with the
statutory Duties. Diagram 1 shows how a potential framework
for improving equality and human rights could be structured. In
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other areas of the public sector, such as local government, steps
have been taken to promote the links between equality, service
improvement and performance management.
Diagram 1: Potential Framework for Improving the Equality and
Human Rights Agenda in NHS Wales
Leadership &
Accountability
Governance &
Compliance
Service
Delivery
Workforce &
OD
Performance
Management
Improved
Patient
Outcomes
Access –
Physical and
data
Modernisation
& Improvement
Tackling
Health
Inequalities
Patient
Experience
Procurement
CONCLUSION
It should be noted that this focus on internal arrangements and process is not
distinct to the health service in Wales, but is an issue that the majority of
organisations in the public sector and their partners are trying to address
more fully. The UK Government has published the Equality Bill which looks to
harmonise existing equality legislation and put a new Equality Duty on public
bodies to combine the existing duties for race, disability and gender and
further incorporate other ‘protected characteristics’ which are religion or belief
(or non-belief), sexual orientation, age, gender reassignment, marriage and
civil partnership, and pregnancy and maternity. The Welsh Assembly
Government also has devolved powers to develop a set of Specific Duties for
Wales and the Equality Minister Dr Brian Gibbons AM launched a ‘listening
exercise’ on 27th July 2009 to inform the Welsh Ministers’ thinking in this
respect. Also of relevance is the work being carried out by the Equality and
Human Rights Commission Government Equalities Office (in collaboration
with the London School of Economics) to develop a more consistent
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measurement framework for equality across the UK which is very much going
to focus on tracking improvements in equality of outcome.
The NHS reorganisation does offer a unique opportunity for health service
organisations to take stock and identify more outward-looking and patientfocused priorities for equality and human rights. That said, mainstreaming
equality into the strategic and operational functions of organisations is a legal
duty for health organisations and is widely considered to be the best method
of working if sustainable change is to be realised. In reality, full
mainstreaming is still some way off and will require:
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
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strong leadership and accountability,
a continued focus on embedding equality and human rights into
structures and,
dedicated resource/expertise across the Service and including Primary
Care.
A twin-track approach to promoting equality and human rights should combine
making improvements in the organisation’s internal arrangements and
capacity with a focus on tackling the key health inequalities in the local
community.
If the new organisations are to meet their minimum legal requirements, better
understand and meet the needs of patients and tackle the most persistent
access barriers that contribute to health inequalities (which are key objectives
of the NHS restructure), there needs to be a greater focus on improving
outcomes for patients (particularly those from disadvantaged groups) and
effectively measuring progress.
Further Information
If you would like to discuss any aspect of the NHS CEHR’s Equality Mapping
Exercise or you would like to engage with the Centre on further developing
your organisation’s work on equality and human rights, please contact Paula
Walters, Interim Director - NHS CEHR, [email protected] ,
Tel: 01443 233496 or 01443 233450.
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