Equality, Diversity and Inclusion in the NHS

Equality, Diversity and Inclusion

• Equality, diversity and inclusion (EDI) means treating people fairly, valuing their differences and making sure everyone can take part

• In the NHS it rests on the Equality Act 2010, which protects nine characteristics, and on the duty to treat patients and colleagues fairly

Equality

everyone has the same rights and opportunities, and nobody's treated worse because of who they are

Diversity

the mix of people in a team or a patient population, including ethnicity, sex, age, disability, religion, sexual orientation and background

Inclusion

the culture that lets everyone in that mix take part fully, speak up and feel they belong

Does equality mean treating everyone exactly the same?

• No

• Equality means fair treatment, and fair treatment sometimes means doing something different for one person.

• A deaf patient needs a British Sign Language interpreter that other patients do not.

• The aim is an equal chance of a good outcome

What is the equality act 2010?

• The Equality Act 2010 is the law that protects people in England, Scotland and Wales from discrimination

• It lists 9 protected characteristics

What are the 9 protected characteristics?

• Age

• Disability

• Gender reassignment

• Marriage and Civil Partnership

• Pregnancy and Maternity

• Race

• Religion or belief

• Sex

• Sexual Orientation

Age

• People of any age, old or young

• Example in NHS: Not assuming that an elderly patient cannot use an app

Disability

A physical or mental impairment with a substantial, long-term effect on daily life

A loner appointment for a patient with a learning disability

Gender reassignment

• Anyone proposing to undergo, undergoing or having undergone a process to reassign their sex

• Using the name a trans patient asks you to use

Marriage and Civil Partnerships

• People who are married or in a civil partnership (protected at work only)

• Equal parental leave for staff in a civil partnership

Pregnancy

• Pregnancy, the period after birth and breastfeeding

• Not passing over a pregnant colleague for training

Race

• Colour, nationality, and ethnic or national origins

• Booking a professional interpreter instead of relying on a relative

Religion or belief

• Any religion, religious or philosophical belief, or lack of one

• Offering a same-sex clinician where faith makes that important

Sex

• Being a man or a woman

• Single-sex wards and bathrooms

Sexual Orientation

• Attraction to the same sex, the opposite sex or both

• Asking about a partner without assuming their sex

What would you add other the equality act?

• Socioeconomic background

• deprivation shapes health more than almost anything else

Types of discrimination?

• Direct discrimmination

• Indirect discrimmination

• Harassment

• Victimisation

• Failure to make reasonable adjustments

Direct discrimination

• Treating someone worse than others because of a protected characteristic

• Example: Rejecting a job applicant because of their age

Indirect discrimination

• A rule applied to everyone that puts people with a characteristic at a particular disadvantage and cannot be justified

• Letters sent only in English, with no interpreter line

Harassment

Unwanted conduct related to a characteristic that violates dignity or creates a hostile, degrading or offensive environment

Racist jokes on a ward WhatsApp group

Victimisation

Treating someone badly because they complained about discrimination or supported a complaint

A nurse losing shifts after reporting a colleague

Failure to make reasonable adjustments

• Not taking reasonable steps to remove a substantial disadvantage for a disabled person

• No step-free route to a clinic room

• Section 20 says that where a rule, a physical feature or the lack of an aid puts a disabled person at a substantial disadvantage, reasonable steps must be taken to remove it, and the disabled person can never be asked to pay

A common adjustment is time: a patient with a learning disability gets a double appointment, a carer in the room if they want one and an easy-read letter. None of that is special treatment, it's what the law expects.

Positive discrimination VS Positive Action

• Positive discrimination, meaning choosing someone because of a protected characteristic, isn't lawful

• Positive action is allowed: encouraging under-represented groups to apply, targeted outreach, and choosing the under-represented candidate in a tie between two equally qualified people

• Widening participation sits on the lawful side of that line.

What is the public sector equality duty?

The public sector equality duty is the part of the Act that asks public bodies, including NHS trusts and GP practices, to think about equality before they decide rather than after a complaint

They must have due regard to the need to:

1. Eliminate discrimination, harassment and victimisation

2. Advance equality of opportunity between people who share a protected characteristic and people who do not

3. Foster good relations between those groups

Impact of this duty

It's why trusts carry out equality impact assessments before changing a service, and why the Accessible Information Standard requires NHS organisations to record how a disabled patient needs information given to them.

Why does diversity matter in a medical workforce?

• Trust and disclosure: Diversity in the NHS workforce matters because patients get better care from a service that understands them. patients tell more to clinicians they feel understand them, and a history taken in full is safer than one taken in part

• Health Inequalities: between 2022 and 2024 the maternal death rate was 2.7 times as high for Black women as for White women, which the national maternity investigation linked partly to stereotypes about pain

• Workforce: in March 2025, 30.7 per cent of NHS trust staff and half of medical and dental staff were from Black, Asian and minority ethnic backgrounds, so an NHS that treated them unfairly couldn't staff itself

diversity changes what patients disclose and what teams notice

WRES and WDES

The Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES) are the NHS measures that compare the experience of staff from different backgrounds, published every year

The WRES is an NHS measure, introduced in 2015, that compares the experience of minority ethnic and white staff across nine indicators every year

WRES Statistic

• Discrimination: 15.0 per cent of minority ethnic staff reported discrimination from a manager or colleague in the previous year, against 6.7 per cent of white staff

Widening Participation in Medicine

• Widening participation means the schemes that help students from under-represented backgrounds into medical school

• The tools are contextual admissions, which judge grades against the school and area they were earned in, gateway years and outreach such as summer schools

• Widening participation is positive action, and the reason for it is the same as the reason diversity matters for patients.

Questions regarding transgender patients?

• On 16 April 2025 the UK Supreme Court ruled in For Women Scotland Ltd v The Scottish Ministers that sex, man and woman in the Equality Act 2010 refer to biological sex, and that a gender recognition certificate does not change that for the purposes of the Act.

• Guidance on single-sex spaces has been under review since

• in November 2025 the health minister told Parliament that NHS England was reviewing its guidance on same-sex hospital accommodation to reflect the ruling.

• Ward placement therefore follows current guidance, local policy and a conversation with the patient.

• you'd follow the trust's current policy, involve a senior colleague and keep the patient's privacy and dignity whatever the placement

Good Medical Practice

• Good Medical Practice = the GMC standard every UK doctor is held to

• Paragraph 56: you must not abuse, discriminate against, bully or harass anyone based on their personal characteristics, or for any other reason

• The 2024 version expects doctors to act on bullying, harassment and discrimination they witness, with a firmer duty on those in leadership roles

• the student who overhears a racist remark about a colleague is expected to support that colleague and to raise it with someone senior, because the duty to act applies to witnesses as well as to the person who spoke

On placement you hear a nurse make a racist comment about a colleague. What do you do?

• Politely ask to speak to the nurse privately

• Confront her about the derogatory comment she made, explain why her behaviour is unacceptable and ask why she thought it was appropriate

• Equality and Diversity Act 2010 - Race is a protected characteristic

• Explain that she must act in accordance with the Good Medical practice Guidelines, in. which discrimination is not tolerated and should be reported

• The 2024 Good Medical Practice emphasises the responsibility of healthcare workers to report racism and all other forms of discrimination

• I would report the incident to my line manager

A patient refuses to be examined by a doctor because of their ethnicity. How should the team respond? - Non-Emergency

• Maintain calm and courteously ask the patient the reasoning behind their refusal, in order to address the root cause of this issue. For example, the patient may have a misinformed opinion of a certain ethnic group. If possible, try to explain to the patient that all doctor, regardless of their ethnic background will act in the best interest of the patient

• Talk to the patient factually to understand the situation (e.g., repeating back what they have stated without using judgment-loaded labels like "racist" or "offensive" to see if there is a communication barrier, trauma, or confusion)

• Make it clear to the patient that the doctors and staff are qualified, and explain the consequences of refusing care from the designated provider

• Check local practice or trust protocols regarding transferring care to another provider, keeping in mind that discriminatory preferences should not be routinely accommodated unless required by specific clinical or safety rule

• Ensure the affected doctor is not left isolated or solely responsible for the patient's ongoing care

• Accurately document the patient's statements, the exact refusal, and the team's response in the medical or administrative record to justify any subsequent withdrawal of non-urgent care.

A patient refuses to be examined by a doctor because of their ethnicity. How should the team respond? Emergency

In an emergency or life-threatening situation, the patient must be treated immediately, and the discriminatory behavior addressed strictly after clinical needs are met

How would you care for a transgender patient on a hospital ward?

• Address the patient by their chosen name and correct pronouns. Update electronic and physical records promptly and discreetly

• Do not use a patient’s former name ("deadname") or incorrect pronouns

• Do not discuss a patient's transgender status or medical history with other staff, visitors, or in public areas without the patient's explicit consent

• : Provide a single side room when available to enhance privacy, dignity, and comfort during an inpatient stay

• Ensure safe and private facilities: Ensure bathroom and shower facilities offer adequate privacy (such as single-occupancy or all-gender facilities

• Trans patients have to be treated according to their biological sex

• April 2025 Supreme Court ruling and the fact that NHS guidance on single-sex accommodation has been under review since. Say that ward placement follows current guidance, local policy and a senior colleague, and stay calm

Is it fair that some applicants get lower offers through widening participation schemes?

• No, it is not unfair

• WP = Positive action, which aims to bridge the gap between inequalities

• Their lower offers are contextualised to the performance of their school

• Candidates that attend private school are often seen as being at an advantage over their state-school peers, therefore lower grades achieved at a low-performing state school are often seen as equivalent to high grades at a private school

• Increases progression into the medical field to those from deprived areas

• Studies have shown that at university level, contextual students perform equal to, if not better, than their private school counterparts, once certain inequalities have been reduced