Race equality action plan: final report

Progress made on the actions in the Race Equality Action Plan 2017 to 2021 and action taken to tackle race inequality in response to the 2020 to 2021 COVID-19 pandemic as well as action from 2021 onwards to implement the aims of the Race Equality Framework 2016-2030.

Annex C – Health

These annexes provide updates on all original actions from the Race Equality Action Plan followed by updates on the reprioritised and refocused actions from the end of Year 2. Additional activity in Year 3 that has taken place in response to either COVID-19 or Black Lives Matter is then captured.

Action status categorisation is as follows

  • Complete*
  • Ongoing**
  • Paused
  • Reprioritised

*We cannot see this work as being done just because an action has been completed within a timeframe. For some actions, the marking of a status as complete may mean that the specific one-off action as originally proposed has been undertaken however work continues in this area and this is reflected in the update.

** Actions may be marked as 'ongoing' for the same reason. Much of the work reflected in these annexes is long-term in nature and continues beyond the end of the REAP.

Year 1 only
Action Action Status
We will ensure the development of the national priorities for public health reflect the health inequalities that exist in our minority ethnic communities. Complete In 2018, we published Scotland's national Public Health Priorities: our subsequent public health improvement action plans are enabling us to tackle some of the most significant health challenges we face, specifically in relation to PH Priority 4: A Scotland where we reduce harm from alcohol, tobacco and drugs and Priority 6: A Scotland where we eat well, have a healthy weight and are physically active.
We are working closely with Public Health Scotland to support the delivery of all the public health priorities. Through their Strategic Plan, Public Health Scotland has focused on Community and Place and Poverty and Children as high level areas they believe they can have biggest and best impact. Their outcomes based approach recognises that ethnicity is a key factor to be considered in addressing health inequalities within these areas and evaluating such specific inequalities plays a significant role in improving the overall health and wellbeing of our communities. A critical part of work underway is action to improve data across a number of priority areas, aligned with the recommendations set out by the Expert Reference Group on COVID-19 and Ethnicity. We are actively supporting a whole system approach that fosters better collaboration between the wider public, third and community sectors to be increasingly focussed on improving health and the wider social, environmental and economic determinants of that. Ensuring that the priorities focus the whole system on areas which will have the greatest potential to improve healthy life expectancy, reduce persistent health inequalities and support sustainable economic growth over ten years remains a key commitment and will be reflected in the context of a post-COVID landscape.
We will establish an inequalities network, involving clinical and academic experts from across Scotland as well as organisations such as Cancer Research UK and Jo's Cervical Cancer Trust. The network will focus on groups where significant health inequalities exist and participation in screening is low; this includes minority ethnic groups, travelling communities and those from disadvantaged backgrounds. It will oversee the development of a national screening inequalities strategy and will include a 3 year programme of action. Complete A Screening Inequalities Network was established and a dedicated space created on the Knowledge Hub, providing a platform for discussion and collaboration on inequalities issues within the screening community. Since 2016/17 we have made up to £5m available over 5 years under the cancer strategy Beating Cancer: Ambition and Action 2016 to tackle inequalities in access to screening services. We have already funded a number of NHS Board and Third Sector pilot activities and continue to fund projects into this financial year. This year (2020/21) we have sought out projects that aim to tackle new and emerging inequalities as a result of COVID-19. A number of projects have been funded that will seek to address inequalities faced by minority ethnic groups and people from disadvantaged communities. For example, one of the projects will carry out research through focus groups with Muslim women in Glasgow with the aim of designing a faith based intervention targeting uptake in all screening programmes for Muslim women.
Year 2 only
We will work with Health Boards to audit their mainstreaming data and workforce outcomes to support minority ethnic recruitment, retention and progression within the NHS in Scotland. Ongoing An audit of Health Board's mainstreaming data was carried out at the end of 2019. The need for more focussed workforce outcomes, specific to individual Health Boards' needs was identified and agreed with NHS Diversity and Inclusion Leads. These outcomes will be developed, once the NHS moves off its emergency footing to cope with the pandemic. Moving forward, work to improve data and outcomes for new and existing NHS staff will be taken forward through the new national Minority Equality Network for the NHS, under its employment workstream. Work is underway to establish the network which will include the development of a portal to allow staff from local networks, across health and social care make connections, share information and good practice.
We will work with our delivery partners to actively promote the participation of minority ethnic young people in NHS Scotland Boards' youth employment activity, including new employment, work experience, development and training opportunities. Paused 15% of participants on our 6 week employability programme with the Prince's Trust in 2019 identified as minority ethnic. A guaranteed interview with a health board is offered at the end of the programme. The conversion rates to employment were 65% nationally, rising to 91% for Greater Glasgow and Clyde and 100% for Lanarkshire. Work on these and other programmes such as Modern Apprenticeships was paused when Health Boards were put onto an emergency footing from March 2020 and will resume once the NHS in Scotland remobilises.
We will consider data and evidence on minority ethnic groups as part of the evaluation of the pre-medical entry programme, forming part of our drive to widen access to medicine. Ongoing We have examined the data and our findings are that representation of minority ethnic groups on pre-medical entry programmes is high, particularly those from a South Asian background. However other ethnic groups are not so well represented. These findings link to wider inequalities in attainment levels and other inequalities for minority ethnic groups. Since 2017 students from a minority ethnic background have constituted 45.8% of the total number of participants on the pre-med course at Glasgow University with the proportion of minority ethnic students within each annual intake varying from 34.6% to 56.5%. At Aberdeen University, 57.55% of the cohort since 2017 on the pre-med course have come from minority ethnic backgrounds with the proportion of minority ethnic students within each annual intake varying from 42.6% to 70%. All 5 Scottish Medical Schools, since 2016/17 to 2020/21 have had 10 Widening Access (WA) places (those from the lowest SIMD20%) each year to fill on their medical undergraduate intake numbers. For the 2021/22 intake each Medical School will now have at least 12 WA places to fill. However, Widening Access does not directly translate into dealing with race inequality and we will look at ways in which this action can be subsumed into the wider work on race inequality, led by the Scottish Government Health Workforce Directorate.
Multi-year actions
Action Action Status Update
We will carry out a baseline assessment of the sources, quality and completeness of ethnic coding in health and care records and will provide recommendations to Ministers during 2018 for systematic improvement. Ongoing This action is now being implemented as part of the recommendations from the Expert Reference Group on COVID-19 and Ethnicity. Work is already underway reflecting our commitment to improve the data and our wish to make progress. Public Health Scotland (PHS) are already working with analytical partners across the Scottish Government, National Records of Scotland and the NHS and discussions are underway with National Services Scotland and NHS Inform on adaptation of the current patient registration form to support better recording of ethnicity data. We will ultimately use the new CHI system, which will have an ethnicity field to routinely record ethnicity in health and social care records. Public Health Scotland (PHS) is also leading a programme of work to establish a clearer picture of the impact of COVID-19 on minority ethnic communities in Scotland.
We will develop and implement a Diabetes Prevention Framework to support early identification, diagnosis and treatment of those at risk of developing type 2 diabetes. This will be published in 2018 and will identify risk assessment tools and outline appropriate interventions to support the prevention of diabetes and its complications. It will be achieved by establishing collaborative and co-ordinated approaches to prevention and early intervention between services, government and the third sector. It will identify ways of engaging with people from hard to reach communities, including minority ethnic communities, and socially deprived backgrounds. Complete A Healthier Future: type 2 Diabetes prevention, early detection and intervention: framework was published in July 2018. It sets out the importance of reducing health inequalities as was reflected in the Diabetes Improvement Plan (2014) as Priority 4 – Equality of access, which aims to reduce the impact of deprivation, ethnicity and disadvantage on diabetes care and outcomes. Furthermore, in keeping with NHS Health Scotland's health inequalities policy review recommendations, the provision of universal services under this framework should include added support for vulnerable groups. It also makes clear: Co-production of services and resources must be carried out to ensure that effective support, guidance and services are provided for the individuals who will use them. Co-production is also at the heart of reducing health inequalities and making progress to wider population health goals. Recent activity that has been undertaken includes
  • Public Health Scotland hosted a webinar on 20th January 2021 to support boards to consider a human rights based approach in response to and recovery from the COVID-19 pandemic – helping to support the most marginalised and excluded in our communities. The session also covered co-creating inclusive and accessible communications and explored the lessons learned from the Scottish Government's communications and engagement around COVID-19, particularly around engagement with minority ethnic communities.
  • Work is underway to explore how we might take forward a digital discovery exercise to understand user needs and inform future service delivery in relation to Type 2 Diabetes (T2D) prevention, early detection and early intervention, including weight management services.
  • Funding has been allocated to three health boards to test the digital Type 2 Diabetes prevention and education programmes provided by Oviva. These programmes are delivered by Dietitians and offered in 22 different languages to meet the needs of our ethnically diverse population who are also at higher risk of developing Type 2 Diabetes. These programmes are already underway and evaluation and outcomes will be reported in June 2021, including information on uptake and clinical measures.
  • Feedback from territorial boards has revealed capacity concerns to undertake local EQIAs as public health teams are deployed to COVID-19 response. We are exploring how to best support the completion of these by central means as they are an essential component of needs analysis and programme design and success at community level.
We will consider data and evidence on inequality relevant to diabetes and CVD policy, including the SHELS reports, to support the delivery of the priorities within our Diabetes Improvement Plan and our Heart Disease Improvement Plan (2014) on minimising the impact of inequality. Ongoing We are currently in the process of refreshing the heart disease improvement plan. The delivery of equitable care is a core component of the refreshed plan. As part of this work, we are considering how best to amplify the voices of groups who face disparities in their access to care or outcomes from heart disease, including on the basis of ethnicity. This will enable us to ensure that the implementation of new models of care is based upon a wide range of lived experience Our Equality and Impact Assessment identified that people of South Asian origin are at higher risk of developing coronary heart disease than those of White European origin in the UK. We also know that people from African or African Caribbean backgrounds are at higher risk of developing high blood pressure and having a stroke than people from other ethnic groups. Targeted engagement with people from South Asian, African and African Caribbean backgrounds will form part of our lived experience work, in order that new models of care implemented as a result of the plan, take into account their needs and address disparities in outcomes. Improved access to, and utilisation of, data relevant to cardiovascular disease will also form a key part of this work in order to better understand unwarranted variation and disparities in care. The refreshed Heart Disease Plan is due to be published in Spring 2021.
We will establish an Equality of Access group to drive improvement and address issues around difference in access to services where there is a health inequalities dimension. Ongoing This action is superseded by the activity in the above action. Governance and engagement mechanisms are currently being considered as part of this work.
We will ensure that the Short Life Working Group on HIV Testing, set up to explore how to improve HIV testing in Scotland, will specifically consider what could be done to increase the uptake of testing among African men living in Scotland, who have been identified as a key target group. Suggested actions will be passed to the NHS Sexual Health and Blood Borne Virus Executive Leads to consider how services can be improved. Complete The Short Life Working Group has ended. However, work to improve HIV Testing in Scotland continues. The NHS Sexual Health and Blood Borne Virus Executive Leads Group was disbanded in May 2019. It was replaced by the Scottish Health Protection Network (SHPN) Sexual Health and Blood Borne Virus Strategic Leads. The HIV Short Life Working Group did not continue following the establishment of the Strategic Leads group. Oversight for increasing HIV testing in specific populations, including African men, will now be progressed through the SHPN, and through the Scottish Government's next multi-year Sexual Health and Blood Borne Virus Framework. Increasing access and reach of HIV testing is also at the core of the Scottish Government's commitment to explore ending HIV transmission elimination in Scotland by 2030. Meaningful engagement and partnership working with minority communities will be a vital part of taking all of this work forward. As an example, Scottish Government currently provides funding to Waverley Care's African Health Project, and we will continue to work with them to progress these important actions.
We are working directly with key delivery partners to ensure that people from minority ethnic communities who have lived experience of mental health services are represented at our Bi-annual Forum. The views and input of the Forum will be fundamental in the development of the Mental Health Strategy's first Annual Report to Parliament in 2018 which will include a section on equality, and the experiences of minority ethnic stakeholders will be part of this. Ongoing The first annual progress report included a section on assessing equality and human rights impacts. This detailed the work undertaken with advocates for protected characteristic groups, including minority ethnic communities to review the equality impact assessment for the strategy. In response to the COVID-19 Pandemic the Mental Health Transition and Recovery Plan was published on the 8th October 2020. It lays out the Government's response to the mental health impacts of COVID-19 and specifically acknowledges the mental health impact on minority ethnic groups. To help address this, we have established an Equality Stakeholder Forum for Mental Health. This Forum will look at the causes of mental health inequality at a structural and individual level and address the issues identified. It will act as a key mechanism through which minority ethnic communities are represented and play a key part in mainstreaming equalities across the plan's implementation and wider mental health policies. BEMIS has been invited to be a member of our Equalities Forum and we will be working with them to reach out to, and consult with, wider minority ethnic networks and those with lived experience.
We will increase engagement and participation of minority ethnic communities in the implementation of health and social care processes through funding a key delivery partner to provide guidance and consultancy support to at least 3 Integration Authorities in developing inclusive models of working by November 2018. Complete CEMVO Scotland was commissioned to provide consultancy support to a number of Health and Social Care Partnerships, focussing on:
  • Engaging minority ethnic communities in health and social care issues.
  • Facilitating dialogue between the Integration Joint Board and minority ethnic organisations.
  • Enabling the needs of minority ethnic communities to be integrated into strategic planning processes.
  • Direct capacity building of Health and Social Care Partnerships in addressing race equality.
CEMVO provided the Scottish Government with guidance in May 2019, and it is the ongoing responsibility of Health and Social Care Partnerships to develop inclusive models of working that involved active engagement and participation of minority ethnic communities in the implementation of health and social care processes.

Additional Health actions generated in Year 3 can be found in the main report


Email: charlie.goodwin@gov.scot

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