Transforming Roles paper 9 - allied health professions advanced practice: equality impact assessment

Summary of impacts for each protected characteristic:

The potential impact of the recommendations in Transforming Roles Paper 09 with protected characteristics under the Equality Act 2010 have been thoroughly assessed and a summary of this assessment is provided below.

Age

Impact: Positive

Rationale: Transforming Roles Paper 09 promotes equitable access to development opportunities, enabling AHPs of all ages to progress into advanced practice roles based on competence rather than length of service. Advanced practice roles support career development at all stages, offering pathways that are accessible to both early-career and experienced practitioners.

Evidence suggests that individuals further on in their careers may be less likely to undertake additional education or training, which could reduce the proportion of older AHPs choosing to pursue advanced practice roles if requirements are perceived as overly demanding. This highlights the need for flexible, supportive training models.

Current data from England indicates that most advanced practice trainees (70-80%) are aged 25–44, while the median age of AHPs in NHS Scotland is 42. Further analysis is recommended to understand whether this advantages or disadvantages particular age groups in Scotland.

Scotland has an ageing population and older people are more likely to develop multiple long-term conditions and require health services. Strengthening AHP advanced practice roles can support earlier intervention and improve access to skilled, timely care for service users.

Disability

Impact: Positive

Rationale: Transforming Roles Paper 09 can advance equality of opportunity by ensuring that pathways into advanced practice roles are inclusive and accessible for AHPs with disabilities. Current data from England shows that 7% of advanced practice AHPs have declared a disability, which is higher than the national average. This indicates positive representation and suggests that advanced practice roles can already be attractive and attainable for disabled staff. In Scotland, we expect that Transforming Roles Paper 09 can build on this by strengthening reasonable adjustments, offering flexible and adaptable training routes, and ensuring equitable access to supervision, assessment and development opportunities. It is recommended that participation and progression of disabled staff within AHP advanced practice pathways in Scotland is monitored to ensure that equality of opportunity is realised in practice.

For service users, Transforming Roles Paper 09 can also advance equality of opportunity by improving access to AHPs who are skilled in delivering person-centred, adaptable care. Advanced practice AHPs have a key role in reducing health inequalities through prevention, early intervention, and population-health approaches. Ensuring that the development of advanced practice roles incorporates accessibility requirements and includes service user involvement will further support equitable experiences and outcomes for people with disabilities.

Gender reassignment

Impact: Positive

Rationale: Data from England shows that a small number of advanced practice trainees identify with a gender that differs from their sex assigned at birth. The absence of equivalent data in Scotland prevents assessment of whether this reflects the wider population. Transforming Roles Paper 09 has the potential to strengthen equity further by promoting inclusive, transparent pathways and ensuring that training environments are safe, supportive and free from discrimination. Strengthening visibility, inclusive practice and appropriate support can help advance equality of opportunity for trans and gender diverse AHPs.

Pregnancy

Impact: Positive

Rationale: The work supports equality of opportunity by ensuring that access to AHP advanced practice roles is based on competence rather than time served. The flexible, modular structure of advanced practice education will enable staff to pause and resume learning as needed, reducing the disadvantage often experienced by those taking extended leave.

Race

Impact: Positive

Rationale: Transforming Roles Paper 09 promotes equity of access by ensuring that progression into advanced practice roles is based on competence rather than background, providing consistent, national opportunities for AHPs of all ethnicities to access training, mentorship and career development. This competency-based approach supports fair and inclusive pathways across the workforce.

For service users, Transforming Roles Paper 09 can advance equality of opportunity by improving access to AHPs skilled in delivering person-centred, culturally sensitive care. Advanced practice AHPs contribute to reducing health inequalities through population health initiatives, prevention, and targeted interventions.

Religion and belief

Impact: Positive

Rationale: Transforming Roles Paper 09 can advance equality of opportunity for staff with diverse religious or protected beliefs by ensuring that access to advanced practice training, supervision and career development is based on competence and transparent criteria. Flexible learning options and scheduling, such as consideration of religious holidays, prayer times, or dietary requirements at training events, further support participation, inclusion and engagement for staff from all faiths or belief systems.

For service users, Transforming Roles Paper 09 develops AHPs skilled in delivering person-centred, culturally sensitive care that respects and responds to faiths and belief systems, supporting equitable access and outcomes.

Sex

Impact: Positive

Rationale: Transforming Roles Paper 09 provides competency-based, nationally consistent pathways, ensuring equitable access to advanced practice roles. Current data from England shows that most advanced practice trainees are female (78%), which reflects the overall composition of the AHP workforce in NHS Scotland (79%). Further analysis is recommended to understand whether there is any discrimination based upon sex in proportion to the workforce in Scotland.

Sexual orientation

Impact: Positive

Rationale:Transforming Roles Paper 09 provides competency-based, nationally consistent pathways that ensure equitable access to advanced practice roles for AHPs of all sexual orientations. Within the trainee advanced practice workforce in England, 9% identify as LGBTQIA+. Further analysis to understand whether there is any discrimination based upon sexual orientation in proportion to the workforce in Scotland is recommended.

For service users, Transforming Roles Paper 09 develops advanced practice AHPs who are skilled in inclusive, non-discriminatory care.

Marriage and civil partnership

Impact: Positive

Rationale: As Transforming Roles Paper 09 is based on competency, it promotes a consistent, national approach for all staff, regardless of marital status.

People living in remote, rural and island communities

Impact: Positive

Rationale: Transforming Roles Paper 09 supports flexible learning approaches, enabling AHPs in remote, rural, and island communities to access development opportunities without frequent travel. Advanced practice roles in these areas can also enhance recruitment and retention of skilled staff.

For service users, AHP advanced practice roles, including those built on the Remote & Rural Advanced Practice Educational Pathway, help reduce geographical inequalities in access to specialist services, improving timely care and reducing travel burdens.

Intersectional and human rights impacts

Transforming Roles Paper 09 aims to provide equitable, competency-based pathways into AHP advanced practice roles. These pathways are designed to be inclusive of multiple protected characteristics simultaneously, recognising that individuals may experience compounded barriers due to intersecting identities, such as age, gender, ethnicity, disability, sexual orientation, or remote and rural location. For example:

• A mid-career AHP with a disability living in a remote area may face combined challenges of access to training, flexible work arrangements and travel requirements. Transforming Roles Paper 09 promotes flexible, part-time and remote learning models to help mitigate these compounded barriers.

Transforming Roles Paper 09 aligns with human rights principles by promoting:

• Non-discrimination and equality of opportunity, consistent with the Equality Act 2010 and broader human rights obligations.
• Promoting educational and professional development, enabling all AHPs to access advanced training and supervision irrespective of protected characteristics or socio-economic status.
• Promoting health and access to healthcare services for service users, by supporting the deployment of skilled AHPs across diverse settings, including rural and underserved communities.

Transforming Roles Paper 09 covers a number of articles and human rights. By considering both intersectionality and human rights, Transforming Roles Paper 09 seeks to ensure that AHP advanced practice opportunities are accessible to all AHPs and that service users benefit from equitable, person-centred care, reducing disparities linked to protected characteristics.