These news pages are maintained by Jennifer Hoskins to keep you abreast of relevant current developments. Please let us know if you would like anything to be added to them.

Support For Raising and Escalating Workplace Concerns

On 22^nd December, The Health Professions Council published information for its registrants about the principles of raising and escalating concerns within the workplace.

Health Professions Council registrants are expected to act in the best interests of service users, including patients, and to act to protect them if they are at risk of harm, for example, if they are concerned about the behaviour of a colleague.

Unemployment and Equality

As unemployment in the UK rises to almost 2.5 million, the Chartered Institute of Personnel and Development has found that employer attitudes remain the most significant barrier in preventing people from particular groups from being at work.  In association with KPMG, it reported on 22^nd December 2010 on barriers to employment for disadvantaged groups and demonstrated that concerns about employing people from such groups are largely unfounded.

Ex-offenders are the most disadvantaged in securing work, only 12% of public sector organisations have employed someone with a criminal record in the last three years, despite that figure being higher for the private and voluntary sectors.  Fifteen percent of public organisations have employed people aged 65 or over in the last three years and the figure is 23% for the long-term unemployed. 

People aged 18-24 with few or no qualifications, the hardest hit by the current climate, have been employed by 54% of public sector organisations and those aged 18 and under in the same circumstances by 26%.  In contrast, people from ethnic minorities, lone parents and disabled people were more likely to be employed but remain disadvantaged in the job market.

Employers admitted to deliberately excluding people from certain groups and in descending order of importance their reasons were: lack of relevant qualifications; lack of experience; lack of basic skills; trust; reliability; bad experience and risk of disruption.  However, alternative reasons (that were not supplied) topped that list.

The survey suggests that the exclusion of particular groups is not justified.  Disabled people, for example, are ranked as performing better than the rest of the workforce.  Ex-offenders are judged to be more loyal, while the quality of their work is no worse than the rest of the workforce.  Lone parents and ethnic minorities also score fairly highly across a range of performance criteria with the exception of absences and communication skills respectively.  Older people are ranked as performing more effectively across all performance measures indicating that employers need to make more use of available talent in the over 50s age group.

Right to Request Flexible Working Extended

The right to request flexible working has been extended to parents of all children aged under 18.  The new regulations were laid before Parliament on 16^th December 2010 and the extension will come into force on 6^th April 2011.

Currently, the right applies to parents of able-bodied children under 17, or disabled children under 18, and some carers of adults.  When a parent or carer requests flexible working using this statutory right, the employer must seriously consider the application, and only reject it if there are good business reasons for doing so.  The Government is intending to publish proposals on extending the right to request flexible working to all employees shortly.

The Government has also announced an overhall of rights to maternity and paternity leave, proposing a more flexible system.  From April, fathers will be able to take an extra 26 weeks of leave if their partner chooses to return to work after 20 weeks, but the new system will enable a father to take any remaining unpaid maternity leave should his partner choose to return to work early.

Predicted Doubling of Medical Students' Debt

On 6^th December 2010, the British Medical Association (BMA) reported that the average student debt could more than double as a result of the recent parliamentary vote to enable universities to charge course fees of between £6,000 and £9,000 annually.

The average medical student debt could increase to almost £70,000, not taking into account the overdrafts, credit cards and professional loans which many students depend upon.  Currently medical students also rely on an average of £16,000 worth of financial support from their parents.  The BMA is concerned about the difficult choices that will need to be made by low and middle income families.  As it stands, only one in seven sucessful applicants to medical school comes from the lowest income groups, while the overall university intake draws one in three students from the same groups.

The BMA believes that there is a strong case for additional and targeted investment by the public in certain courses.  These may be courses that deliver significant social returns such as to provide skills and knowledge currently in shortage or predicted to be in the future.  It has called on the government to retain the current cap on tuition feeds of £3,145 a year and to look at its proposal for a forgivable loan system for medical students that would allow student debt to be reduced for each year a docter is employed by the NHS.

Muslim students may be deterred from taking out student loans because repayments will now be structured so that higher-earning graduates are paying higher levels of interest rates, up to 3% above inflation.  A proportion of Muslims view interest linked to inflation as not constituting real interest (because the lender makes no profit) and therefore compliant with Sharia law.  This has enabled them to take out student loans which currently have interest linked to inflation.  The Federation of Islamic Students has described the government as demonstrating insensitivity and disregard to Muslim students for introducing variable interest rates.

Meanwhile, the General Medical Council has revised its guidance to ensure that disabled students do not face unnecessary barriers in pursuing a medical career.  In 2009, less than 6% of medical students declared a disability compared to 19% of working-age adults in the UK.  The guidance now takes account of developments including the 2009 edition of Tomorrow's Doctors and the Equality Act 2010, and highlights examples of reasonable adjustments.

Government Equalities Office Scrapped

The Government published its new Equality Strategy on 2^nd December 2010.  Included is the announcement that the Government Equalities Office will no longer exist as a separate department, its functions will be carried out by the Home Office from 1^st April 2011. 

The strategy also suggests that the publishing of monitoring data with a view to giving individuals and communities the responsibility to regulate the organisations that serve them will be a central plank of Government Equality and Diversity Policy.

Equality Delivery System For The NHS

The Equality and Diversity Council (EDC) is developing an Equality Delivery System aimed at improving the equality performance of the NHS and embedding equality into mainstream business.  The Equality Delivery System is based on best practice, including the Equality Performance Improvement Toolkit that is operating sucessfully in the North West.

On 19^th November 2010, EDC representatives wrote to all Chief Executive Officers across the NHS to seek their organisation's commitment to implementing the EDS.

Participating NHS organisations are required to:

• draft and complete a migration plan from a 3-yearly Single Equality Scheme to a 4-year Equality Strategy and Annual Improvement Plan (AIP) by December 2011.
• have a 4-year Equality Strategy, Objectives and AIP in place by April 2012 (posted on website with assessed grades); and
• re-assess grades by March 2013.

Grading of equality performance is made against a set of Equality Delivery System goals and outcomes and carried out by NHS organisations and local interests who agree one of four grades for each outcome: excellent, achieving, developing and undeveloped.  Based on the grading Annual Improvement Plans will show the most immediate priorities to be tacked, by whom and when.

NHS Employers is working with the EDS in the development of the toolkit.  Draft outcomes and goals have been published by Newcastle PCT.

Positive Action Extended

Junior Equalities Minister, Lynne Featherstone announced on 3^rd December 2010 that the government will enact the extension of positive action in recruitment that is detailed in section 159 of the Equality Act 2010.  The measures will allow employers to make their organisations more representative by allowing them to choose a candidate from a group that is under-represented when selecting from two candidates of equal merit.  The measures are voluntary and the government has stressed that positive discrimination will remain unlawful.

Government To "Nudge" Improvements to Public Health

A white paper, published on 1^st December 2010, has set out the structural change that the government will implement to tackle the causes of ill-health that often lead to health inequalities.  The plans include a ring-fenced portion of the NHS budget to be handed to local authorities along with responsibility for tackling issues such as smoking, obesity and excessive drinking.  In addition, a new central body, Public Health England, will organise national programmes such as immunisation and screening.

Details of specific policies will not be published until the New Year, but the government intends to improve maternal and children's health, prevent excess winter deaths and challenge adult behaviour.  The White Paper, Healthly Lives, Healthy People, highlights the government's preferred approach of nudging people into good habits rather than forcing them.  However, the BMA has called for tougher action, such new restrictions on advertising, describing nudging as insufficient.

The Paper also states that The Department of Health will work in partnerships with employers to encourage breastfeeding-friendly employment policies, through pilots involving an acute NHS trust, over 300 children's centres, and two schools.

Socio-Economic Duty Scrapped

On 17^th November 2010, Theresa May confirmed that the socio-economic duty set out in section 1 of the Equality Act 2010 will not be brought into force.  The duty would have required public bodies to have due regard to the desirability of exercising their functions in a way designed to reduce the inequalities of outcome which result from socio-economic disadvantage.  She suggested that the duty was an example of the worst aspects of pointless political correctness and social engineering, as the opposition accused Ministers of not caring about socio-economic equality.

The single equality duty is still expected to come into force on 4^th April 2011, leaving public sector organisations little time to prepare.  Consultation on the duty has not yet closed and the government's response to the consultation and the Equality and Human Rights Commission guidance may not be published until February 2011.

Female Unemployment Rises as Pay Gap Reduction "Stalls"

Whilst the overall unemployment rate in the UK fell by 9,000 in the three months to September 2010, the number of unemployed women rose rapidly during the same period.

The figures, published by the Office for National Statistics on 17^th November 2010, showed the number of unemployed women rising by 31,000 in the same three months to reach 1.02 million, the highest since 1988.  This is likely to be a reflection of the public sector being the only sector to record an increase in redundancies in the latest quarter.

In the three months until September 2010, non-UK born peoples' employment rate in the UK rose slightly to 67.8%, a 1.4% increase on the same quarter in the previous year and UK born people's employment rate was 71.6%, virtually unchanged from the previous year.

The latest gender pay gap data published by the Office For National Statistics on 8^th December 2010, has revealed that the full-time pay gap decreased from 12.2% to 10.2% in the year to April.  The overall pay gap, including part-timers, fell from 22% to 19.8%, and in the public sector it fell from 20.7% to 19.2%.

The Fawcett Society described the progress as stalling and points out that another generation of women are at risk of experiencing being paid less than men throughout their working lives.  It has labelled 2^nd November as Equal Pay Day, drawing attention to women working for free from that date until the end of the year.

New Guides to Pregnancy and Work

The department of Business, Innovation and Skills (BIS) have produced new guides for employers and employees on pregnancy and work in relation to babies which are due on or after 3^rd April 2011.  The guides reflect the changes in relation to additional paternity leave from that date.

No Compromise Agreements Under The Equality Act

The Law Society has pinpointed an apparent error in the Equality Act 2010 which is likely to have an effect on the use and effectiveness of compromise agreements made under the Act.  On a literal interpretation of s147(5)(d), it seems that it is not possible for a solicitor to sign off on a compromise agreement so as to settle discrimination claims.

The law states that the complainant must receive advice from an independent advisor about the terms and effect of any compromise agreement.  The Law Society released a statement on 28^th October saying that a solicitor who was instructed by the employee prior to the production of the final contract for consideration; or who has acted in any way for the employee prior to the production of the final contract.  In fact, no lawyer consulted by the employee, and therefore acting for him or her, can be said to be independent.

Compromise agreements under the Act may therefore be unenforceable, unless, perhaps, the settlement has gone through ACAS.  As the main provisions of the Act are already in force, the Law Society has requested an urgent meeting with the Government Equalities Office to consider how this question can be resolved as well as notifying the Home Secretary of its concerns.

Equality Act Codes of Practice

The Equality and Human Rights Commission's statutory Codes of Practice on the Equality Act 2010 were published and laid before parliament on the 13^th October 2010.

There are three codes: The Code of Practice on Equal Pay, The Code of Practice on Employment and The Code of Practice on Services, Public Functions and Associations.  The Codes do not impose legal obligations and are not an authoritative statement of the law.  However, they can be used in evidence in legal proceedings brought under the Act and courts and tribunals must take into account any part of the Code that appears to them relevant to any questions arising in proceedings.

Please note that the codes are still labelled as being drafts because technically they have not yet been approved by Parliament and signed off by the Minister.

The Commission has also published a guide to making fair financial decisions in the light of the spending review.

How Fair is Britain?

A three-year review from the Equality and Human Rights Commission has highlighted a strong association between low socio-economic status and poor health.  How Fair is Britain, published on 11^th October 2020, found that those who have never worked or are long-term unemployed have the highest rates of self-reported poor health and that people in routine occupations are more than twice as likely to say their health is poor than those in managerial and professional occupations.

Around 1 in 5 of people report having a disability or limiting long-term illness and are as likely as average to say that the health service treats them with dignity and respect.  However, there is evidence to suggest that older people are sometimes dealt with in ways that they find humiliating or distressing.

In terms of ethnicity, Pakistani and Bangladeshi groups are more likely to report poor health than average and are more likely to find it hard to access and communicate with their GPs than other groups.  Among groups defined by religion, Muslim people report worse health than average.

The research suggests that there may be an association between harassment and poor mental health.  Lesbian, gay, bisexual, and transsexual people, and Gypsies and Travellers, and asylum seekers are all more likely to experience poor mental health and sometimes these groups also feel misunderstood by health services.  Gypsies and Travellers can find it difficult to register with a GP, and transgender people can feel that their doctors do not support their decision to seek gender reassignment.

The evidence does not show a clear trend of one gender experiencing worse health than the other, but men are less likely to use their GP and women have specific concerns about maternity services.  Men are more likely to take exercise, but less likely to eat the recommended amounts of fruit and vegetables and women are vice-versa.

Hospital Food for Children - Shocking

New research published on the 10th October has revealed that children receiving hospital treatment are being given meals containing shocking amounts of salt, sugar and saturated fat.  The study was carried out by the food campaign group Consensus Action on Salt and Health (CASH), which is headed by an expert in cardiovascular medicine.

CASH analysed the nutritional content of 451 main meals, snacks and desserts served to children in hospitals in England.  The trusts concerned were not disclosed but the food was provided by the three main producers of hospital food, Apetito, Anglia Crown and MediRest.  Nearly half of the children's hospital main meals exceeded school nutritional standards for salt or saturated fat and one in three of the surveyed items would be classed red under the traffic-light food labeling system.  One main meal had 14 times more salt and 8.5 times more saturated fat than the equivalent school lunch, and a sticky toffee pudding had six times more saturated fat and double the amount of sugar that would be permitted by school nutritional standards.

CASH are calling for legal nutritional standards for all food served in public sector institutions.

Flexible Working and Paternity Leave

The government announced on 30^th September 2010 that the additional paternity leave regulations implemented in April will remain in force and that it will extend the right to request flexible working.  All parents with children under 18 years old will be able to request flexible working from April 2011.

The additional paternity leave will give employed fathers a right to up to six months extra leave which can be taken once the mother has returned to work.  Some of the leave may be paid (at 90% of earning up to the same standard rate as Statutory Maternity Pay) if taken during the mother's maternity leave period.  The regulations will have effect for parents of children due on or after 3 April 2011.

New Guidance for NHS Equality Inspectors and Assessors

The Care Quality Commission and the Equality and Human Rights Commission (EHRC) have launched draft joint guidance on equality and human rights for inspectors and assessors.  The draft guidance includes:

• An overview of how the essential standards relate to equality and human rights law and what inspectors and assessors can do if they think that this law may be breached.
• Context about equality and human rights for each of the key sections in the essential standards.
• Detailed charts which 'map' the equality and human rights dimensions of the essential standard.
• Prompts that inspectors and assessors can use about equality and human rights - complementary to the prompts in the essential standards of quality and safety.  These 'unpack' the equality and human rights elements of the prompts in more detail.

The guidance is out to public consultation until 12^th November 2010 and the EHRC invite providers, users, commissioners and others to give their feedback.

Main Provisions of the Equality Act Come Into Force

The following provisions of the Equality Act 2010 came into force on the 1^st of October:

• The definitions of the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.
• The basic framework of protection against direct and indirect discrimination, harassment and victimisation in employment and service delivery.
• Changing the definition of gender reassignment, by removing the requirement for medical supervision or treatment.
• Extending discrimination by perception - direct discrimination against an individual thought to possess a protected characteristic is extended to disability, gender reassignment and sex (it already covered age, race, religion or belief, and sexual orientation).
• Leveling up discrimination by association to cover age, disability, gender reassignment, race, religion or belief, sex and sexual orientation, providing protection for carers for example.
• Providing protection for breastfeeding mothers in public places such as cafes and shops.
• Extending protection for disabled people including prohibiting discrimination arising as a consequence of disability and restricting the circumstances in which employers can ask job applicants about disability or health.
• Extending protection from third party harassment (such as harassment from patients) to all protected characteristics.
• Allowing claims for direct gender pay discrimination where there is no actual comparator and making pay secrecy clauses unenforcable.
• Introducing new powers for employment tribunals to make recommendations which benefit the wider workforce.

The new public sector Equality Duty and the dual discrimination provisions are expected to come into force in April 2011.  The provisions for positive action during recruitment and promotion, for gender pay reporting and for a prohibition of age discrimination in the provision of goods and services are still being considered by the government and may not come into force at all.

Female Graduates Highly Rate NHS Graduate Scheme

When 17,000 graduates were asked to rank the organisation for which they most wanted to work, NHS Graduate Schemes made it to third place for women yet was rated only 34^th by men.  In general, women were drawn towards the public sector, including the police, prison and probation services, whereas men showed a bias towards science and IT based professions.

The Guardian UK 300 Survey, September 2010, found that the women questioned demonstrated a pronounced social conscience whereas men were more interested in salary levels.  However, it's also thought that women are influenced by an organisation's reputation for flexibility and work-life balance, and restricted by the choices they make at school when subjects are selected.

Overall, the NHS was the most popular of public sector organisations, and was the most attractive to graduates from Wales, Scotland and the North of England.

NHS Provides "Mediocre Services" For Children

A report published on 16th September 2010 has concluded that children are suffering from a culture that does not give their health needs the priority and status they deserve.  Getting it right for children and young people:  Overcoming cultural barriers in the NHS so as to meet their needs by Professor Sir Ian Kennedy states that while some NHS services for children and young people are very good, others are in need of significant improvement.

Professor Sir Kennedy lists the cultural barriers to improvement at a number of levels, from Whitehall, through regional and local organisations, to contacts between individual professionals, and with children, young people and those looking after them.  Children, he states, have a low priority in the NHS.

The report makes nearly 40 recommendations.  They include GPs to be given additional paediatric training; training for all professionals caring for children to occur together to a common curriculum; investment to be shifted towards children and young people's health services and an increased focus on prevention and early intervention.  It also recommended the creation of a single point of responsibility for children's health and wellbeing, linked into other public services used by children, with an identified funding stream for their health and healthcare at a local level.

Acute Trusts Struggling to Hire Foreign Staff

A restriction introduced by the coalition government on the number of non-EU workers allowed to enter Britain has left some acute trusts unable to recruit the staff they need.

On 14th September, The Nursing Times reported that 100 foreign nurses with job offers from North West London Hospitals Trust are in limbo because the trust cannot issue them with a certificate of sponsorship.  The number of certificates that employers are allowed to issue to foreign staff needing UK residency has been cut by 5%.

The Trust is appealing against the restriction with the UK Border Agency and a decision is expected in October.  Other trusts are said to be experiencing similar issues, including being unable to extend the contracts of existing staff.

Software to Identify Cultural Identity From Names

In September 2010, Professor Richard Webber, founder of a company called Origins Info, claimed that its software can identify people's cultural identity from their names and postcodes.  The software has been designed to enable organisations to monitor and better understand the cultural, ethnic and linguistic origins of customers, clients or employees.  Webber says that they can then use the data to change aspects of working practices that may be directly, or indirectly, discriminatory.

The system, which does not claim to be 100% accurate, is apparently already being used by some NHS organisations.  A demo version is available on Origin Info's website.

Trusts Failing to Meet Equality Requirements

Research reported on in the Health Service Journal and Health Workforce Bulletin at the end of August 2010 has revealed that as many as 90% of NHS Trusts could be failing to meet their legal requirements to publish equality documents online.  An audit of 40 trusts carried out by Vincent Hodges, Director of Consultancy and Interim Management at Healthcare Equality Partners, showed that 90% were failing to meet publication duties in full.

A standard previously employed by the Healthcare Commission was used in the audit - the documents must be found within half an hour of starting a website search.  Only 70% of the trusts audited had met the requirement for publishing Equality Schemes, 72.5% had published initial Equality Impact Assessments (EIAs), 32.5% had published full EIAs, and 35% had published annual progress reports.  In respect of equality monitoring only 22.5% had published current workforce monitoring reports, and a very low 7.5% had published current services monitoring reports.  Common failings included out-of-date equality schemes and monitoring data.

The sample of 40 trusts covered ten each of acute, primary care, mental health and ambulance trusts.  Overall, ambulance trusts tended to perform the best, and mental heath the most poorly.  Of the 40 trusts included in the audit, the best performing were Frimley Park NHS Foundation Trust, Kent and Medway NHS & Social Care Trust, and Surrey PCT.  All three had previously been issued with non-compliance notices by the Equality and Human Rights Commission warning they could face legal action if they did not put race equality schemes in place.  Surrey PCT and Kent and Medway Trust were also told to improve their employment monitoring.

Vincent Hodges said: The impact of the Equality Act 2010, together with the Care Quality Commission Regulations, means that going forward trusts will need to put a greater emphasis on information and data collection, analysis and effective use than they have in the past, particularly with regard to service delivery.

Disability Regulations Published

The government published The Equality Act 2010 (Disability) Regulations 2010 on 31^st August. The regulations re-enact, with amendments, provisions which were previously made under the Disability Discrimination Act 1995, and include a breakdown of the meaning of disability under The Equality Act.

The most notable change is that an individual no longer has to show that, where an impairment adversely affects his or her ability to carry out a normal day-to-day activity, that activity involves one of a specified list of capacities such as mobility, speech, or the ability to understand.   This is expected to make it easier for individuals to demonstrate that they meet the criteria for disability.  The regulations come into force on 1^st October 2010, and the guidance in determining whether or not an employee or service is disabled is being consulted on until 31st October 2010. 

On 1^st September 2010, a survey was published by Scope which found that although 91% of people say they believe disabled people should have the same opportunities as non-disabled people, only 21% of non-disabled people have ever worked with a disabled person (as far as they are aware).  The poll, commissioned by Scope from ComRes, also found widespread social exclusion, 40% of non-disabled people do not know any disabled people, and 90% have never had a disabled person in their home for a social occasion.

Drug Addicts Who Refuse Treatment May Have Benefits Withdrawn

Proposals published by the government on 20th August 2010 suggest that drug addicts and alcoholics who refuse treatment may have their benefits withdrawn.  The consultation paper on the government's drug strategy for England, Wales and Scotland asks respondents to comment on the options of:

1. some form of financial benefit sanction, if [users] do not take action to address their drug or alcohol dependency; or
2. additional support to take such steps, by tailoring the requirements place upon them as a condition of benefit receipt to assist their recovery (for example temporarily removing the need to seek employment whilst undergoing treatment).

In May, after Labour announced pilot programmes to get drug users back into work, the social security advisory committee said that withdrawing benefits from drug users would lead them into crime and prostitution.  Concerns have also been raised about introducing effective compulsion for treatment services that should be therapeutic, consensual and confidential.

In the same consultation paper, the government announced plans for a temporary ban on 'legal highs' while their potential harm is assessed and greater penalties for those selling alcohol to underage drinkers.

Equality Duty: An End to The Specific Duty?

The Government has launched a consultation on the equality duty expected to come into force in April 2011.  The Equality Act 2010: The Public Sector Equality Duty - Promoting Equality Through Transparency was published on 19^th August 2010 and the consultation remains open until 10^th November 2010.

The document states, The approach we are taking is significantly different from the arrangements in place under the existing duties, and from the last Government's approach.  It is proposed that a specific duty to carry out prescribed types of engagement work, or a particular process to equality impact assess, is not necessary.  Where organisations are making slow progress on eliminating discrimination, advancing equality and fostering good relations, arming citizens and civil society groups with information will allow them to apply public pressure to drive a faster pace of change.

The information required to be published by public bodies with 150 or more employees will be set out by the Equality and Human Rights Commission in its statutory Code of Practice and Guidance on the Equality Duty.  Different bodies will be required to publish different data sets relating to their particular business, but the Government would expect this to include annual data on important inequalities such as the gender pay gap, the proportion of staff from ethnic minority communities and the distribution of diasabled employees throughout an organisation's structure.

Public bodies will be required to set equality outcome objectives but not required to publish the action plans they intend to carry out in order to meet these objectives.  We believe that our proposals on transparency render this requirement redundant.

Another key change proposed in the document is that public sector organisations should have the freedom to buy goods or services from suppliers as they see fit, without having to conduct procurement activity in terms of meeting specific equality criteria.  It states, We do not believe it is necessary to impose burdensome additional process on public bodies telling them how to conduct their procurement activity:  they will be judged on the outcomes that they deliver.

Midwives Attack 'Hysteria' Over Home Births

The Royal College of Midwives (RCM) has spoken out against the cumulative global impact of a recent Lancet editorial and other international reports which criticise homebirths.  Cathy Warwick, general secretary of the RCM, said: We are extremely concerned that there appears to be a worldwide anti-homebirth, anti-midwife and anti-normal birth movement.  We feel under attack and that there is a concerted and calculated global attack and backlash against homebirth and midwife-led care.

Ms Warwick goes on to state that there is no guarantee that a woman will have a safer birth in hospital than at home, and that homebirth is being wrongly linked to high perinatal mortality rates.  Risk during childbirth is a very relative concept and its exaggeration highlights the way that women can be persuaded and frighted into making choices they don't want or need.

The Wax research in America, which was cited in the Lancet editorial, has been described as having serious methodological limitations by the Natural Childbirth Trust which draws attention to the small sample size and failure to distinguish effectively between planned and unplanned home births.

New Resource Pack on Retirement Flexibility

NHS Employers published a new resource pack on NHS Pension Scheme retirement flexibilities on 16^th August 2010.  The pack will help NHS Trusts in England and Wales to effectively provide a wide range of retirement options to their staff.  It enables employers to explore a range of flexibilities with staff such as:

• Wind down: as an alternative to retiring staff, can opt to wind down by working fewer days or hours in their current post.
• Step down: into a less demanding lower graded (paid) post that still makes use of their skills and experience.
• Retire and return to the NHS: staff who have reached the minimum retirement age can opt to retire, take all their pension benefits and return to NHS employment.
• Draw down:  allows members to take part of their pension benefits whilst continuing in NHS employment.

As a larger proportion of experienced staff approach retirement age in the NHS, many organisations are finding it difficult to replace them and are experiencing skills shortages.  Greater flexibility will enable trusts to retain staff in a way that fits in with their lifestyles and need for continued income.

Default Retirement Age To Be Phased Out

On 29th July 2010, the government published a proposal to phase out the default retirement age (DRA) over a six month period.  The proposal states that from 6^th April 2011, employers will not be able to issue any notifications for a compulsory retirement using the DRA procedure.  Between 6^th April and 1^st October, only people who were notified before 6^th April can be compulsorily retired and the default retirement age will cease to exist from 1^st October 2011.

The consultation asks what additional support is required for employees and employers in implementing the changes, and whether there are unintended consequences for insured benefits and employee share plans.  It will run until 21^st October 2010.

The proposals have been welcomed by NHS Employers in the Nursing Times.  The Campaign Director of the Employers Forum on Age described them as an incredible leap forward on employment practices and great news for individuals.  However, other organisations, including the Confederation of British Industry and the Institute of Directors, have criticised the proposals, saying that organisations have had little time to prepare and concern has been expressed about the impact on youth unemployment. 

NHS Direct to Adopt More Home Working

On 26^th July 2010, NHS Direct decided to progress with its plans for home working, following a successful pilot with eight nurses who had worked at the Plymouth contact centre.  One hundred more nurses working from home will be recruited across the organisation by March 2011.

The results of the pilot included:

• The number of patients nurses were able to speak to per hour increased by 25%;
• The time nurses were available to answer calls and spend with patients rose by over 10%; and
• The number of calls completed within NHS Direct (giving self-care advice) rose from 60% to over 80%.

Nurse advisors taking part in the pilot reported significant benefits, including eliminating travelling time and working in quieter surroundings with less background noise.  It was also easier to work extra hours as they can log-on for short periods for which it would not be worth travelling to a contact centre.

A survey of 500 NHS Direct nurses found that 85% would be interested in undertaking their role from home on a permanent basis.  The main reasons nurses gave for not wanting to do so were isolation and loss of social interaction with colleagues, although these factors were not found to have impacted the nurses undertaking the pilot.

Female circumcision Cases Increasing in Britain

A growing number of female genital mutilations (FGM) are being carried out in Britain, warn police and health professionals in the Observer newspaper on 25^th July 2010.  An estimated 500 to 2,000 British schoolgirls will be genitally mutilated in the UK this summer at private "cutting parties", typically without anaesthetics or sterilised instruments.

Women and girls are protected from FGM by UK law.  It is an offence to carry out FGM or aid, abet or procure the service of another person to do so.  Since 2003, it has also been an offence for FGM to be performed anywhere in the world on UK permanent residents of any age, an offence which carries a maximum sentence of 14 years imprisonment.  Yet no prosecutions have been made under this legislation.

Comfort Momoh, who works at a clinic at Guy's and St Thomas' Hospital which deals with the aftermath of FGM, spoke of the anxiousness felt at this time of year, saying the school summer holidays are the time when all the professionals need to be really alert.

Asha-Kin Duale, a community partnership advisor in Camden, said, FGM is not confined to African countries.  It has no basis in Christianity, it has no basis in Islam; none of Muhmmad's daughters had it done.  For some parents it is enough to let them know that and they will drop it completely.  Everyone needs to understand that every child, no matter what the background or creed, is protected by this law in this land.  She also spoke of the need to understand the perceived social function of FGM, and to spread understanding that girls can be good girls without being mutilated.

Current guidance from the BMA for dealing with the issue is here.

Initial Equality Impact of NHS Reform

The Government has published an initial equality impact assessment (EqIA) of the White Paper proposing the restructuring of the NHS, Equity and Excellence: Liberating the NHS and will publish a full EqIA following further consultation and involvement.

The assessment considers the impact of the proposals on healthcare inequalities and the need to build a service that is personal, fair and diverse.  The emphasis on patient engagement and choice in the White Paper is acknowledged as requiring all sectors of the community to be able to access and use information on which to base choices and to consider differing patient knowledge of, and attitudes towards, choices.  It commits the Department of Health to consulting widely on this matter and publishing an information strategy this autumn, including an equality impact assessment of that strategy.

Other barriers to patient choice are not specifically mentioned in the EqIA but there will be a public consultation on improving health outcomes in general, including an assessment of the potential impact on equality.  The need to strengthen the voice of patients and to overcome barriers to patient participation will be part of the role of a new independent consumer champion, HealthWatch.

Proposals for freeing existing NHS providers and putting foundation trusts outside state control has led to speculation that they will no longer be subject to the equality duties.  The EqIA states: Foundation trusts are currently bound by the requirements of equality legislation, and as we consult on and develop our proposals we will consider their implications for this.  We will ensure that as they move to new governance arrangements they build on existing arrangements and good practice in the commercial and social enterprise sector to continue to take account of their corporate social responsibility and embed ethics, equality and rights across their services and functions.

Concern has also been expressed by a number of organsations about the impact of the restructuring on health inequalities, not least because implementing change will tie up resources and distract from the core business.  An independent think tank, Civitas has suggested that the plans are likely to lead to at least a one-year dip in NHS performance and that the reorganisation could set the NHS back three years.  The British Medical Journal has echoed these findings. 

On 12^th July 2010, The Social Market Foundation offered the opinion that, Giving control of NHS Funds to GPs is like asking your waiter to manage a restaurant... Commissioning healthcare is very difficult and needs a specialised organisation to do it.  On the same day, mental health charity, Rethink, published a survey which showed that only 31% of GPs feel equipped to take on the commissioning role for mental health services.  Rethink expressed concern that without a national plan to up-skill GPs in mental health, 1.5 million people with severe mental health illnesses may fail to get the treatment they need.

The EqIA does not consider the impact of the White Paper on NHS employees.  NHS Employers have detailed the impact on the workforce and Unison and Unite have spoken out against the end to national pay bargaining and increasing privatisation.  The British Medical Association have called for doctors to engage with the consultation process despite, and because of, concerns about the impact of the White Paper.  The Royal College of Nursing described the plans as ambitious and not without risk.

GMB Calls For Zero Tolerance of Assaults

On 5^th July 2010, GMB union called for zero tolerance of verbal abuse and physical assaults on ambulance staff.  NHS figures reveal that there were 2,705 assaults on ambulance staff in the two years to April 2009 in the 11 NHS ambulance trusts in England.  In 2009, there were 117 physical assaults on ambulance staff in Scotland and 192 in Wales.

Justin Bowden, GMB National Officer for ambulance services, said: Every single day at least three ambulance workers are assaulted whilst doing their jobs.  That is as shocking as it is unacceptable.  Being attacked at work is not an occupational hazard for ambulance workers and the only way to confront this issue is with zero tolerance.

Ambulance workers deserve full protection from their employers and the law [but] less than half of the reported cases led to prosecutions.  In some Trusts there is an automatic recourse to law regarding damage to property but not on attacks on staff.  Also in one authority there is a proposal to remove stab-proof vests as a protection to staff.  A change of attitude by management is needed on this.

Socio-Economic Duty To Be Scrapped?

The Coalition Government announced on 3^rd July 2010, that the main provisions of The Equality Act will come into force in October this year, according to the previous timetable.  The main provisions do not include the socio-economic duty which would impose an obligation on public sector bodies to consider socio-economic disadvantage when making strategic decisions about how to exercise their functions and had been expected to be implemented in April 2011.

The Equality and Human Rights Commission (EHRC) released a statement saying, we look forward to ministerial decisions on the implementation of the other provisions under the Act, such as the socio-economic duty.  Despite persistent speculation, the Government has not yet announced any decision on the duty, which, prior to the election, was supported by the Liberal Democrats and opposed by the Conservatives.  One likely outcome is that a decision on implementation will be shelved for some time to come.

Other provisions in the Act which may not be implemented are the use of positive action during recruitment and gender pay reporting.

Guidance on the Act has now been published by ACAS, the EHRC and the Government Equalities Office.