This essay covers assessment criteria for the Level 5 units:
Equality & Diversity in Health & Social Care
By Daniel Dutton (6/11/2019)
Equality, diversity and inclusion are essential components that underpin modern, well-run health and social care services. This essay will examine how organisations can promote and champion these principles by bringing together legislation, models of practice and the agreed ways of working from my own organisation, as well as reflection on my own personal experiences. I will also collate, present and analyse information about the diversity of staff and clients from a small sample within my organisation and explore how risk can be managed when ethical dilemmas between duty of care and an individual’s rights occur.
To begin, it will be useful to provide some definitions. Equality is the right of all individuals to be treated fairly. This does not necessarily mean that everybody should be treated the same, however everybody should be afforded the same opportunities. When individuals are not treated fairly, this is discrimination. The Equality Act 2010 identifies nine ‘protected’ characteristics that it is unlawful to discriminate against. They are sex, sexual orientation, gender reassignment, age, religion/belief, pregnancy/maternity, marriage/civil partnership, race and disability.
Discrimination can be direct (where an individual is treated less favourably because of a protected characteristic) or indirect (where an organisation’s agreed ways of working disadvantage people with protected characteristics). There is also perceived discrimination (where someone is discriminated against because it is assumed they have a protected characteristic) and associated discrimination (where someone is discriminated against because they are associated with an individual or group with a protected characteristic).
Diversity is about recognising and valuing other people’s characteristics such as their background, culture, experiences and skills. When people acknowledge and respect these differences, they can have a greater understanding of one another and work together more effectively.
Inclusion is proactively working to ensure that different groups and individuals are treated fairly, feel socially accepted and have a sense of belonging. This results in them being better able and comfortable to engage with others and feeling valued.
There are several models of practice that can help to promote equality, diversity and inclusion in the workplace. Firstly, everyone should be treated as unique individuals and their differences should be valued and respected. By working in this way, an individual’s specific needs will be recognised and addressed and they will be treated fairly. It is important to note that treating individuals in a fair and equitable way does not mean treating everybody the same. Some actions may need to be modified to cater for an individual’s differences. For example, if an individual is visually impaired, they may require information to be provided in a large text or braille format. Although the action is different, the end result (provision of information) is the same and the individual will have been treated fairly. It is also important to develop an organisational culture that is committed to valuing equality and diversity. Everybody must have access to and be able to understand policies governing these principles and resources should be allocated to allow sufficient training and discussion in this area. In addition, the organisation’s leaders and managers should demonstrate these values in their day-to-day work to provide a positive role model to others. The equal opportunities model was designed to ensure that all workers are treated equitably by their employer with regards to recruitment and promotion. Many organisations have an equal opportunities policy, which can give potential employees confidence that the employer treats equality and discrimination seriously. Employers should also take great care to ensure that their policies and procedures do not discriminate against groups or individuals inadvertently. This should be proactive and consideration of how they may affect different people must be made preemptively.
When policies and ways of working are discriminatory, even if unintentional, they create institutional and organisational barriers to equality and inclusion. The Equality Act 2010 makes it clear that reasonable adjustments that are fit for purpose must be made to remove these barriers. The same applies to physical barriers that may make it impossible or very difficult, for example, for an individual in a wheelchair to access services, such as a meeting room only being accessible by stairs. Of course, organisations are constrained by resources and finances but in this particular case it would be sufficient to include in the policy that an alternative and more accessible option is available for meetings when one or more of the participants have mobility issues. The indirect discrimination that poorly thought-out policies, systems and processes causes can lead to individuals not feeling valued and potential legal implications. In contrast, well developed policies, systems and processes can result in all employees understanding their responsibilities, a positive workplace culture and the promotion of the principles of equality and diversity. It is also important to ensure that there are processes in place to regularly monitor, review and evaluate the effectiveness of the policies and make changes when and where they are necessary. This could be performed by providing employees, clients and partners with a questionnaire to request feedback on how they feel equality, diversity and inclusion is promoted throughout the company. It is also important to ensure that there is a swift, confidential and safe procedure for investigating allegations of discrimination so that individuals do not have to fear reprisals if they report any concerns or have complaints.
Other barriers to equality and diversity are discriminatory beliefs, attitudes and behaviours that people believe are acceptable. These beliefs can often be deeply ingrained from an early age and can lead to prejudice that can result in individuals feeling sad, angry and upset and lower their self-esteem. People may not believe that they are prejudiced, so it is important to challenge it if it is experienced. By doing so, it gives the opportunity for individuals to question their prejudiced beliefs and, on reflection, maybe change their way of thinking. When the perspective is altered, the behaviour can also change and it can lead to a previously prejudiced individual challenging others that hold the same beliefs that they previously did.
As touched upon earlier, the Equality Act 2010 makes discrimination unlawful, however there are other pieces of legislation that also promote equality, diversity and inclusion. The Human Rights Act 1998 sets out a list of freedoms and liberties that all UK citizens can expect. These include the freedom of thought, religion and belief, the freedom of expression and the right to marry and start a family, which back the promotion of a fair and diverse culture. The Mental Capacity Act 2005 empowers individuals that may have limited mental capacity to make as many decisions for themselves as possible, which helps health and social care workers to work in a way that doesn’t discrimination against individuals with mental impairments, whether they are permanent or temporary. For example, all individuals should be assumed to have capacity to make decisions and wherever possible they should be supported to make their own decisions, even unwise choices. Guidance for the Mental Capacity Act 2005 can be found in the Mental Capacity Act 2005 Code of Practice 2007.
The social model of disability also promotes equality, diversity and inclusion. This model promotes the perspective that individuals with disabilities are disabled by societal structures and attitudes rather than their medical condition. This is in contrast to the medical model of disability which promotes the perspective that it is solely the physical or mental impairment that disables an individual. For example, society can discriminate against individuals with disabilities by use of prejudice, labels, being over-protective or by not providing information in an accessible way. Removal of these societal barriers can make a fairer and more equal society as well as promoting independence, choice and control.
The individuals that I work with have learning disabilities and can sometimes be discriminated against when out in the community, which highlights some of the issues that the social model of disability pertains to. They may be stared at or occasionally laughed at. If I can do so safely and without causing undue anxiety for the client, I will challenge these behaviours. It is also a common occurrence for these individuals to be ignored by the sales and service industry – very often shopkeepers and salespeople will direct their questions and conversation at myself rather than the client, even though it is the client that is making the purchase. This highlights some of the general ignorance and lack of training in today’s society. I often manage this by redirecting the question to the client to ask for their opinion and then give them time to answer. I find this to be a polite approach that brings the client into the conversation and sensitively informs the salesperson that the client is more than capable of answering themselves. I also believe that it subtly educates them that people with learning disabilities are able to make decisions and communicate for themselves, without causing embarrassment.
My organisation has an Equality and Human Rights Policy and Procedure, which applies to clients and also incorporates person-centred values. We also have a more general Equality and Diversity Policy and Procedure which applies to both staff and clients. In addition, part of the induction process for new employees includes training on equality and diversity and we have recently completed an Equality & Diversity Action Plan (see Appendix B) with all clients to obtain information and open a dialogue to ensure that we are supporting them correctly and are not inadvertently discriminating against any protected characteristics they may have. Although we have made great strides in terms of equality and diversity within our client base, I believe this could be improved by extending it to our staff. I will be advising our company director that I think more work needs to be done in this area which includes regular refresher training and discussion as well as the periodic collection and analysis of statistical data to ensure that we have a diverse workforce where everybody feels included and is treated fairly.
To investigate the diversity within my own organisation, I have collected and collated data on the age, gender and ethnicity of a small sample of clients and employees. This was collected with each individual’s permission and on the understanding that it would be used solely for statistical purposes and no personally identifiable information will be shared. For this reason, ages have been split into ranges of ten years. Also the ethnicity ‘other’ has been used to group the three unique ethnicities that are not ‘white British’. Graphical representation of this data can be found in Appendix A.
Starting with gender, it is interesting to note that although there is an almost 50/50 split between male (45%) and female (55%) clients, males only make up around 20% of employees. This is mirrored on a national level, with male support staff making up only around 18% of carer staff (Skills for Care, 2017). There are several reasons for this. Care has traditionally been a female-dominated profession and “35% of the public think working in a care home is a ‘woman’s career” (Guardian, 2018). A report by Anchor Hanover Group and the International Longevity Centre (ILC) states that “There is undoubtedly stigma attached to the care sector with the very word ‘caring’ often perceived to be ‘feminine’ in some way” (Franklin, 2014). The report continues by advising that more needs to be done by the care sector to attract males into care roles.
Ethnicity is dominated by white British clients (100%) and employees (89%). This is slightly higher than the national population of white British people, which stands at around 80% (Cabinet Office, 2018) and the 80% of white British people that make up the social care workforce in general (Skills for Care, 2017). This could suggest that my organisation has more work to do in ensuring that staff are represented by a more diverse range of ethnicities.
Diversity is reflected far more in the ages of our employees. Although 46% of the workforce are aged between 25 and 34, we have representatives across all other age ranges. The highest frequency age range for clients is also 25-34 (64%) with representatives also in the 15-24 (27.3%) and 45-54 (9.1%) age ranges.
As a manager, I lead by example and ensure that my own practice models good equality, diversity and inclusion principles. I talk to my staff about the importance of working in an anti-discriminatory and person-centred way and always challenge discrimination when I encounter it. I will also support others to challenge discrimination when the need arises. I have experienced discrimination directly myself on several occasions as a male in female-dominated industry. For example, in a meeting where I was the only male participant we discussed a client that had recently moved into a new property and required a lock fitted to a door. I was asked if I would be able to do it as I was a man. When I challenged the preconceived and false concept that men are inherently good at installation and repair in a respectful and transparent way, I was able to open up a dialogue that helped others to challenge their own prejudices.
This is important because barriers to equality, diversity and inclusion can lead to individuals feeling stigmatised, singled-out and discriminated against. This can result in low confidence, low self esteem, lack of motivation, anxiety and depression.
Equality is very much about tolerance and respecting others, including the decisions that they make. However, there are times when the rights of an individual receiving care are in conflict with a health and social care worker’s duty of care. This may be due to a safeguarding issue where an individual has informed a care worker that they have been abused but do not want them to tell anyone. Usually, the care worker would want to respect the individual’s choice, privacy and confidentiality but when there has been an allegation of abuse it is the worker’s duty of care to pass this information on to the appropriate person (usually their manager) to protect the individual. A general rule is that if there is a likelihood that significant harm would come to an individual or others as the result of an individual’s decision then a care worker must exercise their duty of care in lieu of the individual’s rights.
When making decisions, it is essential that Individuals are able to make an informed choice. This means that they have access to all the information they need to weigh up the different options provided in a medium that they can understand. It also means that they are given enough time to process the information and are able to get answers to any questions they have before they arrive at their decision. It is also important to document the steps that were taken to ensure that an individual can understand the information given to them and retain it long enough to make a decision as well as being able to communicate that decision to others. If an individual is unable to complete any of these steps then they may not have the capacity to make a decision. Where there is doubt of an individual’s capacity, an assessment must be performed and if incapacity is established then a decision may be made on behalf of the individual by others that is in the individual’s best interests.
To manage the risks when balancing individual rights and duty of care, it is essential to have robust systems in place to ensure that best practices are used to ensure positive outcomes for the individual. This means using risk assessments to identify, manage and mitigate risks to the individual and others.
- Cabinet Office (2018). Population of England and Wales. [online] Available at: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/population-of-england-and-wales/latest [Accessed 12 Nov. 2019].
- Equality Act 2010. London: The Stationery Office.
- Franklin (2014). [online] Available at: https://ilcuk.org.uk/wp-content/uploads/2018/10/Future-Care-Workforce-Report.pdf [Accessed 12 Nov. 2019].
- Guardian (2018). ‘Lots of lads I know wouldn’t give it a shot’: the men starting care careers. [online] the Guardian. Available at: https://www.theguardian.com/society/2018/sep/14/men-starting-care-careers [Accessed 12 Nov. 2019].
- Human Rights Act Act 1998. London: The Stationery Office.
- Mental Capacity Act 2005. London: The Stationery Office.
- Skills for Care (2017). What do we know about men working in social care? . [online] Available at: https://www.skillsforcare.org.uk/About/Blog/Article/What-do-we-know-about-men-working-in-social-care.aspx [Accessed 11 Nov. 2019].
- Skills for Care (2017). [online] Available at: https://www.skillsforcare.org.uk/Documents/NMDS-SC-and-intelligence/NMDS-SC/Analysis-pages/State-of-17/State-of-the-adult-social-care-sector-and-workforce-2017.pdf [Accessed 12 Nov. 2019].
Statistical data of gender, age and ethnicity of a sample of 28 Healthcare employees and 11 Healthcare clients, presented as pie charts.
Gender of Staff
Age of Staff
Ethnicity of Staff
Gender of Clients
Age of Clients
Ethnicity of Clients
Appendix B – Equality & Diversity Action Plan
This Equality & Diversity plan is to identify how we support our clients to live a valued life with meaningful life events by ensuring that their protected characteristics do not impact on this. Once completed this information needs to be inputted into the relevant support plan.
|Protected Characteristic||Is this applicable? Yes / No – please explain||How can / do we ensure that the client is supported with this?|
|Age – does the client have the opportunities and valued life experiences for their age?|
|Disability – does the clients disability impact on them accessing work, education, and having valued life experiences? How do we support them to overcome this?|
|Gender reassignment – has the client experienced discrimination or difficulties because of their gender reassignment? How are we ensuring access to opportunities?|
|Marital or civil partnership status – how have we ensured that clients have the same marriage opportunities / valued life experiences as everyone else?|
|Pregnancy / motherhood – has the client experienced any issues in accessing services because of this? How are we supporting the client if they have expressed a wish in the area?|
|Race (including ethnic or national origin, colour and nationality) – how are ensuring the same opportunities and valued life experiences for the client?|
|Religion or Belief (including lack of belief) – how are we promoting the clients cultural needs i.e. attending place of worship, diet, dress, festivals, times of celebration?|
|Sex – how are we ensuring the clients equality for their gender? If in employment, is pay fair & equal?|
|Sexual Orientation – how are we promoting the clients relationships and natural life experiences. Has the client experienced any discrimination based on their sexual orientation choice?|