Your health

Ethnicity refers to a common group identity based on language, culture, religion or other social characteristics. This means that people define their own ethnicity, that everyone (and not just those in minorities) has ethnicity and that a person’s ethnic identity may change over time. For example some people might describe themselves as Scottish Chinese.

Race is the group you belong to, or are perceived to belong to, in the light of a limited range of physical factors. The term ‘race’ should be used in relation to legislation only and not to describe people who belong to an ethnic group.

The term BME is often used within the public sector. It’s an abbreviated term for Black and Minority Ethnic and is often used to describe people from minority ethnic groups, particular those who have suffered racism or are in the minority because of their skin colour and/or ethnicity.

Racism refers to the combined use of power with racial prejudice (the belief that some races are inferior to others) which leads to the oppression or discrimination of specific racial or ethnic groups.

Racism can be detected through attitudes, processes, behaviours and actions which impact on any ethnic group/s and can lead to differences in education and employment opportunities, living conditions and health. We all have an ethnicity.

The Equality Act is designed to ensure that large public organisations like NHSGGC promote race equality and challenge discrimination on the grounds of race, colour, nationality (including citizenship), ethnic or national origins. We are required to;

1. eliminate unlawful racial discrimination;
2. promote equality of opportunity; and
3. promote good relations between people of different racial groups.

Following is a short film by the Equality & Human Rights Commission titled ‘What is race discrimination?’.

Racism can be intensified by other forms of discrimination, for example on the basis of sex, disability, age and social class.

1. Black African women are six times more likely to die from pregnancy-related causes than white women.
2. Women from the South Asian community are less likely to attend breast cancer screening and only half as likely to accept an invitation to be screened for bowel cancer than members of the non-Asian community.
3. Evidence suggests the health gap between white and black/minority ethnic communities is greater in older people.
4. Over a third of people from minority groups are in poverty after housing costs are taken into account, compared with 17% of the ‘white British’ group

Race and ethnicity affect people’s health in a number of ways. Our ethnic background can affect our susceptibility to certain diseases and conditions. There is also a clear link between discrimination and health and implications for the way in which health services should be provided.

For example:

1. Black and Minority Ethnic Scots are much more likely to live in poverty, with a poverty rate of 38% for  Mixed, Black or Black British people and 34% for the Asian or Asian British community, compared to 18% for White British people. Poverty is a key factor in poor physical and mental health and creates barriers to accessing health & social care services
2. One third of black and minority ethnic people in Scotland report experiencing racial discrimination. Racially motivated hate crimes are the most reported type of hate crime.
3. Gypsy/Travellers are more likely to report long-term health conditions than the general population. They are also twice as likely to report three or more categories of health conditions. 

How we are addressing race issues

‘A Fairer NHSGGC 2020-24’ explains how the organisation is meeting the requirements of equality legislation. This includes demonstrating how we will assess the impact of the measures we have put in place to ensure race equality for service users and staff.

Areas of work include:

Access to Services

National evidence shows the BME community experience additional barriers in accessing health and social care services.

We are currently working intensively with two services – diabetes and pain management/physiotherapy – to improve access for BME patients. The learning from this has helped develop a Equality Sensitive Patient Pathway for NHSGGC as a whole.

Following consultation with staff and patients current actions include –

Review all patient information for readability and accessibility
Develop information routes for those with lower health literacy around pain
Explore how the opt-in service accommodates the needs of those from BME communities specifically
Develop a route for non-English speakers to ask for advice outwith appointment times via direct patient access to telephone interpreting
Understand how therapeutic group work can work best whilst utilising spoken language interpreters.

Perinatal Care

National evidence indicated marginalised groups, in particular, BME pregnant women; women living in poverty and those experiencing gender based violence, fair worse in accessing and using maternity services.

A local baseline research was conducted with patients, maternity and third sector staff to assess current issues for marginalised groups using NHSGGC maternity services. A review of best practice interventions was also carried out. The focus of the work has been to look at the patient journey through maternity and identify any barriers for BME women.

Actions identified so far to address these issues include –

Develop a leaflet in multiple languages to describe each stage of the maternity pathway, how to access support and highlight emergency routes
Explore how to maximise the value of ante natal classes for non-English speakers
Develop training for Maternity Staff on meeting the needs of BME women thnrughout our pathway
Develop a route for non-English speakers to ask for advice outwith appointment times through direct patient access to telephone interpreting.

Interpreting service

Interpreting services address a number of risks for both service users and staff. For example, patients who have a limited understanding of English:

• may not be able to give informed consent
• may not be able to ask questions or seek assistance
• may not be aware of what services are available to them
• may not be able to use medication properly or follow care plans
• may come from cultures with different understandings of health and illness
• may not understand how to use NHS services
• may not understand their rights and responsibilities within the healthcare system

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned.In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHSGGC’s in-house interpreting service provides interpreters to NHS patients on request. The service is available to a wide range of service areas and departments, including hospital wards, outpatient clinics, medical practices, dental surgeries,pharmacies and opticians located throughout the NHSGGC area.

‘Clear to All’ Accessible Information Policy

Effective information and communication are vital for the provision of high-quality services and care. Many of those who access services have difficulty understanding the information provided. An Accessible Information Policy has been produced to ensure that all information can be made available in various languages and formats to meet the needs of our diverse community.

A toolkit for staff has been developed which helps to provide information and support in the development of accessible information for NHS patients, their carers and the public. The toolkit aims to ensure that the material we develop is clear, consistent with NHSGGC guidance, accurate and in everyday language.

Details are available on the ‘Clear to All’ Accessible Information Policy web page.

Briony’s Story

Briony is part of the travelling people’s community and has lived in Scotland all her life.

Briony and her family have lived on the caravan site for 8 of the last 10 years. They were there for three years, moved into a flat for two years, and then have been back at the site for the last five years. When they moved into the flat it was mostly due to her health problems, but they also felt like maybe they would want a change and settle in for a little while. But after a couple of years, they wanted to move back to the caravan site because that is who they are and it was where they wanted to be.

She tells about how it was for her and her family to register with the local surgery when they first moved to the caravan site. There was not just one doctor’s surgery for everyone on the site, so all of the people living there were allocated to different surgeries. Briony herself went around to all of the local surgeries to see if she could register with one, but none would take them on. “They kept telling me ‘you aren’t from this area, so we can’t take you. She had to wait to get a letter from NHS telling her which surgery they had been allocated to and where to go before she could register.

When they moved into the flat, they didn’t have any problem registering with a surgery, and everyone was really nice to her. When asked why she thought there were no problems with getting registered and why they were nice, she says, “Oh, I couldn’t speak for them. But it could because I was in a flat at the time and not from the caravan site. This surgery was one of the ones I went around to when we were first at the caravan site and they said they wouldn’t take us on. But when we were in the flat, they would.

“I‘m still with that surgery now, even though we’ve moved back to the site. And they are still nice”.

Publications

• Amina
• Awaz FM
• Black and Ethnic Minority Infrastructure in Scotland (BEMIS) 
• CEMVO Scotland
• Glasgow Helps
• Govanhill HA
• Scottish Refugee Council

• Find a course | NCL (nclanarkshire.ac.uk)

• Glasgow Kelvin College | Real Opportunities, Real People, Real Glasgow

• Study in Glasgow | Glasgow Clyde College

• City of Glasgow College | Full Time, Part Time, Evening and Weekend College Courses

• Marie trust | Marie Trust (themarietrust.org)

• Nemo Arts – Improving Mental Health and Wellbeing

• Volunteer Glasgow – Services & information on volunteering and engaging volunteers in Glasgow

Restart is an NHSGGC mental health project that works in conjunction with Community Mental Health Teams, in patient and specialist service in the GCHSCP. The main focus of the project is to offer recovery based support to those living with severe and enduring mental health conditions. Trainees are given the opportunity to take part in various vocational training activities.

Each trainee is assigned a Vocational Guidance Counsellor who will work with them to set goals and personal development plans. Trainees will also be able to access support from Psychiatric Nurses and Instructors.

At Restart we can offer individuals the opportunity to:

• Have a greater sense of hope for the future
• Increase self belief and build resilience
• Learn new vocational skills
• Greater feelings of social inclusion
• Support on your recovery journey.

If you wish to refer somebody to Restart project they MUST be a patient in a community mental health team(CMHT) in patient, specialist service or attached to secondary mental health services in GCHSCP. Please refer using our projects referral form – click below for download. 

Referral forms can be returned electronically to the projects email address.

Email: restart.project@ggc.scot.nhs.uk

Client Testimonial

“I came along to Restart to have some structure and work on an interest that I had in Digital Photography, also to be in the company of others as I was feeling isolated. I was struggling on a daily basis feeling down and not having anything to look forward too. Having spent time attending the project and taking part in photography and picture framing I am feeling better both mentally and physically, I have some focus in my life, feel less isolated and my confidence is growing. I would recommend Restart as it takes your mind of your mental health problems, gives you some routine and a sense of purpose”.

Quote by current Restart trainee

Ageism can be very subtle but is common throughout society; it can affect wellbeing, damage confidence and create exclusion. Individuals can be subject to assumptions and different treatment based on their age or perceived age, no matter how old or young they are.

Older people in particular, are subject to stigma, prejudice and social isolation. Older people are often also the poorest in society, and some are vulnerable to abuse. 

Children and young people can also be discriminated against and are viewed with suspicion by society. Their lack of power means that their views are often ignored and they are also vulnerable to abuse.

Discrimination arises either because difference is ignored and therefore people’s needs are not met or difference is recognised but forms the basis of unfavourable treatment or stereotyping.

Age equality means that age should not be used to define or presume anything about the role, value or potential of an individual.

The following video is a short film by the Equality & Human Rights Commission titled ‘What is Age Discrimination’.

Age and Other Protected Characteristics

Age discrimination links to other forms of discrimination- 

• Older people, especially older women are often on low incomes. This is caused by a combination of factors including the state pension not being linked to earnings and women being less likely to have occupational pensions of sufficient level.
• Disability increases with age, especially visual impairment and blindness. 74.25% of those registered blind or partially sighted in Scotland are aged 65 or over.
• Young people may be discriminated from exploring their sexuality and their gender identity by their family, at school or in hospital. LGBTQ+ young people may be less likely to express their sexuality or their gender identity due to fear of discrimination from family, friends and other young people. This can lead to low self-esteem and serious long-term negative health effects e.g. anxiety, depression and feeling suicidal.
• Peer pressure can pressure young people into concealing their religious beliefs or practices, while overt symbols of faith make young people more likely to be victims of religious provocation.
• Ageing may further reduce the ability to communicate for those for whom English is not their first language.
• Teenage women living in areas of highest deprivation are four times more likely to become pregnant than those in the least deprived areas. ; Teenage women from the most deprived areas are more likely to deliver than to terminate their pregnancy. In contrast, those from the least deprived areas are more likely to terminate than to deliver their pregnancy.
• The health of older people in Scotland varies according to social circumstances. The gap in life expectancy between the most affluent and deprived communities has widened significantly in the last 40 years, particularly among males. Life expectancy has either stopped increasing or has decreased in almost all council areas since 2012-2014.
• Emergency hospital admissions as a result of unintentional injury are over 40% higher for children living in the most deprived areas.

Older People

Long life is a sign of good health, and the ageing of the world’s population is an indicator of improving health worldwide. Although there are no specific conditions or illnesses associated with ‘being old’, the older people get the more likely they may be to experience a range of different conditions such as chronic disease, cancer and disability and to experience more than one of these together.

Increased protection for adults at risk of harm or neglect is in place through the Adult Support and Protection (Scotland) Act 2007. While the Act defines adults at risk as those aged 16 years and over, it provides protection to many older people with cognitive impairments such as dementia.

Young People

Healthcare, lifestyle and experience in childhood and adolescence have a significant impact on physical and mental health in later life. Certain conditions particularly affect young people, such as some inherited problems, accidents and injury and sexual and mental health issues, or they may have different experiences of conditions which affect all ages.

The United Nations Convention on the Rights of the Child (UNCRC) is the base standard for children’s rights and sets out the fundamental rights of all children. On 16 March 2021, the Scottish Parliament unanimously passed the United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill (‘the UNCRC Bill’). The UNCRC Bill is a landmark piece of legislation that aims to incorporate the UNCRC into Scots law to the maximum extent of the Scottish Parliament’s powers. We already use the UNCRC as a framework to ensure that we consider children’s rights whenever we take decisions, and to help provide every child with a good start in life and a safe, healthy and happy childhood. It forms the basis of our national approach for supporting children, called Getting it right for every child (GIRFEC). Fulfilling children’s rights is also critical to our commitment to #KeepThePromise that all care experienced children and young people will grow up loved, safe and respected.

All Ages

Traditional assumptions about age related conditions are increasingly being challenged. People with conditions previously associated with childhood, e.g. cystic fibrosis, severe physical disability, are increasingly surviving into adulthood. Similarly, younger people may suffer from conditions previously associated with ‘old age’ such as dementia or the need for social care and support.

Age Discrimination and Health

Age discrimination in health can lead to inappropriate treatment, misdiagnosis or reluctance from patients to get involved with health services. It may take some of the following forms:

• Stereotyping of old age as being automatically linked to ill-health
• Low expectations of older people’s mental capacity, leading to inappropriate behaviour or symptoms not being believed.
• Health or social care support or treatments having upper or lower age limits.
• Lack of support or time for meals, resulting in undernourishment
• Young people being placed in adult wards
• Information not produced with age group in mind
• Judgemental attitudes
• Confidentiality and anonymity not respected
• Abuse or neglect or older or young people, in hospitals, care settings or at home
• Denial of the right to make choices about health and personal affairs

How we are addressing age issues

NHSGGC is working to ensure no-one using our services is discriminated against on grounds of age or any other protected characteristic.

We are also working to raise awareness of the nature of direct and indirect age discrimination and our responsibilities under equalities legislation. We will do this by improving education and training of healthcare professionals on the effects of ageism in clinical care and care settings and by improving patient and carer experience of discharge planning.

Patients aged 81 and older are less likely than younger patients to feel they have been given adequate information about their discharge and what to do about their health if they are worried after leaving hospital. A Fairer NHSGGC 2024-25 highlights our plans to ensure that older people and their carers are routinely involved in discharge planning and decisions as part of person centred care.

This will be supported by the application of the Frontline Equality Assessment Tool (FEAT) which has been designed to assess inequalities sensitive practice within frontline services. This involves checking the patient information collected, how communication support is assessed and knowledge of protected characteristic related issues as well as the impact on discharge planning. Within NHSGGC’s frontline services the use of FEAT will contribute to the recognition and sharing of good practice as well as highlighting where improvements in services can be made.

Overall service planning is increasingly taking account of the changing age profile of the population and the impact this will have on demand for services. Awareness of the need to ensure age equality within our services informs this planning process. However, there are circumstances where a targeted approach to specific age groups is appropriate both when providing services and when consulting and involving individuals. For example, Sandyford sexual health services have been designed to ensure that they are accessible to young people and have the confidence of young people.

Publications

• Age discrimination: key points for the workplace
• Fairer Scotland Older People Framework
• Ethnic Health Inequalities in Later Life
• Later Life UK Factsheet
• That Age Old Question
• UN Convention on Rights of the Child

Websites

• Age Scotland
• Public Health Scotland 
• NHSGGC Public Protection Team
• UNICEF –  Convention on the Rights of the Child
• Research Institute for the Care of Older People (RICE)
• Scottish Public Health Observatory