NHS Policy Audit - working party

[KnottyAuty]

Following on from Thread #23 of the Peggie v NHS Employment Tribunal. Anyone who wants to help with survey/audit of paperwork against the Equality Act protected characteristics please join here 😊

Good grief Umbel, that’s a corker from South West Yorkshire. Is it Stonewall-speak, or original prose the Trust developed by themselves?

Particularly noticed the instructions to staff about what to do following a risk assessment of applying the policy when a trans identified person is admitted on to a ward:

“….action to manage risks, such as reviewing the care plans of all those affected, facilitating discussions with all parties to see if education and understanding about inclusive practices is necessary; for the people using the ward services and the staff working on the ward.
^^
A transgender person should not be moved solely in response to this enhanced risk and if it is deemed necessary to move someone the focus should be on the person exhibiting prejudicial behaviours not the person affected by them.”

It seems a bit sinister to suggest that the care plans of those ‘affected’ should be reviewed: what is this code for - denial of care and immediate discharge for granny if she queries having a fully intact TIM in the bed next to her?

Save button worked for me using 'copy link option', which makes a new URL for the draft. Data is preserved when opening that in a new window.
Iit also offers an email based login, using Microsoft or Google account which I declined. Thanks for doing that (& the rest ofc!)

My other Q - happy to keep it simple.

Tayside have an intimate care policy which has an EqIA at the back. Unfortunately it doesn’t actually address the 9 protected characteristics so it’s a fail. Also while it’s well written the scenario of there being a trans healthcare professional and DU style views isn’t addressed. The way it’s written in theory a woman could be offered a male HCP and a male chaperone but I assume that’s highly unlikely

I haven't found a staff policy but I have found a single sex patient care document. Might be worth looking for that because it was a target for the scottish government until the gender identity stuff was added in. The two approaches crash together really quite violently

"Trans people who have proposed, commenced or completed reassignment of gender should be accommodated according to their presentation (the way they dress, the name and pronouns that they currently use). This may not be the same as their physical/biological sex appearance; it is not dependent on them having a legal name change or gender recognition certificate. Some patients may present as non-binary where they do not identify as either sex, male or female. If this is the case it is best to accommodate them in a single room."

is right up against this:

"A breach occurs when a patient is placed in mixed sex accommodation (out with the exempted areas and exceptional situations listed). This must be reported on the Datix Adverse Event Management System. Reporting must include the numbers of patients affected. Reporting in Datix must use the sub category “single sex policy breach” to enable reports to be obtained from the system.
• All patients and/or their families and carers must receive an apology
immediately the breach occurs and an explanation offered
• The breach and rationale must be clearly documented in the patients nursing
record
• Staff will provide extra personal nursing support to the patient, for example
use a separate quiet room for personal conversations and avoid giving
personal care (for example toileting) in the mixed bay/area where possible
• Patient screens must be available around all individual bed areas. Moveable
screens are not considered adequate for screening on a permanent basis

Edited to add:
"For the purposes of this policy single sex accommodation is defined as when a room or bay is specifically for one sex with washing facilities also available solely for this one sex."

Make it make sense!

While googling for policies on single sex, google ai tells me:

"in the context of single-sex, it's important to note that NHS Scotland provides services for LGBTQ+ individuals, including gender identity clinics and access to gender-affirming care."

Based on this result and these policy documents I'm finding I'd like to suggest that the existential threat is not of concern to trans people. It is clearly the female sex which is being disappeared.

Well, I know how to bag a single room next time in hospital now : just tell em I’m non-binary… the bliss of not having to listen to other people …

You might get your legs waxed while you're in there. Non Binary is where it's at LOL

Sterling work @KnottyAuty
it is indeed jaw-droppingly bad so far

@Bunpea I quite liked this corker:

"8.8 Agreeing the point at which the individual will commence using single sex facilities in their new gender.

The employer and employee should agree the point at which the use of facilities such as changing rooms and toilets should change from one gender to the other. It is advised that the individual starts to use the facilities for their new gender at the point where they begin to live in that gender, irrespective of the progress of surgical procedures.

It is not acceptable to insist that a trans or intersex person uses separate facilities such as a disabled toilet. Under no circumstances should they be expected, after transitioning, to use the facilities of their former gender."

@Bunpea - thanks!
which trust was this - I’ve seen the exact same wording in one of mine. It was wording provided by a trans lobby/training group

@KnottyAuty wow, another blinder!

The example I came across was South West Yorkshire. I haven’t been on their website, this was through google. Hope this link works.
see section 5 .
https://www.southwestyorkshire.nhs.uk/wp-content/uploads/2022/12/1168-Transgender-Equality-PolicyService-Users.docx

It is a swash-bucklingly (if that is a word) confident document.

@KnottyAuty the quote I posted, the one where you recall exact wording, was South Yorkshire, from here: https://www.southwestyorkshire.nhs.uk/wp-content/uploads/2023/01/1109-Trans-and-intersex-equality-policy.docx

SWYT is the MH trust I mentioned earlier that have also removed pretty much all evidence of sex from their EqIAs. They also have this nice graphic of the protected characteristics.

East London NHS FT Transgender inpatients policy https://www.elft.nhs.uk/sites/default/files/Transgender%20Inpatients%20Policy%202.0.pdf

3.3 Transgender people have the right to access single sex wards in accordance with the gender they identify with. They will be involved, as much as is possible, in the admission process with a view to help staff understand what they can do to support the transgender person on the identified ward.

3.4 On the ward, transgender patients will be granted the right to use any spaces, facilities and activities appropriate to their gender identity.

4.8 For non-urgent searches and medical examinations involving intimate contact, the care team will make every effort to provide a member of staff of the preferred gender of the trans service user. If this is not possible a chaperone could be considered.

4.9 The care team will make every effort to ensure that any intimate observation of a trans service user will be performed by a member of staff of the preferred gender choice.

University Hospitals of North Midlands NHS Trust, again, relating to patients, not staff https://www.uhnm.nhs.uk/media/12jhq3q2/20240828-c64-supporting-trans-and-non-binary-patients-foi-ref-342-2425-2-of-2.pdf

7.1.3 The patient should be in a single sexed environment of the gender they have presented as. However, they may prefer not to be placed on a ward of their identified gender so a discussion should take place. The patient may be asked if they prefer the privacy of a side room, if one is available, but this should not be automatic or arranged without their consent.

7.1.4 Non-binary patients should be supported on a single sex ward by, for example: ensuring the correct pronoun is used, g

East Lancashire Hospitals NHS Trust https://elht.nhs.uk/application/files/3217/2503/2591/Support_Trans_Staff_and_Patients_Version_2.pdf

1. Use of Single Sex Facilities Good practice indicates that facilities such as toilets and changing rooms should be accessed according to the full-time presentation of the employee in the new gender role. The line manager, (with the possible support of the People Directorate - HR), and the employee should agree the point at which the use of facilities such as changing rooms and toilets should change from one gender to another.

RDaSH - Patients Trans equality policy https://www.rdash.nhs.uk/policies/patients-trans-equality-policy/

Trans, gender fluid or non-binary persons should be accommodated according to the gender they identify with. This may or may not be related to their current presentation, for example, dress or name and it is important to discuss and clarify with the person when it is appropriate to do so.
It does not depend on their having a gender recognition certificate (GRC) or legal name change. It applies to toilet and bathing facilities.

Colleague Trans equality policy - https://www.rdash.nhs.uk/policies/colleague-trans-equality-policy/

5.1.5 Changing facilities, toilets, and other single sex facilities
The use of changing or toilet facilities should be part of the discussion process with colleagues. An appropriate stage for using the facilities of the new gender is likely to be the change of social gender. Trans people are entitled to use single sex facilities in accordance with their gender.

Birmingham and Solihull MHFT https://www.bsmhft.nhs.uk/wp-content/uploads/2023/09/Trans-and-non-binary-Equality-Policy-for-Employees-FINAL-1.pdf

3.5 Changing facilities, toilets and other single sex facilities Trans people are entitled to use single sex facilities in accordance with their gender. For non binary people, this might mean using gender-neutral or accessible facilities, or using a combination of different facilities. Trans people will never be required to use gender-neutral or accessible toilets unless they wish to do so.

There are dozens and dozens of them - same/similar wording.I'll stop clogging the thread now!

@KnottyAuty Just done my second Scottish trust NHS Grampian, just the fragrant NHS Fife to do tomorrow. Not very much of interest TBH although much of it is very out of date.

Thank you! We will need to scoop these into a survey to store the documents and snips in a format which can be shared - let’s finish Scotland first then get cracking on the English trusts?
great work xx

Brilliant thanks!

that’s probably 5 out of the 14 completed

if anyone is struggling shout out because there are a few volunteers who could lighten your load?

This is a corker - “gender identity at birth” to be recorded and not what is relevant to health issues for recall of individuals for health checks (smear, breast, prostate etc) which would be “sex allocated at birth” surely?!

Are the health statisticians really thinking this through?

digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/submit-data/data-quality-of-protected-characteristics-and-other-vulnerable-groups/gender-identity

@umbel Thanks! these policies sound great for trans people.

Are there accompanying risk assessments (for others affected by the policies) and if so do they seem reasonable?

Some time ago, on another thread I think, someone mentioned the risk assessments they had seen were hopeless, had been created the staff from the Trust’s Pride network and had missed whole sections of the community that were impacted.

@umbel so trans people get first dibs on any available side rooms? doesn’t seem very fair.