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 😊

If you'd like someone unidentifiable to submit an FOI on your behalf, PM me. This week has been unexpectedly manic so I haven't made a start on any English trusts, but I am determined to get to it.

that sounds like hard work!

what do they know conceals your address and possibly name if you apply through that site. But maybe don’t bother at this point? It might be worth doing in future but probably a bit much for our quick snapshot.

Alternatively try searching policies on the For Women Scotland website because I’ve picked up some there from their searches.

But don’t worry if it’s not all immediately available - because not being transparent is a major fail. It shouldn’t be necessary for a prospective patient or potential staff member to have to resort to a FOI… regular people should be able to get this information transparently and easily. And what we have found is that it is far from east to know what you’re getting….

Also while I think of it - let me know roughly how long the search plus data entry took you? Some trusts are easier than others so there’s no right answer 😊 thank you xx

An hour or two apiece for the grep -rni 'chief executive' * and similar search steps, plus reading and evaluating and typing.

Multiple hours for the scraping, but that's an unattended overnight task.

An hour or so setting up a VM and starting the scrapes, but that's a trade skill for me so others should expect that to take longer.

not being transparent is a major fail

Yup, as Fife have found out at the expert hands of Ms Cunningham.

I’m sorry I haven’t had a chance to help as I thought I would this week - unforeseen circumstances. I will keep an eye and help if possible later in the week. Well Done everyone

Thanks all for your hard work! 12 into the form and only 2 left which is brilliant for only a week when we are all busy people. The two left are - please shout if you need a hand:

Group 1: Sternly
NHS Ayrshire & Arran

Group 6: TwoLoons
NHS Lothian

In general it seems clear that there are no/few changing room policies to be found and I have only seen one single sex ward policy. However everyone seems to have a transgender staff policy - which look like they have come from a single source. It would be interesting to try to AI it to see if we could find who produced the original - seems a bit of a rip off if all the trusts paid for expert advice on their policy and got biased and unlawful advice, which wasn't bespoke - money for old rope?

NHS Highland seems to have the most up to date policy that I have seen. It has a lot of the same things in it as other areas, but there are signs of softening/understanding about other staff objecting. Although nothing actually that would meet the needs of religious, GC or lesbians. Solution seems to be curtains in showers and changing rooms... And on page 17 an indication of social transitioning for under 18s on work experience which was a bit of a shocker...
https://www.nhshwellbeingatwork.scot.nhs.uk/wp-content/uploads/2025/02/SupportingTransgenderAndNonBinaryStaffWorkplace.pdf

This is also the first EqIA which I have seen also from Highland. Thoughts on balance please? In our non expert opinion does this meet the Public Sector Duty?
https://www.nhshighland.scot.nhs.uk/media/4dabiec4/eqia-supporting-trans-and-non-binary-staff-guidance.pdf

Also came across this report - yet to have a look through but interesting as it seems much more up to date than a lot of the other stuff. https://www.scottishtrans.org/wp-content/uploads/2024/07/Scottish-Trans-and-Nonbinary-Experiences-Research-Report.pdf

Surprising generally that now it is known that the trans population is actually 50% non binary, that most policies assume that trans people will want to make binary gender choices. Odd.

This is also the first EqIA which I have seen also from Highland. Thoughts on balance please? In our non expert opinion does this meet the Public Sector Duty?

No. I think I mentioned on the form that they noted that written responses contained concerns about conflicts between PCs, especially surrounding genuine occupational requirements for female staff, but then there's no detail given about exactly what those concerns are and they aren't mentioned in the bit on p6 where they discuss the impact on the PC of sex.

They've also not even covered the impact of the policy on the PC of religion, which would be very much relevant to changing rooms.

Thanks @KnottyAuty and everyone else for all the hard work!

The Highland policy document is completely delusional. So much emphasis on keeping confidential that a staff member is transitioning or has transitioned, as if it isn’t blindingly obvious to everyone they meet. The administrative gymnastics is ridiculous. I have never understood quite what the point is of a GRC if no-one is allowed to ask to see it, and it’s very existence is a secret.

The impact assessment, in the “who will be impacted” section, considers the impact only on trans and non-binary staff. What about everyone else?
Because it doesn’t consider anyone else, unsurprisingly it finds no negative impacts.
There are a few passing comments about retaining some single sex toilets, but that’s it.
If NHS Fife had done an impact assessment, I expect it would have been something like this one. If Highland continue to use it they can probably expect to end up in a Tribunal too.

I might have missed it, but I didn’t see any consideration of policy implementation costs in either document.

Oh everyone else is considered - read on to find out about all the positive impacts for them.

My favourite is the idea of increased male awareness of menstruation due to sanitary bins in the gents loos. Although I suppose that could very indirectly be a good thing if architects (mostly male) are made to sit of the dreaded box like the rest of us. Might result in off-centering of more loos… But as a benefit it’s a stretch

Also the consultation/EqIA included 3 pro trans groups and no input from other bodies. So I’d like to see what the EHRC have to say about this one. IANAL but I only got a whiff of an attempt at balancing need.

@Bunpea

I might have missed it, but I didn’t see any consideration of policy implementation costs in either document.

If you mean financial costs, I haven’t come across any consideration of that at all in any of the documents I’ve looked at.

@Bunpea @KnottyAuty The EqIA is deeply flawed in my view. It would be usual to present a clear methodology showing the positive and negative impacts identified for all PCs as well as listing the evidence in support of those conclusions. A working group heavily weighted to 'T' plus a 'survey' [the contents of which are not disclosed] is not exactly unbiased. I'd bet a substantial sum, the subject matter expert mentioned is from Stonewall or similar not an expert in EqIAs. A lawyer in court would have a field day!

Indeed. Of course this is public sector.

it would be interesting to see cost considerations from a private sector organisation’s thinking on impact of supporting trans, and then ask why public sector doesn’t also take them into account.

Yes! I’m sure most men think it’s great to have a sanitary bin in their loo, and I really appreciate the extra understanding this will give them 🙈.

Still, bins are increasingly required for stoma and incontinence products, so they need to get used to it.

The British Standards Institute sets the size of toilet cubicles, BS 6465-1:2006, which is the "Sanitary Installations" standard. It’s only guidance but is very influential and is what is followed most of the time in institutional settings. Do you think the committee that came up with this included any women?!

This is going back a bit, but in case you are interested, this came up in my trawl:

FOI re sexual assault in an NHS Lothian hospital:

https://org.nhslothian.scot/foi/wp-content/uploads/sites/22/2025/02/9606.pdf

Summary response for those who don’t want to click through: we don’t have a specific category on DATIX for Sexual Assault or Rape; we do have Sexual Abuse but we don’t consider that to be the same thing so we didn’t look at it. We did a word search but can’t find anything that matches Sexual Assault and Rape. Nothing to provide.

When I had a look at NHS Lothian, Orkney, and Lanarkshire they all mentioned the Highland EqIA - it looks like they have all out-sourced their thinking to the person who wrote that one. Also some of the NHS trusts are so small they don't have their own EDI offer and share the Grampian/Highland one so I think that region is disproportionately influential

Crumbs - so they will record Upton's hate incident which involved use of the words "you are a man you shouldn't be in here" and they don't have a category for rape. You couldn't make this up. Must be NHS wide if they are all using the datix....

Lothian now uploaded.

Just spotted @ThatPithySheep’s comment about the Highland’s Eqia, and to be honest although it was a document that came up when I googled, it wasn’t one that I think I saw explicitly referenced in the Lothian docs I found. It is quite possible I’ve missed a ref to it though - I was going cross-eyed by the end.

Lothian does have its own toilet (non-)policy, which explicitly has not been impact assessed though, so I think we’re ok if we don’t have reference to the Highland Eqia in there.

Well done to all doing this important work. Results so far seem highly depressing for women and girls, but sadly not surprising.

What a waste of our taxpayer money all this focus on one PC (which is a tiny proportion of the population) and ignoring the needs of everyone else.

To answer this point:
The administrative gymnastics is ridiculous. I have never understood quite what the point is of a GRC if no-one is allowed to ask to see it, and it’s very existence is a secret.

I think the administrative gymnastics is the point, creating an Orwellian environment of coercive control where everyone is walking on eggshells in case they commit some form of wrongthink or wrongspeech. And due to that climate of fear, do not oppose the clearly bonkers and harmful policies such as mixed sex (by stealth/ deception) private spaces in the NHS.

I think the most ridiculous thing is that this information is so hard to find, and actually much of the work to determine whether policies comply with the public sector duty of the Equality Act, is simply not done. There is an expectation that allowing men to access single sex female spaces if they wish is completely fine, and no-one in their right mind would have an issue. Rather that it is a marvellous way to make people more tolerant.

I think it’s also an “if you build it they will come” thing. Way back, when the assumption was that maybe one person every few years would apply for a GRC, and they would all look like [the female actress who played a transwoman in whatever that soap was] so no one would ever, ever guess that they weren’t a real woman, then it was seen as “kinder” to not out said person to their community.

But as has been pointed out before, if you create a sacred caste, then “they will come” - anyone who wants to operate without oversight or accountability will want to have a piece of the lovely, lovely privacy provided by a GRC. It’s a bonus that the obfuscating language breaks down people’s natural resistance to, eg, men in women’s bathrooms. You get to operate in secret, and people are so confused about it they either outright support you, or they are too scared to not support you.

Precisely! Like having tampons in men’s bathrooms - that will make men think about periods every time they see them! Such a positive and important thing to do! So marvellous! So kind!

🤮

Also yes, none of this should be hard to find. It should be front and centre.

Speaking of which, @KnottyAuty, I’d say it took me 3-4 full days to put together my report.

Big thanks to Knotty for pulling this all together. It has been a lot of work approx 12 hours from me I think. I was surprised how poorly some of the websites are organised and how out of date policies were on some of them. It certainly made the task more difficult.

if architects (mostly male) are made to sit of the dreaded box like the rest of us. Might result in off-centering of more loos…

😂😂😂 We can only hope.

I think it would be a proportionate means of achieving a legitimate aim for it to be a legal requirement that women's loos be designed by women.

I hate to tell you - many of them are - it's the Architect's Metric Handbook that is the problem... the ladies loos don't mention the necessary asymmetric layout and the gents don't mention avoiding putting the (rusty) radiator next to the urinal. Apparently there are bugbears in the gents too - the radiator is pee splashed and rank. Maybe accounts for the perma-stink