Executive summary

Each public sector body is required by the specific requirements of the Public Sector Equality Duty to publish data annually to show it is compliant with the general aims of the Duty.  As an organisation we have due regard to our commitments, both as an employer and as a service provider.

University Hospitals Birmingham (UHB) is committed to creating an inclusive environment by eliminating any form of discrimination and by building a workforce which is effective, motivated and supported and whose diversity is valued. By ensuring that our workforce reflects the local population the Trust will be better placed to meet the healthcare needs of all those who use its services. The Trust is committed to raising awareness of diversity to ensure equality of opportunity across the broad range of difference that characterises individuals, and to establish a supportive working environment where everyone is valued equally and treated with dignity and respect. The Trust believes that this commitment will lead to improved healthcare outcomes for our patients.

Aims of the report

The purpose of this report is to publish Information to demonstrate the UHB compliance with the Equality Duty, as well as to inform on progress against the equality objectives set out in last year’s report and identify areas for improvement in 2019/20.

This report aims to present the main aspects of patient activity and workforce data. In relation to workforce the data will include workforce demographics, recruitment and selection, NHS Staff Survey, employee relations (disciplinary and grievance), leavers data and staff representation across the protected groups, where this data is available. The report helps us to identify potential disadvantages for any protected groups and to agree further actions. It should be noted that any comparisons or data relating to the NHS Staff Survey are based on responses to the 2018 Survey.

The report outlines Trust wide equality activity undertaken in patient care areas and data/information collated against protected characteristics in the following areas;

• Patient activity in in-patient, out-patient, A&E and maternity areas
• Satisfaction with hospital services and complaints
• Engagement exercises and feedback
• Interpreting and translation services
• Meeting cultural and religious needs of patients/service users
• Equality Impact Assessment of policies

The information contained in the report is collated by the Trust’s Workforce Diversity and Inclusion Manager and the Service User Inclusion Manager, supported by the Workforce Information and Analysis Team, and presented to the appropriate Committees for review. 

The evidence collation shows how the Trust is meeting its Public Sector Equality Duty requirements and implementing the Equality Delivery System Framework Plan.  

The Trust is committed to compliance with the Public Sector Equality Duty supported by specific duties, set out in regulations which came into force on 10 September 2011. The specific duties require public bodies to publish relevant, proportionate information demonstrating their compliance with the Equality Duty; and to set themselves specific, measurable Equality Objectives.

The Trust has used the Equality Delivery System (EDS) toolkit which has been designed to help NHS Organisations to meet the requirements of the Public Sector Equality Duty. The EDS toolkit supports NHS organisations to identify areas for improvement.

Trust equality objectives 2016 – 2020

The EDS toolkit is structured around 4 Goals:

• Goal 1: Better health outcomes for all.
• Goal 2: Improved patient access and experience.
• Goal 3: Empowered, engaged and included staff.
• Goal 4: Inclusive leadership at all levels.

The Trust has developed and agreed 4 Equality Objectives for 2016 to 2020. These objectives are monitored and the progress is reviewed annually and revised at four yearly intervals in line with equality legislation.

The Trust`s Equality Objectives for 2016 to 2020 are:

In March 2018 the Trust undertook an assessment of performance against the EDS2 Trust Equality objectives in order to arrive at our 2018 scores. The Trust obtained feedback from key stakeholders. An action plan was developed to address gaps and areas for improvement.

Monitoring

Monitoring and review of the Equality Data will be through the delivery and implementation of the WRES and Stonewall Workplace Equality Index, and soon to be WDES as of October 2019, with bi-monthly updates to the Trust’s Inclusion Steering Group.

EDS2 progress is reported via the updates to the EDS2 Action Plan to the Trust Board and CCG on a 6 monthly basis.

Progress will also be reviewed annually within the Trust’s Equality and Diversity Annual Workforce and Service Monitoring Reports.

1.0 Equality duty and public sector equality duty

1.1 Introduction

The Equality Act 2010 came into force on the 1^st October 2010, replacing the previous anti-discrimination legislation in the UK.

Public sector organisations have specific responsibilities under the Act, namely the Public Sector Equality Duty (PSED) that came into force on the 6^th April 2011.  It consists of a general duty comprising 3 main aims and specific duties.

The purpose of the Equality Duty is to embed equality considerations into the day-to-day work of public bodies. 

The Equality Duty covers the following protected characteristics:

• Age
• Disability
• Gender Identity
• Pregnancy and maternity
• Race (includes ethnic or national origins, colour or nationality)
• Religion or belief (includes no belief)
• Sex
• Sexual orientation
• Marriage and civil partnerships are protected characteristics under the Act, however, under the Duty organisations only have to have due regard to the need to eliminate discrimination.

1.2 The general duty

Under the General Duty public bodies are required to have due regard to the need to:

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Equality Act 2010.
• Advance equality of opportunity between people from different groups
• Foster good relations between people from different groups
• Meet the needs of people with protected characteristics and reduce or eliminate the disadvantage that such groups may suffer.

1.3 The specific duties

These duties require public bodies to set specific, measurable equality objectives and to publish information regarding their performance on equality.  The information that needs to be published is as follows:

• Equality objectives, at least every four years
• Information to demonstrate compliance with the Equality Duty, at least annually

2.0 Workforce monitoring and information

The Equality Act requires employers with 150 plus employees to produce and monitor data on their workforce to demonstrate that they can show compliance with the Public Sector Equality Duty. Workforce equality monitoring data is collected when an individual commences employment at UHB, although staff can opt out of this.

The workforce profile is based on the Trusts staff in post data as at September 2018. Staff survey information is based on the 2018 Staff Survey analysis. Population data is based on the 2011 Census. Where available, data is compared to that produced for the previous year. Selected data has been included within this report to illustrate each protected characteristic. Further data is available in the accompanying workforce profiles.

2.1 Ethnicity profile

When combined proportionately for the Trust, the overall BAME population is calculated as 29.8%. This is a slight decrease on the previous year.

Consideration must be given to the variance in local population demographics which surround each of the hospital sites. For instance, local population data shows that for the hospital sites at Good Hope and Solihull the BAME workforce population is considerably higher than the local BAME population, whereas the opposite is the case for the Heartlands site. This is being picked up through the Workforce Race Equality Standard (WRES) report to address the BAME underrepresentation throughout the workforce with a focus on the attraction, selection and retention of BAME staff.

Ethnicity profile by staff group

In regards to staff group, the overall picture of BAME representation in the workforce has not altered from the previous year. BAME representation is high across certain groups, such as, Medical and Dental 53.2%. However, there are still areas in the Trust where there is low BAME representation, such as Allied Health Professionals 21.8%.

The overall BAME workforce population across the Trust stands at 29.8%. From the data taken from Electronic Staff Records (ESR) it can be seen that BAME staff are overrepresented at Band 5 with 39.2%. This is a similar picture throughout the Medical grades with 57.7% of Junior Doctors are BAME. The data also illustrates that within the unqualified Bands 1- 4, the percentage of BAME staff at Band 4 is greatly reduced from the percentage of BAME staff at Bands 1, 2 and 3. The same pattern is seen within Bands 5 to 9 with 39.2% of BAME staff at Band 5 and the percentage reducing as the pay bands rise to Band 6, 27%, Band 7, 18%, Band 8a, 17%, Band 8b, 12%, Band 8c, 8%, Band 8d, 7%, Band 9, 0%.

Data for Senior Managers in the Trust show 7.9% to be of a BAME background.

BAME underrepresentation in the workforce across the staff groups is being addressed through the actions in the WRES report and by profiling the career progression of prominent BAME staff throughout the Trust. The WRES 2018 report includes an action to formalise the "acting up’ process for all positions in the Trust which will ensure the routes for career progression are fair and will reduce any possible discrimination. The Trust has also made a commitment to implement unconscious bias training for staff, in particular, managers throughout the Trust, as well as, promoting NHS Leadership Academy’s Stepping Up and Ready Now Leadership Programmes to all BAME staff.

2.2 Recruitment and selection analysis by ethnicity

Recruitment and selection activity from September 2017 to September 2018 was analysed in order to understand the percentage of applications, shortlisted and appointed by ethnicity. It can be seen that throughout this period there has been more BAME applications (55%) than White applications, (45%) for all positions across the Trust

However, the figures show that despite there being more BAME applicants than white applicants during this period, the numbers appear to even out at the point of shortlisting with 48% BAME candidates shortlisted and 52% White candidates shortlisted. Yet despite the relative even number of BAME and White candidates shortlisted there appears to be twice as many White candidates appointed with 3080 (64%) White appointments compared to 1702 (36%) BAME appointments.

The disparity between BAME and White candidates appointed has been recognised in the WRES 2018 report as an area in need of improvement for the Trust. The report highlights that the relative likelihood of White staff being appointed from shortlisting compared to BAME staff is 1.58 times greater. This is a slight improvement on the previous year of 1.60% in 2017.

This is being addressed through the action in the WRES report 2018 to review the Trust’s Recruitment and Selection process. The Trust will be exploring options to introduce Unconscious Bias training to all managers in the Trust, including as part of the Recruitment and Selection training, to reduce any possible bias and discriminatory behaviours.

It is mandated by the Trust that all "hiring managers attend the Trust’s recruitment and selection training before undertaking any recruitment activity in their departments. In addition, all interview panels, regardless of band or position, must consist of at least 3 panellists and one must be "external to the recruiting department. This is to provide cognitive diversity and to ensure decisions are challenged where necessary. Furthermore, the Recruitment Manager conducts a regular monthly audit on a random selection of recruitment files to ensure the correct process has been followed and a report of the audit findings is presented to the Director of HR. This recently introduced initiative has sent out a strong message to hiring managers that the Trust takes recruitment and selection very seriously and that scrutiny will be paid to ensure that a fair and evidence based process, without bias, has been followed.

In addition, following the success of the Trust’s Black History Month Conference, a new initiative called "Aspire has been established. Aspire will form part of a much broader inclusion strategy and aims to support professional development and good recruitment practices at all levels of the organisation. Open to any internal candidate who feels they would benefit, with a particular emphasis on candidates from under-represented groups, or who have accessed the careers clinics, this new initiative will coach internal candidates prior to their interview and support interview panels with good recruitment practices.  This is part of a holistic approach to leadership and professional development and our commitment to a positive and inclusive working culture.

2.3 Leavers

Data taken from ESR for leavers from April 2018 to January 2019 split by ethnicity shows that 33% of leavers were BAME and 67% were White. However, it needs to be noted that the overall percentage of BAME employees within the Trust is 29.8% and therefore the percentage of BAME leavers is higher than the proportion of BAME staff in the workforce, which is a recurring theme year on year.

As part of the Trust-wide policy review a revised leaver’s policy has been launched to include a more robust exit interview process for all staff. The exit interview data is reported on a quarterly basis to the Human Resources Managers and monitored as a KPI. Any trends or areas of concern are escalated to the appropriate Senior Managers.

2.4 Employee relations indicators

Data taken from ESR shows the proportion of disciplinary and grievance cases by ethnicity as of September 2018. Disciplinary cases are proportionately higher for BAME staff when compared to the workforce profile. It can be seen that BAME staff make up almost 38% of the disciplinary cases and 40% of grievance cases even though the overall percentage of BAME employees within the Trust is 29.8%. This analysis can be broken down further to show the percentage of disciplinary cases split by gender and ethnicity. During this period 38% of disciplinary cases were BAME female compared to 62% White females. Likewise, 29% of disciplinary cases were BAME male compared to 71% White male. Brief analysis of the data shows the gender split for disciplinary cases for BAME females is disproportionate to the overall BAME representation in the workforce.

The WRES 2018 report states that the likelihood of BAME staff entering the disciplinary process was 1.29 times greater than that of White staff. This is an improvement on the position in WRES 2017 when the likelihood was 1.90 times greater.

The overrepresentation of BAME staff entering the formal disciplinary and grievance process has been analysed as part of the WRES 2018, and in an attempt to address this, the Trust will be offering Unconscious Bias training to all staff, in particular managers, to raise awareness of the biases which can occur both consciously and unconsciously in our day to day work. The Trust has also incorporated unconscious bias into the HR Masterclass training received by managers, including Disciplinary and Grievance training.

The Trust has established a senior review panel for all employee relations casework which will review any cases which either involve an individual with a key protected characteristic or where the case relates to a protected characteristic. It will involve us reviewing allegations and initial facts before any casework is commissioned to determine whether formal action is justified and equitable, and there will be fortnightly reviewing of any cases that are commissioned. The panel includes Executive for Workforce, Human Resources Director and Deputies.

2.6 National Staff Survey results

In response to the questions in the 2018 National Staff Survey, the most notable differences between White and BAME staff were:

• 65% BAME staff responded that they often look forward to going to work, compared to 54% of White staff.
• BAME staff reported a more positive appraisal experience compared to White staff:

Appraisal/review definitely helped me improve how I do my job (37% BAME / 18% White)

Clear work objectives definitely agreed during appraisal (44% BAME / 30% White)

Appraisal/performance review: definitely left feeling work is valued (39% BAME / 27% White)

• Appraisal/performance review: training, learning or development needs identified (76% BAME / 65% White)
• 15% of BAME staff said that they had experienced discrimination from patients/services users, compared to 4% of White staff.
• WRES tells us that disciplinarycasesareproportionatelyhigherforBAME staff when compared to the workforce profile.ThelikelihoodofaBAME employee entering the disciplinary process is 1.29 times greater than that of a White employee. However, this is an improvement on the previous year. Also, there is a disparity in the recruitment and selection figures with the relative likelihood of appointing the white candidate at 1.58%
• TheoverallnumberofBAME staff in post at the Trust is not reflective of the local population. This position has not changed significantly since the last report.BAME staff are underrepresented in most pay bands, with the exception of Junior Medical, Senior Medics and Qualified Nursing.ThereisparticularlylowBAME representation in the higher bands and Senior Management.

2.7 Ethnicity - observations

Overall the picture on ethnicity gives some mixed outcomes:

• WRES tells us that disciplinary cases are proportionately higherforBAME staff when compared to the workforce profile. The likelihood ofaBAME employee entering the disciplinary process is 1.29 times greater than that of a White employee. However, this is an improvement on the previous year. Also, there is a disparity in the recruitment and selection figures with the relative likelihood of appointing the white candidate at 1.58%
• The overall number of BAME staff in post at the Trust is not reflective of the local population. This position has not changed significantly since the last report. BAME staff are underrepresented in most pay bands, with the exception of Junior Medical, Senior Medics and Qualified Nursing. There is particularly low BAME representation in the higher bands and Senior Management.
• BAME staff responded more positively to several staff survey questions, but responded less positively to whether the Trust acts fairly on career progression (69% BAME / 86% White)

3.0 Gender

3.1 Staff in post

Data taken from ESR illustrates the workforce population split by pay band and gender. Overall the female workforce population in the Trust is 76% compared to 24% male. This percentage split of 70/30 has remained constant for many years and is representative of the workforce gender split across the NHS nationally.

When viewing the percentages of the female population within each of the pay bands, the Trust wide overall figure of 76% is broadly representative for pay band 2 at 87.1% through to Band 8a at 83%, Band 3 82%, Band 4 at 84%, Band 5 at 86%, band 6 at 83%, Band 7 at 80%. However, from Band 8a onwards we start to see the percentage of females in the workforce steadily drop from Band 8a at 72%, Band 8b at 62%, Band 8c at 66%, Band 8d at 29% and Band 9 at 50% (However, at band 9 this equates to only 4 members of staff).

A brief analysis of Senior Managers shows that 45% of this group are female. However, it is important to note that this equates to 36 females and 44 males in the SMP pay scale in 2018.

It has been noted that within the Junior Medics 51% are female compared to 49% are males, which is reflective of the national figures. However, at Consultant level this drops to 29% are females and 71% are males.

3.2 Recruitment

Data taken from NHS Jobs illustrates the recruitment outcomes in the Trust by gender from September 2017 to September 2018. The overall percentage of applications for positions within the Trust has remained steady with 73% of applicants being female and 27% being male. This is a contributing factor the high proportion of female staff within the Trust.

During the period the data suggests that male applicants overall were less likely to be shortlisted than female applicants. Of the 27% male applicants only 23% were shortlisted and 22% were appointed. This is compared to 77% of female applicants shortlisted and 78% were appointed.

3.3 Promotions

Data taken from NHS Jobs and ESR provides the number and percentage of promotions from September 2017 to September 2018 split by gender and ethnicity. As of September 2018 some 80% of promotions were to female staff, which reflects the overall Trust wide proportion of females in post. In total there were 638 promotions recorded and of this figure 126 promotions secured by males. It can be seen that only 25% of the promotions during this period of time were gained by BAME staff. Of the total number of females who were promoted during that time 21% of the females were from a BAME background. These figures have not significantly changed from the previous years.

The data in relation to promotions can be analysed further to show the pay band of the employee when they achieved a promotion. Although the sample size of the male population being examined is smaller than the female population, it is interesting to note that when comparing the data for promotions within Band 5 and Band 6 there appears to be a greater likelihood that male BAME staff will be promoted compared to female BAME staff.

A brief analysis of Senior Manager promotions (band 8a and above) shows that 24 staff gained a promotion during this period of time, only 2 of whom were BAME.

It is important to note that the significant number of promotions at band 2 are attributed to nursing staff commencing with the Trust at band 2 and then appointed substantially at band 5 upon obtaining their PIN.

Further analysis into Nursing and Midwifery promotions at Heartlands, Good Hope and Solihull (HGS) and QE from 1 January 2017 to 31 October 2018 shows that at HGS on average it took the White member of staff 51.2 months at band 5 before being promoted to band 6. However, on average it took the BAME member of staff 115.7 months at 5 before being promoted to band 6. At QE on average it took the White member of staff 76.8 months at band 5 before being promoted to band 6.  On average it took the BAME member of staff 114.5 months at band 5 before being promoted to band 6.

Although caution must be paid to the low numbers, this evidence would suggest that BAME band 5 are taking twice as long as White staff before being promoted to band 6.

3.4 Leavers

49% of female leavers are white and 19% are BAME. Likewise, 33% of all leavers are from BAME origin which is above the percentage of the total number of BAME staff in the workforce at 29%.

The percentage of females leaving the Trust has remained steady at 68%. This is representative of the overall Trust wide proportion of female staff in post. Conversely 32% of leavers were male, higher than the overall Trust wide proportion of male staff in post. The Trust has recently reviewed and revised its Leavers Policy which includes a more robust exit interview process in order to ascertain the reasons behind the person leaving and to address any areas of concern.

3.5 Employee relations indicators

Data taken from ESR shows the percentage of disciplinary and grievance cases by gender as of September 2018. The most notable difference relates to what appears to be a disproportionate number of male staff undergoing disciplinary action, 29% compared to 71% female and in context with the 80% to 20% ratio of female to male staff. Likewise 24% of grievances relate to male staff compared to 73% female staff. Interestingly, although the numbers are very small, 100% of cases whereby staff have reported receiving harassment during this period have been made by female staff.

3.6 National Staff Survey results

In relation to gender, the most notable differences between Males and Females were:

• In last 3 months, have come to work when not feeling well enough to perform duties (52% Male / 60% Female)
• Last experience of harassment/bullying/abuse reported (36% Male / 46% Female)
• Involved in deciding changes that affect work (55% Male / 50% Female)

3.7 Gender pay gap

Equal pay deals with the pay differences between men and women who carry out the same jobs, similar jobs or work of equal value. It is unlawful to pay people unequally because they are a man or a woman.

The gender pay gap shows the difference in the average pay between all men and women in a workforce. It is a legal requirement to publish the first report on the Trust’s website and the Government Equalities Department, Gender Pay Gap portal by 31 March 2018, and by 31 March thereafter.

Observations from the Gender Pay Gap Report 2019 (Queen Elizabeth Hospital Birmingham):

• In terms of mean pay, males received £5.96/hr more than females, a pay gap of 28.74%. When comparing median pay, males received £1.89/hr more than females, a pay gap of 12.62%.
• Females were over-represented in the 2nd and 3rd pay quartiles (78.49% and 79.16% respectively) and under-represented in the 4th Pay quartile (57.62%), compared to the proportion of women in the workforce (72.12%).
• 2.95% of the total workforce received a bonus payment, with 0.96% of females receiving a bonus and 4.89% of males. Mean bonus pay for males was £10,104.14 more than females and median bonus pay was £6,893.39 more for males than females.

Observations from the Gender Pay Gap Report 2019 (Hearltands, Good Hope and Solihull Hospitals):

• In terms of mean pay, males received £5.91/hr more than females, a pay gap of 28.25%. When comparing median pay, males received £1.80/hr more than females, a pay gap of 11.75%.
• Females were over-represented in the 2nd and 3rd pay quartiles (86.25% and 84.19% respectively) and under-represented in the 4th Pay quartile (68.46%), compared to the proportion of women in the workforce (79.66%).
• 2.01% of the total workforce received a bonus payment, with 0.53% of females receiving a bonus and 4.73% of males. Mean bonus pay for males was £3,318.07 more than females and median bonus pay was £3,491.15 more for males than females.

3.8 Gender - observations

• When viewing the percentages of the female population within the Medical grades, female make up 51% of the Junior Medics. It is worth noting that 29% of females are Consultants.
• In Bands 2 – 7 the proportion of females averages at 80% of the workforce. However, at Band 8a this drops to 72%, Band 8b at 68%, Band 8c at 67%, Band 8d at 29%, Band 9 at 50% (however, band 9 equates to only 4 people) and Senior Managers at 45%. This is despite females making up 76% of the total workforce.
• Whilst the NHS has a predominantly female workforce, the male workforce remains steady at around 24%. This also reflects the national figures of men 23% and women 77% of the NHS workforce.

4.0 Disability

4.1 Staff in post

Data produced by NHS Employers states that 9.15% of the Birmingham and Solihull Local Authority declared they had a disability. Information taken from ESR shows that 2.6% of staff (539 employees) has stated that they have a disability.  However, there remains a high percentage of staff 19.9% (4095) where disability status is unknown or not declared.

Information from the 2018 National Staff Survey shows that 1051 staff declared they had a disability (16.5%) of respondents indicated that they have a disability, suggesting that more staff have a disability than we have recorded on ESR, and also suggests staff are more likely to declare to have a disability via an anonymous source.

In 2017 the HGS undertook a data cleanse exercise to address the high percentage of staff where disability status is unknown and to improve the overall quality of the data which is recorded on Electronic Staff Records (ESR). As a result of the success of the data cleanse exercise there has been a reduction in the number of staff records which state "not declared for disability from 23.4% in 2015 to 17.3% in 2017. There are plans to repeat this exercise in 2019 for the whole of UHB.

Data taken from ESR shows the percentage of staff recorded as having a disability by grade.  The data in 2018 is consistent with the previous year, with disabled employees least represented within the medical grades, with only 7 Consultants declaring a disability. The same is true for senior managers from band 8a and above with only 12 employees declaring they have a disability.

The only two pay bands to have no known disabled employees are band 8c with 81 members of staff in total and band 9 with 4 members of staff in total. Further analysis of the data has been carried out to include the staff group and identifies which groups have gaps in the data in relation to disability. The data shows there appears to be trends between staff groups where certain protected characteristic, including disability, has been undeclared.

4.2 Recruitment and selection

Data taken from NHS Jobs shows the passage of disabled candidates from application to shortlisted to appointed from April 2018 to December 2018. Although the data shows the percentage of disabled candidates at application to be 3.95% (3363 people) and shortlisted 3.97% (1165 people) stages, the percentage of disabled staff appointed is only 2.58% which represents 127 appointees.

The Trust recognises this is an area in need of improvement and in the same way as the Trust reports on progress in relation to ethnicity through the Workforce Race Equality Standard (WRES), the Trust will also be reporting on progress in relation to the experiences of our staff with a disability through the Workforce Disability Standard (WDES) when it is implemented nationally in October 2019 and a plan of actions for improvement will be initiated through this report.

The Trust is also committed to the Disability Confident Scheme which aims to attract, recruit and retain people with a disability. Currently the Trust holds "Committed status with the scheme and plans are in place for this to be upgraded to "Employer" status in 2019/20.

4.3 National Staff Survey results

The 2018 National Staff Survey highlights some differences between disabled and non-disabled staff:

• Not experienced harassment, bullying or abuse from patients in the last 12 months (70% Disabled Staff / 76% Non-Disabled Staff)
• Not experienced harassment, bullying or abuse from managers in the last 12 months (80% Disabled Staff / 88% Non-Disabled Staff)
• Not experienced harassment, bullying or abuse from colleagues in the last 12 months (71% Disabled Staff / 83% Non-Disabled Staff
• Reported harassment, bullying or abuse (43% Disabled Staff / 44% Non-Disabled Staff)
• Organisation acts fairly on career progression (72% Disabled Staff / 84% Non-Disabled Staff)
• Not felt pressure to attend work when feeling unwell (64% Disabled Staff / 75% Non-Disabled Staff)
• Satisfied with the extent the organisation values my work (36% Disabled Staff / 48% Non-Disabled Staff)
• Disability: Organisation made adequate adjustments to enable me to carry out work (70% Disabled Staff)
• Staff Engagement Score (6.5% Disabled Staff / 7.1% Non-Disabled Staff)

4.4 Disability - observations

• The workforce comparison against the local population suggests under reporting of disabilities. Although the position has improved through the data cleanse exercises carried out in 2017 at HGS there is still work to be done to improve the data which is recorded on ESR in relation to staff with a disability. This is highlighted by 16.5% (1051 staff) of those staff who completed the 2018 National Staff Survey declared they have a disability compared to 2.6% of staff (539 employees) on ESR.
• Further investigation is required into the relatively low proportion of disabled recruits. The Trust will report via WDES on the planned actions to improve the attraction, recruitment and retention of people with a disability.
• There are some notable differences within national staff survey results, in particular, the organisation acts fairly on career progression (72% Disabled Staff / 84% Non-Disabled Staff) warranting further investigation.

5.0 Age

5.1 Age profile

Data taken from ESR compares the age profile of the workforce across the Trust in 2018. The overall profile for the Trust remains largely unchanged over the past two years with around two thirds of staff falling within the age range 26-50. Almost a third of staff (28.2%) are aged over 50, with 6.4% of staff in the age bands 61 to 65 and 66 plus.

It is to be noted that across the age bands 26 to 55 there is an even distribution of staff throughout the workforce, averaging at 12% for each age band. This is constant with the data from previous years.

Further analysis of the data allows for comparisons between the age bands of each of the staff groups. For example, within the staff group Administration and Clerical the majority of staff are aged between 46 and 55, whilst within the staff group Allied Health Professionals the majority are aged between 26 and 35. This is constant with the data from previous years.

It is to be noted that 23% of Qualified Nursing and Midwifery staff are aged over 50 with 10% aged over 55, which although stays the same as last year, it does represent a rise over 7 of the last 8 years. Again this is constant year on year.

Around 47% of Estates and Ancillary staff are aged over 50, which remains constant year on year. Whilst there are no current issues recruiting into these roles, pro-active management within this area, supporting development opportunities for current staff to acquire new skills means that staff are better placed to apply for future roles within the organisation when they become available. In addition, an apprenticeship scheme has been implemented.

5.2 Recruitment

Data taken from NHS Jobs shows the recruitment percentages by age. Initial analysis indicates that applicants aged between 25-29 make up 24% of the total number of applicants during that year and were more likely to be appointed in proportion to the number of applications made in that age band.

It can be seen from the data that within the age band, 20 to 29, the percentage of applications (41.8%) make up almost half of the total number of applicants that year and of those 40.1% are appointed.

In the age range 40 to 49, despite there being a lower percentage of applicants at 15.7%, of those applicants 17.3% were appointed.

5.3 Leavers

Data taken from ESR shows the percentage of leavers by age band.  As of December 2018 it can be seen that almost half of all leavers (46%) were aged 35 or under. Analysis conducted recently has highlighted retention as an issue for Band 5 nurses under the age of 30. As result, a project team has been established to look at ways of improving retention for this staff group.

5.4 National Staff Survey

Some noticeable differences based on age within the 2018 national staff survey include:

5.5 Age - observations

With the change in the law relating to age in employment and pensions it may be that more staff will choose to work longer. The Trust needs to be aware of this and to plan accordingly.

6.0 Sexual orientation

6.1 Staff profile

Data taken from ESR shows the reporting of sexual orientation across the workforce. In 2017 HGS undertook a data cleanse exercise to address the high percentage of staff where sexual orientation status is unknown and to improve the overall quality of the data which is recorded on Electronic Staff Records (ESR).  

According to ESR, 1.2% of the workforce has identified as Lesbian, Gay, Bisexual, however, 3.2% (210 staff) of the total number of respondents who completed the National Staff Survey 2018 identified as LGB, suggesting that more staff within the Trust identify as LGB than we have recorded on ESR, and also suggests staff are more likely to declare their sexual orientation via an anonymous source.

However, 32.9% of staff who were asked their sexual orientation declined to provide a response. Further analysis is required to ascertain the reasons behind why these staff would prefer not to say.

Data taken from ESR allows the Trust to understand better the sexual orientation of the workforce   by staff group. As at December 2018 it can be seen that 1709 Nursing and Midwifery staff and 1241 Medical and Dental staff have chosen not to declare their sexual orientation. Also 1188 Additional Clinical Services staff and 1280 Administration and Clerical staff are also "undeclared" which shows a trend between sexual orientation, religion and belief and disability being undeclared and for these staff groups.

In 2016 the Trust joined Stonewall’s Diversity Champions program and for the first time submitted to the Workplace Equality Index (WEI). In the 2016 WEI results the Trust was ranked 328 out of 439 organisations which took part. In response the results the Trust implemented a plan of actions over the following 12 months in order to address the areas which were highlighted as in need of improvement and development. The Trust invested in a suite of specific training from Birmingham LGBT in order to improve staff understanding and raise awareness of sexual orientation and gender identity. To celebrate LGBT History Month in February 2018 and 2019 the Trust held a Sexual Orientation and Gender Identity Conference with a line-up of prominent guest speakers. A combination of implementing LGBT specific initiatives throughout the Trust and the introduction of a policy to support individuals who are Trans for patients and staff, has resulted in the Trust rising a staggering 192 places up the WEI in 2017, to be ranked 136 out of 434 organisations, to entering Stonewall’s Top 100 Inclusive Employers in 2018, ranked 84^th out of 445 organisations. The Trust was also awarded the Highest Performing Public Sector Employer in the West Midlands 2019 by Stonewall.

6.2 National Staff Survey Results:

Some noticeable differences based on sexual orientation within the 2018 national staff survey include:

6.3 Sexual orientation - observations

• Although previous data cleansing exercises carried out by the Trust has resulted in a significant reduction in the number of staff recorded as "undefined" for sexual orientation on ESR there is still work to be done to address the 32% of staff who do not wish to disclose.

• There appears to be trends between staff groups where certain protected characteristic data, including sexual orientation, has been undeclared. It is hoped that this position will improve with further data collection exercises scheduled for 2019/20 and in response to the Stonewall Workplace Equality action plan.

• Monitoring of sexual orientation and gender identity is an area which the Trust has recognised as in need of improvement for both staff and patients. Current staff and patient recording databases offer limited options to record sexual orientation and gender identity and a national project is underway to address the required changes to the data recording systems used within the NHS. The Trust realises that staff training is required in order to equip staff to ask and record this data.

7.0 Religion and belief

7.1 Staff profile

Data taken from ESR shows the overall workforce profile by religion and belief as at December 2018.

The Trust undertook a data cleanse exercise in 2017 to address the high percentage of staff where religion or belief status is unknown and to improve the overall quality of the data which is recorded on ESR.  As a result the Trust saw a reduction in the number of staff records were religion or belief was "undefined" in 2017. However, this meant a significant increase in number of staff opting for "I do not wish to disclose" for their religion or belief resulting in a rise in this category.

Further analysis of the data shows religion or belief by staff group. The table illustrates that 1774 Nursing and Midwifery staff and 1249 Medical and Dental staff have chosen not to declare their religion or belief. Also 1293 Additional Clinical Services staff and 1428 Administration and Clerical staff are also undeclared which shows a trend between undefined religion, disability and sexual orientation for these staff groups.

7.2 Religion and belief - observations

Although the data cleanse carried out by the Trust in 2017 has resulted in a significant reduction in the number of staff recorded as "undefined" for religion and belief on ESR there is still work to be done to address the 36.06% of staff who do not wish to disclose.

There appears to be trends between staff groups where certain protected characteristic, including religion and belief, has been undeclared. It is hoped that this position will improve with further data collection exercises scheduled for 2019/20.

Currently the NHS Staff Survey does not present analysis on religion and belief.

Review of actions made in the Annual Equality Report 2017/18 Actions

1. Action: Whilst the data cleanse exercise which was carried out by the Trust in 2017 was a success and resulted in a significant improvement in the quality of the data which is recorded on ESR, there appears to be trends between some staff groups where certain protected characteristic data, including religion and belief, sexual orientation and disability, has been undeclared. The Trust will carry out further data collection exercises scheduled for 2018/19 which will be supported by a campaign to raise staff awareness and improve understanding of the rationale and importance of knowing this data.

Progress: In April 2018 the Heart of England NHS Foundation Trust merged with the Queen Elizabeth Hospital Birmingham to form one Trust, University Hospitals Birmingham NHS Foundation Trust, with over 22,000 staff and caring for over 2 million patients each year. As a result of the merger an Implementation Project team has been established to bring the two Trusts together as one Trust, including merging services, team structures and databases. This work is on-going and as such a number of improvements have been identified including the need to improve the quality of the data we record and update the system, such as the recording of sexual orientation for staff and patients. A further exercise to cleanse the data will be scheduled for 2019/20.

2. Action: Monitoring of sexual orientation and gender identity is an area which the Trust has recognised as in need of improvement for both staff and patients. The Trust will commence plans to instigate the changes which are required in order to record sexual orientation and gender identity for staff and patients and realises that training is required in order to equip staff to appropriately ask and record this data.

Progress: Patient Administration System (PAS) national upgrades have delayed the Trusts ability to monitor service user data. However, recent changes and additions to data fields have enabled the Trust to record sexual orientation and gender identity based on the Stonewall recording criteria. This is currently only available to the QE site and with IT upgrade full trust wide recording should be in place within 12-24 months.

3. Action: The workforce comparison against the local population suggests the under reporting of disabilities with only 2.89% in 2017 of the Trust staff declaring a disability. Although the position has improved through the data cleanse exercises carried out there is still work to be done to encourage staff to declare disabilities and to increase the representation of people with a disability amongst the workforce. The Trust will investigate the relatively low proportion of disabled recruits and will report via WDES on the actions to address improvements in attracting, recruiting and retaining people with a disability.

Progress: Following the merger in April 2019, data taken from ESR shows that 2.6% of staff (539 employees) have stated that they have a disability.  However, there remains a high percentage of staff 19.9% (4095) where disability status is unknown or not declared.  In addition, information from the 2018 National Staff Survey shows that 1051 staff declared they had a disability (16.5%) of respondents indicated that they have a disability, suggesting that more staff have a disability than we have recorded on ESR, and also suggests staff are more likely to declare they have a disability via an anonymous source.  The Trust recognises this is an area in need of improvement and will report on progress in relation to experiences of our staff with a disability through the Workforce Disability Standard (WDES) when it is implemented nationally in October 2019 and a plan of actions for improvement will be initiated through this report. The Trust is also committed to the Disability Confident Scheme which aims to attract, recruit and retain people with a disability.  Currently the Trust holds "Committed" status with the scheme and plans are in place for this to be upgraded to "Employer" status in 2019/20.

4. Action: Both this report and the WRES report, highlight a significant need for the Trust to address the underrepresentation of BAME in Senior Management roles. Although there has been a slight increase in the numbers of BAME staff in senior management posts, there is still more work to be done. The Trust will profile prominent BAME staff throughout the Trust to showcase the routes to career progression and will work with underrepresented groups of staff to understand better the barriers to entering senior management posts.

Progress: To celebrate Black History Month in October 2018 the Trust held a Panel Discussion Event which was well attended by staff from all levels throughout the Trust. The panellists consisted members of our own BAME staff plus a range of external experts and discussed topics including microaggressions, barriers career progression, leadership opportunities and addressed the results of the WRES report 2018. Following the success of this event the Trust has introduced a new initiative called Aspire which aims to support staff from underrepresented groups with interview coaching and advice.  In addition, the Trust provides regular updates to all staff on the National Leadership Academy Stepping Up and Ready Now programmes and has a number of BAME staff undertaking these courses. The Trust has also embarked on a cohort of reverse mentorships, and as a result of a Trust wide plan to revise its leadership offer to staff, will be launching a portfolio of leadership programmes which will be available for all.

Actions planned for 2019/20

1. Action: The Trust recognises there is more work to be done to improve on the result in the WRES report year on year. As a result the Trust will work with our staff to better understand the experiences of our BAME workforce. This will involve working with the National WRES Forum to share best practice and implement the learning at the Trust. An action plan will be established to monitor the progress against the actions planned in the WRES Report 2019 and key stakeholders will take ownership of driving forward the actions in the report.
2. Action: The Trust aims to understand better, and make improvements for, our staff with a disability or long term health condition. Data taken from ESR, NHS Jobs and National Staff Survey tell us that a significant number of our staff do not feel able to declare they have a disability, and those staff who have told us, report a much lower engagement score than those without a disability. The Trust will report on progress in relation to experiences of our staff with a disability through the Workforce Disability Standard (WDES) when it is implemented nationally in October 2019 and a plan of actions for improvement will be initiated through this report. The Trust is also committed to the Disability Confident Scheme and intends to upgrade the membership status to "Employer" in 2019/20. In addition, we recognise there is limited availability of disability related training and awareness raising initiatives available to staff in the Trust and aims to address this through the introduction of a new training provider [Skills Booster] and delivering bespoke awareness raising sessions and events for all staff.
3. Action: Following the merger of two Trusts to become one in April 2018 this provides an exciting opportunity for the Trust to revisit its inclusion strategy and reprioritise commitments over the next two to five years. As a result the Trust will engage with staff to listen to their voices and hear what is important to them. This will form the basis of a revised inclusion strategy which will look to address the priorities for the merged Trust. A plan to embed inclusion over this period will be developed to include education, culture change, awareness raising and acceptance through a number of means. The Trust will enhance current inclusive initiatives and introduce new innovative ways to reinforce the inclusion message.

We will continue with specific, measurable equality objectives and publish information regarding our performance on equality and diversity in line with the WRES, WDES, EDS2 and Stonewall’s WEI.

The Trust will continue with embedding our core values and the associated behaviours, through values based appraisals, and running through all Trust policies and procedures. The Trust will also continue to launch and support staff steering groups and network groups to allow for a collective voice on shaping and influencing the Trust’s equality and diversity agendas.