Transgender Support 1798.pdf - East Cheshire NHS Trust

HUMAN RESOURCES / PATIENT & PUBLIC
INVOLVEMENT
POLICIES AND PROCEDURES
TRANSGENDER SUPPORT
POLICY

Policy Title
Executive Summary:
Transgender Support Policy
The aim of this policy is to communicate East Cheshire NHS Trust’s
commitment to the promotion of equality.
The policy seeks to ensure that the provision for Transgender people is
responsive to individual need; is prejudice free and challenges the
discrimination individuals may experience. The policy will provide a
framework for managers and clinical staff to support staff and service
users who identify with a gender other than that assigned at birth
Supersedes:
Not Applicable
Description of Not Applicable
Amendment(s):
This policy will impact on:
Patients, employees, applicants, contractors, volunteers, agency staff and visitors to the Trust
Financial Implications:
Limited financial impact.
Policy Area: HR Document Reference:
Version Number: 1.0 Effective Date: 26.1.2011
Issued By:
Chief Operating Officer andReview Date: 31.12.2013
Director of HR & Workforce
Author: Ruth Knighton, HRBP Impact Assessment
Date:
January 2011
APPROVAL RECORD
Committees / Group
Date
Consultation: Management & HR Team 20.12.2010
The Gender Trust 29.12.2010
Formal JCNC 26.1.2011
Approved by Director: January 2011
Received for information: Operational Communication Forum
Associate Director’s Group
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CONTENTS PAGE
Page
1. Policy Statement 4
2. Organisational Responsibilities 4
3. Statement of Intent / Scope 4
4. Definitions 5
5. Legislation 6
6. The Policy - Employment 8
7. The Policy – Service Provision 11
8. Planning & Implementation 13
9. Measuring Performance 13
10. Audit 14
11. Review 14
12. Further Reading 14
13. Impact Assessment 15
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1. POLICY STATEMENT
East Cheshire NHS Trust is committed to equality for all communities and to providing services
which are accessible, appropriate and which recognize the diversity of people, their needs and
choices.
To deliver a patient led service the Trust must ensure that services and care delivery recognise the
needs of each individual service user. The Trust recognises that Transgender (Trans) service
users and staff may experience discrimination. East Cheshire NHS Trust is clear that it does not
tolerate discrimination directly or indirectly against any person including Trans people.
2. ORGANISATIONAL RESPONSIBILITIES
2.1 The role of the Trust Board
The Board and the Trust Management Team have a responsibility to develop a culture and
climate in which employees can excel at work and maximise their potential regardless of
their transgender status and be free from any form of bullying and harassment behaviour.
2.2 The role of the Chief Operating Officer and Director of HR & Workforce
To oversee the introduction, operation and monitoring of the policy.
2.3 The role of Equality and Diversity Leads
The E&D Leads are responsible for providing appropriate advice and guidance to all staff
on the use of the policy and its application generally and specifically (i.e. individual cases).
HR will provide an advisory role to managers and staff in respect of the procedure and
appropriate solutions. The Patient and Public Involvement Manager will provide advice to
service providers and service users in the implementation of this Policy.
2.4 The Role of Individual Staff
Every employee has a personal responsibility for their own behaviour and must treat their
colleagues, patients and visitors with respect and fairness regardless of their gender, sex,
race, nationality, age, disability, religion or beliefs.
3. STATEMENT OF INTENT / SCOPE
3.1 This policy applies to all those working in the Trust, in whatever capacity. A failure to follow
the requirements of the policy may result in investigation and management action being
taken as considered appropriate.
3.2 This may include formal action in line with the Trust's disciplinary or capability procedures
for Trust employees; and other action in relation to other workers, which may result in the
termination of an assignment, placement, secondment or honorary arrangement.
3.3 If it is alleged that a service user is subject to discrimination this should be reported to the
person in charge of the service area and an incident report completed and sent to the Risk
Management Department for investigation and reporting. This will automatically be copied
to the service lead for Equality & Human Rights. Should the subject of the allegation be the
person in charge of the service area, the issue should be escalated to their line manager.
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4. DEFINITIONS
4.1 Transgender Person
This is a person whose own identity does not confirm to the sex they were assigned at
birth.
4.2 Transsexual Person
A person who lives (or wishes to live) permanently in their ‘new’ gender. In the United
Kingdom, those who are intending to undergo, undergoing or having undergone gender
reassignment, under medical care are protected in law. Those who have changed their role
permanently may obtain legal recognition of their new gender status in accordance with the
Gender Recognition Act.
4.3 Trans
The expression Trans is an inclusive term for all people who cross gender boundaries
permanently or temporarily. This would include people who identify as transexual,
transgender, transvestite or simply trans. Sometimes its use is specific; for instance, those
born as female but identifying as men may be referred to as Trans men; and those born as
male but identifying as women may be referred to as Trans women. Where Trans people
have transitioned permanently, many prefer to be regarded as ordinary men and women.
For the purpose of this document the term Trans and Trans people will be used as it is a
more encompassing term and generally accepted by the Trans community.
4.4 Gender Identity
Gender Identity describes the gender a person identifies with. This is not necessarily the
same as the sex they were assigned at birth. It is not necessarily based on biological fact,
either real or perceived, nor is it always based on sexual orientation.
4.5 Gender Dysphoria
A medical diagnosis of a consistent and overwhelming desire to live in the opposite gender
to that assigned at birth,
4.6 Sex Reassignment Therapy (or Gender Reassignment)
The process of transitioning from the gender assigned at birth to the gender the person
identifies with. This may involve medical and surgical procedures. Many people simply call
this process transition.
In addition to undergoing medical procedures, transsexual people who go through sex
reassignment therapy usually change their social gender roles, legal names and legal sex
designation. Transition describes the point at which a permanent change of gender role is
undertaken, in all spheres of life - in the family, at work, in leisure pursuits and in society
generally. Some people make this change gradually, however, others emerge overnight.
4.7 Legal Sex
In the past in the UK, the legal sex of someone was defined by their birth certificate and
could not be changed. The Gender Recognition Act 2004 means people can now apply to
gain recognition of their change of gender for all legal purposes.
4.8 Transphobia
A fear and dislike of Transgender people, which can lead to hatred resulting in verbal or
physical attacks and abuse.
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4.9 Sexual Orientation
Sexual orientation is a separate issue from gender identity. Trans people may be gay,
lesbian, bisexual, heterosexual or, occasionally, asexual. Their sexual relationships may
remain the same through the transition process, or they may change.
5. LEGISLATION
5.1 Sex Discrimination Act 1975 – Under this act it is unlawful for employers to discriminate
on grounds of sex, marriage, pregnancy and maternity leave or because someone intends
to undergo, is undergoing or has undergone, gender reassignment.
5.2 The Sex Discrimination (Gender Reassignment) Regulations 1999 amended the Sex
Discrimination Act 1975 and was extended to prohibit discrimination on the grounds of
gender reassignment in both employment and vocational training.
In employment and vocational training, the Sex Discrimination Act protects individuals who
are discriminated against because they:
Intend to undergo gender reassignment
Are currently undergoing gender reassignment
Have already undergone gender reassignment
5.3 The Gender Recognition Act 2004
The Act gives transgender people legal recognition as members of the sex appropriate to
their gender (male or female) allowing them to acquire a new birth certificate, affording
them full recognition of their acquired sex in law for all purposes, including marriage.
People present evidence to a Gender Recognition Panel, which considers their case and
issues a Gender Recognition Certificate (GRC). If the person involved is in a legally
recognised marriage they will be issued an “Interim Gender Recognition Certificate”, which
can then be used as grounds for annulment of the marriage, but otherwise has no status.
After annulment, a full Certificate will be issued.
The Act requires applicants to have transitioned two years before a certificate is issued. It
makes no requirement for sex reassignment surgery to have taken place, although such
surgery will be accepted as part of the supporting evidence for a case where it has taken
place. A birth certificate drawn from the Gender Recognition register is indistinguishable
from any other birth certificate, and will indicate the new legal sex and name.
The Gender Recognition Act safeguards the privacy of transsexuals by prohibiting the
disclosure of information acquired in an official capacity relating to a gender recognition
certificate or about the gender history of a successful applicant. It is a criminal offence to
disclose such information and subject to a maximum £5000 fine. It is not, however, an
offence to disclose ‘protected information’ if the person cannot be identified or if the
individual gives their consent. However, it should be recognised that to even publicly
acknowledge that there is a transsexual employee could result in ‘outing’ them.
A Transgendered person should not be treated less favourably because they do not
possess a Gender Recognition Certificate. Providing a person is living fully in an acquired
gender role, they should be treated equally to a person who is in possession of a Gender
Recognition Certificate.
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5.4 Human Rights Act 1998
The Human Rights Act 1998 gives further legal effect in the UK to the fundamental rights
and freedoms contained in the European Convention on Human Rights. These rights not
only impact matters of life and death, they also affect the rights you have in your everyday
life: what you can say and do, your beliefs, your right to a fair trial and other similar basic
entitlements.
Most rights have limits to ensure that they do not unfairly damage other people's
rights. However, certain rights – such as the right not to be tortured – can never be limited
by a court or anybody else.
5.5 Genuine Occupational Requirement (GOR) – Following legal recognition of an individual,
the entire body of employment law must be interpreted on the basis that Trans people are
regarded for all purposes as a member of the acquired gender.
If the single sex GOR applies to a post and the job holder changes gender then it is
reasonable for the Trust to reconsider the continuation of the job holder within the post.
The Trust must treat the individual reasonably in all circumstances.
5.6 Equality Act 2010
The Equality Act came into force on 1 st October 2010 and defines gender reassignment as
a protected characteristic.
People who are proposing to undergo, are undergoing or have undergone a process (or
part of a process) to change their gender by changing physiological or other attributes of
gender have the protected characteristic of gender reassignment.
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6. THE POLICY - EMPLOYMENT
6.1 Employment
Staff will be treated in their acquired gender for all purposes of daily living from the point
they commence a real life test to live and work in their new gender role.
All employees must observe the privacy of transsexuals afforded by the Gender
Recognition Act. Breaches of confidentiality will be treated in accordance with the Trust’s
Disciplinary Procedure.
6.2 Recruitment and Selection
There is no barrier to a person who identifies as Trans from applying for employment within
East Cheshire NHS Trust. All those involved in the recruitment and selection process
should be made aware of their responsibilities to select fairly and without prejudice.
6.3 Confidentiality within the recruitment and selection process
Applicants do not have to disclose their transgender status during the recruitment and
selection process including at interview, or as any condition of employment.
If applicants choose to disclose their status this must not be used as a reason for not
offering the person employment with the Trust and also non-disclosure or subsequent
disclosure are not grounds for dismissal.
6.4 Records and Information Sharing
All personnel records must be updated at the start of the transition process. At this point,
the member of staff will be able to apply for a driving license and passport in their new
acquired gender.
A new personnel file will be created to ensure confidentiality. It will be necessary to retain
records relating to a member of staff’s identity at birth prior to obtaining a full GRC,
however, once the member of staff has obtained this, such records must be replaced with
the new details. The old personnel file will not be destroyed but access to this will be
restricted to the Head of Human Resources and appropriate Head of Service.
The line manager should also ensure that all information held in telephone directories,
email address and employment details reflect the acquired gender of the person.
If giving a reference, the reference should be in the name which will be used in the new job
and must not disclose a former name. It may sometimes be necessary for a transsexual
person to disclose a previous identity in order for references from past employers to be
obtained. In these cases, strict confidentiality and respect for dignity should be applied.
Those staff who are professionally registered are advised to contact their professional
bodies to find out whether there are any specific requirements in terms of name changes
etc. Where the Trust has to keep evidence of professional status or qualifications, it should
be discussed with the member of staff how this information will be retained so as not to
compromise or breach disclosure of protected information.
A person who as changed their gender role and living in their acquired gender role does
not have to be in possession of a GRC to be afforded equal treatment to a person who is in
possession of a GRC.
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6.5 Criminal Records Bureau Checks (CRB)
Staff who work in the NHS are required to have a CRB check. Part of this process involves
a strict requirement for applicants to state all previous names and aliases. CRB checks
however should not be a problem for Trans people. The CRB has a confidential checking
process for Transgender people applications who do not wish to reveal details of their
previous identity to the person who asked them to complete an application form for a CRB
disclosure. The applicant may wish to contact CRB customer services 0151 676 1452 to
discuss this matter in confidence.
Trans applicants for a CRB disclosure should contact CRB on the above number to
clarify anything they are not sure about and ensure that the CRB know they will be
using the confidential checking process.
The Trans applicant should complete the form presented by their employer in the
normal way, except that they need not complete details (or supply forms of evidence)
that would expose their gender history to their employer.
If they wish to leave out details that could “out” them then they should photocopy the
form, ensuring they have a clear record of the application serial number.
The applicant should then immediately contact the CRB in Liverpool on the number
above and notify them of the application number.
The special security section of the CRB in Liverpool then have the means to intercept
the application that was forwarded by the employer. They will ask the applicant to
supply the information needed to replace that which was omitted.
This is then married up so that a rigorous criminal records check can be carried out in
the same way as for any other applicant.
Disclosures sent to the employee and their employer will not reveal the applicants
former identity unless they have an offence or caution that has been recorded in that
name in Police records. In this case there is no way of avoiding the disclosure of that
former identity to the employer.
If the offence itself is not serious enough to preclude employment, reassurances should
be given to the applicant /member of staff in this event.
6.6 Accommodating Gender Transition in the Workplace
East Cheshire NHS Trust is committed to supporting all its employees with regard to
personal circumstances that may impact on work.
6.6.1 Procedure
Once an employee has decided they wish to undergo gender reassignment it is essential
that a support network is set up as soon as possible to accommodate this. It is for the
individual to decide whom to approach for advice and support, be it their line manager,
Human Resources or trade union representative. Once this is agreed a member of Human
Resources staff should be assigned to act as a contact for the individual concerned to
answer any queries or action any requirements and act as an advisor. The appointed
advisor will need to discuss with the individual how they wish to handle the transition. The
following issues should be considered and agreed by both parties:
a) The practicalities of remaining in their current post. (If the employee also has a
disability then ‘reasonable adjustments’ would need to taken into account or existing
arrangements would need to be transferred to a new post in line with the Disability
Discrimination Act).
b) The expected timescale for medical procedures (if to be undertaken) and any time
off required for treatment.
c) The expected point at which the change of name and personal details should occur.
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d) Whether the employee wishes to inform the line manager, colleagues and other staff
and clients, or would prefer the appointed advisor / a third party to inform them
instead.
e) Agreeing a point at which their individual gender specific dress will change.
f) Agreeing a point at which the individual will change use of single sex toilets /
changing facilities in their new gender. This could be from the first day of
transitioning.
g) Whether new arrangements will need to be made for any accommodation used for
work purposes.
6.6.2 Time off work
In line with the Trust’s Absence Policy, any absence from work for medical requirements
would need to be covered by a medical certificate. Any additional leave for specialist
appointments would be classed the same as other hospital / GP appointments and in
accordance with Trust Policy.
6.6.3 Support Mechanisms
The list below shows just some of the options available to individuals who wish to seek
support within the organisation during a gender transition period. Support encompass
identifying individual support needs; including additional diversity issues such as age,
culture, disability, ethnicity, religion or sexual orientation.
Human Resources. An appointed advisor from within the Human Resources
department identified at an early stage to offer support; put in place practical changes
that need to be made to an individual’s post or personal records; to support positive
working relationships between the individual and wider team members if relevant. Any
qualified Human Resources professional should have the necessary knowledge and
awareness required to deal with such personal and sensitive issues.
Occupational Health. A referral to occupational health may be considered by the
individual, their manager or the human resources representative for additional support
and advice concerning any counselling needs or advice regarding the medical process
of the transition. Managers may also need advice regarding the needs of the individual
and on how to support changes that may need to be made within the team or work
environment.
Equality and Diversity Lead. Someone who has specialist knowledge of issues in
relation to Equality and Human Rights that can be used as a resource.
6.7 Sharing Personal Information
Under Section 22 of the Gender Recognition Act 2004 it is illegal for staff to share
information regarding someone’s Trans status. The Gender Recognition Act states that:” It
is an offence for a person who has acquired protected information in an official capacity to
disclose the information to any other person” unless
‣ There is specific agreement to do so by the Trans person.
‣ If it is necessary for professionals to know someone’s Trans status then it is
recommended that the Trans person is asked to provide permission in writing.
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‣ The Secretary of State may by order make provision prescribing circumstances in
which the disclosure of protected information is not to constitute an offence under
this section.
(For clarity on this issue see www.opsi.gov.uk Section 22 of the Gender Recognition Act
2004)
6.8 Single Sex Facilities
Part of the process of gender reassignment involves a Trans person living as their acquired
gender before undergoing surgery, if surgery is the desired outcome. Living in a different
gender will obviously include using single sex facilities. The issue of when this will begin is
something that needs to be decided by the individual and supported by the appointed
advisor and those around them. This will involve open discussion, education and
understanding. Trans people (like everyone else in Britain) can use toilets or changing
facilities appropriate to their gender presentation with or without a Gender Recognition
Certificate.
6.9 Bullying and Harassment of Trans Staff
East Cheshire NHS Trust is committed to creating a working environment where every
employee is treated with dignity and respect and where each person’s individuality and sense
of self-worth is maintained. Any harassment or bullying behaviour at work, whether by staff or
service users, is not acceptable and will not be permitted or condoned by the trust.
Any form of bullying, harassment or inappropriate behaviour which causes offence, whether
intentional or not, will be treated very seriously. Staff are encouraged not to tolerate bullying
or harassment at work and will be supported by the trust in raising complaints under the
harassment policy.
7 THE POLICY – SERVICE PROVISION
7.1 General Principles
East Cheshire NHS Trust will ensure that Trans people, both service users and staff, are
accepted and treated at all times as the gender in which they permanently present.
In instances where a Trans person is admitted to inpatient services, protecting their dignity,
safety and privacy must be paramount. In such circumstances, decisions such as
ward/room allocation, should be made in conjunction with the service user themselves and
in accordance with their preferences
Trans people (that is, individuals who have proposed, commenced or completed
reassignment of gender) have legal protection against discrimination. In addition, good
practice requires that clinical responses be patient-centered, respectful and flexible
towards all transgender people who live continuously or temporarily in the gender role
that is opposite to their natal sex.
7.2 General Key points
Trans people should be accommodated according to their presentation (the way they dress,
and the name and pronouns that they currently use)
This presentation may not always accord with the physical sex appearance of the chest or
genitalia
It does not depend upon their having a gender recognition certificate (GRC) or legal name
change
It applies to toilet and bathing facilities (except, for instance, that pre-operative trans people
should not share open shower facilities)
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The views of the Trans person should take precedence over those of family members
where these are not the same.
A Trans person should not be treated less favourably because they do not possess a
Gender Recognition Certificate. Providing a person is living fully in an acquired gender role,
they should be treated equally to a person who is in possession of a Gender Recognition
Certificate
7.3 Single Sex Facilities
Those who have undergone full-time transition should always be accommodated
according to their gender presentation. Different genital or breast sex appearance is not a
bar to this, since sufficient privacy can usually be ensured through the use of curtains or by
accommodation in a single side room adjacent to a sex-appropriate ward. This approach
may only be varied under special circumstances where, for instance, the treatment is sexspecific
and necessitates a Trans person being placed in an otherwise opposite sex ward.
Such departures should be proportionate to achieving a ‘legitimate aim’, for instance, a
safe nursing environment.
This may arise, for instance, when a Trans man is having a hysterectomy in a hospital, or
hospital ward that is designated specifically for women, and no side room is available. The
situation should be discussed with the individual concerned and a joint decision made as to
how to resolve it. At all times this should be done according to the wishes of the patient,
rather than the convenience of the staff.
In addition to these safeguards, where admission/triage staff are unsure of a person’s
gender, they should, where possible, ask discreetly where the person would be most
comfortably accommodated. They should then comply with the patient’s preference
immediately, or as soon as practicable. If patients are transferred to a ward, this should
also be in accordance with their continuous gender presentation (unless the patient
requests otherwise).
If upon admission it is impossible to ask the view of the person because he or she is
unconscious or incapacitated then, in the first instance, inferences should be drawn from
presentation and mode of dress. No investigation as to the genital sex of the person should
be undertaken unless this is specifically necessary in order to carry out treatment.
In addition to the usual safeguards outlined in relation to all other patients, it is important to
take into account that immediately post-operatively, or while unconscious for any reason,
those trans women who usually wear wigs are unlikely to be wearing them and so may be
‘read’ incorrectly as men. Extra care is therefore required so that their privacy and dignity
as women is appropriately ensured.
Trans men whose facial appearance is clearly male may still have female genital
appearance, so extra care is needed to ensure their dignity and privacy as men.
7.4 Considerations for gender variant children and young people
Gender variant children and young people should be accorded the same respect for their
self-defined gender as are Trans adults, regardless of their genital sex.
Where there is no segregation, as is often the case with children, there may be no
requirement to treat a young gender variant person any differently from other children and
young people. Where segregation is deemed necessary, then it should be in accordance
with the dress, preferred name and/or stated gender identity of the child or young person.
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In some instances, parents or those with parental responsibility may have a view that is not
consistent with the child’s view. If possible, the child’s preference should prevail even if the child is
not Gillick competent. Gillick competence is a term used in medical law to decide whether a child
(16 years or younger) is able to consent to his or her own medical treatment, without the need for
parental permission or knowledge
More in-depth discussion and greater sensitivity may need to be extended to adolescents whose
secondary sex characteristics have developed and whose view of their gender identity may have
consolidated in contradiction to their sex appearance. It should be borne in mind that they are
extremely likely to continue to experience a gender identity that is inconsistent with their natal sex
appearance so their current gender identity should be fully supported in terms of their
accommodation and use of toilet and bathing facilities.
It should also be noted that, although rare, children may have conditions where genital appearance
is not clearly male or female and therefore personal privacy may be a priority.
8. PLANNING & IMPLEMENTATION
The policy will go through a structured consultation process, involving external agencies, key
stakeholders and staff side representatives. The policy will then be approved by the Trust Board
and once approved, will be ratified by the Chief Operating Officer and Director of HR & Workforce.
All Associate Directors, Service Managers, Clinical Directors and Clinical Leads will be briefed on
the policy. Any training relating to the process will be reviewed as appropriate.
It is the responsibility of Associate Directors to ensure that relevant Departmental Leads receive a
copy of this policy for onward communications to staff. Line managers have the responsibility to
cascade this information to the staff they manage. Line managers must ensure that departmental
systems are in place to enable all staff including agency staff, contractors and volunteers, access
to relevant policies, procedures, guidelines and protocols and to remain up to date with the content
of new and revised policies, procedures, guidelines and protocols.
All staff have a responsibility to ensure that they are aware of Trust documents which are relevant
to their area of work and that they act in accordance with these at all times.
9. MEASURING PERFORMANCE
The Department of Patient & Public Involvement (PPI) and the Human Resources Department will
manage the overall responsibility for the monitoring and delivery of this Policy.
To support the delivery of this Policy, PPI and Human Resources will work alongside Managers
and staff in order to;
Support the delivery of this Policy into practice
Ensure that the requirements and standards described in this Policy are being met
Measure the effectiveness of different aspects of this Policy
Identify any necessary changes in Strategy, Policy or practice and develop the Policy
accordingly
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10. AUDIT
The Equality & Diversity Leads within the HR and Patient & Public Involvement teams will ensure
that monitoring of this policy is undertaken annually and that any action plan is implemented and
reported to the Trust’s Equality and Human Rights Group. Any relevant findings will be included in
the six monthly Equality and Human Rights Trust Board Report. Monitoring of this policy will
consist of an audit review of incidents of non compliance with this policy and development of any
subsequent action plan. Results will be reported via the HR Annual Board Report.
Monitoring Arrangements
Process for monitoring e.g. audit
Responsible individual/ group/ committee
Frequency of monitoring
Responsible individual/ group/ committee for
review of results
Responsible individual/ group/ committee for
development of action plan
Responsible individual/ group/ committee for
monitoring of action plan
Responsibility / Process / Frequency
Audit
The Equality & Diversity Leads within the HR and
Patient & Public Involvement teams
Annually
Equality and Human Rights Group
The Equality & Diversity Leads within the HR and
Patient & Public Involvement teams
The Equality & Diversity Leads within the HR and
Patient & Public Involvement teams
11. REVIEW
The Equality & Diversity Leads within the HR and Patient & Public Involvement teams will review
this policy every 3 years to ensure it is in line with current legislation and national guidance to
minimise any risk and potential adverse consequences for the Trust.
The policy will be monitored and reviewed by management and staff-side representatives in line
with legislative changes and best practice guidelines.
The impact of the Policy will be reviewed by the Director of HR in consultation with the appropriate
Senior Management and staff groups, 3 years after implementation. The outcome of this review
will be made available to Partnership Forum for information and policy improvement.
12. FURTHER READING
The following can provide further information on the issues raised:
www.gires.org.uk/glossary.php
www.transgenderzone.com
www.acas.co.uk/index.aspx?articleid=2064
www.gendertrust.org.uk
www.gender-matters.org.uk
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www.equalityhumanrights.com
www.unison.org.uk/file/A3226.doc - Unison Document: ‘Bargaining for Transgender Workers’
Rights’ April 2007
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089
941 - Trans: A Practical Guide for the NHS (2008), Department of Health
Related Trust Policies & Procedures:
Equality & Human Rights Policy
Single Equality Scheme
Sickness Absence Policy
Recruitment & Selection Policy & Procedure
Harassment Policy – Maintaining Dignity at Work
Grievance & Disputes Policy
Work Life Balance Policy
13. IMPACT ASSESSMENT
The purpose of an Equality Impact Assessment (EIA) is to improve the work of the Trust, by
promoting equality and ensuring that policies and functions do not discriminate either directly or
indirectly against staff and service users.
East Cheshire NHS Trust recognises its responsibility to ensure that no-one is discriminated
against, disadvantaged or given preference, through membership of any particular group,
particularly including people with disabilities, people from different ethnic backgrounds or religions,
or on the grounds of their gender, age, or sexual orientation. This policy has undergone an impact
assessment to ensure that it does not discriminate on the above groups either directly or indirectly.
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Equality Analysis (Impact assessment)
What is being assessed? Name of the policy, procedure, proposal, strategy or service:
TRANSGENDER SUPPORT POLICY
Details of person responsible for completing the assessment:
Name: RUTH KNIGHTON
Job title: HR BUSINESS PARTNER
Team: HUMAN RESOURCES
State main purpose or aim of the policy, procedure, proposal, strategy or service:
(usually the first paragraph of what you are writing. Also include details of legislation, guidance,
regulations etc which have shaped or informed the document)
The aim of this policy is to communicate East Cheshire NHS Trust’s commitment to the promotion of equality
and diversity, and to support the Trust’s commitment to the Public Sector Equality Duty.
The policy seeks to ensure that the provision for Transgender people is responsive to individual need; is
prejudice free and challenges the discrimination individuals may experience. The policy will provide a
framework for managers and clinical staff to support staff and service users who identify with a gender other
than that assigned at birth
2. Consideration of Data and Research
To carry out the equality analysis you will need to consider information about the people who use
the service and the staff that provide it.
2.1 Give details of RELEVANT information available that gives you an understanding of who
will be affected by this document
The population of Cheshire as at the 2005 mid year figures (Cohesia Report 2008) is 684,400.
Age:
17.8% (30,500) of the population in Cheshire East is over 65 compared with 15.9% nationally. This results in
a high “old age” dependency ratio, i.e. low numbers of working-age people supporting a high non-working
dependant older population. The percentage of “older” or “frail” old is also considerably higher, with 2.3%
(8,200) persons 85 and over compared to 2.1% nationally.
Cheshire East has the fastest growing older population in the North West. By 2016, the population aged 65+
will increase by 29.0% (8,845) and the population aged 85+ by 41.5% (3,403).
This will have an impact on the number of patients being managed by ECT and the complexity of the health
and social care issues that the older person is experiencing. In addition the staffing profile of ECT will
change to include an increasing number of staff over 65 in the workforce.
Race:
The 2005 mid year estimate (Cohesia Report 2008) show that the majority of the population in Cheshire
(94.6%) is White British, with 5.4% non White British. The Cheshire 2007-10 Local Area Agreement
identified that minority ethnic communities account for around 3% of the population. Issues for BME
communities include lack of knowledge of services, access to services, access to translation/interpretation,
cultural differences, family values. Many people from BME communities experience poverty, poor housing
and unemployment which make it difficult for them to lead healthier lives. 4180 migrant workers registered in
Cheshire in 2006/07 and comparison to the mid year population estimates for Cheshire in 2005 strongly
suggests that Cheshire’s migrant worker population is larger than every individual BME group other than the
White-Other White group.
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Gypsies and travellers – at the last count (July 2006) the highest number was recorded in the Borough of
Congleton (125). 42% of gypsies and travellers report limiting long term illness compared to 18% of the
settled population, with an average life expectancy 10-12 years less than settled population. 18% of gypsy
and traveller mothers have experienced the death of a child compared to 1% in the settled population.
Disability:
There are over 10 million disabled people in Britain, of whom 5 million are over state pension age. Nearly 1
in 5 people of working age (7 million, or 18.6%) in Great Britain have a disability.
Hearing loss: 1 in 4 has a hearing problem.
Sight problems: There are 2 million people with sight problems in the UK.
Learning disabilities: There is quite a high proportion of people with learning disabilities in the local area due
to there being a number of residential homes/institutions in the area.
Problems encountered can be lack of staff awareness, communication issues, information requirements.
Dementia
Approximately six in 100 people aged over 65 develop dementia and this rises to around 20 in 100 people
aged 85 or over. Dementia affects 750,000 people in the UK.
Carers
Around 6 million people (11 per cent of the population aged 5+) provided unpaid care in the UK in April
2001. While 45% of carers were aged between 45 and 64, a number of the very young and very old also
provided care. By 2037, it is anticipated that the number of carers will increase to 9 million.
Gender
On average in Cheshire, 49% of the population are male and 51% are female
Transgender: No local data available, national trends show:
1/12,000 males, transgender from male to female
1/33,000 females, transgender from female to male
Specific issues around access to services, specific services for men or women, and ‘single sex’ facilities. In
terms of the transgender population, GIRES (Gender Identity Research and Education Society ) gives an
estimate of 600 per 100,000. If these figures were applied to the Cheshire East community based on the
2005 mid year estimates, there may be around 2,100 trans people in the area.
Religion/Belief
In the Cheshire East area the 2001 census showed:
Christian - 80%
Buddhists - 0.16%
Hindu - 0.15%
Jewish - 0.12%
Muslim - 0.36%
Sikh - 0.05%
Other religion - 0.15%
No religion - 11.84%
Not stated - 6.67%
The Muslim population has the highest levels of ill health amongst faith groups – this includes higher
smoking rates amongst men and higher rates of coronary heart disease and diabetes.
Sexual Orientation
Lesbians, gay men and bi sexual people (LGB) make up to 5-7% of the UK population (Dept of Trade and
Industry, 2003). 13% of Gay men and 31% Lesbian women are parents (Morgan and Bell, First Out: Report
of the findings of Beyond the Barriers national survey of LGB people)
The experience and health needs of gay men and women will differ. However, both groups are likely to
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experience discrimination, higher levels of mental ill health and barriers to accessing health care
National Health Inequalities data shows that lesbian, gay, bisexual and transgender (LGBT) people are
significantly more likely to smoke, to have higher levels of alcohol use and to have used a range of
recreational drugs than heterosexual people. They are also at greater risk of deliberate self-harm. Although
most LGBT people do not experience poor mental health, research suggests that some are at higher risk of
mental health disorder, suicidal behaviour and substance misuse.
2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints either
from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service
or its effects on different groups?)
NO
2.3 Does the information gathered from 2.1 – 2.3 indicate any negative impact as a result of
this document?
NO – THIS POLICY DEMONSTRATES POSITIVE ACTION
3. Assessment of Impact
Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy or
service (part 1) and looked at the data and research you have (part 2), this section asks you to
assess the impact of the policy, procedure, proposal, strategy or service on each of the strands
listed below.
RACE:
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, racial groups differently? No
Explain your response: The policy focusses on positive action around transgender issues.
GENDER (INCLUDING TRANSGENDER):
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, different gender groups differently? Yes - Positively
Explain your response:
The Trust is committed to equality for all communities and to providing services which are accessible,
appropriate and which recognize the diversity of people, their needs and choices. This Policy seeks to
support the trust’s commitment to the Public Sector Equality Duty and ensure its services are delivered in
a positive way to all. To deliver a patient led service the Trust seeks to ensure that services and care
delivery recognise the needs of each individual service user. The Trust recognises that Transgender
(Trans) service users and staff may experience discrimination. East Cheshire NHS Trust is clear that it
does not tolerate discrimination directly or indirectly against any person including Trans people.
DISABILITY
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, disabled people differently? No
Explain your response: The policy focusses on positive action around transgender issues.
AGE:
From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have
the potential to affect, age groups differently? No
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Explain your response: The policy focusses on positive action around transgender issues.
LESBIAN, GAY, BISEXUAL:
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, lesbian, gay or bisexual groups differently? No
Explain your response: The policy focusses on positive action around transgender issues.
RELIGION/BELIEF:
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, religious belief groups differently? No
Explain your response: The policy focusses on positive action around transgender issues.
CARERS:
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect, carers differently? No
Explain your response: The policy focusses on positive action around transgender issues.
OTHER: EG Pregnant women, people in civil partnerships, human rights issues.
From the evidence available does the policy, procedure, proposal, strategy or service affect, or have
the potential to affect any other groups differently? No
Explain your response: The policy focusses on positive action around transgender issues.
4. Safeguarding Assessment - CHILDREN
a. Is there a direct or indirect impact upon children? No
b. If yes please describe the nature and level of the impact (consideration to be given to all
children; children in a specific group or area, or individual children. As well as consideration of
impact now or in the future; competing / conflicting impact between different groups of children
and young people:
c. If no please describe why there is considered to be no impact / significant impact on children
The policy focusses on positive action around transgender issues. It is recognized that questions around
gender can arise early on in life for some people and staff would be supportive of anyone wishing to raise
and discuss such issues.
5. Relevant consultation
Having identified key groups, how have you consulted with them to find out their views and that the
made sure that the policy, procedure, proposal, strategy or service will affect them in the way
that you intend? Have you spoken to staff groups, charities, national organisations etc?
The Gender Trust were consulted during the development of the Policy
6. Approval – At this point, you should forward the template to:
The Trust’s Equality and Diversity Lead lynbailey@nhs.net
Equality and Diversity response: Approved
7. Any actions identified: Have you identified any work which you will need to do in the future to
ensure that the document has no adverse impact?
Action Lead Date to be Achieved
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8. Review Date: 31 January 2013
Date completed: December 2012
The Trust’s Equality and Diversity Lead:
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