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Transgender Support 1798.pdf - East Cheshire NHS Trust

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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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