Equality champion Scott Durairaj has developed a human rights toolkit for NHS decision makers. Louise Hunt reports

When Scott Durairaj joined the NHS as a paramedic in Merseyside in the early 1990s he was regularly referred to as "Shadow" or "Midnight" by his colleagues because of his race.

He says he had to work twice as hard to become a station manager. It took him seven years, despite being qualified, and even then some colleagues grumbled that it was positive discrimination when he was finally offered a post a 60-mile commute away.

"There was a hardcore of racists where I worked," he says. "I left the NHS because of discrimination."

He went on to gain a postgraduate qualification in equality and worked for the Commission for Racial Equality before returning to the NHS at a time when more black and Asian staff are breaking into middle and senior management.

This decision, he says, was spurred by "the health inequalities faced by people on the fringes of society".

Scott's experiences led him to develop one of the first single equality impact assessment schemes in the North West while working for Mersey Care trust in 2003.

Now also a "thinking partner" for Race for Health, he has created what he believes is one of the UK's first equality and human rights assessment toolkits, which he introduced at Redbridge primary care trust this January while he was head of community engagement and equalities.

While impact assessments themselves are not new, he believes it is the first toolkit to be updated to bring together the standard equality assessments of race, disability, gender, age, sexual orientation, religion and belief with the human rights articles on right to life, inhuman treatment and freedom of conscience, marriage and the family.

"I realised each of the areas crossed over massively with the human rights agenda," he says, adding: "There are still plenty of organisations that are doing single equality race, disability and gender schemes that haven't incorporated the Human Rights Act."

Broad perspective

The new toolkit is designed to weed out and prevent inequalities from a much broader perspective, with the dual function of protecting both staff and communities against discrimination.

"This is about looking at things that could negatively affect groups of people and their health outcomes. It is about identifying those people who don't fit into key communities and are likely to develop health inequalities," says Scott.

He gives the example of Gypsy and Traveller men, who have a life expectancy of middle age, according to research by Sheffield Hallam University.

"Or if you're black you are more likely to access mental health services because you have been sectioned under the Mental Health Act or through the criminal justice system rather than via talking therapies or a GP and if you have a learning disability you're less likely to get breast screening," he adds.

Drawing again on his experience as a paramedic, he says that just like arriving at a major incident, "the people who are not screaming are the ones you have to worry about".

He says the toolkit will reveal whether, for example, a section of the community is not attending medical appointments at a particular time because they are at prayer, or if some people are not accessing services because they cannot understand the format in which the information is presented.

"Things like the equalities and human rights impact assessments will help trusts to think about these issues," says Scott.

At Redbridge the toolkit is now used to assess every policy, document and decision the PCT makes to ensure it addresses the needs of all the relevant groups. Around a 100 people so far have been trained to use the toolkit. These are normally carried out with the author of the policy, the service manager and a relevant member of the community.

The toolkit comprises a series of questions to help trusts identify whether policy and practices discriminate against each of the equalities areas. It then cross-references with the articles of the Human Rights Act. At the end of the process the policy in question is given a risk score, which trusts can include on their corporate risk registers. They can then develop action plans to mitigate the risk.

"It means trusts are constantly reviewing policies and they can financially plan to remove any negative equality or human rights impacts," says Scott.

He says the scheme is starting to impact on policy and practice at the PCT, but believes it will take a few years before this work starts to show in improved health outcomes.

"Staff are asking more questions about equality. By the time policy leaders have done five or six impact assessments they are already starting to think with an open mind. It is changing the management process to look for discrimination. If you don't look for it, it can be easy for practices to be unwittingly discriminating," he says.

Stronger links

Some of the immediate changes include preparing information in different formats, such as an easy to read version for people with learning disabilities.

The scheme has also helped forge stronger engagement between the PCT and community. The PCT has set up a community panel involved in recruitment and tender selection for a polyclinic development in Redbridge using the equality impact assessments, says Scott.

"This work has changed staff and community attitudes; it is bringing people together. This way the polyclinic is delivered by the PCT for the community, with the community. Only last year that wouldn't have happened. Community engagement is a big part of the impact assessment tool."

Presentations that Scott has given on the equalities and human rights toolkit have aroused interest from other PCTs, and it has just been introduced at Sussex Partnership foundation trust, a large mental health trust heavily investing in equality and human rights, where in September he began a new job as programme manager for equality and diversity. He has also met with NHS Employers to discuss the possibility of developing the toolkit as a national standard.

"The equality and human rights impact assessment tool is a change management tool, not a political correctness tool - it is for everybody," says Scott.

See HSJ survey shows 'racism alive in NHS'