Anti-racism in Scotland: progress review 2023

12. Theme 6: Health and Housing

Vision: Minority ethnic communities in Scotland have equality in physical and mental health as far as is achievable, have effective healthcare appropriate to their needs and experience fewer inequalities in housing and home life.

Health and wellbeing are strongly linked with family life and the home environment, and equality in these areas of life is vital to improving life chances. The pandemic highlighted the existence of unjust and avoidable health inequalities in Scotland. While much of the work on health inequalities has tended to focus on socioeconomic circumstances as a fundamental cause, an extensive body of research shows that structural racism and discrimination are intertwined and overlap resulting in deepened health inequalities for minority ethnic groups/communities Much of our work to address this has been via our Immediate Priorities Plan and based on the data and systemic recommendations of the Expert Group on Covid-19 and Ethnicity. Work to improve our evidence on ethnicity within the health and housing sectors has been progressing, but the task is complex and will require an ongoing commitment and focus to ensure we better meet the needs of people from minority ethnic communities.

Goal 26: Minority ethnic communities and individuals experience better health and wellbeing outcomes.

Work to improve population health and reduce health inequalities requires a whole of Government response covering economic, environmental, education, justice, housing and other policies. This is evidenced by numerous studies, including the Fair Society, Health Lives Report (The Marmot Review), which reaffirmed the need for more coordinated efforts to improve the conditions of everyday life and reduce socioeconomic inequalities through activities spanning six key policy objectives. This list of policy objectives was recently updated in a 10 Years On Report to include strategies that address structural and systemic racism and discrimination.

The Care and Wellbeing Portfolio, established in 2022, is the Scottish Government’s principal vehicle for health and social care reform. It brings oversight and coherence to the major health and care reform programmes designed to improve population health and wellbeing, reduce inequalities and achieve health and care system sustainability. To maximise opportunities for early intervention and prevention, the Portfolio has adopted the eight Marmot policy objectives as its overarching policy framework. The framework is clear on the breadth of factors (determinants of health) that impact on people’s health and wellbeing, many of which go beyond what the health and social care system itself can deliver. The Portfolio approach provides a means by which to coordinate and maximise health and care’s contribution to these wider policy areas to address the wider determinants of health and in turn reduce health inequalities.

The principal work of the Portfolio is led through three interlinked programmes: Place and Wellbeing (P&W), Preventative and Proactive Care (PPC) and NHS Recovery, Renewal and Transformation (NHS RRT). All Programmes are tasked with considering the health and wellbeing outcomes of racialised communities and individuals, alongside other groups who experience health inequalities disproportionately. The PPC Programme is currently developing the Getting It Right Together for Everyone (GIRFE) model which looks at new ways to support households at greatest risk of child poverty, including minority ethnic families. Work is also being led by the P&W Programme's Anchors workstream to support Scotland’s health and social care bodies to operate as effective and collaborative Anchor Institutions. Their Workforce Group has an outcome that health and social care bodies recruit and retain a workforce that is representative of the local population and to improve to prospects of local people.

Scottish Government issues guidance to Health Boards on what to consider and prioritise as part of their operational planning process. Current guidance includes a focus on reducing health inequalities. However, our approach to reducing health inequalities and articulating priorities for Health Boards and the wider health and care system is evolving. As already noted, the Care and Wellbeing Portfolio is helping to bring greater oversight and coherence to this through the coordinated activities of its Programmes and Enablers, which together form a comprehensive and progressive health and social care reform package.

Type 2 Diabetes and Cardio-Vascular Disease (CVD)

Research shows that the South Asian ethnic groups in Scotland, comprising mostly people of Pakistani and Indian origins, have substantially higher rates of CVD and type 2 diabetes (3-4 times higher for diabetes) compared to the White Scottish population.^[36] We are focused on addressing this by reinvigorating efforts on culturally competent health promotion and disease prevention of type 2 Diabetes and CVD for people from minority ethnic communities. In November 2022, we published Minority ethnic groups - understanding diet, weight and type 2 diabetes: scoping review. This is supporting the evidence base to inform future approaches. We are currently exploring a pilot project to take action to meet the IPP recommendations.

Health literacy

Health literacy is about enabling people to have sufficient knowledge, understanding, confidence and skills to cope with the complex demands of modern health care. Meeting people’s health literacy needs and communicating in meaningful ways is key to delivering person-centred care. It also improves the safety and effectiveness of care and helps address health inequalities.

We have recently undertaken a programme with the intention of updating Making it Easier - Health Literacy Action Plan and are working with our partners NHS Shetland on small-scale test pilots to improve health literacy and build capacity to generate improvement projects. Among other things the projects looked at how to discover barriers people face in engaging with healthcare and how to work with them to overcome these.

Goal 27: Minority ethnic communities and individuals experience improved access to health and social care services at a local and national level to support their needs.

The Scottish Government acknowledges there are health inequalities between racial minorities and majority white groups, as well as between different minority ethnic groups. The picture is complex and needs to be addressed by government, service providers and communities working together. Whilst the root causes of poor health lie largely outside of the health system, we have an important role to play in narrowing the gap, particularly in improving health and care access, experiences and outcomes.

A number of prominent reports and studies have highlighted the health inequities experienced by minority ethnic populations and the extent to which Covid has exacerbated these. Whilst our understanding is limited by the lack of good quality ethnicity and intersectional data, we have no reason to believe that the situation in Scotland is any different to the rest of the UK. This is substantiated by Scottish publications such as Public Health Scotland’s report 'Monitoring ethnic health inequalities in Scotland during COVID-19’, the Mental Welfare Commission for Scotland’s ‘Racial Inequality and Mental Health in Scotland’ report, and the findings and subsequent recommendations made by the Scottish Government commissioned Expert Reference Group (ERG) on Covid-19 & Ethnicity in relation to data, evidence, risk and systemic issues. Around half the recommendations made by the ERG were for health and social care to take forward; all recommendations were accepted by Ministers in November 2020.

Good progress has been made on several recommendations, including initial work to improve the collection of ethnicity data through the vaccinations programme (further details below). Significant work was undertaken to make public health messaging more inclusive, notably through efforts to improve Covid vaccine uptake through targeted communications and stronger collaboration with minority ethnic, religious and community groups. Specific workstreams have also been established in various parts of the Scottish Government including Population Health, Vaccines and Health Workforce to improve equity for minority ethnic patients and staff, as well as other equality groups.

Racialised Health Inequalities in Health & Social Care in Scotland Steering Group.

The overarching aim of the Group is to address structural racism within health and social care in Scotland, and to pursue equity of access, experience and outcomes for minority ethnic people. The Group is co-chaired by the Director of Population Health and Director of Evidence at Healthcare Improvement Scotland. Core membership includes the Scottish Government’s Chief Medical Officer, Directors and Deputy Directors from policy areas across Health and Social Care, the Chair of the NHS National Ethnic Minority Ethnic Forum, as well as representation from NHS Health Board Chief Executives and Directors of Public Health.

The Group, which was set up in April 2022, has prioritised the development of a high-level action plan focussed on existing ERG commitments and other areas where action is needed to achieve its overarching aim and Race Equality Framework for Scotland goals.

Ethnicity Data

Improving the quality and completeness of ethnicity data is a high priority if we are to effectively identify and address racialised inequalities in health and social care, and measure progress.

As part of the work being taken forward by the Steering Group, a short life working group, led jointly by Public Health Scotland and Scottish Government, has been established with the aim of developing a cohesive, coordinated approach to improving ethnicity data collection and use within health and social care, adhering to ethical and anti-racism principles, and ensuring our work is aligned to our new Data Strategy for Health and Social Care – ‘Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age’ (Feb 2023).

The Scottish Government works closely with partners to monitor the impact of COVID-19, including Public Health Scotland (PHS) who published data by ethnicity on a regular basis as part of its weekly national respiratory infection and COVID-19 statistical report. This included:

• data on the uptake of COVID-19 vaccinations released as part of the equalities analysis on the Flu and COVID-19 vaccination uptake in Scotland dashboard.
• data relating to ethnicity of hospital admissions released as part of the COVID-19 & Respiratory Surveillance in Scotland interactive dashboard.

The collection of ethnicity data for COVID-19 vaccinations was introduced in November 2021, with ethnicity now routinely collected for COVID-19, influenza, shingles and pneumococcal vaccines, where a record is not already held. Ethnicity data collected through the vaccination programme is combined with data held from other health systems to achieve more robust ethnicity data. Analysis of the Winter 2022 influenza and COVID-19 Vaccination uptake on 29 January 2023 showed ethnicity has been assigned to over 93% of the eligible COVID-19 records and to 90% of eligible influenza records.

Public Health Scotland (PHS) has also published a summary report ‘Monitoring ethnic health inequalities in Scotland during COVID-19’ (March 2022) which collates the data and analyses that have been published by PHS on ethnic health inequalities in Scotland during the pandemic, and sets out actions that PHS and partners are undertaking to improve ethnicity data collection and use. For instance, ethnicity recording has been made mandatory on hospital admission datasets submitted by NHS Boards to PHS.

PHS will be publishing a second annual report on monitoring racialised health inequalities in Scotland on 30 May 2023. It provides information on ongoing improvements in ethnicity data collection and analysis to allow routine monitoring of racialised health inequalities across the health and care system. This year's report:

• Focuses on ongoing work within Maternity and Early Years data. This reflects both the importance of public health advice and interventions during maternity and early years in improving the health of the population and the progress being made in capturing ethnicity information in these key areas.
• Updates on an evaluation of the COVID-19 vaccination programme, looking at factors affecting vaccine uptake among different ethnic groups and how the lessons learned can be used to improve uptake in future vaccination programmes.
• Updates on ongoing work to refresh the Happy to Ask Happy to Tell toolkit which seeks to empower health and care professionals to ask data providers about their equality characteristics, including ethnicity.
• Provides information on work PHS is doing, in partnership with others, to address the health inequalities faced by Gypsy, Roma and Travellers.

The new SG Data Strategy for Health and Social Care – ‘Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age’ (Feb ’23) commits to further improving the quality and consistency of protected characteristics data, including ethnicity data, to ensure that equitable care is provided to everyone in Scotland requiring it. The strategy emphasises the importance of treating privacy, particularly of protected characteristics like ethnicity, sensitively to prevent bias or discrimination. It also includes a commitment to assess the fairness and impartiality of data processes and working with experts in systemic racism, disability, and social policy to ensure appropriate analysis, and to mitigate bias and discrimination.

We are taking forward a multi-agency and multi-year partnership to make improvements to the quality of ethnicity data within social care:

• We are currently working on a data improvement programme which focuses on consolidating current data and tackling barriers to sharing management information between organisations. This includes engaging with local partnerships to better understand how ethnicity data is recorded at source and assessing how to better use what ethnicity data is currently collected.
• A data review has commenced which will enhance the quality, completeness of information on care homes.
• We are working closely with PHS to examine options for developing Source data and related data collections, including utilising an ethnicity reference file (currently being developed) and investigating whether linkage to other sources of ethnicity data, such as health datasets, could be used to enhance the quality of ethnicity data in social care.
• We will develop a nationally consistent, integrated, and accessible health and social care record to allow safe, secure and efficient sharing of social care and health data cross relevant care settings, and with the individual. We will co-design the record to ensure the person is at the centre of the record and individuals are enabled to engage positively with their care, including their own care and health information.

Leadership & Awareness

Embedding anti-racism leadership across health and social care is essential. In addition to the Racialised Health Inequalities in Health & Social Care Steering Group, work is in hand to ensure senior leaders across DG Health & Social Care have anti-racist performance objectives. To support effective delivery of those objectives, the Coalition for Racial Equality and Rights (CRER) is delivering anti-racist leadership development sessions to Steering Group members and senior civil servants across DG Health & Social Care.

To build capability within the DG Health & Social Care and our delivery partners, we have also established a Community of Practice on addressing racialised health inequality in health and social care. Over one hundred policy and delivery colleagues have joined the community so far, with meetings to date focused on a range of topics including racialised determinants of health outcomes, mental health, anti-racism policy-making and inclusive communication.

Inclusive Public Health Messaging

In response to the ERG recommendation on improving public health messaging for minority ethnic groups, Scottish Government and Public Health Scotland are jointly funding MECOPP to take forward a project on inclusive communication. Specifically, it will look at the process of developing culturally appropriate and accessible public health messaging in partnership with those from a minority ethnic community.

Focusing on the Gypsy/Traveller community, the project will establish testing panels who will review existing information resources, as well as supporting and advising on the development of new materials. SG will use the findings from the project to further build on the work carried out during the pandemic to make public health messaging more inclusive and culturally competent. This will inform the development of resources for staff across SG Health & Social Care on practical steps that can be taken to ensure specific sensitivities, barriers and cultural differences are routinely considered as part of relevant work.

Improving Health Outcomes for the Gypsy/Traveller (G/T) Community

We continue to progress the health related actions in the SG/COSLA Gypsy Traveller Action Plan, with the aim of improving health outcomes for the Gypsy/Traveller community who continue to face some of the most significant health inequalities in Scotland. Health specific commitments have a strong focus on improving Gypsy/Traveller awareness of their rights and entitlements in relation to health care and services, as well as ensuring services are responsive to specific Gypsy/Traveller needs.

Our work is closely aligned with key third sector partners, with funding supporting targeted projects including the establishment of MECOPPs (Minority Ethnic Carers of People Project) Community Health Matters Programme. A key aspect of this project was to recruit, train and support Gypsy/Traveller Community Health Workers, enabling them to provide information and support on a wide range of health and social care issues to those in the Gypsy Traveller community. The positive impact the health workers are having in the community has been highlighted by stakeholders and community members, as well as in the interim evaluation report undertaken by Dundee University. Scottish Government has confirmed funding for the remainder of financial year 2023/24 to enable continued learning from the project to be gathered, as plans to mainstream it into Health Board core provision (from 2024/25) are taken forward.

Maternal and Infant Health

A number of recent reports have further emphasised the inequality in outcomes for Black and Asian minority ethnic groups in particular across the UK. For example, Black women are 3.7% more likely to die than white women in pregnancy or childbirth, with Asian women 1.8% more likely to die than white women.

While it is encouraging that the most recent MBRRACE-UK report (Nov ’22) highlighted improved pregnancy outcomes for Black and Asian women, much more can be done to ensure continued improvements. As such, we are actively considering the findings from recent reports, such as those from Birthrights and FIVEXMORE, alongside the actions and recommendations from all audit reports and the MBRRACE-UK confidential enquiries and working with clinical leads to develop a programme of improvement activity in Scotland.

Mental Health

A range of work is being progressed to ensure that ethnic inequalities are being considered as part of our work on mental health. Our Mental Health Transition and Recovery Plan, published in October 2020, commits to making the mental health of minority ethnic groups a priority. The plan lays out specific actions including engagement with these groups to better understand and respond to mental health inequalities which may impact them. We have established an Equality and Human Rights Forum to provide advice on the implementation of the Transition and Recovery Plan and wider equalities work within mental health policy. This includes representation from ethnic minority groups, ensuring that the causes of minority ethnic mental health inequalities are considered in policy development and delivery. We have also increased investment in NHS services and third sector mental health organisations to improve access, experience and outcomes for minority ethnic groups. NHS Mental Health expenditure rose from £1.25bn in 2020-21 to £1.3bn in 2021-22, an increase of £51.5m or 4.1% - representing 8.8% of total NHS expenditure. Expenditure on CAMHS also rose from £88m in 2020-21 to £97.6m in 2021-22, an increase of £9.3m or 10.6% - representing 0.66% of total NHS expenditure.

As part of our focus on prevention and early intervention, we have made a number of investments. In 2021-22, this included:

• £250K in the Mental Health Foundation’s Covid Response Programme which focussed on minority ethnic and refugee communities. A minority ethnic peer learning network has been established with minority ethnic led partner organisations with the aim of building the organisations capacity to promote, create and sustain the mental wellbeing of different minority ethnic communities going forward.
• £150K in MECOPP to work in and with Gypsy/Traveller communities to raise general awareness of mental health and improve mental health and wellbeing outcomes and support for children and young people.
• £20K in Progress in Dialogue to set up a project to tackle the hate crime, stigma and discrimination that exacerbate mental health outcomes for Gypsy / Traveller communities.

We have also invested £36m in our Communities Mental Health and Wellbeing Fund for adults over the past two years, with approximately 3300 grants being made to local organisations across Scotland. A further £15 million of funding for 2023/24 was announced on the 24 April 2023, bringing total investment to £51 million over three years. The Communities Mental Health and Wellbeing Fund has supported grass roots community groups in building resilience and tackling social isolation, loneliness and the mental health inequalities made worse by the pandemic and, more recently, the cost crisis. It prioritises a range of ‘at risk’ groups such as minority ethnic people. For example, in South Lanarkshire, Hope Amplified Gardening Project offers 50 families (aged 18-40) from the African community, an opportunity to learn gardening and cook heathy, nutritious, inexpensive meals in a setting that boosts family bonding, improves confidence, and raises self-esteem whilst acquiring valuable social skills at the Fern Brae Gardening Allotment. Through the Community Mental Health and Wellbeing Supports and Services Framework, we have provided local authorities with £15 million per annum in 2021/22 and 2022/23 to fund community-based mental health supports for children and young people aged 5-24 (26 if care-experienced), their family members and their carers. Through the framework funding, services for minority ethnic young people have been put in place by Edinburgh City Council and Glasgow City Council.

Scotland now has record levels of investment to improve support and services and we are working to ensure everyone’s right to access appropriate mental health care is realised. Our forthcoming Mental Health and Wellbeing Strategy will build upon our work to date and set out a vision for Scotland that has addressing mental health inequalities at its heart. The Strategy will be evidence based, informed by lived experience and underpinned by equality and human rights. We will take full account of the experience of minority ethnic people and set out actions to address racialised mental health inequalities. We will continue to engage with our Equality and Human Rights Forum in the development of the Strategy and accompanying EQIA. A standalone research report on mental health in equality groups, including minority ethnic groups, will also be published alongside the Strategy and support robust EQIAs of actions going forward.

Our forthcoming Mental Health and Wellbeing Workforce Action Plan will also set out intentions for a more culturally competent and diverse workforce. As part of the development of the Workforce Action Plan and the associated impact assessments we will be working with partners to have a robust evaluation and monitoring framework that supports the actions and intended outcomes.

Covid-19 Test and Protect

The Scottish Government fairly and equitably transitioned away from an emergency response in line with the publication of the Test and Protect Transition Plan. The strategic aims of the transition plan include protecting those in highest risk settings, where minority ethnic individuals are over-represented in jobs with increased exposure risks to COVID-19. Risk of exposure to COVID-19 in health and social settings is mitigated by ongoing access to testing alongside other infection prevention and control measures. Additionally, health and social care workers continue to be eligible for COVID-19 vaccination.

Throughout the Covid pandemic accessibility and inclusivity has been a key priority for Test and Protect. We worked with local partners to plan locations of walk-through test sites in areas of higher deprivation and low car ownership, ensuring disabled access routes, additional space to accommodate families and those who required privacy while being tested, and provided instructions in languages other than English. For those with access to a car, six drive-through regional test sites across Scotland had assisted PCR testing for 12-year-olds and over. We also developed a network of twenty-six small-scale test sites in partnership with NHS Highland, NHS Grampian, the Scottish Fire and Rescue Service and the British Red Cross to provide access to testing for rural communities; and we increased the accessibility of the home test kit system to island communities in NHS Highland.

Furthermore, we worked with local partners to establish community testing sites to reach underrepresented groups, which included test sites in mosques and churches, and have worked with local partners to distribute PCR and LFD kits to high prevalence neighbourhoods when new variants of concern appeared in Scotland. LFD kits were available to collect at pharmacies across Scotland, which research showed are highly trusted services among ethnic minority groups. In addition to establishing test sites and distribution points, we worked with local partners to embed local communication strategies and widen the reach of messaging with translations in languages local communities speak. NHS Inform updated guidance in easy read, British Sign Language (BSL) and language translations regularly.

We have also ensured that the needs of different groups with protected characteristics were met via the testing system. Those without digital access phoned the 119 Freephone service to order PCR and LFD kits, report their LFD test result, or receive their PCR test result. In addition, those with visual impairments used the ‘By My Eyes’ service for assistance with PCR testing.

Vaccination

The collection of ethnicity data through the Covid-19 vaccination programme began in November 2021 and this data has been included in PHS Covid-19 statistical reports since January 2022. PHS developed evidence papers with recommendations for increasing uptake in communities where data showed uptake was lower (e.g., African, Black, Caribbean, Polish and Pakistani) and followed up with sessions for Boards to share experience and practice. The Scottish Government, PHS, NHS Boards, third sector and community organisations worked in partnership to promote vaccine uptake and remove barriers. NHS Boards developed dedicated inclusion plans within the vaccination programme outlining how they would actively offer vaccination to people who may face barriers to uptake.

The national Vaccine Inclusive Steering Group shares learning and solutions co-produced with those who know their communities best and develops community engagement to support and promote vaccine uptake among minority ethnic communities.

Shielding: meeting the needs of minority ethnic communities

An announcement was made in Parliament on 27^th April 2022 that Scotland’s Highest Risk List (HRL - for those at risk from Covid-19) would be ending on 31^st May 2022. We published the Coronavirus (COVID-19) advice for people on the Highest Risk List evidence review on 27 April 2022 to help individuals on the Highest Risk List understand their reduced risk from COVID-19 following the vaccination programme and new treatments. We carried out user testing in May 2022 on letters/messages around the ending of the HRL with people on the List (aiming to be as representative and include protected characteristics as possible with small sample numbers for qualitative work) to ensure they were understood and accessible.

The Chief Medical Officer wrote to everyone on the HRL thereafter to explain the decision in ending the HRL, setting out the identification process the NHS would retain to quickly identify people who should be prioritised for vaccination, treatments, and to ask individuals to follow the same advice in relation to COVID-19 as the general public, unless advised otherwise by their GP/Clinician. The Scottish Government continued to offer translation the letters into any format and language needed and we completed an Equality and Fairer Scotland Impact Assessment for the ending of the Highest Risk List which was published on 31^st May 2022. We also carried out engagement with various medical charity stakeholders to ensure they were fully briefed and able to respond to questions and concerns from people they represent in relation to the ending of the HRL.

Goal 28: Scotland's health and social care workers are better able to tackle racism and promote equality and community cohesion in delivery of health and social care services.

Scottish Government are working to ensure that Equality, Diversity and Inclusion training for Health and Social Care staff incorporates up to date messaging and relevant information on equality including anti-racism, sexual harassment, ageism, LGBTI+ equality, and identifying/reporting incidences of equality-based harassment.

We have committed to develop anti-racist training resources for NHS staff, with the Coalition for Racial Equality and Rights (CRER) awarded the contract to develop these resources by the end of 2024. CRER will work in collaboration with the NHS National Ethnic Minority Forum (EMF), NHS employers and other key partners to ensure that the resources developed are relevant to the experiences of staff and patients in Scotland.

The resources will have a specific focus on:

• Understanding and identifying systemic and structural racism both in general and within the health and social care settings in particular.
• The impact of racism on mental and physical health of both the victims and the witnesses.
• Racialised health inequalities.
• Intersectional racism, including islamophobia, and prejudice affecting specific groups such as minority ethnic women, asylum seekers and refugees.
• Reporting of incidents; and
• Support structures and resources across NHS Health Boards in Scotland.

The NHS National Ethnic Minority Forum (EMF) was established in April 2021 and aims amplify the voices of ethnic minority staff across the health service and tackle issues of systemic racism. We continue to work closely with EMF on their priorities for 2023/24, which include:

• the development of a ‘How to Talk about Race’ in the workplace guide.
• considering support for staff reporting incidents of racial abuse/harassment
• supporting the development of anti-racism training resources for staff (an action that Scottish Government are taking forward).

We are also working with EMF to develop a longer-term workplan.

As social care staff are employed by local government, third sector providers or independent providers, the Scottish Government does not have the statutory powers to mandate them to take forward actions such as mandatory training for managers or redress procedures. However, we are committed to work with our partners to ensure Fair Work is central in the delivery of social care. This includes improving staff welfare through the introduction of collective bargaining, improved pay and conditions and enhancing effective voice at a local level, ensuring all staff have equal access of opportunity and ways to raise matters of concern and importance to them. We are working with partners to further develop ethical commissioning principles and practice.

Goal 29: Scotland's health and social care workforce better reflects the diversity of its communities.

The Leading to Change Programme offers a range of talent management and leadership development opportunities for the health, social work and social care workforce that promotes collaborative, compassionate systems leadership, underpinned by the requirement to foster an empowering and inclusive culture. Efforts will also focus on enabling and encouraging diverse leaders at all levels to be identified and supported into more senior roles across health, social care and social work. A number of interventions are live including the Diversity Coffee Connect Programme and the Diversity Blog Series. More interventions including supporting line managers and others to be active allies, targeted assistance for groups of diversity networks, and a tailored programme to support the minority ethnic workforce are currently in the scoping and planning phase.

Diversity and Inclusion objectives have been set for NHS Chairs, on a rolling basis as their appraisals coincide with their appointment dates. These are in the process of being reviewed to ensure they fully align with their assurance and scrutiny roles.

Goal 30: Minority ethnic communities experience fewer housing inequalities.

A review of evidence on the housing needs of minority ethnic groups was published in January 2021: Housing needs of minority ethnic groups evidence review

A review of evidence about the accommodation needs of Gypsy/Travellers in Scotland, drawing on both academic and grey literature, was published in October 2020. Housing to 2040 sets out a vision for housing in Scotland to 2040 and a route map to get there. It aims to deliver our ambition for everyone to have a safe, good quality and affordable home that meets their needs in the place they want to be.

Gypsy/Traveller accommodation

As set out in Housing to 2040, the Gypsy/Traveller Accommodation Fund is providing up to £20 million to local authorities, between 2021-26, for more and better accommodation.

To drive a significant improvement in the quality of sites going forward, we have published an Interim Site Design Guide for Gypsy/Traveller sites, developed in conjunction with local authorities and with input from members of Gypsy/Traveller communities. This is intended to assist new build and site re-development of a high quality, to meet the varying needs of families, including children, older and disabled people and to align with key principles of Housing to 2040 such as accessibility and energy efficiency.

The fund and Interim Site Design Guide will help us deliver our shared objectives with COSLA under the Gypsy/Traveller Action Plan Improving the lives of Scotland's Gypsy/Travellers for more and better Gypsy/Traveller accommodation.

We are commissioning an evaluation of the Fund and Design Guide in 2023 which will gather the key points of learning from the demonstration projects to inform future projects, a final Site Design Guide and policy on Gypsy/Traveller accommodation.

In 2023 we plan to commission work on an Accommodation Needs Toolkit - This has a practical focus, aimed at improving the way that Housing Needs and Demand Assessments, Local Housing Strategies and Development Plans reflect the needs of Gypsy/Travellers and helping Local Authorities to meet their duties under the Planning (Scotland) Act 2019 in relation to Local Development Planning and Evidence Reports.

The Scottish Government published Minimum Standards for Gypsy/Traveller sites in 2015. The Minimum Standards are now part of the Scottish Social Housing Charter. Compliance with the standards is monitored and reported on by the Scottish Housing Regulator (SHR).

The Site Design Guide does not replace Minimum Standards. The Minimum Standards for Gypsy/Traveller sites remain in place as a threshold below which site standards should not fall.

The SHR plans to undertake a thematic study on Gypsy/Traveller accommodation during 2023. SHR and the Scottish Government will liaise on the outcomes of this and what it may mean for their respective regulatory/policy approaches.

Social Housing

In relation to social housing, the SHR worked with the social housing sector to produce (and then updated) equality data collection guidance for social landlords. This follows new data collection requirements introduced by SHR to help landlords better understand their tenants which in turn informs better and ’equal’ policymaking in the things that affect social housing tenants particularly those that are ME and disabled.

SHR is working with the Scottish Human Rights Commission (SHRC) to produce a briefing note / guidance on the human rights aspects of housing. This is part of a broader approach that requires landlords to consider a human rights approach in their provision of social housing.

The Scottish Social Housing Charter

As part of the review of the Scottish Social Housing Charter (the Charter), Scottish Government held a range of “Involving All” Charter consultation sessions that covered a range of stakeholders including with Black and minority ethnic communities. Their feedback helped us to revise the Charter to incorporate a reference to human rights and the ‘right to housing’ for all individuals into the equalities outcome. The revised Charter was approved by Parliament and took effect from November 2022.

The New Deal for Tenants

The New Deal for Tenants – consultation on a Rented Sector Strategy (RSS) included specific questions to explore any particular barriers people with protected characteristics face in their experience of the rented sector. The consultation closed on 15 April 2022.

As part of the RSS consultation, we were seeking to develop specific consultation sessions for those in minority ethnic groups as well as for disabled people. However, due to prior workload commitments within the teams approached, alternative engagement methods were undertaken. The analysis of responses to the consultation was published in August 2022 and we will aim to look at the responses in more detail as part of our Housing to 2040 commitments.

In terms of the Private Rented Sector, the Joseph Rowntree Foundation (JRF), in partnership with the Scottish Government, published the tenant insights report: What do lower income tenants in Scotland’s private rented sector want to see from a new Rented Sector?. We are currently considering the findings of this report to assess how best to take forward the recommendations.

Living_in_scotland_PRS_survey_report_sept_2022.pdf (housingevidence.ac.uk) was published in September 2022 (as part of the overall findings of the above report) and this survey noted some interesting equality findings.

We are looking to further development engagement in the private rented sector with the creation of a tenant participation panel and we will seek to understand the views, experiences, and housing needs from minority ethnic groups as well as other protected characteristics. However, it must be noted that participation, is fairly challenging given the fragmented nature of the sector.