NHS Scotland Agenda for Change (AFC) Pay Deal for 2018-21: EQIA

Stage 2: Data and evidence gathering, involvement and consultation

Official statistics for the NHS Scotland workforce are provided by Information Services Division (ISD)^[2]. This published data includes non-AfC staff (e.g. medical staff). We therefore requested additional information from ISD for AfC staff only, which now dates from one year before the latest official statistics. It is not therefore directly comparable.

Equality and diversity information for NHS staff is based on self-reporting. It is usually captured via staff engagement forms when people join or change boards within NHS Scotland, or via the e:you questionnaire exercise undertaken for all NHS Scotland staff in post. Completion of the questionnaire exercise is optional and response rates vary across the country.

Age

As at March 2019, the median age of all NHS Scotland staff (by a whole-time equivalent, or WTE, measure) is 46. The modal age group (16.6% of the total) is 50-54 years. 36.7% of all staff are under 40, 38.9% of all staff are over 50, and 8.5% of all staff are over 60. The modal age group largely reflects the age distribution of the Scottish population, where there are two modal peaks around ages 25 and 50-55.^[3]

The data for AfC-only shows that (by headcount) in Bands 3, 4, 6, 7 and 8, the modal age group is 50-54. Band 5, however, shows a different age structure, where staff are more evenly distributed across the age groups, and the modal age group is 25-29 (15% of the total) – this is likely to be due to the large numbers of staff nurses in this Band [Figure 1], including those who have recently qualified.

Figure 1: Age breakdown of AfC bands (as percentage of total)

Source: Scottish Workforce Information Standard System (SWISS), ISD Scotland

Disability

Disability is self-reported in the statistics and only around half of NHS Scotland staff have declared whether or not they have a disability. As at March 2019, ISD official statistics show that 0.8% of staff working in NHS Scotland declared a disability^[4]. This figure includes those staff who have not declared a disability status.

The AfC-only data shows that 1.6% of staff who provided their disability status declared that they had a disability. Breaking this down by band shows that declared disability is higher at Bands 3 (2.4%), 8A and 8B (each 2.1%) and lower at Band 2 (1.2%).

Compared to the Scottish population as a whole, these figures appear to be low. In the 2011 Census, one in five of Scotland's population reported that their day to day activities were limited by a long-term health problem or disability; 355,000 people (7% of the population) declared a physical disability.^[5]

The figures for NHS staff should therefore be treated with caution. There is no legal obligation for an employee to disclose a disability, and under-reporting is likely for a variety of reasons. Across Britain, for example, the Fair Treatment at Work Survey (2008) showed 19% of disabled people experienced unfair treatment at work compared to 13% of non-disabled people^[6]. This may relate to people's willingness to declare a disability.

Sex

As at March 2019, ISD official statistics show that 77.4% (WTE) and 79.3% (headcount) of all NHS Scotland staff are female^[7], including non-AfC staff. The figure is larger by headcount because a greater proportion of women work part-time.

The AfC-only data shows that that there is a higher proportion of women within AfC grades than NHS Scotland as a whole (82.1%, by headcount). Breaking this down by band shows that the proportion of women is higher at Band 4 and 5 (at 86% each) and lower at Band 8 and 9 (at 74% and 50% respectively).

Pregnancy and maternity

Whilst official statistics are available on sex (as above) and the prevalence of part/full-time working patterns, it is not possible to extrapolate from this to acquire robust evidence on pregnancy and maternity.^[8]

Gender reassignment

Although official statistics on the percentage of NHS staff with a declared transgender status are published, the value at Scotland level, to 1 decimal place, rounds to zero. This includes staff whose transgender status is unknown – over half of the total.

The AfC-only data shows that 0.08% of staff who provided their transgender status declared themselves to be transgender.

Equivalent data is not available for the Scottish population. However, this data gap is acknowledged and will be addressed: from 2021 the Census will include (voluntary) questions on transgender status and sexual orientation.^[9]

The UK Government's Equalities Office 'tentatively estimates' there are 200,000-500,000 transgender people living in the UK (as at 2018)^[10]. With a mid-2018 population estimate of 66,435,600 for the whole of the UK, this would mean 0.3-0.7% of the UK population are transgender.^[11]

The figure of 0.08% for AfC staff in Scotland is comparatively low, but it remains unclear from the available data whether staff under-report on gender reassignment, or whether staff who have undergone gender reassignment are under-represented in the workforce. This is partly a data collection issue.

Sexual orientation

As at March 2019, ISD official statistics show that 1.8% of staff working in NHS Scotland declared their sexual orientation as gay, lesbian, bisexual or other.^[12] This includes staff whose sexual orientation status is unknown – almost half of the total.

The AfC-only data shows that 44.1% of AfC staff (headcount) did not answer or chose not to disclose. 1.5% declared themselves gay, lesbian, bisexual or other.

The Scottish Surveys Core Questions (2017) estimates 3% of the Scottish population are LGBT, though notes that these figures are likely to be low due to under-reporting.^[13] Corroborating this, a survey by the charity Stonewall (2018) shows that, across the UK, 35% of LGBT adults declared they have hidden their sexual orientation at work due to fears of discrimination.^[14]

More broadly, there is minimal consensus about the demographics of sexual orientation. The ONS figure (2017) across the UK is 2%.^[15] The charity Stonewall argue that this is low, as people are reluctant to disclose their sexuality. Although the question relates to same-sex experiences rather than sexual orientation, it is notable that the UK's National Survey of Sexual Attitudes and Lifestyles (2010-12) gives much higher figures, showing 7% of men and 16% of women reported having had 'any same-sex experience'.^[16]

Taking these points into account, the figure of 1.5% noted above may be low. This is partly a data collection issue. As discussed, from 2021 the Census will include (voluntary) questions on sexual orientation.^[17]

Race and ethnic group

As at March 2019, ISD official statistics show that 3.3% of staff working in NHS Scotland were from a non-white ethnic group.^[18] This includes staff whose ethnic group is unknown – almost one-third of the total.

The AfC-only data shows that 97.1% of staff who provided their ethnic group were white. Of the remaining 2.9%, or 3,124 respondents: 1,859 were Asian; 545 were African; 389 were of mixed or multiple ethnicities; 224 were of an ethnicity not listed ('other'), and 107 were Caribbean or Black.

Breaking this down by AfC band indicates that non-white groups are under-represented at Bands 3, 6 and 7 (at 2.1%, 2.4% and 2.1% respectively).

Cross-referencing by age group shows that older members of the NHS workforce are more likely to be white: 97.2% of the workforce aged 50-54; 98.2% aged 55-59, and 98% aged 60+ are white. By contrast, 92.5% of the workforce aged 40-44 are white.

In Scotland as a whole, the 2011 Census shows non-white minority ethnic groups make up 4% of the population.^[19]

Religion and belief

As at March 2019, ISD official statistics show that 33.0% of staff working in NHS Scotland declared their religion as Christian and 5.7% to a non-Christian religion.^[20] This includes staff whose religion is unknown – one-third of the total.

The AfC-only data shows that 53.2% of staff who provided data on their religion reported they were Christian, 42.4% reported they had no religion and 4.4% reported they belonged to a non-Christian religion.

Breaking this down by Band shows that Christian groups are over-represented at Band 7 (57.1%) and under-represented at Band 2 (50.3%). The opposite is the case for those with No and Other religions.

Marriage and civil partnership

Official statistics on the NHS Scotland workforce do not give information on marriage and civil partnership status.