UN Human Rights Council Universal Periodic Review - fourth cycle recommendations: Scottish Government response

6. Health

A) Access to Healthcare

Recommendation(s) and Responses

Relevant section(s) of the Scottish Government’s October 2022 UPR Position Statement

• 6(F) – Access to Services
• 6(G) – Health Inequalities
• 6(H) – Mental Health

Recent Progress and Next Steps

In June 2023 the SG published ‘Anti-Racism in Scotland: Progress Review 2023: The Race Equality Framework and the Immediate Priorities Plan’^[126]. This report takes stock of what we have achieved to date in relation to the goals set out in the Scottish Government’s 2016 Race Equality Framework^[127], as well as the actions set out in the more recent Immediate Priorities Plan^[128].

Anti-racism leadership development sessions are being delivered to members of the Racialised Health Inequalities in Health & Social Care Steering Group and senior leaders across Scottish Government’s DG Health & Social Care by the Coalition for Racial Equality and Rights. Senior civil servants within DG Health & Social Care have also been provided with support (guidance and a workshop) to set themselves meaningful anti-racism business objectives.

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.

A new Data Strategy for Health and Social Care^[129] – ‘Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age’ – has been published in February 2023. The strategy 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.

Public Health Scotland published its second annual report on monitoring racialised health inequalities^[130] 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.

Scottish Government is providing a final year of funding for the Gypsy / Traveller Community Health Worker service to enable a sustainable model or solution for maintaining the provision for Gypsy / Traveller health related support and services to be identified and continued learning from the project to be gathered. Recruiting and training Gypsy/ Traveller Community Health Workers was one of the key health related commitments included in the Scottish Government’s 2019 Gypsy/Traveller Action Plan. The aim of the Health Workers is to improve access, experience and outcomes in healthcare and health for the Gypsy/Traveller community. Feedback on the impact of the service has been excellent and is outlined in the Interim Evaluation Report^[131] published by the University of Dundee in August 2022.

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

The overarching aim of the Group is to improve equity of access, experience and outcomes for minority ethnic people in Scotland, and address structural racism within health and social care. The current focus of the Group, which was set up in April 2022, is to deliver on existing commitments made in relation to the findings of the Expert Reference Group on Covid and Ethnicity.

Care & Wellbeing Portfolio

The Care and Wellbeing Portfolio^[132], 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^[133], Preventative and Proactive Care (“PPC”) and NHS Recovery, Renewal and Transformation. All programmes are tasked with considering the health and wellbeing outcomes of racialised communities and individuals, alongside other groups who experience health inequalities.

Relevant National Outcomes

• We are healthy and active.
• We respect, protect and fulfil human rights and live free from discrimination.

Relevant Sustainable Development Goals

• 3 - Ensure healthy lives and promote well-being for all at all ages.
• 10 - To reduce inequalities, policies should be universal in principle, paying attention to the needs of disadvantaged and marginalized populations.

B) Gender Identity Health Services

Recommendation(s) and Responses

Relevant section(s) of the October 2022 UPR Position Statement

• 6(T) – Gender Identity Services

Recent Progress and Next Steps

The Scottish Government has provided direct funding to all Scottish Health Boards that host a gender identity clinic to support work to improve how these services are delivered, and to reduce waiting times.

In November 2022, the Scottish Government awarded a grant to develop a third sector hosted Lived Experience Coordinator role. This post engages with trans/non-binary people across Scotland who have personal experience of accessing, or waiting to access, gender identity services, and represents their voices to the Scottish Government and NHS partners in work to improve gender identity healthcare.

In early 2023, the Scottish Government awarded a grant to the University of Glasgow to deliver a programme of research into the long-term health outcomes of people accessing gender identity healthcare.

In December 2021, the Scottish Government published its NHS gender identity services: strategic action framework 2022 – 2024^[134].

This Framework sets out how Scottish Government is working with partners to improve access to, and delivery of, NHS gender identity services.

Commitments made in this Framework which are currently being progressed include:

• developing national standards for adult and young people’s gender identity services;
• developing a Transgender Care Knowledge and Skills Framework for healthcare staff; exploring opportunities for staff training and improved resources to support best care of trans people accessing services in the NHS;
• establishing robust national waiting times data collection, monitoring and reporting for gender identity services;
• funding research into the long term health outcomes of people accessing gender identity healthcare; and providing direct funding to Scottish Health Boards that host a gender identity clinic to support work to improve services and reduce waiting times.

Relevant National Outcomes

• We are healthy and active.
• We respect, protect and fulfil human rights and live free from discrimination.

Relevant Sustainable Development Goals

• 3 - Ensure healthy lives and promote well-being for all at all ages.
• 10 - To reduce inequalities, policies should be universal in principle, paying attention to the needs of disadvantaged and marginalized populations.