Is the NHS on gender duty?

If the new Gender Duty introduced under the Equality Act is to have any impact, it is vital that it is met throughout the NHS. How far have they got so far? The Men's Health Forum Peter Baker addressed this question at the Forum's recent Gender Duty Conference. This is his speech in full.

We believe that the Gender Duty, if implemented effectively, has the potential to bring about the biggest improvement in male health since the NHS was founded in 1948.

More widely than health, the Duty has the potential to put men's issues on the public policy agenda across the board. This has implications for education, employment, crime and violence, parenting and many other areas, in terms of both policy and service delivery.

The legislation also, of course, has enormous implications for women's health.

The potential might be huge but what's really likely to happen? Where are we now? Well, we don't really know; it's too early to say for sure.

What we do know is where we're coming from.

We're coming from an NHS which has almost entirely overlooked and not even understood gender. In so far that gender has been understood at all, it's been defined as 'women'. And even then in a very limited way — as being about reproductive health issues, primarily.

We're coming from an NHS which has, despite being run overwhelmingly, by men, almost completely overlooked men's health. The assumption has been that men are either genetically programmed to self-destruct at the age of 70 or that men are so wedded to risk-taking behaviours that there's no point in trying to help them.

When we surveyed PCTs a year ago as part of background study on the Duty we found that only one-fifth said they always took into account gender differences in health needs, behaviours and attitudes when developing public policy.

Just 14% said they always sought to ensure that the services they provide or commission were delivered in such a way that they are used by men and women in direct proportion to differences in needs.

I have to say that I have some trouble believing that so many PCTs always do this, but even if it's true, it's a low proportion.

We're also coming from an NHS which, according to the Healthcare Commission, is failing to comply with race relations legislation in terms of publishing race equality schemes, employment monitoring statistics and outcomes of race equality impact assessments. These are very similar requirements to the gender duty, except that they've existed for much longer and are in a much higher profile equality area. The HC found that just 1% of trusts have fully met the legislation's publication requirements. 1%! Only 6% met two of the three requirements.

We're also coming from an NHS where PCTs have been reconfigured, where there are deep-seated financial problems and also where responsibility for equality and diversity overwhelming lies in HR departments rather than in policy or service delivery. In other words, the Duty will be seen first and foremost as an internal employment issue rather than an issue for the public and patients.

This must all sound very pessimistic. In fact, I'm the opposite. I'm optimistic for a number of reasons:

The legislation is actually pretty good. It's clear what's required. It's almost what we've been lobbying for over the last 10 years. There's little ambiguity. The focus is also very explicitly on outcomes rather than process. The legislation also has some teeth, not enough, but some to make people think twice about ignoring it.

The DH has also done a pretty good job of making clear to the NHS what's required. It's also listened to us and other outside organisations and this is reflected in the advice that's being given. I must also commend the EOC for its guidance on health. Also, take a look at The Guardian this Wednesday — EOC-sponsored supplement on the Duty with large articles on men's health and women's health.

There are a small but increasing number of equality champions in the NHS who take are taking gender seriously and are committed to making progress. I can give one example from our work — chlamydia screening. There's been a complete turnaround in the approach of the NCSP and a real openness to working towards more equal levels of screening of men and women. We're no beginning to see this in some local CSOs.

But what we still need to see from the NHS:

• Proper collection and disaggregation of data by gender.
• SHAs should appoint gender leads.
• A greater emphasis on training on gender.
• A central database of good practice.
• Standing advisory groups of men and women.
• Local targets broken down by gender.

Above all, we need pressure to make sure the Duty is implemented.

This is where the voluntary sector comes in. We have a golden opportunity to push for policies and services that much more effectively meet the needs of the people — all the people — we work on behalf of. If we work together, we can achieve even more, which is why we're setting up the Network which you'll hear more about later.

So — even though the legislation comes into force next week, we can't expect instant results. But with enough pressure and persuasion, we have can hope to see over the next few years a health service that is more in tune with the specific needs of men and women, tackling one of the most overlooked areas of inequality in health. 

• Full conference report
• More on the Gender Duty from the MHF