The Equality Act provides protection to groups of people who may be discriminated against because of certain characteristics they share. It provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. The groups protected by the Act include:

• Age – People of different ages including children, young and older people
• Disability – People with a long-term condition, or with mental, physical, sensory, learning disability or impairments, or a combination of these
• Gender Reassignment – People who have changed, or are in the process of changing, their sex
• Marriage and Civil Partnership – People who are married or in a civil partnership
• Race – People characterised by shared ethnicity, language or culture
• Religion or Belief – People with or without a religion or belief
• Sex – Men and women
• Sexual orientation – People who identify as Lesbian, Gay, Bi-sexual or Transgender
• Pregnancy and Maternity – Women who are having or have just had a baby

The Equality Act sets out the Public Sector Equality Duty. This duty requires public bodies to consider all individuals when carrying out their day-to-day work – in shaping policy, in commissioning and delivering services, and in relation to their own employees. It requires us to have due regard to the need to:

• Eliminate unlawful discrimination, harassment and victimisation, and other conduct prohibited by the Act.
• Advance equality of opportunity between people who share a protected characteristic and those who do not.
• Foster good relations between people who share and people who do not share a relevant protected characteristic

The Equality Act also sets out specific duties to help us better perform the Equality Duty. It does this by requiring us to be transparent about how we respond to the Equality Duty.

We are accountable to our service users and open to public scrutiny. The duties, therefore, provide the public with the information they need to challenge and hold us to account in relation to our performance on equality.

The specific duties require us to:

• Publish sufficient information to show that we have considered the three aims of the general duty when making decisions, and the equality data that underpins those decisions.
• Publish Information related to people who share protected characteristics who are employees, or others affected, such as patients.
• To publish the information that is accessible to the public.

To comply with the requirements of the Equality Act 2010, we will work to continually:

• Monitor our workforce and analyse any unintended variations.
• Assess the health needs of our local communities.
• Commission programmes and services to address health inequalities.
• Carry out Equality Impact Analysis to inform our decision making.
• Involve member practices, communities, staff, patients and the public in our decision-making processes.
• Produce an equality strategy and annually measure our performance against it.

To can find out more about how we are meeting these requirements below.

We have obligations under the Human Rights Act 1998 that, as a public body, we must at all times act in a manner compatible with the rights protected in this Act and safeguard these for patients and staff in our care and employment. Human rights are underpinned by a set of common values and have been adopted by the NHS under the acronym FREDA. The FREDA principles represent:

• Fairness, e.g. fair and transparent grievance and complaints procedures.
• Respect, e.g. respect for same-sex couples, teenage parents, older people.
• Equality, e.g. not being denied treatment due to age, sex, race etc.
• Dignity e.g. sufficient staff to change soiled sheets, help patients to eat/drink.
• Autonomy, e.g. involving people in decisions about their treatment and care.

The Equality and Human Rights Commission states that putting human rights principles into public service practice is in the public interest. Evidence shows that public bodies taking human rights seriously treat people better.

We will work to embed a human rights-based approach in the way that we commission services and in our role as an employer. This approach is not new, and is evident in NHS policy initiatives such as Dignity in Care, Essence of Care, Standards of Better Health, and the Knowledge and Skills Framework.

We have a legal duty under the Health and Social Care Act 2012 to reduce inequalities between patients regarding their ability to access health services, and with respect to health outcomes, as well as to ensure that services are provided in an integrated (joined up) way.

The Act also places duties on us to promote the NHS Constitution, to enable choice, and to promote patient, carer and public involvement. To discharge this responsibility effectively, we will need to work with our partners to reduce health inequalities among those in greatest need and embed this requirement into our joint health and wellbeing strategies. We will also need to demonstrate how we will provide culturally sensitive services and ensure all patients can exercise choice and be involved in decision making.

There are 502,990 people living in Shropshire, Telford and Wrekin, 179,854 of those live in Telford and Wrekin and 323,136 live in Shropshire. Whilst Telford and Wrekin is predominantly an urban area, Shropshire, in contrast, is predominantly rural.

• Age  

Both of our counties have aging populations, with more people reaching retirement, and fewer young people living in the area.  Shropshire has one of the oldest populations in the UK, and the average age has increased by 4 years since 2011, from 44 to 48.  In Telford, the number of people aged 50 to 64 years rose by around 6,100 (an increase of 20%), while the number of residents between 35 and 49 years fell by just under 1,300 (3.4% decrease). 

• Disability 

In 2021, 9.1% of Telford and Wrekin residents were identified as being disabled and limited a lot. This figure decreased from 10.8% in 2011.  Similarly in Shropshire, there was a decrease to 6.7% in 2021, down from 8% in 2011.  This means that in Telford and Wrekin, the percentage of the population who are disabled and limited either a little or a lot is greater than the rest of the UK, and the West Midlands. 

• Race 

In 2021, 97% of people in Shropshire identified their ethnic group within the White category. This is a slight decrease from 2011.  1.3% identified their ethnic group within the Asian, Asian British or Asian Welsh category and 1.2% as Mixed.  This makes Shropshire one of the least diverse counties in the United Kingdom.  Telford and Wrekin is made up of a more diverse population.  88% are White, a decrease of 5% in 10 years, with 5.4% Asian, Asian British or Asian Welsh and 3% Black, Black British, Black Welsh, Caribbean or African. 

• Religion or Belief 

Both of our local authority areas are becoming notably less religious, with more people declaring No Religion at the census, similar to national trends.  In 2021, 48% of people in Telford and Wrekin described themselves as Christian (down from 62%), whilst in Shropshire 56% described themselves as religious (down from 69%). 

In both counties, Christians make up the largest single group, with no other religion making up more than 1% of the population in Shropshire, whilst in Telford 2.7% are Muslim, and 1.5% Sikh. 

• Pregnancy and Maternity 

In 2021, the number of conceptions for women of all ages in England and Wales, rose for the first time in six years from 817,515 conceptions in 2020 to 824,983 conceptions in 2021.  During this year, the West Midlands had the highest conception rate in England and Wales, with 78.1 conceptions per 1,000 women aged 15 to 44 years. 

Within STW, there were 6,161 pregnancies in 2021, with both counties below the West Midlands average, and Shropshire reporting one of the lowest rates in the country. 

• Sexual orientation 

In 2021 within Shropshire, Telford and Wrekin, 10,429 answered the census and reported being LGBTQ+.  In Telford, this represented 2.8% of the population, whilst in Shropshire this is around 2.3%.   

(Data sourced from the 2021 Census and the ONS)

The NHS workforce is more diverse than at any other point in its history.

The national NHS Workforce Race Equality Standard shows Black and minority ethnic (BME) staff make up almost a quarter of the workforce overall (24.2% or 383,706 staff) – an increase of 27,500 people since 2021 (22.4% of staff).

The analysis shows more than two fifths (42%) of doctors, dentists, and consultants, and almost a third (29.2%) of our nurses, midwives, and health visitors are from Black and minority ethnic backgrounds.

You can find our latest NHS Staff Survey results below:

NHS Staff Survey 2022 Breakdown Report

NHS Staff Survey Benchmark report 2022

Information coming soon

Improving Workforce and Commissioned Services

Our Equality Objectives aim to drive equality, diversity, and inclusion (EDI) improvements across our workforce and the commissioned services we are responsible for. These objectives support compliance with the Public Sector Equality Duty (PSED), integrate population health management principles, and align with the NHSE Equality Delivery System (EDS) themes.

Objective 1 – Embed Equality Impact Assessments in Decision-Making: Ensure all decisions affecting healthcare services, our population and our workforce include a completed Integrated Impact Assessment (IIA) or Quality Equality Impact Assessment (QEIA), considering protected characteristics and Core20+ populations.

• Measurement: Compliance will be monitored through governance processes, and completion rates reported quarterly.
• Documentation: Impact Assessments will be referenced in board reports and annual review documentation.

Objective 2 – Strengthen Inclusion and Health Equity Reporting: Ensure all reports to the Executive Group or Board contain narrative around EDI and are accompanied by an Impact Assessment.

• Action: Revise governance and reporting structures to embed EDI considerations in board papers and executive decision-making.
• Measurement: Annual audit of board papers for EDI compliance.
• Documentation: Inclusion Health and Equity findings will be published in an annual “State of the Region” or “Knowing Our Patch” report.

Objective 3 – Enhance Engagement and Feedback Mechanisms: Establish a targeted approach to empower patients, communities, and staff, particularly from marginalised backgrounds, to share experiences. Collaborate with Healthwatch, community groups, and advocacy organisations to capture, analyse, and act on feedback to improve services and workplace inclusion.

• Measurement: Number of engagement events, feedback themes acted upon, and community participation levels reported annually.
• Documentation: Findings published in the annual “State of the Region” / “Knowing Our Patch” report and used to inform planning.

Objective 4 – Leverage Data to Address Inequalities: Use population health data, workforce intelligence, and inequalities dashboards to inform service planning and workforce development. Take targeted, data-driven actions to address disparities in health outcomes, service access, and workforce experience, focusing on protected characteristics and Core20+ groups.

• Measurement: Regular review of dashboards, targeted interventions tracked and reported annually.
• Documentation: Data insights and actions will be captured in the annual “State of the Region” / “Knowing Our Patch” report.

Leadership Development and Accountability

Leadership will play a pivotal role in driving the Equality, Diversity, and Inclusion (EDI) agenda.

Objective 5 – Strengthen Leadership Capacity and Accountability for EDI: Ensure leaders are continuously developed to understand their EDI duties and inclusive practices and oversee the delivery of these objectives. This includes ensuring proper impact assessments, data collection, moving from shared values to inclusive practices and EDI narratives within governance processes.

• Action: Provide annual EDI leadership training and review leadership compliance with EDI duties.
• Measurement: Training completion rates and leadership involvement reported annually, changes in WRED/WDES data and annual staff survey.
• Documentation: Leadership actions and impact documented within annual EDI reports and governance minutes.

Not all of us have the privilege of living a long and healthy life.

For reasons outside of their control, certain groups and populations are far more likely to die early, or develop debilitating health conditions, as a result of unfair, unjust and avoidable factors.

Good health is a fundamental human right and it is up to us to do our part in changing these outcomes.

Here at NHS Shropshire, Telford and Wrekin, we pledge to tackle the problems of ill-health, health inequalities and access to healthcare. We strive for fairness and equity, so everybody can live a fuller, healthier life.

What are health inequalities?

Health inequalities are unfair, unjust and avoidable differences in health across the population, and between different groups within society. We measure health inequalities by looking at:

1. Average life expectancy – how long people are likely to live.
2. Healthy life expectancy – the quality of someone’s life and what health conditions they might develop throughout their life.

National data tells us that, for example:

• The median age at death for people with a learning disability is 20 years earlier than someone without a learning disability (data source).
• Double the amount of people from Gypsy, Roma or Traveller (GRT) communities report being in bad or very bad health compared to the general population (data source).

There are three key ways in which the NHS can make an active contribution to tackling health inequality:

1. By tackling healthcare inequality - the inequalities in access and experience of healthcare services.
2. By influencing multi-agency action to address social determinants through the part we play in our Integrated Care System (ICS).
3. By using our roles as Anchor Institutions to impact positively on our local communities through our business-related functions. This includes through the employment opportunities we offer, our procurement of goods and services and our use of buildings and spaces. To find out more visit NHS England - Anchors and Social Value.

When we think about making changes to our services, policies, or workforce practices, it is important that we fully consider the impact that it may have on all of our population groups, along with how it may positively or negatively affect other environmental factors, such as climate change. 

The integrated impact assessment process is our tool to ensure that we fully assess the impact of changes on our local population and communities.  It is a holistic framework that is used to ensure that new policies and programmes have been considered through not only an equality lens, but also economic, environmental, and health inequalities.   

It seeks to  

• Identify the positive and any negative impacts for the local population;  
• Identify which (if any) of the protected characteristics groups are more likely to be affected by the proposals and what these impacts will be; 
• Identify the impact on staff from equality and protected characteristic groups 
• Identify the impact that the proposals may have on a set of societal considerations, including climate change and social inclusion. 
• Develop an overall set of integrated conclusions on the comparative advantages and disadvantages of the different options; and  
• Provide recommendations on ways in which positive impacts can be maximised for the population and for those with protected characteristics and ways in which to mitigate, or minimise, any adverse effects. 

Once an Integrated Impact Assessment is completed, it is reviewed by our Quality Team and Health Inequalities Team.

To read more about our Integrated Impact Assessment and to view the tool we use, click on the following link: Assessing the Impact of Change.

The Equality and Involvement Committee provides assurance to the Board that its strategies, plans, service designs and developments have adequately and appropriately:  

• considered and addressed the health and care needs and aspirations of residents in Shropshire, Telford and Wrekin who do, or may, experience inequalities in access to health services and health outcomes   
• involved people who do, or may, use the services under consideration.  

The EIC is a sounding board for programme leads, providing advice and suggestions on how impact assessments and engagement plans can be developed and strengthened, and people and communities identified and reached. 

To read more about the EIC, click on the following link: EIC

The NHS Equality Delivery System is a performance framework enabling organisations to review their performance on equality and diversity, and to identify future priorities and actions. It is designed to help organisations to deliver better outcomes for patients and communities and better working environments for staff.

NHS England have produced a short animation video which explains what EDS2 is and how it should be implemented by local NHS organisations. This video can be used by NHS organisations to help communicate the key EDS2 messages to their workforce and communities.

Central to the EDS is a set of 11 outcomes aligned to four goals. These outcomes focus on the issues of most concern to patients, carers, communities, NHS staff and Boards. The three EDS goals are:

• Commissioned or provided services
• Workforce health and wellbeing
• Inclusive leadership

It is against these domains and the accompanying outcomes that we will assess and grade our performance and determine collectively the action to be taken. The EDS grades are set out below:

• Undeveloped activity
• Developing activity
• Achieving activity
• Excelling activity

Further information: NHS England – Equality Delivery System

Domain 1 evidence, scoring and actions 2024

Domain 2 evidence, scoring and actions 2024

Domain 3 evidence, scoring and actions 2024

DRAFT EDS2 Report 2023

NHS England introduced the Workforce Race Equality Standard (WRES) in 2015. The WRES requires NHS organisations to demonstrate progress against a number of indicators of workforce equality.

The WRES makes sure all healthcare staff are treated fairly and with respect. It is included in the NHS standard contract and is a requirement for both NHS commissioners and NHS providers.

Further information can be found here on NHS England’s WRES webpage

To read our latest report, please click on the following link Draft WRES Report Feb 2025

The Workforce Disability Equality Standard (WDES) is an equality reporting requirement introduced by NHS England. The aim of the WDES is for NHS organisations to review the experiences and outcomes of disabled and non-disabled staff. The WDES helps organisations to review their workforce across ten metrics and to produce an action plan to improve workplace experiences of disabled staff.

To read our latest report, please click on the following link Draft WDES Report March 2025 

Organisations with 250 or more employees are mandated by the government to report annually on their gender pay gap.  The requirements of the mandate, set out within the Equality Act 2010 (Gender Pay Gap Information) Regulations 2017, are to publish information relating to pay for specific measures.

To read our latest report, please click on the following link Draft Workforce Gender Pay Gap Report March 2025

Involving people and communities in a meaningful way brings many benefits. It increases the legitimacy of decision making, builds the reputation of public bodies, and makes them more accountable and transparent. It is the right thing to do.

NHS bodies are also required by law to make arrangements to involve individuals, their carers, and representatives, as set out in the National Health Services Act 2006 and
amended by the Health and Care Act 2022:

• section 13Q for NHS England
• section 14Z45 for integrated care boards (ICBs)
• section 242(1B) for NHS trusts and NHS foundation trusts

To read our Involving People and Communities Strategy click on the following link People-and-Communities-Strategy.pdf