Discrimination, harassment and victimisation lead to isolation and reduced confidence. They have consequences for the employer as well as the employee, including reduced efficiency and lack of motivation.

Positive action to tackle these, and the effective implementation of appropriate policies, must be undertaken by all employers, including trusts and hospitals, general practices and medical schools.

Dealing with complaints effectively is important, but the long-term aim of organisations must be to encourage a culture within which any sort of discrimination is unacceptable.

If you hold a managerial role or employ staff it is important to know how to deal effectively with equality and diversity issues.

Equality checklist

• Employers should have an equality and diversity policy, and employees should be aware of where this can be accessed.
• Have a plan in place which sets out how often this policy is reviewed and by whom.
• Make sure there's a process in place to monitor how well the policy is working. If it is not working then you need to consider why.
• Monitor the diversity of the existing workforce and new recruits regularly so that you can see how the organisation is doing. If the results show that your workforce is not diverse and that you are not attracting a diverse range of people for your roles, then you should take steps to ensure this changes in the future.
• Harmonious working relationships are essential for any business to work well. Minor problems should be dealt with before they become major grievances. Suitable policies and procedures are essential and, in most cases, early effective and informal intervention can lead to a positive result.

Policies you need

One of the key policies is a bullying and harassment policy.

To make sure employees are treated fairly, the policy must be implemented in practice and regularly monitored.

Read NHS Employers guidance on bullying and harassment

This policy is the essential foundation stone to ensure that all staff are treated fairly and valued equally. It should be communicated effectively to all employees, so that all staff know the importance the employer gives to equality of opportunity and treatment.

It is important that the culture of an organisation, including the equality and diversity and harassment policy, is introduced to new staff during their induction. Training must be given so that all staff understand their responsibilities under the policy, are equipped to fulfil the responsibilities in practice and appreciate what the consequences will be if they fail in those responsibilities.

Monitoring should also be carried out to ensure that actions taken are effective in reducing the incidence of discrimination and harassment.

It is also important to have leadership, demonstrated by a named person responsible for monitoring the policy. It is preferable if this person is at a senior level and can champion any changes needed to develop the policy or the working environment.

How does the Public Sector Equality Duty affect me?

In April 2011, the general equality duty came into force in Great Britain, requiring public bodies to:

• have due regard to the need to eliminate discrimination
• advance equality of opportunity
• foster good relations across all of the protected characteristics.

In order to show that they are meeting the public sector equality duty, public bodies must meet the requirements of the specific equality duty.

If you are an employer in one of these organisations, you will need to understand how the general and specific equality duties apply to your organisation and implement appropriate systems for data collection and analysis.

What are the requirements of the specific equality duty?

Supporting the general equality duty is the specific equality duty, which outlines the standards for the publication of information and setting of equality objectives.

 Is there a system that can help my organisation meet the public sector equality duty?

Yes, the Department of Health's Equality and Diversity Council have been working on a system that they hope will embed equality and diversity considerations in the NHS called the NHS Equality Delivery System (NHS EDS).

The NHS EDS is based on a system developed by the NHS North West and the Department of Health are looking to roll it out nationally. The purpose of the EDS is to 'drive up equality performance and embed equality into mainstream NHS business'.

It has been designed to help NHS organisations, in the current and new NHS structures, to meet:

• the requirements of the Public Sector Equality Duty
• equality aspects of the NHS Constitution
• equality aspects of the NHS Outcomes Framework
• equality aspects of Care Quality Commission's Essential Standards
• equality aspects of the Human Resources Transition Framework.

The core of the EDS system is 18 performance outcomes, which are grouped into four goals:

• better health outcomes for all
• improved patient access and experience
• empowered, engaged and included staff
• inclusive leadership.

A self-assessment system builds on these goals in such a way that it allows organisations to determine how they are doing against these goals and outcomes; giving themselves a red, amber or green rating.

It is expected that these ratings will be published and will feed into measurements of an organisation's performance by external assessors, such as the Care Quality Commission or HealthWatch.

Am I liable if clients or customers harass my employees?

Possibly. The Equality Act 2010 makes employers responsible for harassment of their employees by people who they do not employ (third parties), such as clients or customers.

An employer will only be liable if:

• the employee has been harassed on at least two previous occasions
• you are aware of the harassment
• you have not taken reasonable steps to prevent it from happening again.

The protection against third party harassment was originally in the Sex Discrimination Act 1975 and has been extended to cover age, disability, race, sexual orientation, gender reassignment and religion or belief.

Can I use pre-employment health questionnaires?

It is unlawful for employers to ask job applicants health or disability-related questions prior to making offers of employment (except in limited prescribed circumstances).

Questions can only be asked to achieve the following:

• to help an employer decide if reasonable adjustments are required so that a person is able to participate in the selection process
• to help an employer decide if the person is able to carry out a function that is essential ("intrinsic") to the job
• to allow an employer to conduct diversity monitoring of the people applying for the job
• to allow an employer to take positive action to assist disabled persons
• to assure the employer that a candidate has the disability where the job genuinely requires the jobholder to have a disability eg recruiting counsellors for a mental health service which requires the counsellors to have personal experience of mental illness.

If a person applying for the job thinks an employer has acted unlawfully by asking prohibited questions they can complain to the Equality and Human Rights Commission.

Once a person is offered the job, an employer may ask appropriate health-related questions.

It is important that if you routinely use pre-employment health questionnaires, you review your practices and consider whether the information that you seek to obtain is essential to the recruitment process and the particular vacancy that is advertised.

A standard practice of issuing questionnaires to all applicants regardless of the position applied for can no longer be considered appropriate. If you believe that health information is still needed from the applicant, you must ensure that the reasoning for doing so can fit within one of the exemption criteria.

How do I ensure training and development is provided fairly?

Every employee should have a personal development plan, which is informed by the annual staff appraisal process.

Read more about medical appraisals.

How do I avoid discriminating against pregnant employees or those on maternity leave?

All employers should have policies in place which advise on pregnancy and maternity. Under the Equality Act 2010, new protections have been introduced that protect women who are breastfeeding from less-favourable treatment because they are breastfeeding.

Guidance produced by the Government Equalities Office highlights that, for businesses that provide goods and services, the requirements of the Equality Act 2010 mean a business should:

• make sure women to whom services are provided are allowed to breastfeed on the premises if they want to
• make sure women breastfeeding babies are not discriminated against, regardless of the age of the baby
• make sure all employees are trained, particularly those dealing with the public, to ensure they understand the protections under the Equality Act 2010.

The Equality and Human Rights Commission provides model policies on breastfeeding for employees and UNICEF provides information on drafting policies for healthcare organisations providing maternity care.

All jobs should be considered for flexible working unless there are clear business reasons why some jobs need to be excluded.

In order to remove any ambiguity, employers should develop policies on flexible working, which will need to take into account the legal obligations on employers and should encompass the following types:

• part-time working
• job sharing
• flexitime
• annual hours contracts
• flexible rostering
• term-time working
• school-time working
• teleworking
• voluntary reduced working
• fixed work patterns
• secondments