Cultural issues and non-english speaking women guideline (GL814)

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1 Cultural issues and non-english speaking women guideline (GL814) Approval and Authorisation Approved by Maternity & Children s Services Clinical Governance Committee Job Title or Chair of Committee Chair, Maternity Clinical Governance Committee Date 5 th February 2016 Change History Version Date Author Reason 1.0 G Valentine (Director of Midwifery), P Street (Consultant Obstetrician) Trust requirement 2.0 April 2010 G Valentine (Director of Reviewed Midwifery), P Street (Consultant Obstetrician) 3.0 May 2013 D Parris (Named midwife for Reviewed Social Inclusion), G Valentine (Director of Midwifery), P Street (Consultant Obstetrician) 4.0 January 2016 D Parris (Named midwife for Social Inclusion), G Valentine (Director of Midwifery) Reviewed This document is valid only on date Last printed 22/02/ :35:00 Page 1 of 7

2 Contents 1.0 Overview 2.0 Equality Act 2006, guidance on Part 2 (came into force on 30th April 2007) 3.0 NHS Act (Amended) Cultural Issues 5.0 Contact 6.0 Conclusion 7.0 References: Appendix 1 - Religion or Belief legislation and the workplace This document is valid only on date Last printed 22/02/ :35:00 Page 2 of 7

3 1.0 Overview Various issues have arisen within our maternity service due to the increasing diversity of cultures and languages in the region. This guidance is based upon recent legislation and best practice. 2.0 Equality Act 2006, guidance on Part 2 (came into force on 30th April 2007) This piece of legislation focuses on the provision of goods, facilities and services. It makes it unlawful to refuse to supply normal service to someone, or treat them less well than others on the grounds of their religion or belief (or lack of their religion or belief), their assumed religion or belief, or the religion or belief of someone with them. 3.0 NHS Act (Amended) 2006 This statute clearly states that whilst we are under a duty to provide care to all those who are entitled to do so, we do not have a duty to provide a particular doctor or nurse or health care professional but we are expected to make reasonable effort to achieve the wishes of the patient, regardless of their denomination, race or religious beliefs. In the absence of being able to do so we are not providing a cause of action. 4.0 Cultural Issues Muslim women can be attended to by any clinicians (men or women) without fear of the fact that we are breaching their religious beliefs/rules/teachings. This is because the context in which they prohibit contact between persons of the opposite sex is not what the context of healthcare. However we have experienced difficulties with patients who interpret this as being applicable in the healthcare setting, therefore reference to the NHS Act (amended 200) is important. Under the NHS Act 1990 we have a duty to provide a proper standard of care to all our patients but we do not have a duty to promise it will be delivered by a particular person or sex In cases where we find ourselves in a position to offer choice to the patients in a way that does not affect our ability to care for others and does not adversely affect our staff, we can offer that choice on that occasion. However each case should be considered alone, since the same situation arising later may be subject to a completely different set of circumstances, such as This document is valid only on date Last printed 22/02/ :35:00 Page 3 of 7

4 availability of staff, other patients needs which will then render that choice impossible. The Important thing is that we provide a proper standard of care at all times. By ensuring that it is clear that each case is taken individually with a view of the circumstances at the time we lessen our vulnerability to allegations of discrimination even where this may be unintentional. All efforts must be made to calmly manage the situation at the time, being cognisant of the above guidance. The staff are reminded that the Trust operates a zero-tolerance policy for violence/aggression and if the situation requires, this policy should be implemented (link to legal services violence & aggression policy) The women must be supported at all times. 5.0 Contact For further information or questions contact Peter Sandham, Equality & Diversity Officer on Ext: 8828, Monday to Friday between 0900hrs and 1700hrs Stephanie Seigne Head of Legal Services and Corporate Risk ext: 7156, also contactable via the switchboard out of hours. 6.0 Conclusion Muslim women can be attended to by any clinicians (men or women) without fear of the fact that we are breaching their religious beliefs/rules/teachings. This is because the context in which they prohibit contact between persons of the opposite sex is not the context of healthcare However we have experienced difficulties with patients who interpret this as being applicable in the Healthcare setting. Therefore reference to the NHS Act (Amended) 2006 is important. (See later) As an NHS hospital we have finite resources, given this it is unrealistic to expect the Trust to provide every patient s need in terms of choice of who they wish to attend to them. However we are expected to make an effort to do so. Lack of resources to provide an appropriate standard of care is not a defence to claims in negligence, but it is clear that under The NHS Act (amended) 2006, we are not obliged to provide a team, nor membership of that team, because of the personal/religious preferences of the patient. To do our best to do so, without compromising the care of the patient, the unborn child and other patients and staff is acceptable. However we are not legally bound to do so. This document is valid only on date Last printed 22/02/ :35:00 Page 4 of 7

5 In cases where we find ourselves in a position to offer choice to the patients in a way that will not compromise care of the patient or others, or the work of the Hospital it is appropriate to do so. Each case should be taken on its own, and as such therefore we are not putting ourselves in the position where the same choice will have to be offered in another similar situation. These cases should be treated as individual cases, which stand alone. 7.0 References: 1. Religion or belief legislation and the workplace, appendix, Elizabeth Nyawade Equality & Diversity Officer Royal Berkshire Hospital 2. Violence & aggression policy; intranet, legal services & corporate risk 3. NHS Act (Amended) 2006 Authors: Patricia Street (Consultant in fetomaternal medicine) & Gill Valentine (Director of Midwifery) Date written: February 2008 Reviewed: June 2010, June 2013, December 2015 Review date: February 2018 This document is valid only on date Last printed 22/02/ :35:00 Page 5 of 7

6 Appendix 1 - Religion or Belief legislation and the workplace PART A Legislation: NHS Act (Amended) 2006 This statute clearly states that whilst we are under a duty to provide care to all those who are entitled to do so, we do not have a duty to provide a particular doctor or nurse or health care professional but we are expected to make reasonable effort to achieve the wishes of the patient, regardless of their denomination, race or religious beliefs. In the absence of being able to do so we are not providing a cause of action. The 2 key pieces of legislation driving Religion or Belief at the workplace are; Employment Equality (Religion or Belief) Regulations 2003 (came into force on 2nd December 2003) This piece of legislation mainly focuses on the rights of employees/workers. It prohibits discrimination against workers/employees because of religion or belief (or lack of religion or belief) on all facets of employment including recruitment, terms and conditions, promotions, transfers, dismissals and training. Equality Act 2006, guidance on Part 2 (came into force on 30th April 2007) This piece of legislation focuses on the provision of goods, facilities and services. It makes it unlawful to refuse to supply normal service to someone, or treat them less well than others on the grounds of their religion or belief (or lack of their religion or belief), their assumed religion or belief, or the religion or belief of someone with them. Both pieces of legislation outlaw direct and indirect discrimination, victimization and harassment. Direct discrimination occurs when someone is treated less favourably than other people are/would be treated and there is no material difference in the relevant circumstances and the reason for the treatment is the religion or belief the victim holds or is thought to hold, or that of someone associated with them. Indirect discrimination occurs when provisions, criteria or practices, that are applied generally, result in people of a particular religion or belief (or lack of religion or belief) being put at a disadvantage, as compared with others, and these provisions, criteria or practices cannot be objectively justified. This applies even if the negative impact is unintentional. This document is valid only on date Last printed 22/02/ :35:00 Page 6 of 7

7 PART B - Key things to bear in mind when dealing with Islam/Muslims Islam is based upon the teachings of the Quran and Sunnah (sayings & actions of Prophet Muhammad). The understanding taken from the Quran & Sunnah make up the rules of Islam. The Quran is written in Arabic, a language that most Muslims do not read, speak or understand fully and in some cases at all; given this they rely on their faith leaders, called Imams, to interpret and teach them aspects of their faith. This has resulted in varying degrees of interpretation of the Islamic law and teachings, wholly based on the depth of the Arabic knowledge of the interpreting Imam. Unfortunately, Islam has no set standard of assessing who can be or who qualifies to be an Imam resulting in a lack of standardisation of what is communicated to the followers. Example Islam requires followers to dress modestly. To some Imams this means women must cover all parts of their bodies from head to toe while to others it simply means dressing in day to day clothing with skirts below the knee and sleeves to elbow length. PART C - Islam s teachings with regard to contact between men and women In relation to the above subject, Islam lays a strong emphasis on marriage as the only legitimate sexual relationship between a man and a woman. Any other relationships between persons of the opposite sex, other than immediate family members (e.g. mother to son) are strictly prohibited. This is strictly aimed at ensuring sexual relationships outside marriage do not occur, hence those acts (free mixing between males and females, touching the opposite sex or even a handshake) which are perceived as having the possibility of developing into a sexual relationship between persons of the opposite sex are discouraged. It is in this context of their understanding that those who strictly apply their religion in this matter, given the interpretation they have received ask to be seen by a female clinician only, for women. How strictly one can apply that understanding of the Islamic law when attending a medical appointment/in a hospital setting, where female and male clinicians are employed to attend to patients, is open to individual s interpretation, level of knowledge of the religion as a whole or lack of it, which in turn depend upon the Imam this individual has received Islamic teachings from. This document is valid only on date Last printed 22/02/ :35:00 Page 7 of 7

NHS Greater Glasgow and Clyde Equality Impact Assessment Tool For Strategy, Policy and Plans

It is essential to follow the EQIA Guidance in completing this form Name of Strategy, Policy or Plan NHS Greater Glasgow and Clyde Equality Impact Assessment Tool For Strategy, Policy and Plans Protocol