Religion or belief A practical guide for the NHS DH INFORMATION READER BOX Policy Estates HR/Workforce Commissioning Management IM & T Planning/ Finance Clinical Social Care/Partnership Working Document Purpose Best Practice Guidance Gate Reference 9756 Title Religion or belief: A practical guide for the NHS Author Department of Health/EHRG Publication date January 2009 Target audience PCT CEs, NHS Trust CEs, SHA CEs, Foundation Trust CEs, Medical Directors, Directors of PH, Directors of Nursing, PCT PEC Chairs, NHS Trust Board Chairs, Directors of HR, Directors of Finance, Allied Health Professionals, GPs, Communication leads, Emergency Care leads, Equality leads, Commissioning leads Circulation list Description This document gives practical guidance to enable NHS organisations to address their responsibilities relating to religion or belief. Cross reference N/A Superseded Docs N/A Action required N/A Timing N/A Contact details Equality and Human Rights Group Department of Health Skipton House 80 London Road London SE1 6LH 020 7972 5128 for Recipient’s Use Religion or belief: A practical guide for the NHS Contents Foreword 3 Executive summary 5 Section One: Context 6 Legal requirements 7 The role of religion or belief in healthcare 9 Policy implications 10 Section Two: Key areas to consider in employment 12 Overview 13 Recruitment 13 Religious observance in the workplace 14 Retaining staff 17 Training 17 Healthcare chaplains 18 Gathering information on staff 20 Sexual orientation 20 Trans people 21 Gambling and interest-bearing accounts 21 Proselytising 22 Section Three: Key areas to consider in providing services 24 Overview 25 Diet, modesty and other matters 25 Beginning of life 26 Contraception 26 Abortion/termination 27 Prenatal medicine 27 Practices at childbirth 27 Circumcision 28 Palliative care 29 End of life concerns 31 Concerns with certain drugs and treatments 31 Mental health issues 32 Psychotropic drugs 33 Suicide 34 Contents 1 Section Four: Process – how to integrate issues on religion or belief into action planning for single equality schemes 36 Gathering information 37 Consultation 38 Assessing policies and functions 38 Action planning 39 Monitoring actions 39 Section Five: Resources 40 Annex A – Healthcare Apprenticeship Scheme 41 Annex B – Human rights and religion or belief 42 Worksheet 1 – Action planning framework 44 Worksheet 2 – Sample action plan 48 Worksheet 3 – Multi-faith event calendar 52 Useful organisations and links 53 Appendix A – Sample presentation 55 Authors 66 2 Religion or belief: A practical guide for the NHS Foreword our staff and more informed, personalised patient care. As an employer and provider of healthcare services, the NHS should not only comply with the law, but should also aspire to be an exemplar of good practice in ensuring that its services and employment practices respond to the needs of the whole of our society. This means that it is essential that we strive to take account of everyone’s needs in the This guide is part of a suite of guidance design and delivery of services – including that seeks to equip NHS staff at all levels – people of different religions or beliefs and whether as employers, employees, service those with none. It is also essential that we planners, commissioners or providers – to strengthen our role as an inclusive employer understand the needs of all people. – removing barriers that might prevent us from attracting, recruiting, developing and Research suggests that attention to the retaining people with the best skills and religious and cultural needs of patients and aptitude to make careers in the NHS. service users can contribute to their wellbeing and, for instance, reduce their length of stay in hospital. Religion and belief are therefore important considerations for all patients and staff. This guide, whilst summarising our legal obligations in this regard, also sets out how equality issues in religion or belief relate Surinder Sharma to the principles that underpin our health National Director for Equality and Human objectives. Rights, Department of Health Other existing public sector equality duties, ongoing reform towards personalised services and the commissioning agenda present a real opportunity for NHS organisations to reconsider the design of services to take full account of the equalities agenda. By developing expertise and implementing the lessons learnt, we can embed equality at the heart of all functions and structures and contribute to a better understanding of Foreword 3 Religion or belief: A practical guide for the NHS Executive summary This guidance document is part of a However, in developing a SES it is important suite of equality guides produced by the to understand that there are significant Department of Health (DH) for the NHS. It differences between the legal requirements gives practical advice to NHS organisations for the different equality strands that must be to help them comply with recent equality understood in order that they are complied legislation, understand the role of religion with. This guidance is designed to assist NHS or belief in the context of healthcare, and organisations to implement and comply with integrate this knowledge into single equality the requirements of legislation on religion schemes (SESs). Other guides in the series or belief enacted recently, and also provides include those for disability, gender, sexual general practical guidance around the issues orientation, learning disability and trans that fall out of that for the NHS. people. The Race for Health programme provides extensive guidance and support for The guidance will provide a workbook and the NHS on issues of race. The Department a one-stop shop for information about the of Health is also sponsoring a guide on age legislation, its impact and examples of best issues to be produced by Age Concern. practice. It will take you through the steps necessary to equality impact assess and plan Many NHS organisations will already be for the integration of issues of religion or working towards developing a SES. A single belief during the development of your overall equality approach helps to bring together equality schemes. Many of the processes, parallel strands of key systems, e.g. equality such as equality impact assessment and impact assessment, data collection etc, consultation, are similar to those described needed to respond to the specific duties for the other equality strands, but the of the different equality laws. This helps to guidance will highlight any areas that need utilise expertise and scarce resources more special attention for religion or belief and effectively. It also contributes to a better will also provide a handy reference for best understanding of staff and workforce issues practice and cohesive and collaborative and encourages a personalised approach to working. patient care, treating patients as individuals. A combined approach will help to minimise ‘information request overload’ through frequent consultation and ensure that key personnel, such as public health analysts, service managers and administrative and frontline staff, are encouraged to work together to ensure a co-ordinated approach to achieving equality of outcomes. Executive summary 5 Section One: Context 6 Religion or belief: A practical guide for the NHS Legal requirements • Direct discrimination: treating workers or job applicants less favourably than Over recent years in the UK, levels of others because they follow, or are awareness of different religions and beliefs perceived to follow, a particular religion have grown – and, in the main, equitable or belief. The regulations also extend to treatment of individuals and inter-faith cover discrimination based on a person’s relations have improved. But, in spite of this, association with someone of a particular discrimination on the grounds of religion or religion or belief. belief, religious intolerance and prejudice still exist in certain areas. • Indirect discrimination: applying policies or practices that – although applied Until December 2003, legal protection to all employees – could disadvantage against discrimination on grounds of people of a particular religion or religion or belief was confined to those from belief. These policies or practices are particular faiths who were covered by virtue unlawful unless the organisation can of their ethnicity, as in the case of Sikhism justify implementing them because of and Judaism. A certain degree of protection a legitimate business need. was afforded to other religious and non­ religious communities by Article 9 of the • Harassment: behaviour that is offensive, European Convention on Human Rights, as frightening or in any way distressing given effect by the Human Rights Act 1998, related to a person’s religion or belief. but this was very limited. It also includes comments or behaviour aimed at the religion or belief of those The European Council Directive of 2000 with whom the person associates. establishing a general framework for equal Harassment can include violation treatment in employment and occupation of a person’s dignity, or creating an came into force in the UK in December intimidating, hostile, degrading or 2003 through the Employment Equality offensive environment. It can also include (Religion or Belief) Regulations. These preventing someone from declaring their regulations make it unlawful to discriminate religion or their lack of belief in religion. against people on the grounds of their religion or belief. The regulations apply