Corporate report

Equality in 2022: how DHSC met the public sector equality duty

Published 2 October 2023

About this report

The Equality Act 2010 (Specific Duties and Public Authorities) Regulations 2017 requires relevant public bodies, including the Department of Health and Social Care (DHSC), to publish information at least annually to show how they comply with the public sector equality duty, and to set and publish equality objectives at least every 4 years.

This report is split into 2 sections. Section 1 lists the department’s equality objectives and gives an overview of the work that the department has done to comply with the public sector equality duty for our public policies.

Section 2 outlines our compliance with the public sector equality duty in relation to our workforce and our shared commitment for the Civil Service to become the UK’s most inclusive employer. The section also sets out our current workforce data and how we are using data and evidence to inform our activities.

Both sections cover the reporting period from 1 October 2021 to 30 September 2022. This is the first combined report where timescales for reporting are fully aligned.

Introduction

The department’s vision is to enable everyone to live more independent, healthier lives, for longer:

• supporting healthy behaviours
• improving our health and care system
• creating healthy environments

We deliver this vision through 4 core roles of:

• supporting and advising our ministers, providing world-class advice that is supported by expert research and analysis, being accountable to Parliament and to the public, and striving to achieve the highest standards of good governance in everything we do
• driving transformation of the health and care system by setting strategy, shaping policy, securing the funding and developing the legislation that supports it
• playing a major role in people’s day-to-day lives by working with our agencies and partners to deliver health and care services to improve and protect everyone’s health and wellbeing, while thinking ahead to ensure that services can respond to changing needs and being there in the last resort to take the action necessary to safeguard the nation’s health
• working with other government departments, our agencies and partners locally, regionally, nationally and internationally to contribute to the government’s wider health, economic and social goals

Our key departmental priorities for 2022 to 2023 are summarised as follows:

• improve healthcare outcomes by providing high-quality, integrated and sustainable care at the right time in the right place, by tackling the electives backlog and by improving infrastructure and transforming technology
• protect the public’s health through the health and social care system’s response to COVID-19
• improve healthcare outcomes through a well-supported workforce
• improve, protect and level up the nation’s health, including reducing health disparities
• improve social care outcomes through an affordable, high-quality and sustainable adult social care system

The department’s objectives are delivered in conjunction with our arm’s length bodies (ALBs) and wider health and care partners.

World-class policymaking and delivery depend on having people in the department with different backgrounds and life experiences, who see the world in different ways. Teams that are able to look at problems from a range of perspectives are more likely to identify policy solutions and think about implementation in ways that are innovative and practical and contribute to decisions that reflect the views and needs of all those who use health and care services.

The Equality Act 2010

The public sector equality duty in section 149 of the Equality Act 2010 is an important means to ensure that public bodies, like DHSC, take account of equality when shaping policy and delivering services. Policy and decision-makers, including ministers, must have due regard to the following 3 equality aims in the duty when developing or changing any policies or services that impact people:

• eliminating discrimination, harassment and victimisation and any other conduct that is prohibited by or under the act
• advancing equality of opportunity between people who share a relevant protected characteristic and people who do not share it
• fostering good relations between people who share a relevant protected characteristic and those who do not share it

Advancing equality of opportunity involves considering how our decisions:

• can remove or minimise disadvantages suffered by people due to their protected characteristics
• can meet the needs of people who share a protected characteristic, where those needs are different from the needs of those who do not share that protected characteristic
• encourage people with protected characteristics to participate in public life or in other activities where their participation is disproportionately low

Public bodies need to have evidence of how they have complied with the duty in the decisions they make. This includes having a record of how the aspects of the duty were considered for a policy.

The protected characteristics covered by the Equality Act are:

• age
• disability
• gender reassignment
• pregnancy and maternity status
• race
• religion or belief (including lack of belief)
• sex
• sexual orientation
• marriage and civil partnership status (only in respect of eliminating unlawful discrimination)

We know that a person’s protected characteristics can interact with, and impact on, their experiences. As such, taking an intersectional approach - that is, looking at a combination of protected characteristics - can give an organisation a better understanding of people’s experiences and outcomes. Where such evidence is available, this can inform better policymaking and delivery, as well as improve the understanding of diversity in an organisation and inform diversity and inclusion (D&I) action plans.

DHSC also extends its equal opportunities policies and practices for its employees to other characteristics not covered by the Equality Act, namely working patterns, caring responsibilities, geographical location and socio-economic background. The department is required to have regard to issues such as geography and socio-economic status in its public policies through the Secretary of State’s duty regarding health inequalities.

The equality duty aims to get public bodies to consider equality as part of their day-to-day business. It requires organisations to consider how they can contribute to advancing equality in the design of their policies and the delivery of services. Decisions taken without considering their impact on different groups are unlikely to have the intended effect and may lead to greater disparities and poorer outcomes. However, carefully considering equality issues also makes good business sense as organisations that meet the diverse needs of their users and employees are likely to achieve their objectives more effectively.

The department is the guardian of the health and care system and therefore, as well as listing the equality objectives, section 1 gives a sample of evidence to illustrate our compliance with the equality duty in the development and implementation of health and care policies. Our partner organisations are responsible for delivering many of these policies and they may publish information on how they meet the equality duty.

Section 2 contains equality information about DHSC’s workforce and demonstrates how the department collects and monitors data on workforce diversity. This allows us to examine how our employment policies and processes are working so we can identify areas where these appear to have a disproportionate impact on certain groups of employees. The data collection along with analysis informs and shapes appropriate action.

Both sections of the report cover the reporting period 1 October 2021 to 30 September 2022.

The department has also published information on its gender pay gap.

This is our final annual report outlining our progress on the DHSC equality objectives for 2019 to 2023. Next year’s report will outline progress on our new equality objectives for 2023 to 2027.

We use the term ‘ethnic minority’ in this document to refer to ethnic minorities, not including white minorities.

1. Equality in our policies: equality objectives from 2019 to 2023

The department developed a high-level set of equality objectives in 2019 to ensure that advancing equality of opportunity and eliminating discrimination remained central to the department’s work to ensure equitable policymaking and improved health outcomes for people in England. This continued to be important during the pandemic, which saw different impacts on different groups and communities.

This section lists the objectives and provides evidence to demonstrate compliance with the equality duty in the period from 1 October 2021 to 30 September 2022.

This section covers a broad selection of the department’s work and policies. This aims to give a sense of what the department has done and is not intended to cover all areas of work. Information on other work and policies may also be included in reports by our ALBs or by other government departments where they lead on particular issues.

Objective 1

We aim to build an inclusive culture within the department which values and respects diversity, and where everyone can achieve their potential. As an employer we are also committed to the Civil Service ambition to become the UK’s most inclusive employer.

The department has continued to progress its internal D&I priorities. Our progress is outlined in section 2 of this report.

Objective 2

We will continue to build and develop our relationships with stakeholders and the public, including those that represent groups with protected characteristics, to improve our functions and services.

Mental health

The COVID-19 pandemic highlighted the importance of addressing mental health disparities as more people than ever sought help with their mental health from the NHS.

Work is ongoing across the department and its ALBs at both national and local levels to tackle disparities in the way that people from different ethnic groups or with other protected characteristics access mental health services and their experiences of them.

Improving mental health and wellbeing

From April to June 2022, we launched our public Mental health and wellbeing plan, including a discussion paper and call for evidence, which sought views on what can be done to improve everyone’s mental health and wellbeing. Across all the questions in the paper, we sought views on how any future mental health plan could address mental health disparities. To inform these responses, the annex to the call for evidence provided respondents with detailed evidence on key disparities and provided links to sources to help inform people prior to their response. The responses received are feeding into the development of the Suicide prevention strategy and forthcoming major conditions strategy.

We also invested £15 million in the 2021 to 2022 financial year in activity to promote positive mental health in the 40 most deprived local authority areas in England through the Prevention and Promotion for Better Mental Health Fund to help level up mental health and wellbeing across the country.

Draft Mental Health Bill

In June 2022, we published the Draft Mental Health Bill, which set out measures to address mental health disparities, in particular the disproportionate detention of people from ethnic minority communities under the Mental Health Act. The bill aims to make the act work better for people with serious mental illness and will give individuals much more of a say in their care and treatment. Under the bill’s reforming provisions, people would be able to access increased support from independent advocates and, for the first time, they would be able to choose the person they want to represent their interests.

Advocacy pilots

As part of our wider work to reform the way the Mental Health Act supports people with serious mental illness, we are funding a number of culturally appropriate advocacy pilots to improve outcomes for people from ethnic minority groups. This is in response to one of the key recommendations from the 2018 Independent Review of the Mental Health Act and was a policy commitment in the government response to the Reforming the Mental Health Act public consultation. These pilots are exploring different approaches to identifying, supporting and advocating for the specific cultural needs of people from ethnic minority groups.

Seni’s Law

We are committed to tackling the disproportionate use of force in mental health services against groups who share a protected characteristic under the Equality Act 2010, including people from ethnic minority groups. The Mental Health Units (Use of Force) Act 2018 (also known as Seni’s Law) was introduced to improve the oversight and management of restrictive practice and use of force on patients detained under the Mental Health Act. The accompanying statutory guidance published in December 2021 set out how we expect mental health services to implement the requirements of the act. The majority of the provisions within the act were brought into force in 2022 and those still outstanding are expected to be brought into force as soon as possible.

Disabilities

We continue to take action to improve health and care outcomes for disabled people, autistic people and people with a learning disability, and tackling the disparities they face remains a priority.

National autism strategy

We published our refreshed national autism strategy on 21 July 2021. The strategy was backed by over £74 million in the first year to:

• improve understanding in society
• reduce diagnosis waiting times
• improve access to high-quality health and social care for autistic people, including funding to reduce the number of autistic people inappropriately admitted to mental health hospitals

The new strategy was extended to children and young people for the first time in recognition of the importance of ensuring that autistic people receive the right support from early years and throughout their lives.

Since publication, notable progress has been made across government, including several actions in the department and within NHS England. Building on the previous investment of £13 million in 2021 to 2022 (through the NHS Long Term Plan and COVID-19 mental health and wellbeing recovery action plan), we invested £2.5 million in 2022 to 2023 to test and embed improved autism diagnostic pathways.

Building the Right Support

We want children, young people and adults with a learning disability and autistic children, young people and adults to be able to live full and rewarding lives. The Building the Right Support Action Plan, published on 14 July 2022, brings together actions we are taking across government and public services to strengthen community support and reduce reliance on specialist inpatient care for people with a learning disability and autistic people. In 2022 to 2023, we invested over £90 million in community services and support for discharges specifically for people with a learning disability and autistic people.

The ministerially chaired cross-system Building the Right Support Delivery Board is responsible for overseeing implementation of the action plan and reviewing progress on its commitments. The board brings together representatives from across government, the health and care sector and experts by experience, to accelerate progress and unblock barriers to delivery.

Draft Mental Health Bill

The Draft Mental Health Bill 2022 also sets out our proposed changes to how the act applies to people with a learning disability and autistic people. The proposals limit the scope to detain people with a learning disability and autistic people under the act and place new duties on commissioners to ensure that there are sufficient community-based services for those at risk of admission.

Where mental health inpatient care is necessary, it must have a therapeutic benefit, be for as short a time as possible, as close to home and the least restrictive possible. Working with the independent Oversight Panel chaired by Baroness Hollins, a second phase of Independent Care (Education) and Treatment Reviews (IC(E)TRs) began in November 2021 to help move individuals in the most restrictive settings towards discharge.

Oliver McGowan Mandatory Training

From 1 July 2022, the Health and Care Act required registered providers to ensure their staff receive specific training on learning disability and autism appropriate to their role. The Oliver McGowan Mandatory Training on Learning Disability and Autism was developed to fulfil the requirement and is the government’s preferred and recommended training for health and social care staff. We are now working to support the roll out this training across registered providers.

Down Syndrome Act

The Down Syndrome Act received Royal Assent in April 2022. The act aims to improve access to services and ensure that health, social care, education and housing services better support the needs of people with Down syndrome and take better account of their needs when designing and commissioning services. The act places a duty on the Secretary of State to publish guidance for relevant authorities (health, social care, education and housing) on the steps it would be appropriate to take to meet the needs of people with Down syndrome. The guidance required under the act will set out practical steps that organisations should take to meet the needs of people with Down syndrome. It will raise awareness of the specific needs of people with Down syndrome and bring together in one place everything that relevant authorities should already be doing to support them. It will also help to clarify the help and services people with Down syndrome can expect to receive.

Disabled Facilities Grant (DFG)

We want older people and adults with a physical or learning disability, mental ill health or autistic people to have the choice to live independently and healthily in their own homes for longer.

The DFG supports older and disabled people to make adaptations to their homes, so that they are safe and suitable for their individual needs and enable independent living. This capital grant, which has been in existence for over 30 years, is administered by local authorities. Updated national guidance on the effective and efficient delivery of the DFG was published by the government in March 2022. It is designed to help local authorities to meet their responsibilities - including legal duties - and tailor local delivery to support their communities and the individual needs of disabled people, their family and carers. In the People at the Heart of Care white paper published in December 2021, the government announced £573 million for the DFG in each year from 2022 to 2023 to 2024 to 2025. Furthermore, Next steps to put People at the Heart of Care announced a further £50 million in 2023 to 2024. On average, the DFG helps around 50,000 older and disabled people per year to adapt their homes. In 2020 to 2021, more than half (57%) of grants were provided to people of pensionable age (aged 66 and over) and nearly 90% of applications related to physical disabilities.

Alongside DFG, we also have the Care and Support Specialised Housing Fund (CASSH). CASSH is DHSC’s capital fund to incentivise the supply of supported housing for older people and adults with a physical or learning disability, autistic people, or mental ill health. Our People at the Heart of Care white paper also announced that CASSH will continue to be provided from 2022 to 2023 to 2024 to 2025.

Acquired-brain injury cross-government strategy

Furthermore, we’re leading on the development of a cross-government strategy on acquired brain injury (ABI). We invited stakeholders nationwide, including healthcare professionals, people living with an ABI, their families and carers, to put forward their views as part of the call for evidence about what should be prioritised within the strategy. Ensuring the voices of people with an ABI were being heard throughout the strategy development has been our central priority, and so in 2022 we established a formal stakeholder representation forum to support the ABI strategy. This Patient and Public Voice Reference Group has proven an essential part of the strategy’s development, creating a space for people with disabilities and patient charities to speak openly and directly to government, making sure that their views and experiences are at the heart of our work.

Adult social care

In December 2021, an impact statement for system reform was published (available to download on the People at the Heart of Care white paper landing page).

Skills for Care

Skills for Care is a DHSC-owned company. It has resources and training available to the social care sector covering inclusivity and diversity. This is for individuals working in the sector as well as those receiving care. The aim is to increase awareness and ensure equal opportunity to access high quality care and provide support to meet individual needs, so that people are not disadvantaged due to their background, culture or community.

Think Local Act Personal (TLAP)

TLAP is one of our funded partners, contributing to the sector-led National Improvement Programme, which supports local authorities, providers and front-line practitioners to meet statutory duties, improve practice and implement reform. As a national partnership of more than 50 organisations, it is committed to transforming health and care, through personalisation of services for people who draw on care and support and community-based support.

In conjunction with partners the National Co-production Advisory Group (NCAG), TLAP works with the Coalition for Personalised Care, where it has facilitated and chaired the Health Inequality Group. This focused on addressing health disparities and promoting equitable access to healthcare services for individuals from diverse backgrounds, including people from ethnic minority backgrounds. Through the group, TLAP has worked towards developing strategies and interventions to reduce health inequalities and ensure that healthcare services are more personalised and inclusive.

TLAP and NCAG also participate in the ‘BAME Personalisation Hidden in Plain Sight’ initiative. This aims to shed light on the specific needs and challenges faced by people from ethnic minority backgrounds in accessing and utilising personalised care services. Here, there has been collaboration with other stakeholders to identify and address any hidden barriers that may exist within the system, and work towards making personalised care more equitable and accessible for people from ethnic minority backgrounds.

Sexual orientation and gender reassignment

Blood donation

In June 2021, the questions asked of everyone who goes to donate blood in England, Scotland and Wales changed. Donors are no longer asked if they are a man who has had sex with another man. Instead, any individual who attends will be asked if they have had sex - and, if so, about any recent sexual behaviours. These changes allowed more men who have sex with men to donate blood, platelets and plasma while keeping blood just as safe.

Following these changes, at the end of 2021 a further change was made to the donor safety check form to remove a question which asked prospective donors if they have recently had sex with a partner who may ever have been sexually active in an area where HIV is endemic, which includes most of sub-Saharan Africa.

This could mean black African donors and other potential donors in long-term relationships may have been unable to donate blood. People who are black African, black Caribbean and of black mixed ethnicity are more likely to have the rare blood sub-group, such as Ro, that many black sickle cell patients need.

Research conducted by the FAIR (For the Assessment of Individualised Risk) steering group and supported by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) found the question could be safely removed without compromising the safety of blood supply in the UK.

The change provides more opportunities for people to donate for the ongoing need for rarer blood types and help improve and save lives in the UK. Removing the question will help to improve inclusivity and equity for black African, and other, donors.

HIV Action Plan

The government is committed to ending new HIV transmissions, AIDS and HIV-related deaths within England by 2030, and our HIV Action Plan published in December 2021 sets out how we will achieve our interim ambitions by 2025. This includes improving access to the HIV prevention drug pre-exposure prophylaxis (PrEP) for key population groups most at risk of HIV and supporting the system in delivering equitable access to PrEP. As part of the implementation of the HIV Action Plan, we are working in collaboration with key stakeholders to improve access to PrEP for those eligible, irrespective of their gender, ethnicity, sexual orientation, disability, geographic area of residence or socio-economic background.

Gender identity services

We are working with NHS England to fulfil its ambition to improve outcomes for individuals experiencing gender dysphoria and people with gender reassignment as a protected characteristic, through improving the healthcare services offered to them.

To this end, we have been supporting NHS England’s implementation of the Cass Review’s recent recommendations for the gender identity services offered to children and young people. Service capacity is being increased with the aim of providing more timely care. New providers of these services will commence operation from autumn 2023, with the aim of establishing 7 to 8 regional hubs in the future. The new service will offer more holistic care based in specialist children’s hospitals.

The service’s evidence base is also being improved, as NHS England’s work with the National Institute for Health and Care Research (NIHR) has resulted in qualitative and quantitative research with York University being commissioned, in addition to ongoing work to commission prospective research into the outcomes from the treatments the new services will offer. Better wellbeing support is also being developed for individuals waiting for care.

We continue to support the expansion of adult gender identity services and their respective workforce, through rolling out new ‘pilot’ gender identity clinics based on a new delivery model rooted in primary care and sexual health services. These clinics are taking patients off the existing waiting list and have been well received by the patients using them.

Women’s health

In the UK, women have a longer life expectancy than men, with life expectancy at birth being 83.1 years for women and 79.4 years for men in 2017 to 2019 (see Office for National Statistics (ONS) national life tables 2017 to 2019). Women spend on average over a quarter of their lives in ill health or disability, compared with around one-fifth for men. Moreover, in recent years, healthy life expectancy has fallen for women but has remained stable for men (see ONS health state life expectancies, UK - 2017 to 2019).

Women’s Health Strategy and Ambassador

In summer 2022, we published England’s first Women’s Health Strategy, setting out our 10-year ambitions for boosting the health and wellbeing of women and girls, and for improving how the health and care system listens to women. We also appointed Professor Dame Lesley Regan as the first ever Women’s Health Ambassador for England. The Women’s Health Ambassador is focused on raising the profile for women’s health, increasing awareness of taboo topics, and bringing in a range of collaborative voices, including women and girls from underserved groups, to implement the Women’s Health Strategy.

Menopause

The menopause is a priority area within the Women’s Health Strategy, and we have set out in detail a series of 10-year ambitions and actions we are taking now to improve menopause care. We committed to reducing the cost of hormone replacement therapy (HRT) prescriptions, meaning menopausal women will pay less money for their HRT prescriptions (the HRT prescription pre-payment certificate was launched in April 2023). The NHS England National Menopause Care Improvement Programme brings together menopause specialists and other key stakeholders to improve clinical menopause care in England.

Access to high demand HRT products has improved since we issued serious shortage protocols (SSPs) for some HRT products in April 2022 to limit dispensing to 3 months’ supply, to even out distribution and allow specified alternative products to be dispensed, as necessary.

We have accepted and are taking forward the recommendations of the HRT Supply Taskforce, which was temporarily established to explore what could be done to address supply issues in the short and long term. One of the key recommendations was to continue the dialogue with industry and we are doing that through regular meetings with individual suppliers and quarterly roundtables to discuss the supply position, identify issues and take action to address them.

Virginity testing and hymenoplasty ban

In July 2022 we banned the carrying out, offering and aiding and abetting of virginity testing and hymenoplasty in any part of the UK. Both virginity testing and hymenoplasty are forms of violence against women and girls and are harmful practices which stem from dangerous misconceptions about a woman’s sexuality.

Inclusion health

Our Inclusion Health Team work on health policy, data, evidence and delivery for people in inclusion health groups. These are groups of people who:

• are socially excluded
• typically experience multiple risk factors for poor health, stigma and discrimination
• are poorly represented in data

These factors result in:

• barriers to accessing healthcare
• differences in experience of the health and care system
• extremely poor health outcomes, often considerably worse than those of the general population

This includes people experiencing homelessness and rough sleeping, vulnerable migrants and Gypsy, Roma and Traveller communities.

Improving inclusion for women with the Women’s Health Strategy

The Inclusion Health Team worked closely with the Women’s Health Team to meaningfully contribute to the Women’s Health Strategy for England, published in August 2022. This includes a 10-year ambition that “health and care professionals feel supported and able to handle the complexity of needs that people in inclusion health groups often face and are enabled to provide the best health and care possible”.

Health and Care Act 2022

Recognising that inclusion health groups can face barriers to accessing health and care, the team worked with system, integration and reform colleagues on an amendment to the Health and Care Act 2022. This amendment relates to the current duty of NHS England and integrated care boards to reduce inequalities in access to health services and extends the duty on these bodies to all persons in their geography, rather than just patients.

The team worked with colleagues to include specific references regarding the need to actively consider the needs of inclusion health groups in guidance on the preparation of integrated care strategies (September 2022) and integrated care partnerships strategy guidance (July 2022).

Migrant health

The team manage the Migrant health guide, a technical resource mainly for primary healthcare professionals to support them to care for migrants in their day-to-day practice.

The guide contains a number of different sections, which include:

• clarifying NHS entitlements
• a checklist on assessing health needs of migrants who have recently arrived in the UK
• guidance on language interpretation and translations
• guidance on immunisations

It includes many other topics and also contains over 100 country-specific health profiles. This has a direct impact on the public sector equality duty by improving the quality of health services to people who were born outside the UK and of ethnic minority groups.

Alcohol and drug-related harm

The 10-year drugs plan

The government’s 10-year drug plan was published on 6 December 2021 and sets out an ambitious long-term vision for real change, with an ambition to reduce overall drug use towards a historic 30-year low.

This is backed by significant new investment of £532 million over the spending review period to start the process of building a world class treatment and recovery system. This funding is prioritised for areas with the highest need, based on the rate of drug deaths, deprivation, opiate and crack cocaine use prevalence and crime.

As a result, we are committed to creating an additional 54,500 treatment places, and an additional 5,000 more young people in treatment. In 2021 to 2022, we invested £95 million of new funding to rebuild drug and alcohol misuse treatment centres and services in England, providing treatment to thousands of people including young people.

Research

In addition to increasing treatment and recovery systems, we have commissioned a number of research projects through NIHR to inform policy in the future. The first project, looking at drug use within ethnic minority groups, began in August 2022 and was due to conclude in August 2023. This research project will help us understand prevalence of non-opiate drug use among ethnic minority groups, as well as how we can ensure treatment services are accessible and designed best to treat people from ethnic minority groups.

The NIHR, in partnership with DHSC and the Joint Combating Drugs Unit, has launched a new £5 million Innovation Fund to Reduce Demand for Illicit Substances. Recreational drug use is higher among people who self-define as having a mixed ethnic background (see evidence pack for the Independent Review of Drugs).

For the year ending June 2022, the proportion of adults reporting any drug use in the last year was highest among those aged 20 to 24 years (23.3%). Cannabis, ecstasy and nitrous oxide use was particularly prevalent among 16 to 24 year olds in the year ending June 2022 (see ONS drug misuse statistics). The aim of the innovation fund is to identify ways to reduce drug use and therefore it will have a positive impact on young people and people from mixed ethnic background.

Alcohol and drug treatment and recovery guidance

On 10 August 2022, we published the new commissioning quality standard for alcohol and drug treatment and recovery guidance which sets standards that will guide local partnerships to commission drug and alcohol services more effectively. This includes a requirement that local authorities develop strategic commissioning partnerships, which should include services that reflect the local population such as services working with all underrepresented groups including women, LGBT+ people and people from ethnic minority groups.

Additionally, local authorities should be carrying out local needs assessments, including a consideration of treatment need for all underrepresented groups, and offering targeted and specialist provision where required.

Research

We invest significantly in health and social care research to support the delivery of its objectives. This is primarily through NIHR, which is the government’s research funding body for translational, clinical and applied health and care research.

An important strength of NIHR is that research reflects the health of the diverse people and communities that make up the nation, so everyone benefits from the social, technical and economic returns to research. This maximises the returns to investment in NIHR.

NIHR works across the health and care system to make opportunities to participate in research an integral part of everyone’s experience of health and social care services.

NIHR is committed to doing more to further improve research inclusion for all members of society. In line with this commitment, NIHR published 2 key reports in the reporting period:

• the first NIHR report on randomised clinical trials (RCTs) - this report has helped us to better understand who participates in research and has shown that, when compared to the results of the 2011 census in England and Wales, RCT participant diversity is broadly in line with diversity in the UK as a whole

• the second formal NIHR diversity data report - this report has helped us to better understand any impediments in systems or biases in processes which have led to some communities, particularly ethnic minorities and people with disabilities, being under-represented in research

NIHR continues to introduce programmes of change - testing plans with relevant communities to ensure that resources are deployed to the areas of greatest need. Key activities in the reporting period included:

• providing guidance to NIHR clinical trials units regarding the collection and sharing of diversity data - improving diversity data quality across RCTs

• improving the accessibility of research funding calls by piloting the use of narrative CVs in funding applications to help attract and retain the full range of the most promising research and innovation talent

• maintaining Shaw Trust Accessibility Accreditation for the NIHR website, to ensure it is accessible to those with a range of disabilities - extending NIHR’s reach to underrepresented groups

• setting diversity targets for research funding selection committees so they reflect the diversity of the UK, enabling better decision-making

• providing training to support committee and panel members in inclusive decision-making when assessing applications

• improving data collection of the NIHR workforce, advisory workforce, research applicants and research participants, on protected characteristics and socio-economic background to provide a robust evidence base for future activities

Tackling bias in medical devices

Led by Professor Dame Margaret Whitehead, the independent review on equity in medical devices was set up in February 2022 to consider equity in the areas of traditional products classified as medical devices, artificial intelligence (AI)-enabled medical devices, genomics and polygenetic risk scores.

To support development of their recommendations on more equitable solutions, the independent review panel has:

• commissioned several experts and academics to prepare detailed reports on the topics pertinent to the review
• conducted a public consultation in the form of a call for evidence
• been regularly engaging with key stakeholders, including:
  • the Medicines and Healthcare products Regulatory Agency
  • National Institute for Health and Care Excellence
  • health technology assessment groups
  • different organisations within the NHS
  • devolved administrations
  • industry representatives
  • academics
  • healthcare professionals

The independent review held a call for evidence (CfE) from 11 August to 6 October 2022. The aim of the CfE was to collect existing data and evidence, as well as information on ongoing data collection and research or evaluation projects. The CfE had a wide audience, including but not limited to academics, researchers, patients and members of the public. The findings from the CfE will be reported as part of the final report from the independent review and a series of thematic roundtables is currently underway to discuss draft recommendations with key stakeholders. The review is on track to report in 2023.

Work and health

The DHSC and Department for Work and Pensions (DWP) Joint Work and Health Directorate (JWHD) reflects the shared agenda of boosting employment for disabled people and people with health conditions, recognising that good work is an important wider determinant of health. We work with employers, local areas and wider government to minimise the additional barriers disabled people and people with health conditions face when in and out of work.

Throughout 2022 to 2023, JWHD continued to provide much needed support to help these groups to start, stay and succeed in work. JWHD has improved alignment of employment and health systems to deliver evidence-based programmes, trials and tests.

Following a positive evaluation, in October 2022 we announced we would expand the employment advisers in the NHS Talking Therapies programme throughout England, increasing access to combined psychological and employment support from 40% to 100% coverage across services in England.

The Health and Wellbeing Programme

The Health and Wellbeing programme was launched in December 2016 and is a joint initiative managed by DHSC, NHS England and the UK Health Security Agency. The programme works with voluntary sector organisations to:

• drive transformation of health and care systems
• promote equality
• address health inequalities
• help people, families and communities to achieve and maintain wellbeing

The programme seeks to achieve its objectives through the following 2 co-dependent funded mechanisms.

Voluntary sector Health and Wellbeing Alliance (HW Alliance)

The HW Alliance is a partnership between sector representatives and the health and care system. It is made up of 18 voluntary sector members that represent communities who share protected characteristics or that experience health inequalities, and a voluntary sector co-ordinator. The programme enables the sector to share its expertise at a national level, with the aim of improving services for all communities.

During 2021, 6 members of the HW Alliance worked with the Vaccine Uptake Team at short notice during the peak of the Omicron variant of COVID-19 to boost vaccine uptake in hesitant communities including Gypsy, Roma and Travellers, pregnant people and homeless populations. Organisations were able to identify vaccine hesitancy and respond with tailored communications, reaching out through trusted partnerships to encourage take-up. The Homeless Health Consortium had requests for over 700 leaflets in 6 different languages and Tommy’s ‘myth busting’ toolkits received 15,000 web and social media interactions.

Voluntary sector Health and Wellbeing Fund (HW Fund)

A new HW Fund is typically launched every year, focusing on a specific theme that aligns with system priorities.

The theme for the 2020 to 2021 to 2022 to 2023 fund was ‘Starting Well’, which focused on maternity projects aiming to improve health outcomes for children starting from preconception to 2.5 years in areas of high deprivation and for people with ethnic minority backgrounds.

Despite the system pressures resulting from the COVID-19 pandemic, the Starting Well organisations:

• linked in with target communities
• created and sustained strong local connections with both statutory and other relevant voluntary sector organisations
• supported a vast number of individuals across the country

The Starting Well organisations shared positive feedback provided by service users, some of whom explained that they now feel less isolated, less anxious, happier and are better informed on how to take care of their health and wellbeing as well as their children’s.

Palliative and end of life care

We recognise that access to high-quality palliative and end of life care can make all the difference to individuals and their families. We continue to work with our stakeholders to identify where service provision could be improved, including for those that represent groups with protected characteristics.

In August 2022, NIHR established a new policy research unit to build the evidence base on in this area, with a specific focus on inequalities.

Furthermore, the voluntary sector HW programme commissioned a number of projects during 2022, investigating inequalities in accessing palliative and end of life care. These include:

• intersectional considerations at the end of life
• digital inclusion
• barriers for those likely to be in the last year of life without a life-limiting diagnosis

Additionally, NIHR has funded research into exploring inequalities in this area exacerbated by the pandemic.

COVID-19

We continued to deliver our COVID-19 vaccination programme with the explicit consideration of mitigating inequalities and ensuring people from all parts of society were able to benefit from COVID-19 vaccination, including by offering vaccination to those who were homeless, refugees or marginalised groups. Building on its previous efforts, in late 2021 the government invested over £45 million in a nationwide army of vaccine ambassadors and Community Vaccine Champions assisting 60 local authorities with the lowest uptake rates to encourage people to get their jabs. Our vaccine ambassadors spoke 33 languages between them and utilised this to promote uptake. We also sent text alerts to everyone in the country urging them to get boosted, on top of using local networks to promote accurate health advice.

Furthermore, as numbers of a new COVID-19 variant continued to rise at an alarming rate in late 2021, the government joined forces with faith leaders to help spread the message that booster vaccines were critical in our fight against the virus. Faith leaders - who are the pillars of many communities across the country - played a vital role throughout the pandemic, backing the vaccine drive. This included adapting places of worship into temporary vaccination centres.

We also continued to update our COVID-19 guidance in our migrant health guide to support healthcare professionals to care for migrants in their day-to-day practice.

The gender pay gap

We are making good progress in addressing the gender pay gap in medicine, following the publication of an independent report in 2020. We have established a gender pay gap implementation panel, chaired by the report’s author, Professor Dame Jane Dacre.

During its first year, the panel made progress with reforms to the National Clinical Impact Awards (formerly the National Clinical Excellence Awards), including changes aimed at enhancing the diversity of applicants.

Recent data presented at a panel meeting suggests that the gender pay gap in medicine has decreased from 17% in September 2018 to 12.7% in March 2021. Although the cause of this decline is difficult to determine, there is broad agreement that the publication of the review and momentum created by the panel have been positive influences.

Objective 3

We will improve the capability and understanding of the public sector equality duty in the department to make better policy decisions and improve the health and lives of the nation.

The DHSC Public Sector Equality Duty (PSED) Team lead the oversight of capability and assurance of PSED in the department by supporting and encouraging staff to consider equality from the perspective of improving outcomes for people, rather than solely as a legal duty or process. The team aims to ensure that equality is put at the heart of all policy and decision-making.

In 2021 to 2022 the team continued to deliver regular training sessions for colleagues across the department. These sessions provide an introduction to PSED and how to build this into the department’s work, to improve outcomes for groups and communities. The majority of these sessions were delivered jointly with colleagues from the Office for Health Improvement and Disparities to offer a comprehensive picture on PSED and health disparities, to raise awareness and ensure colleagues understood why these issues were important and how to effectively consider them in their work.

The team delivered 14 sessions between 1 October 2021 and 30 September 2022 involving over 500 employees, particularly reaching a large number of new starters in the department as well as some colleagues from our ALBs. We had positive feedback from attendees that the sessions were useful and informative.

The team also provides one-to-one support on request from policy teams. This includes providing information on how to effectively consider equality issues and reviewing draft equality impact assessments. This offer is alongside advice available from the department’s legal advisers.

Objective 4

We aim to improve the department’s assurance processes to the public sector equality duty to ensure it is clear throughout the policy development process how we have paid due regard to the public sector equality duty.

We have a template for submissions when providing advice to ministers. The checklist on this template highlights PSED as something that teams must consider as they develop their policy. One of the sections in the template is on legal duties. This reminds teams that they need to provide advice on legal duties including under the Equality Act 2010. Teams also have access to an equality impact assessment template and other guidance on our intranet to help them record equality considerations for their policy.

Furthermore, we undertake bi-annual assurance meetings (or ‘BAMs’) with each director general group, which requires groups to report on their compliance with PSED. These are chaired by the Permanent Secretary and attended by the director general and directors for that group. The BAM process ensures that where issues arise during the year, they are appropriately reported and discussed.

Objective 5

We will build senior engagement in the department and stakeholders to highlight and promote the importance of equalities and encourage senior staff to tackle equality issues.

Our departmental core values are:

• we are inclusive
• we constantly improve
• we are agile
• we challenge

Our approach to diversity and inclusion (D&I) is to embed practical actions into everyone’s role and responsibility, and we recognise how important it is to demonstrate and champion D&I at senior leadership level to ensure our values are integral to the department’s culture. To support this, we introduced the new Senior Civil Service (SCS) D&I standards framework for the 2022 to 2023 performance year. The standards were created to help members of the SCS articulate their level of ambition when it comes to leadership of D&I in the department and guide them on what to include in their plans for meeting their D&I objective.

To develop the standards, we worked together with our key stakeholders including leaders of our Race Equality Action Plan strands, D&I sponsors and networks, D&I committee and executive committee. The standards provide practical measures and a framework for role modelling inclusive leadership and hold senior leaders to account in driving an inclusive organisation where all our people feel they can contribute and belong. All our senior leaders are expected to meet the minimum standards of the framework, including a mandatory D&I objective, with clear links to performance to help provide assurance at key points during the year that those minimum standards have been reached.

In September 2021, we also introduced a reverse mentoring scheme where the mentor has a diverse lived experience or knowledge that the more senior mentee lacks. This form of mentoring can help increase the engagement and retention of underrepresented staff, as well as increase cultural intelligence in senior leaders, all of which results in more considered decision-making and better policy outcomes for the public we serve.

The D&I standards framework and mentoring programme affirms our commitment to removing disparities, developing diverse teams, and making sure we gain from the full breadth of experiences and insights that our colleagues can offer.

2. Equality in our workforce

This section sets out the department’s approach to using equality data and information to inform and develop policy and initiatives in relation to our workforce. The scope of this section:

• relates to DHSC as an employer and does not include any of its agencies
• covers the period 1 October 2021 to 30 September 2022
• covers a snapshot of data as of 30 September 2022 with 4,010 employees
• provides an overview, with data tables, of how equality information is used to inform employee policy and initiatives, rather than the details for every policy

This section focuses on progress and activities that took place during the reporting period and does not include recommendations or actions to be taken after 1 October 2022.

Diversity and inclusion at DHSC

At DHSC we want diversity and inclusion (D&I) to be everyone’s responsibility, embedded in our culture and values. We celebrate difference and the value it brings and aim to create an environment where everyone can achieve their potential. We are committed to promoting and supporting inclusion in the workplace, in line with DHSC values and legal duties as a public sector body and helping to build a diverse and inclusive Civil Service where everyone can realise their potential. Our commitment is underpinned by the Civil Service Diversity and Inclusion Strategy 2022 to 2025, delivered in collaboration with our leaders, staff networks and employees across the department.

We are committed to treating all employees fairly and aim for all internal human resources (HR) policies to promote equality of opportunity, where no employee or job applicant is discriminated against on the grounds of their age, caring responsibilities, disability or long-term condition, gender reassignment, pregnancy or maternity status, race, religion or belief, sex, sexual orientation, marriage or civil partnership status and/or work pattern. We have several policies and activities in place to aid the recruitment and retention of underrepresented groups, including:

• involving the disability staff network and other staff networks in the assessment of workforce policies and guidance

• a comprehensive suite of flexible working policies

• development of specific guidance for managers and employees, covering such issues as:
  • making reasonable adjustments
  • mental health
  • support for carers
  • anti-bullying, harassment and discrimination
  • occupational health support
  • mental health first aiders
• workplace adjustments through accessible IT systems, information and facilities

We regularly review processes and practices to attract diverse candidates from within and outside the department. As a result, we strengthened the requirements of selection panels at delegated grades (AA to G6) to introduce more perspective and lived experiences.

To promote D&I at the highest level, the Second Permanent Secretary acts as the department’s senior D&I champion and is supported by D&I champions from the senior leadership team who individually focus on:

• age
• disability and long-term conditions
• domestic abuse
• faith and belief
• sex
• gender identity
• LGBT+
• parents, carers and flexible working
• race
• social mobility
• freedom to speak up
• wellbeing

D&I champions are committed to supporting this by helping to create an environment which is inclusive and where everyone has equal opportunity to achieve their potential and flourish.

We strive to embed a data-driven, evidence-led and delivery-focused approach in all that we do to progress inclusion. Diversity data is regularly monitored, helping to identify areas for improvement and measure the progress in making DHSC a more inclusive workplace. We use a range of measures to track progress - including self-declaration data in the HR management system, recruitment data and trends in staff survey data (Civil Service People Survey). We have also reviewed our use of external D&I memberships and benchmarking to ensure they deliver effective outcomes and value for money. Those that did not were not renewed.

In 2021 to 2022 we organised a range of events for all employees aimed at raising awareness and advancing inclusion in the department, including Disability Awareness Week, Black History Month and Pride Month.

We have over 30 staff networks which:

• provide support to employees
• increase knowledge and awareness
• provide insight to aid the development of HR policy and initiatives
• contribute to creating an inclusive environment in which individuals can thrive

These networks focus on protected characteristics (as outlined by the Equality Act), grades, professions or other workplace matters, including networks like the Flexible Working Network and Clinician’s Network. Representatives of networks form a Diversity Board, which meets regularly to discuss inclusion-related matters at DHSC.

We continue to operate as a Disability Confident Leader under the Disability Confident scheme, guaranteeing an interview for disabled candidates who demonstrate the minimum requirement at sift. This recognises our commitment to providing an inclusive and accessible recruitment process and working environment. As part of this, we have a disability at work conversation toolkit to ensure employees receive the support they need.

We provide, under the Equality Act 2010, support to employees with a disability or health condition in the form of reasonable workplace adjustments. A workplace adjustment can be a change that removes a barrier or a disadvantage for employees with a disability or health condition including physical, mental and learning disabilities or conditions. To support this commitment, we have a dedicated health and safety team and created a new workplace adjustment advisor role. We also provide support through our occupational health service for workplace and specialist assessments.

Over 2021 to 2022, we continued investment in development programmes focused on inclusion and/or dedicated to those from underrepresented groups, including the:

• Autism Exchange Internship scheme, a cross-government programme managed by the Cabinet Office
• Beyond Boundaries programme, a cross-government programme for grade AO to SEO who want to develop an effective career within the Civil Service - DHSC offers at least 50% of the programme slots for employees who have a disability, are from an ethnic minority group, or from a lower socio-economic background
• Care leavers Internship Scheme, a cross-government programme managed by the Department for Education
• Catapult scheme, a cross-government sponsorship scheme for people from lower socio-economic backgrounds
• Health Policy Fast Track Scheme (HPFTS), a bespoke DHSC graduate scheme, with a focus on promoting the scheme across the diverse talent pool, including candidates from ethnic minorities, disabled candidates and candidates from a lower socio-economic background
• META (Minority Ethnic Talent Association) and DELTA (Disability Empowers Leadership Talent Association), as part of the Future Leaders Scheme, which are cross-government accelerated development schemes

We also use apprenticeship schemes to attract and develop diverse talent, including employees and candidates from lower socio-economic backgrounds, who might otherwise not have access to formal education or training.

All employees have access to an employee assistance programme for independent advice from qualified professionals on topics such as physical or mental health, stress and depression. Internally, employees have access to in-house Mental Health First Aiders who are trained in how to give appropriate help and support, as well as internal Speak Up Advisors, who are DHSC members of staff that are impartial and independent from line management. These individuals act as a source of guidance for those wanting to raise a challenge or concern in work, such as a concern relating to bullying, harassment or discrimination in the workplace.

Workforce summary

We strive to embed evidence-based and outcome-focused approaches in all that we do to progress equality and inclusion in DHSC. We closely monitor diversity data, which enables us to identify areas for improvement and measure our progress in making DHSC a more inclusive workplace. We continue raising awareness of the importance of updating the diversity data and using insights to drive evidence-based change, through communication, system improvements and leadership action.

The data presented in this report shows information relating to DHSC’s employees by protected characteristic. Information is presented on age, disability, gender reassignment, ethnicity, religion or belief, sex and sexual orientation, working pattern, socio-economic background, and caring responsibilities of our employees. Age and gender data is collected and recorded during the onboarding process by the HR team, while the other information is self-declared by employees through our HR management system.

We assumed the following principles during analysis and data presentation:

• percentages have been rounded to the nearest one percentage point - this means percentages may not sum to exactly 100%
• headcount includes permanent and fixed-term appointees employed by the department (including employees out on secondment or loan and all types of absence or special leave)
• for compliance with data protection laws, values are rounded to the nearest 10, and cells containing between 1 and 5 employees are represented by ‘1 to 5’ to prevent the identification of any individual’s diversity characteristics
• for some of our analysis, SCS grades may be grouped together - SCS refers to employees at the following grades:
  • permanent secretary
  • director general
  • director
  • deputy director
• all other grades are represented separately as follows:
  • grade 6 (G6)
  • grade 7 (G7)
  • senior executive officer (SEO)
  • higher executive officer (HEO)
  • executive officer (EO)
  • administrative officer (AO)

Sex

Table 1 shows the representation of employees by sex and responsibility level. There is a higher proportion of women employed across all the grades. 

Table 1: DHSC employment - headcount and proportion by sex and responsibility level

	Women	Men
SCS	170 (60.7%)	110 (39.3%)
G7 or G6	1,080 (63.5%)	620 (36.5%)
HEO or SEO	1,010 (65.6%)	530 (34.4%)
AO or EO	330 (68.8%)	150 (31.2%)
DHSC	2,590 (64.7%)	1,410 (35.3%)

Ethnicity

Table 2 shows the representation of employees by ethnicity and responsibility level. The highest proportion of ethnic minorities (excluding white minorities) are at AO or EO grades.

Table 2: DHSC employment - count and proportion by ethnicity and responsibility level

	Ethnic minorities (excluding white minorities)	White	Not declared	Not reported
SCS	40 (14.3%)	180 (64.3%)	1 to 5 (0.0%)	60 (21.4%)
G7 or G6	230 (13.5%)	980 (57.6%)	20 (1.2%)	470 (27.6%)
HEO or SEO	240 (15.6%)	820 (53.2%)	10 (0.6%)	470 (30.5%)
AO or EO	80 (16.7%)	230 (47.9%)	1 to 5 (0.0%)	170 (35.4%)
DHSC	590 (14.8%)	2,210 (55.2%)	30 (0.8%)	1,170 (29.2%)

Religion

Table 3 shows representation of employees and their religion or belief (including lack of belief) by responsibility level. The highest proportion of employees with declared religion or belief is at AO or EO and G7 or G6 grades.

Table 3: DHSC employment - count and proportion by religion or belief and responsibility level

	Declared religion or belief	No religion	Not declared	Not reported
SCS	80 (27.6%)	120 (41.4%)	20 (6.9%)	70 (24.1%)
G7 or G6	500 (29.4%)	610 (35.9%)	80 (4.7%)	510 (30.0%)
HEO or SEO	410 (26.8%)	560 (36.6%)	70 (4.6%)	490 (32.0%)
AO or EO	150 (31.2%)	140 (29.2%)	10 (2.1%)	180 (37.5%)
DHSC	1,140 (28.5%)	1,430 (35.7%)	180 (4.5%)	1,250 (31.3%)

Disability

Table 4 shows the proportion of employees by disability status and responsibility level. The highest proportion of employees with declared disability is at AO or EO and SCS grades.

Table 4: DHSC employment - count and proportion by disability status and responsibility level

	Declared disability	Declared no disability	Not declared	Not reported
SCS	20 (6.9%)	110 (37.9%)	1 to 5 (0.0%)	160 (55.2%)
G7 or G6	80 (4.7%)	480 (28.2%)	10 (0.6%)	1,130 (66.5%)
HEO or SEO	100 (6.5%)	370 (24.0%)	10 (0.6%)	1,060 (68.8%)
AO or EO	30 (6.3%)	100 (20.8%)	1 to 5 (0.0%)	350 (72.9%)
DHSC	230 (5.7%)	1,060 (26.5%)	20 (0.5%)	2,700 (67.3%)

Sexual orientation

Table 5 shows the proportion of employees by sexual orientation and responsibility level. The highest proportion of LGBO (lesbian, gay, bi, other sexual orientations) employees are at HEO or SEO grades.

Table 5: DHSC employment - count and proportion by sexual orientation and responsibility level

	LGBO	Heterosexual	Not declared	Not reported
SCS	10 (3.6%)	190 (67.9%)	20 (7.1%)	60 (21.4%)
G7 or G6	100 (5.9%)	1,000 (58.8%)	80 (4.7%)	520 (30.6%)
HEO or SEO	130 (8.4%)	850 (55.2%)	60 (3.9%)	500 (32.5%)
AO or EO	30 (6.3%)	240 (50.0%)	20 (4.2%)	190 (39.6%)
DHSC	270 (6.7%)	2,280 (57.0%)	180 (4.5%)	1,270 (31.8%)

Caring responsibilities

Table 6 shows the proportion of employees by caring responsibilities and responsibility level. The highest proportion of employees that declared having caring responsibilities is at SCS grade.

Table 6: DHSC employment - count and proportion by caring responsibilities and responsibility level

	Declared caring responsibilities	Declared no caring responsibilities	Not reported
SCS	70 (24.1%)	50 (17.2%)	170 (58.6%)
G7 or G6	220 (12.9%)	260 (15.3%)	1,220 (71.8%)
HEO or SEO	180 (11.7%)	160 (10.4%)	1,200 (77.9%)
AO or EO	40 (8.3%)	60 (12.5%)	380 (79.2%)
DHSC	510 (12.7%)	530 (13.2%)	2,970 (74.1%)

Gender identity

Table 7 shows the proportion of employees by gender identity and responsibility level. The percentage of employees declaring a gender identity that was different from that registered at birth was 0.2%.

Table 7: DHSC employment - count and proportion by gender identity and responsibility level

	Gender identity different from sex registered at birth	Gender identity same as sex registered at birth	Not declared	Not reported
SCS	0	150 (53.6%)	1 to 5 (0.0%)	130 (46.4%)
G7 or G6	1 to 5 (0.0%)	860 (50.6%)	20 (1.2%)	820 (48.2%)
HEO or SEO	1 to 5 (0.0%)	810 (52.9%)	10 (0.7%)	710 (46.4%)
AO or EO	1 to 5 (0.0%)	240 (50.0%)	1 to 5 (0.0%)	240 (50.0%)
DHSC	10 (0.2%)	2,060 (51.2%)	40 (1.0%)	1,910 (47.5%)

Socio-economic background

Table 8 shows the proportion of employees by socio-economic background and responsibility level. The highest proportions of employees that declared being from a lower socio-economic background is at SCS grade.

Table 8: DHSC employment - count and proportion by socio-economic background and responsibility level

	Declared lower socio-economic background	Declared higher socio-economic background	Not declared	Not reported
SCS	50 (17.9%)	100 (35.7%)	20 (7.1%)	110 (39.3%)
G7 or G6	280 (16.4%)	610 (35.7%)	120 (7.0%)	700 (40.9%)
HEO or SEO	250 (16.2%)	560 (36.4%)	100 (6.5%)	630 (40.9%)
AO or EO	70 (14.6%)	130 (27.1%)	20 (4.2%)	260 (54.2%)
DHSC	650 (16.2%)	1,400 (34.9%)	260 (6.5%)	1,700 (42.4%)