The Equality Act was passed by the UK parliament in 2010 to bring together all the various statutes related to equality and discrimination into one single act. Equality in itself is difficult to define, and in reality equality can never be fully achieved as a community nurse may need to spend more time and resources with one patient than another because of varying needs. Today, ensuring equity is more important so that all people are provided with the support that is necessary to ensure they can access the required services. Alongside equality and equity is allowing for diversity and inclusion, and a community nurse has to ensure that patients from all backgrounds, cultures and marginalised groups receive an equitable service. Before 2010, there were many pieces of legislation that dealt with equality and discrimination, such as the Equal Pay Act 1970, Race Relations Act 1976, Disability Discrimination Act 1995 and the Employment Equality (Age) Regulations 2006. The government believed that despite all of the legislation, discrimination was still taking place. The purpose of the Equality Act was to stop discrimination and provide enhanced protection for people with disabilities or belonging to a minority group. The Equality Act (2010) protects people with the following nine protected characteristics against discrimination:
- Age
- Disability
- Gender reassignment
- Race
- Religion or belief
- Sex
- Sexual orientation
- Marriage and civil partnership
- Pregnancy and maternity.
Every single person will have a protected characteristic and to discriminate against that characteristic is unlawful. For instance, Mary is a 67-year-old community nurse who has applied for a promotion. She is not successful because the employer believes she is too old for the job. This would be direct discrimination against Mary, as the employer is assuming she is not capable of doing the job because of her age. If the employer decided she was not suitable for the job on other grounds, such as performing inadequately at the interview, it would then acceptable to not offer Mary the post. When purely related to age, the refusal is a breach of the Equality Act by the employer. The same would be true for someone with a disability, or someone who has undergone gender reassignment. It also applies to people offering a service. For instance, Wendy is taking Joan, who has a learning disability, to a local restaurant. Joan often makes a mess with her food because of her disability. Some customers in the restaurant complain that Joan is ‘putting them off their food’ and ask that she is removed. The waiter asks Wendy and Joan to leave as it is affecting their business. It is very likely that the courts would view this as discrimination arising from a disability and Joan would be entitled to compensation because of the breach. Disability is not only a physical issue; it also includes mental health and illness. In addition, using language or behaviours that would discriminate against a protected characteristic should be avoided. The use of racist, sexist, misogynistic or homophobic language would be unacceptable for a community nurse, in person or on social media.
Although healthcare professionals cannot discriminate against the protected characteristics, they can refuse service to someone with a protected characteristic. This is pertinent if the person were displaying behaviours unrelated to the protected characteristic. For example, Mr Jones is disabled but he is also very abusive to staff. Healthcare professionals can refuse to provide a service to Mr Jones because of his abusive behaviour, but not on the basis of his disability. This does become more complicated if the behaviour is in relation to their illness, but it is important that any risks of harm to oneself or others be considered before offering a service. While it does not mean that the person will be refused a service, other arrangements might be made. For example a two-person visit may be arranged, in some cases with a police officer or social worker to minimise the risk.
The Equality Act also made it illegal for public bodies or businesses to undertake multiple discrimination. For example, Laura is a Black woman who applies for a job. The job goes to a White man. In the past, Laura would have to seek redress through two pieces of legislation (the Race Relations Act, 1976 and the Sex Discrimination Act, 1975). Under the Equality Act, Laura would only need to sue under the Equality Act, potentially making the process easier (and cheaper) for her. Similarly, making a pregnant woman redundant because of her pregnancy would be a breach of two characteristics, that of sex and pregnancy.
The Equality Act also outlawed discrimination by association. In essence, if a person is caring for someone or is associated with someone who is perhaps disabled or homosexual, it would be illegal for a business or a public authority to discriminate against them because of this association. For example, Mark is friends with Gary. Gary is gay, Mark is heterosexual. The local shop refuses to serve Mark because he is friends with Gary. The local shop is guilty of discrimination by association. It is important for the community nurse to be aware of discrimination by association. A patient related to someone with a protected characteristic offered a lower level of service or no service at all because of the association can sue for breach of the Equality Act.
However, the Equality Act has had its own controversies in the past few years (Davies et al, 2016). Religion or belief and sexual orientation are both protected characteristics for the purposes of the Equality Act. In the case of Bull and another (Appellants) v Hall and another (Respondents) [2013], a gay couple were refused service by the owners of a bed and breakfast who had a strict heterosexual and married couples only policy, based on their Christian beliefs. However, this was found to be discriminatory by the UK Supreme Court. If a service is being offered, it must be offered without discrimination against any of the protected characteristics. In another case (Lee v Ashers Baking Company Ltd and others [2018]), there was clarification from the court that a service must be offered without discrimination, but there was a limit as to the extent of this service if it fundamentally went against the beliefs of another. In this case, a gay couple wanted a cake with the slogan ‘support gay marriage’. The bakers refused to place the slogan on the cake because of their belief system. The European Court of Human Rights said that refusing to write a slogan on the cake was not a breach of the Equality Act, although if they had refused to provide a cake without the slogan, this would have been a breach. For community nurses, it is important not to discriminate against a protected characteristic, but if, for example, the nurse was asked by a relative or patient to pray with them, it would not be unreasonable for the nurse to refuse such a request.
This leads to the duties of the community nurses under the Equality Act. The legislation mentions reasonable adjustments must be made (Read et al, 2018), such as ensuring dementia-friendly guides. However, what is reasonable and unreasonable is often for the courts to decide. Changing the location of a clinic to make it more accessible to people with disabilities may be difficult because of resources and other considerations. In these circumstances, it may be reasonable to only provide ramps and other minor alterations.
The Equality Act originally had the intention of placing new responsibilities (duties) upon public authorities. The first duty was referred to as the socioeconomic duty. The public authority would have ensured that it considered the person's social and economic background and that access to services was not restricted simply because of where the person lived or on their financial stability. A health-related example of this duty may involve the local health provider having to think of ways to address the poorer sections of their society by increasing the number of health clinics or specialists to ensure that people are not being unfairly disadvantaged because of geographical or demographical reasons. The second duty involved equality issues that make it illegal for a public authority to discriminate on grounds of race, disability, sexual orientation, gender, age and religion. However, the 2010 coalition government decided not to enact this part of the bill, despite warnings from organisations such as Age Concern that inequalities of health would continue and potentially worsen consequently. Some authors (Mason and Minerva, 2022) have even advocated for the Equality Act to go further to include appearance so that people who are obese or have tattoos are free from discrimination. It remains to be seen if there will be any strengthening of the Equality Act under the new Labour administration.
The Equality Act 2010 remains an important piece of legislation to ensure that patients receive an equitable service. Community nurses already work with a diverse client group, all with differing needs. An understanding of the protected characteristics will safeguard the nurse from potential breaches of the Equality Act. This includes ensuring that the right terminology is used when describing a patient or when offering a service, so that the patient will feel included and any barriers to treatment or care are removed.