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Promoting equality, diversity and inclusion


We are committed to supporting and promoting equality, diversity and inclusion.

Strengthening our approach to EDI for regulators and Accredited Registers

We announced in Spring 2023 (7 June) that, as part of our strategic focus on equality, diversity and inclusion (EDI), we are changing the way we assess the performance of the organisations we oversee. This includes the 10 statutory regulators and the Accredited Registers.

The statutory regulators are assessed each year against our Standards of Good Regulation. Standard 3, which was introduced in 2019, considers whether the regulator understands the diversity of its stakeholders and ensures that its processes do not discriminate unfairly. Since early 2022, the threshold for meeting this Standard has been under review as we work towards increasing our expectations of the regulators’ performance, having seen improvements across the board since its introduction. We recently published an updated evidence framework and guidance for regulators on Standard 3, outlining our increased expectations for 2023-26.

Organisations in the Accredited Registers programme are assessed against our Standards for Accredited Registers. Following a public consultation earlier this year, a new EDI Standard will be introduced over the coming months which will look at how organisations which hold a Register demonstrate their commitment to EDI and ensure their processes do not discriminate unfairly.

Consumer research - Perspectives on discriminatory behaviour in health and care

We have now published the report of research we commissioned on perspectives on discriminatory behaviour in health and care. This is a piece of qualitative research looking at what constitutes discriminatory behaviour in health and social care and the different ways in which this behaviour may have an impact on public safety and confidence. This research arose from our observations outlined in Safer care for all in relation to how regulators deal with racist and discriminatory behaviour within the fitness to practise process. The report was published on 14 June to coincide with our Chief Executive speaking at a session on equality at the NHS Confed Expo 2023 in Manchester. We envisage that the research will help to inform a consistent and appropriate response by regulators and Accredited Registers towards the various types of discrimination.

Background/context to our first EDI action plan

The murder of George Floyd and the associated Black Lives Matter movement brought into focus the fact that society and organisations still have a long way to go in addressing systemic racial inequalities. The pandemic has further exposed inequalities in relation to race, sex, disability, and socio-economic status, as has the murder of Sarah Everard. The Authority is not unique in facing challenges in relation to its approach and track record on EDI. We have, therefore, been looking at our role.

In November 2020, we commissioned an audit by Derek Hooper to gain feedback from our staff and external stakeholders on EDI to identify areas for improvement. The audit included an assessment of how we were perceived by regulators. It identified key strengths, including the commitment of the leadership and staff to EDI and the work we had already done to encourage regulators to consider EDI as part of their obligations.

The audit also showed that, while the PSA has a commitment to EDI, it still has some way to go in making sure that every employee feels included and able to get their voice heard. Regarding its external role, the organisation was seen by its regulatory community to be lacking credibility on EDI due to its lack of visibility on these issues in the past. We therefore need to improve our performance in this critical area to demonstrate our commitment to EDI in spirit and in practice.

The audit highlighted the following areas for further work and development:

  • Culture
  • Leadership Development
  • Diversity profile of the PSA
  • Staff Development
  • Policy development and EIAs
  • EDI Communication and Messaging
  • EDI in regulation and the role of PSA.

Following that, we appointed Mehrunnisa Lalani to help us develop a plan to embed EDI into our work and culture. Mehrunnisa worked with our staff and Board to prepare an action plan for us to carry forward.

Our vision is to:

Live our values and foster a culture where all our people feel included and are empowered to achieve their best, where we welcome and celebrate diversity, where inequalities and unfair treatment is called out and addressed and, where we set the example for what good looks like for all those we interact with internally and externally.

We have developed three objectives that will give a focus to our work on EDI.

  1. We will develop our capability so that we have the knowledge and understanding to lead by example in creating an empowering and inclusive culture
  2. We will promote an inclusive workplace culture where everyone feels empowered, engaged and valued
  3. We will use our influence to encourage the promotion and progression of EDI across health and social care regulators and accredited registers.

You can download the action plan in Word or as a PDF.

Get in touch

Please let us know if you need our material in other formats. Email

National Inclusion Week 2023

The week ran from 25 September to 1 October 2023 and the theme for this year was 'take action, make impact'. We took the opportunity to reflect on what action we have taken over the last few years and you can find out more in this visual summary.

We also asked some of our colleagues 'What does inclusion mean to me?' You can find out how they answered in the short vox pops below (but there are a few clues in this word cloud).

An image of a word cloud showing words associated with an inclusive workplace

'What does inclusion mean to me?' Watch our videos:
Amrat Khorana, PSA Associate Board Member

Nefo Yuki-Igbinosa, First participant on the PSA’s Work Experience Scheme

Christine Braithwaite, PSA Director of Standards and Policy

No more excuses - tackling inequalities in health and care professional regulation

This is the first chapter in our report - Safer care for all: solutions from professional regulation and beyondIt discusses how there are still unequal and unfair outcomes for protected groups in aspects of professional regulation. Find out more here.

Read our blogs

Reflections from our roundtable in Scotland: barriers to complaining

PSA Board Member Moi Ali reflects on our recent roundtable in Scotland where the topic discussed was "why are there so many barriers to complaining?"

It’s commonly accepted that complaints are a great source of information, highlighting what an organisation is doing wrong, and what needs to be tackled to improve organisational performance. But if organisations generally, and healthcare regulators in particular, really value complaints, why are there so many barriers to complaining? And why is so little focus placed on removing obstacles? That was a topic that the PSA raised in its 2022 report Safer care for all and the focus for the PSA’s stakeholder event in September 2023 in Edinburgh.

I thought I knew a lot about complaints, having held many senior complaints roles over the years – including, currently, being the first Home Office Independent Complaints Examiner, and also undertaking a similar role for the Crown Prosecution Service. Nonetheless, I went away with plenty of food for thought. I’d been of the view that the so-called ‘chattering classes’ (I hate that term!) – namely, the affluent and well-educated middle classes – were well represented amongst complainants, and did not face the same barriers to complaining. I shall have to question my own prejudices following one participant’s insight: some women in that category are what she termed “people pleasers”, who are reluctant to complain because of the social expectations placed on them.

That got me thinking about another awful expression: “Karens”. My own kids introduced me to this undoubtedly pejorative term: “Oh mum, stop being such a Karen,” they exclaimed when I complained about poor service in a restaurant after a family meal. There certainly is pressure on middle class women not to complain, or to be stigmatised for doing so.

It is worth considering the correlation between a willingness to complain/ability to be heard by women and the apparently high volume of patient safety scandals and incidents affecting this group. In Safer care for all the PSA highlighted that, as well as the frequent occurrence of maternity scandals, both the Cumberlege Review and the Paterson Report highlighted harm caused to predominantly female patients and the difficulties faced by those trying to raise the alarm. The Cumberlege Review described a ‘denial’ of women’s concerns.

Another insight at the roundtable in Edinburgh came from Rosemary Agnew, the Scottish Public Services Ombudsman (SPSO), on the need for child-friendly complaints procedures. Research carried out by YouGov on behalf of the Parliamentary and Health Service Ombudsman (PHSO) found that children (and younger people generally), but those from minority ethnic backgrounds, or with disabilities, are most likely to be affected by public service failures, yet least likely to complain.

Talking of the PHSO, a significant barrier to escalating complaints about Government Departments and other public bodies to this final tier of the complaints system is the requirement to have the matter referred by a Member of Parliament (MP). It would be unsurprising if the most disadvantaged (and least likely to complain) found this a deterrent. Although this doesn’t apply to complaints about the NHS which can be made directly to the PHSO (once the matter has been exhausted through other more local routes) or through an MP it still raises an interesting question about the persistence of such obstacles: Are barriers a deliberate part of rationing healthcare complaints? Discuss.

There are many possible reasons why people don’t complain. They may not realise that they can, or be unsure of how to access and navigate the complaints system. The complexity of their issue/concern may be a barrier – both understanding what went wrong and being able to articulate it. This can be magnified if there are literacy difficulties, English is not a first language, or they have special needs. People may be at a very low ebb, without the emotional energy to complain. They might be ill, or made ill by the stress. Then there’s digital exclusion, which may affect some older people, lower socio-economic groups, migrants and homeless groups.

One of the main reasons people don’t complain, even if they can, is that they feel that nothing will change as a result – or worse, they fear that access to the very services upon which they rely, the ones that have failed them, may be adversely affected if they complain. This was a theme which arose from research the PSA recently commissioned into perceptions of discriminatory behaviours in health and care where some participants feared the consequences if they raised concerns about their experiences of discrimination. This too is unsurprising, but the real challenge is how regulators can reach out to under-served communities to encourage legitimate complaints by building trust in the complaints system amongst those groups least likely to complain. It’s a big ask, but a necessary one if the profile of complainants is to change.

And what exactly is the profile of complainants? Monitoring change requires an analysis of who currently complains and, crucially, which groups don’t – and why. As the PSA highlighted in Safer care for all, the data on who does and doesn’t complain is extremely patchy, particularly demographic information, making it difficult to get an accurate picture of who is and isn’t complaining.  Next, an action plan needs to be drawn up and implemented. Performance needs to be measured along the way, and plans amended as necessary. All of this takes time and money – and it takes staff. This, at a time when some of the regulators are struggling to fill fitness to practice vacancies so that complaints can be investigated and, where necessary, put before panels. Perhaps more cross-working across regulators may be part of the solution.

In Safer care for all we recommended that:

  • Regulators work with other health and care bodies to gain a better understanding of the demographic profile of complainants and reduce barriers to raising complaints for particular groups.
  • Demographic data on complaints made to the health and care services across the UK is recorded and made available for all bodies to use.

There is a role for us at the PSA in pushing for more accessible complaints systems across health and care, and for sharing best practice. As a first step, building on the discussion in Scotland, we will be holding an event with the Parliamentary and Health Service Ombudsman in January 2024. This event will bring together health and care sector stakeholders to look at what we know about the barriers that currently exist and promote practical action and solutions to address these. However, we will need to think about further steps we as an organisation can take to bring about change in this area.    

I for one stand ready to support this worthwhile piece of work, so that we can start to see the demographic widen, as complaints processes recognise and remove barriers and thereby widen the diversity of those complaining.