Corporate report

Equality in UK Health Security Agency 2024: how UKHSA met the Public Sector Equality Duty in 2023 to 2024

Updated 10 October 2024

Foreword by Dame Jenny Harries, Chief Executive Officer, UKHSA

The UK Health Security Agency’s (UKHSA) mission is to prepare for and respond to external hazards to our health and to build health security capacity at local, regional and national levels. Underpinning our response is scientific excellence and development in all these hazard areas. These include infectious diseases and pandemics, the health impacts of climate change and poor air quality, and radiological, chemical and nuclear exposures.

External health hazards are not experienced equally by everyone. Stark differences exist between communities and population groups in the risk of exposure to an external health hazard, susceptibility to poor outcomes, and the ability of an individual or community to build and sustain resilience against external threats to health.

Reducing avoidable differences in risks and health outcomes is essential to realising UKHSA’s ambitions to protect every person in every community. For this reason, achieving equitable outcomes in our work on health security is a cross-cutting priority for UKHSA.  This will also support the government’s goal to improve people’s chances of living well for longer and strengthen UKHSA’s contribution to the government health mission, including efforts to:

• halve the gap in healthy life expectancy between the richest and poorest areas of England
• meet targets to eliminate the harmful impacts of disease, including HIV, Hepatitis, and tuberculosis (TB)
• increase uptake of effective prevention strategies, including uptake of vaccine programmes, working with the NHS vaccination strategy

To deliver against this priority, we also need to attract and nurture a diverse workforce who can create effective, innovative solutions to meet the needs of different communities and population groups. 

We have refreshed our Public Sector Equality Duty (PSED) objectives for 2023 to 2026 to ensure we continuously improve our ability to consider the needs of all individuals in our work.

Introduction

This is UKHSA’s second annual report on its approach to meeting its duties under the Public Sector Equality Duty (PSED). UKHSA has developed objectives and activity for 2023 to 2026 reflecting its maturing organisational approach to embedding actions and processes to demonstrate how we consider equalities and health equity. This report aims to give a sense of the action UKHSA has taken over the reporting period and is not intended to cover all areas of work. 

To enable us to meet our duties under the PSED, UKHSA has continued to build a truly diverse workforce and a culture of openness and inclusivity, where difference drives innovation to meet the needs of our workforce and the communities we serve. This report also sets out the steps we have taken to do this.

Equality Act 2010

The Public Sector Equality Duty (PSED) in section 149 of the Equality Act 2010 applies to public bodies and others that carry out public functions. It ensures that public bodies consider the needs of all individuals in their day-to-day work in shaping policy, in delivering services and in relation to their own employees.

The PSED has 3 constituent parts. It requires public bodies such as UKHSA to have due regard to the need to:

• eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010
• advance equality of opportunity between people who share a protected characteristic and people who do not share it
• foster good relations between people who share a protected characteristic and people who do not share it

The protected characteristics covered by the equality duty are:

• age
• disability
• gender reassignment
• marriage and civil partnership (but only in respect of eliminating unlawful discrimination)
• pregnancy and maternity
• race – this includes ethnic or national origins, colour or nationality
• religion or belief
• sex
• sexual orientation

The general Equality Duty is supported by 2 specific duties which require public bodies such as UKHSA to:

• publish information to show their compliance with the PSED
• set and publish equality objectives, at least every 4 years

UKHSA’s PSED objectives for 2023 to 2026 were published in February 2024.

These clearly distinguish between those related to staff and to the wider public. They focus on ensuring that equality considerations are built into any processes, practices and ways of working and that they are implemented as fairly and transparently as possible.

The Health Inequalities Duty (Health and Social Care Act 2012)

In addition to the PSED, the Health and Social Care Act 2012 introduced specific legal duties on health inequalities for the Secretary of State for Health.

Under the framework document between DHSC and UKHSA, UKHSA is required to address health inequalities in relation to performing its role on health protection.

UKHSA’s PSED equality objectives for 2023 to 2026 and our progress against these

UKHSA has published PSED objectives for 2023 to 2026 against which our performance is measured. These build with increased ambition on the goals set in the first full year of our operation as a new organisation.

Our 4 Aims to keep managing PSED better

1. We will use the CORE20PLUS framework to improve our data and evidence on vulnerable population groups, including those with protected characteristics across all our UKHSA strategic priority areas.

2. We will build the evidence base for effective ‘people and place’ interventions that address concurrent risk through models of delivery of health protection services for CORE20PLUS population groups.

3. We will partner with people with lived experience of inclusion health, the voluntary and community sector, health agencies and other government departments to cocreate effective interventions and build trust.

4. We will build capability and awareness of health equity and the public sector equality duty across UKHSA to ensure we design and deliver our functions and services in a way which improves equitable health security outcomes.

Achieving more equitable health security outcomes is a cross-cutting priority for UKHSA. Targeting our health protection efforts on the people and places most at risk is fundamental to delivering our mission as an organisation and to supporting government’s goal to improve people’s chances of living well for longer.

To build on the existing approach and deliver on our cross-cutting goal, UKHSA has developed an internal Health Equity Strategy to inform our work. The strategy was developed by UKHSA’s dedicated health equity function, looking across our programmes, policies and processes.

Through our strategy, we aim to achieve more equitable health security outcomes, where people across the health system are equipped with the information and partnerships formed to identify and address the needs of every community. We have worked with national and local government partners, as well as the voluntary and community sector, to identify 4 areas for the strategy where action is needed.

• Data and Science: to ensure our workforce and our partners understand the impact of external health hazards and the effectiveness of health protection interventions for populations at most risk.
• People and place: to effectively tackle multiple health hazards in at risk groups by considering the populations, places and settings we serve.
• Collaborations: to enhance our collaborations with government, health agencies and communities to provide system leadership on health security for populations at highest risk.
• Culture: to ensure our workforce fulfils our equality objectives to meet the Public Sector Equality Duty, and that UKHSA builds a diverse workforce equipped with the capacity and capability to achieve more equitable health security outcomes.

As part of our strategic approach and to support alignment with the wider health protection system, UKHSA uses the CORE20PLUS framework also implemented by NHSE. The framework defines populations to routinely consider in our work, the ‘CORE20PLUS’ cohorts and communities. The CORE20PLUS framework includes those we know experience health inequalities across health protection, such as:

• the most deprived 20% of the population as identified by the Index of Multiple Deprivation
• people experiencing poverty
• people with protected characteristics
• people with long term health conditions
• people providing and receiving social care
• inclusion health groups

For reporting purposes our focus will be on meeting our obligations with regards to those groups with protected characteristics outlined within PSED, however, in line with our wider strategy, we have extended our approach to report against other CORE20PLUS groups where possible.

UKHSA’s PSED objectives 2023 to 2026 and progress against these during 2023 to 24

Objective 1: Data and Science

We will use the CORE20PLUS framework to improve our data and evidence on vulnerable population groups, including those with protected characteristics across all our UKHSA strategic priority areas.

To do this we will:

• expand evidence available to UKHSA staff on populations identified through the CORE20PLUS framework

• review surveillance outputs and expand activity to capture data on ethnicity and deprivation where possible, and on inclusion health status and settings (for example, prisons or adult social care) where relevant and possible

• build questions regarding impact on vulnerable and high-risk populations into relevant evaluations to inform learning, working this into planned activity

We will know we have achieved this when:

• UKHSA data and science strategies reflect improved data collected on populations at highest risk

• increased evidence is available for staff to access on PSED and CORE20PLUS groups via the internal health equity hub and other routes

• surveillance data covers an increased number of populations and settings

Building our evidence and data on CORE20PLUS populations, including data for those with protected characteristics, is vital to enable us to routinely identify the people and places most at risk in our data. It will enable UKHSA and its partners to target and tailor our interventions and monitor inequalities over time.

In 2023 to 2024, we focused on scoping existing data available on CORE20PLUS populations and identifying new approaches for improving visibility of populations in UKHSA datasets; as well as strengthening the evidence base on CORE20PLUS populations across UKHSA’s strategic priorities.

Case Study 1: Using data to inform action

In October 2023, we published the Inequalities in emergency hospital admission rates for influenza and COVID-19, England technical report which has been widely welcomed by stakeholders at regional and national level to support future winter planning. This showed significant differences for influenza and COVID-19 hospital admission rates for those living in deprived areas and persistent differences between ethnic groups.

These results emphasise the need to improve vaccine coverage across ethnic groups and deprivation levels, for both influenza and COVID-19. There are significant and persistent disparities in vaccine uptake for COVID-19 and influenza by ethnic group and deprivation level.

This analysis also highlights the importance of routine incorporation of variables such as ethnicity and deprivation into our surveillance data. By doing this, we can support the development of policies and actions to reduce these inequalities at national and local level.

Expanding the evidence available

We are addressing data gaps so that we can better target action to address inequalities. Through the UKHSA Data Strategy, we have been reviewing  how we collect data, to better understand exposure and vulnerability of health security threats for different CORE20PLUS populations, including those groups with protected characteristics. This enables us to better target public health interventions.

The UKHSA Science Strategy and the work of UKHSA’s Behavioural Science and Insights Unit are evolving our understanding of different populations that will inform policy making and identify new ways to target health security where it is needed most to protect the whole population. We are also supporting planning of the next Health Protection Research Unit (HPRU) iteration to identify how health equity can be incorporated into each theme. There are 14 NIHR Health Protection Research Units (HPRUs) across England. Each HPRU is a research collaboration between a university and the UK Health Security Agency. The units fund high quality research that aims to protect the public’s health and minimise the health impact of emergencies.

To make sure the data and evidence available is used to inform work across UKHSA, we have sought to align with programmes of work to improve the way UKHSA shares knowledge across the organisation. An example of this is the rapid systematic review published in May 2024, which considered infection transmission risk in communal accommodation settings. This review was commissioned to meet an evidence gap that was identified when UKHSA was requested to provide advice for communal accommodation settings for people seeking asylum. The review found consistent evidence that communal, high-density or crowded accommodation was associated with an increase in infection transmission risk and has been used to inform and strengthen health protection advice provided to other government departments.

Reviewing surveillance outputs

We produce a number of surveillance outputs, including annualised reports aligned with the UKHSA Strategic Plan 2023 to 2026. To ensure these reports can support understanding of inequalities and monitor progress to address them, we have reviewed existing UKHSA surveillance outputs to establish how we can improve data by ethnicity, geography, deprivation, and other protected characteristics, including inclusion health status. This will also give us a baseline against which to monitor progress.   

To create greater consistency across UKHSA, we are looking to support the development of staff guidance on how to disaggregate data, with work underway to incorporate standards into our quality assurance processes for our official statistics.

Case Study 2: Evidence mapping of the health effects of climate change on CORE20PLUS populations

UKHSA has done a rapid mapping review to identify and map primary studies that seek to answer the review question “What is the available evidence on the health impacts of both climate change and the solutions taken to address climate change in population groups experiencing social vulnerabilities in the UK?”

A search of primary studies was made for studies published between January 2010 and July 2023.

Only evidence relating to the UK was included.

Objective 2: people and place

We will build the evidence base for effective ‘people and place’ interventions that address concurrent risk through models of delivery of health protection services for CORE20PLUS population groups.

To do this we will:

• develop and pilot effective models of delivery of health protection services for CORE20PLUS groups

• strengthen our approach to improving outcomes for high-risk populations through incident response structures

• apply evidence on health inequalities to each workstream of the future of the health protection system co-design group

We will know we have achieved this when:

• evidence on effective models of delivery of health protection services for CORE20PLUS groups is shared with our system partners.

• incident response structures include guidance, training and identification of roles and responsibilities on considering and addressing the needs of CORE20PLUS groups.

• measurable health equity outcomes are incorporated into each workstream of the future of the health protection

Progress on objective 2: progress on people and place

Health security, including incident response work often focuses on specific health hazards. Taking a people and place-based approach, can support more equitable health outcomes, including through prevention and early treatment. To do this, we work with partners to build the evidence on what works; co-creating accessible and effective guidance, communications, and models of care to address health protection needs and piloting these to determine effectiveness, including cost effectiveness. By evaluating and sharing our findings with partners we aim to generate commitment to evidence based integrated and person-centred approaches.

Building evidence to enable us to deliver using effective models

In 2023 to 2024, we have focused activity on building on the evidence base on co-created approaches to testing and treatment for inclusion health groups and using learnings to inform our guidance and public health advice.

This has informed discussions with UKHSA’s health protection teams, local authorities and NHS England (NHSE) commissioners regarding effective health protection interventions.

Findings have also been translated into updated guidance. For example, in January 2024 we published the Tackling TB toolkit in inclusion health groups toolkit, a multi-agency toolkit designed to promote and inform holistic prevention, testing and treatment.  

Other work has included developing guidance and advice to support tailored health protection for specific populations such as cold weather guidance for managers in Adult and Social Care settings. We also publishing an equity review of the Adverse Weather and Health Plan.

Future of the Health Protection System

We are embedding health equity through the work of the Future of the Health Protection System (FHPS) co-design group. The FHPS Co-Design Group brings together senior stakeholders from across the health protection system, to enhance the resilience and effectiveness of the current system and ensure it is locally delivered, regionally enabled, and nationally supported.

Health equity outcomes have been developed for each workstream taken forward by the co-design group. For example, in relation to the Screening and Immunisation Delegation workstream, which aims to provide expert advice to NHSE to support the implementation of the NHSE Vaccination Strategy, workstream leads are working closely with NHSE is to ensure that the change in responsibilities across the system when delegating routine immunisations to Integrated Care Boards does not impact on the system’s ability to tackle health inequalities.

Alongside this, we have also started bringing together those from regional and national teams, the voluntary and community sector and people with lived experience to identify shared approaches on implementing health equity at the regional level. We will continue our regional partnering work to further develop joint ways of working on health equity for health protection.

Objective 3: partnerships

We will partner with people with lived experience of inclusion health, the voluntary and community sector, health agencies and other government departments to co-create effective interventions and build trust.   

To do this we will:

• ensure evidence on health security for vulnerable and at-risk populations is available to other partners in the health system to provide a sound basis for collaboration, to agree priorities and deliver integrated and inclusive services that advance health equity for health security
• build and maintain assurance that UKHSA is meeting its legal obligations around PSED and delivering our work on reducing health inequalities
• develop strong partnerships and routes to engage with the people identified through the CORE20PLUS framework and the voluntary and community sector to enable cocreation and implementation of effective interventions

We will know we have achieved this when:

• UKHSA outputs and publications include consideration of health inequalities, and CORE20PLUS groups and are available for partners in the health system

• we publish our annual UKHSA Equality Report demonstrating how we have met the PSED
• a framework is in place to support greater engagement with CORE20PLUS groups

Progress on Objective 3: progress on partnerships

Addressing unequal health outcomes requires collaboration with local, regional and national partners, including our communities. We collaborate closely with health agencies, other government departments, industry, academia, and community groups regionally, nationally, and globally.

Sharing evidence

To support collaboration on shared priorities, UKHSA shares evidence and insights with partners across the system. This includes through conferences such as the International Symposium on Street Medicine and the Adult Social Care symposium, both of which shared learning and best practice on health protection for specific populations with our partners. In addition, we co-chaired the ‘Health in Prisons and Places of Detention’ conference with WHO, hosting 163 participants from 30 countries to share lessons and develop international principles for infectious disease resilience.

At our 2023 UKHSA conference, we shared with health partners our work supporting health equity through health security on a number of topics including:

• health protection in care homes: optimising the quality of care when outbreaks of infectious disease emerge
• supporting equity through health security
• an inclusion health approach to health security
• improving health equity in prisons and other places of detention
• late breaking science: a) new and emerging research b) what we eat and drink
• vaccine communication approaches
• science, surveillance and health equity

We partner with other government departments and health agencies to deliver care and improve services for specific populations, for example, we are a co-signatory on the National Partnership Agreement to improve the quality of healthcare services for people in prison.   

We also work closely with partners to improve our evidence and insights. We collaborate with DHSC and NHSE to deliver the Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Alliance which enables the sector to share its expertise with the health system. Through the Alliance we developed a joint project with NHSE and DHSC working with people with lived experience of homelessness to understand their views around data collection and analysis. This will help to inform the way each partner collects, analyses and reports on data for inclusion health groups.

We supported the development of the NHSE Inclusion Health Framework and are now working closely with UKHSA, NHSE and DHSC regional colleagues to develop shared approaches to delivering health equity in the regions. One example of best practice of multi-agency collaboration has been the London Legacy Health Equity Partnership, which worked across agencies to engage with communities and deliver programmes including health literacy for young people and vaccination communication campaigns. 

Building assurance on tackling health inequalities

For the 3-year period 2023 to 2026 we worked collaboratively to create more stretching PSED objectives aligned to the 3-year Health Equity strategy and associated action plan. These revised PSED objectives, aligned with our Health Equity for Health Security Strategy, were published in February 2024.

Our Health Equity Board continues to oversee work progressing the aims of the Health Equity strategy and our PSED objectives, promoting this work within the organisation.

Work to deliver the Health Equity for Health Security Strategy, launched in June 2023, has been overseen by the cross organisational Health Equity Board, which meets bi-monthly. The Strategy has informed UKHSA’s PSED objectives for 2023 to 2026 and the board also provides oversight to progress against these objectives. Further oversight and steer have been provided by UKHSA’s Executive Committee, the Equalities Ethics and Communities Committee and UKHSA’s advisory board.

Engagement with CORE20PLUS groups

We have been working to strengthen how we engage with CORE20PLUS populations across our work. This has included reviewing how our teams currently engage with populations, barriers to engagement, and where national engagement could improve the effectiveness of our interventions and build trust.

To address challenges, we have commissioned peer-led work across inclusion health groups and with the voluntary and community sector. We have used surveys and focus groups to gather insights around how to build trust with UKHSA, what engagement means to people, and the most effective approaches for engagement.

Alongside this, we piloted a lived experience panel. The panel has supported our long term aims around engagement and provided rapid input to a number of pieces of work, including the methodology for work on terminology, and reviewing a Measles easy read letter.

We have developed an engagement model setting out how we engage with communities and what this means in practice. Our analysis from the consultation analysis and further cocreation work will support setting out how we deliver the engagement framework. This will better standardise our approach to engagement and build trust with CORE20PLUS populations which will strengthen our capability to rapidly engage and coproduce interventions and messaging with inclusion health populations when required.

Objective 4: culture (public-facing impacts)

We will build capability and awareness of health equity and the public sector equality duty across UKHSA to ensure we design and deliver our functions and services in a way which improves equitable health security outcomes.

To do this we will:

• deliver training, awareness raising, and ongoing guidance across UKHSA on health equity, CORE20PLUS groups and PSED
• support colleagues to deliver by documenting and sharing learnings from across the organisation on efforts to achieve more equitable outcomes through internal and external communications
• systematically embed explicit health equity and public sector equality duty considerations in UKHSA processes, policies, and planning processes to ensure they prompt colleagues to make decisions that positively impact health equity

We will know we have achieved this when:

• increased levels of staff have received training on health equity and PSED, including training tailored to different operational needs

• an internal communications and engagement plan is in place to increase awareness of health equity and PSED and to share learnings from across the organisation

• a knowledge audit has been conducted to demonstrate where any gaps and needs exist and, guided by this, awareness of health equity and PSED considerations have increased across UKHSA

• health equity and PSED considerations are embedded into UKHSA processes, policies and planning processes including UKHSA business planning

Progress on Objective 4: progress on culture (public-facing impacts)

We strive to equip our workforce with the capabilities to deliver equitable health security outcomes and ensure all disciplines have the knowledge, awareness and skills to play their role in tackling health inequalities. 

We continue to look at strengthening our training offer and increasing its reach, acknowledging that many of our staff have also received specialist training on health inequalities as part of their professional qualifications.

We have been working to raise awareness of health equity and ensuring that colleagues see delivering more equal outcomes as ‘everyone’s business’.

Building capability and awareness

We offer training on PSED as part of staff induction with further upskilling offered to existing staff.

In total, over 650 colleagues accessed PSED training, including through tailored sessions for different audiences such as staff networks.1400 colleagues received a ‘light’ version of training at a cross-UKHSA session.

Our internal webpages supporting how to consider inequalities in our work generate around 300 unique hits monthly, helping to increase understanding and awareness across UKHSA.

Documenting and sharing learning

A dedicated team provide tailored support on both a proactive basis and on request to support teams in giving appropriate due regard to the PSED and addressing health inequalities. The team supported 51 different pieces of work over the course of the year. 

The Health Equity Hub for staff has been continually expanded to include more advice and guidance to enable colleagues to self-help.

We have also created a repository of historic Equality Impact Assessments (EIAs) which will go live in 2024 to 2025 to provide a resource to colleagues across the organisation demonstrating how others have considered PSED and health equity.

Embedding health equity in our policies and processes

Achieving more equitable outcomes is a cross-cutting goal in the UKHSA Strategic Plan. To ensure as an organisation we are consistently considering equalities impacts, UKHSA has embedded health equity across key processes and procedures. This includes prompts to consider health equity through business planning processes, and plans for delivery of UKHSA’s strategic priorities to support delivery. This goal has also informed the development of key strategies including UKHSA data, science, people and commercial strategies. The UKHSA Health Equity Board remains an important oversight function to hold the organisation to account for delivering on health equity and checking progress against the strategy with regular performance updates. We continue to look at identifying how to do more to monitor performance, impact and risk.

Objective 5: culture (staff-facing impacts)

We will continue to invest in a talented workforce that represents the diversity of the working population. We will nurture and sustain an inclusive and respectful culture and working environment across UKHSA that values and respects diversity and inclusion. 

To do this we will:

• promote inclusive behaviours, through developing managers’ understanding of the link between effective diversity and inclusion and the impact on physical and mental health
• continue to drive up declaration rates, collate and monitor diversity information on our staff and use our diversity dashboard to provide accurate and meaningful data to senior leaders in all directorates as evidence in tackling workforce inequality
• we will attract, recruit and develop a workforce with a blend of strengths and experience, and make UKHSA a place where everyone is proud to work, using our data and insight to put in place new opportunities and interventions

We will know we have achieved this when:

• UKHSA is meeting Key Performance Indicators (KPIs) showing progress on diversity, staff inclusion and the addressing of staff health and wellbeing

• improved diversity declaration rates are demonstrably informing decision making around staff matters

• we have implemented and evaluated improvements based on new interventions around staff talent and recruitment

Progress on Objective 5: progress on culture (staff-facing impacts)

Dashboard

The diversity dashboard presents an entire workforce profile (employees only), and the workforce composition of each Group, disaggregated by age, ethnicity, disability, gender, and sexual orientation. The dashboard is updated and published quarterly internally and is shared with key stakeholders to initiate helpful conversations, which seek to identify useful next steps to address observable imbalances and drive action.

Key Performance Indicators (KPIs) are aligned to the 3 diversity and inclusion strategic priority areas for 2023 to 2025.

• KPI 1 (A): Maintain (within 2% per person) the People Survey responses to the Inclusion and Fair Treatment theme. The 2023 results for KPI 1 increased by 3% to 80%
• KPI 1 (B): Deliver ‘Focus Inclusion’ events to drive leadership and line management capability across 80% of all business areas. By December 2023 Focus Inclusion sessions were delivered to around 400 staff and wider roll out has now commenced across the business
• KPI 2 (A): Achieve 80% completion on Inclusion and Civil Service Expectations mandated learning, there was a 73% completion rate as of 31 March 2024
• KPI 2 (B): To increase current staff network membership by 10% by end March 2025 - network membership has increased by 36% between March 2023 to March 2024
• KPI 3 (A): To increase our current declaration rates in each of the 4 diversity data categories (Disability, Religion, Ethnicity, LGB+) by 5% over the next 24 months. Declaration rates have continued to fluctuate since we started reporting in March 2022. Between March 2023 and March 2024, declaration rates remained at 76%. Through a declaration campaign, we will continue to encourage all staff to declare or update their diversity data
• KPI 3 (B): 100% of networks have an action plan approved by our Executive Committee Champion. 100% of all networks have an action plan or key objectives (for smaller networks), aligned to the UKHSA Diversity and Inclusion (D&I) strategic priorities and approved by their Executive Member Champion

Our work on inclusion

Diversity and Inclusion (D&I) is embedded into UKHSA organisational policies, practices and priorities across the organisation including Human Resources (HR) corporate services, learning and development, recruitment, pay and, pensions. Several initiatives have been developed to drive and further enhance D&I in UKHSA.

Line managers and staff are encouraged to embed the Civil Service Model of Inclusion (belonging, authenticity and voice), into their everyday working practices, to respect and value difference, role model inclusive behaviours, and to ensure diversity of thought in the decision-making process, helping to create an inclusive work environment. The delivery of Focus Inclusion events will aim to further strengthen this approach.

D&I strategic priorities

A strategic goal for UKHSA is to improve health equity across the UK. To do that effectively we are committed to attracting, retaining, and investing in a talented workforce that represents the diversity of our population.

We continue to build a diverse workforce and a culture of openness and inclusivity. We celebrate difference and appreciate the value it brings to meet the needs of our workforce and communities, so we can serve them better. We see a person’s background as an asset and welcome diversity of thought to improve our business and refine our approach.

We take an evidence-led and data driven approach to D&I to help drive innovation and change. We have used the internal diversity dashboard to identify areas for improvement and monitor progress to ensure that we continue to make UKHSA a great place to work.

Our commitment is set out in our D&I Strategic Priorities that we developed in consultation with staff networks. Through listening to staff, we identified 3 strategic priorities for 2023 to 2025: Inclusive Values and Experience, Culture and Engagement, and Evidence and Governance.

Inclusive values and experience

Inclusion is one of our organisational values. Therefore, we continue to build an organisation where everyone is welcome and feels they belong and where we treat each other with respect and tolerance. We work to ensure that D&I is embedded in all our workforce and people practices. We support our leaders to role model inclusion so that diversity of thought and alternative perspectives can benefit the organisation and the communities we serve.

Culture and engagement

We value and invest in all our staff and work with our staff networks to support awareness campaigns, inclusion and learning events. We work in partnership with our People Experience team, our networks and our D&I champions and encourage their involvement at a cross-government level, ensuring we continue to learn and respond as an organisation.

Evidence and governance

We take a data-driven, evidence-led and delivery focussed approach on everything that we do. To support our leaders in delivering against their D&I objectives we continue to develop our D&I dashboard and KPIs to chart and narrate our progress as an organisation and report openly in line with our governance process for D&I. We ensure we uphold our Public Sector Equality Duty and report and progress work in relation to the Gender Pay Gap.

Leadership and governance

UKHSA Director Generals (DGs) are accountable to Jenny Harries, CEO, for the subsequent actions taken by their leadership teams in tackling any identified inequalities. All Senior Civil Servants (SCS) have a mandatory D&I objective and our Executive Committee publish their D&I objectives on the UKHSA staff intranet.

All staff networks have a champion who provide sponsorship to staff networks. The Champions act to provide senior accountability for the delivery of network action plans aligned to the D&I Strategy and are instrumental in supporting D&I activities.

The Talent and Inclusion (T&I) team meet monthly with network chairs and report 6 monthly with People Board or Executive Committee.

Staff networks

UKHSA is proud to have 13 staff networks (which includes sub networks) and over the course of the year have increased network membership and activity. The networks have played an active part in creating and developing our culture and have facilitated and delivered collective learning and development opportunities, engaging events and supported their members across UKHSA.

Networks play a key role in essential programmes of work such as raising awareness and supporting equality impact assessments.

Achievements

UKHSA is proud of the achievements since last year:

• networks continue to increase their membership numbers and between them, have published a total of 48 blogs and articles in the last year
• each D&I network has an action plan or key objectives in place, aligned to UKHSA D&I strategic priorities, and signed off by their ExCo Champion
• all our SCS have a D&I objective, underpinned by a clear set of D&I standards and each Executive Committee member has published their personal D&I objectives on the intranet
• we achieved Disability Confident Level 3 status
• we reviewed our recruitment process through a disability lens and have worked with our recruitment team to embed inclusion into recruitment processes, advertising all roles as suitable for flexible working by default
• we continue to develop our D&I Dashboard to chart progress across the organisation against our D&I KPIs
• we developed and rolled out an in-house positive action development programme Accelerate, for Grade 6 or 7 ethnic minority and/or staff with a disability or long-term health condition The pilot programme has been evaluated and, following its success, has been expanded to the remaining delegated grades

Benchmarks

UKHSA is a Disability Confident Level 3 employer and has Level 2 Carer Confident Accreditation.

Disability

UKHSA is a Disability Confident Leader and is committed to retaining this status. The scheme supports the organisation to meet the needs of staff living and working with a disability.

UKHSA’s workplace adjustments passport and guides, help managers and staff identify workplace adjustments for mental and physical health conditions. UKHSA continues to promote the passport within the organisation such as through work to support International Day of Persons with Disabilities. This year UKHSA celebrated Neurodiversity Week and raised awareness of this topic through events and blogs.

Wellbeing

Supporting our workforce to be healthy and have a strong sense of wellbeing on a daily basis is fundamental to our ability to deliver the UKHSA corporate priorities and ambition, and more so during major national incidents. UKHSA have an exemplary inclusive Health and Wellbeing offer, including access to an Employee Assistance Programme and Occupational Health Advice. The Health and Wellbeing team work in collaboration with key stakeholders to provide a wide range of services to maintain the mental, physical and emotional wellbeing of our staff. There are dedicated and committed volunteers consisting of over 170 Mental Health First Aiders and over 180 Wellbeing Champions across the organisation.

The team host a number of networks and cafés to support staff who may wish to share their experiences and provide support to others, these include the Menopause cafés, Endometriosis cafés, Men’s Health Forum, Cancer Network and Grief and Bereavement cafés. Data and insight are used from the health and wellbeing dashboard, surveys and staff feedback to evaluate the uptake of the offer. Staff are also encouraged to write blogs and articles around health and wellbeing, to share their experience and help to raise awareness that may support others while promoting understanding, compassion and inclusion. Health and wellbeing training is available for managers which focuses on their role in supporting staff wellbeing whilst raising awareness of resources, policies and interventions.

Senior leaders are encouraged to role model positive wellbeing behaviours and encourage their teams to promote safe and supportive working environments by implementing the UKHSA Wellbeing Charter.

Apprenticeships

The apprenticeship scheme in UKHSA is as diverse as the organisation workforce, so there is something for everyone. 

UKHSA actively promotes a wide range of apprenticeships for both newly recruited and existing members of staff where the scheme is used across the organisation to facilitate career development within defined professional pathways. We work with our delivery partners to ensure our offer is aligned to business need and have incorporated programmes directed at certain protected characteristics, such as women in leadership as well as programmes aligned to STEM.

Learning and development

The Learning and Development (L&D) offer at UKHSA is designed to foster an inclusive and fair learning environment, providing equity in the opportunities to access the L&D content that has been evolved through evidence-based practices and ongoing evaluation. We are especially proud of our Effective Manager development programme which covers essential topics such as constructive conversations, time management and delegation, and highlights the important key staff networks across the business, and the support available to all employees. This will be further enhanced in 2024 to 2025 as we adopt the new Cabinet Office management capability standards which has a focus on building team D&I. In addition to this, in response to UKHSA’s people survey results we are focusing UKHSA wide on building a mature learning organisation, which will include greater options for people development, but will also see some dedicated leadership development and people interventions to foster a culture of trust and reduce incidents of bullying and harassment.

In alignment with our commitment to D&I, performance management at senior levels utilises D&I metrics on executive dashboards to ensure a comprehensive understanding of organisational performance and inclusion efforts.

Our L&D policy aims to show the “golden thread of equality of opportunity”, ensuring that every staff member has access to development opportunities essential to help with job performance. We work collaboratively to integrate development and inclusion features across all our offerings and products, reflecting our commitment to both employee growth, diversity, and continuous improvement.

The mandatory training at UKHSA includes ‘Civil Service Expectations’ formerly known as ‘Inclusion in the Civil Service’. We monitor completion rates and engagement closely, reporting monthly to D&I topic leads, senior leaders, and HR business partners to sustain awareness and understanding within our inclusive culture, and seek feedback to support areas where additional L&D focus may be required.

Investments in human-centered design L&D initiatives underscore our commitment to understanding and addressing the needs of individuals and communities. Our suite of bite-sized learning guides, self-help toolkits, and face-to-face modules aim to enhance organisational capability by centering on people’s experiences and requirements in problem-solving, policymaking, and service delivery.

Talent

At UKHSA we recognise that everyone has diversity of insight, strengths and skills that can be developed to benefit the organisation. We appreciate the value of our deep experts, broad generalists and, those ready to expand their leadership and influence beyond their current role or profession. These are all important attributes, enabling us to deliver our UKHSA Strategic Plan and People Promise, live our values and be an employer of choice.

Our Talent Offer includes access to a broad range of cross- government development schemes alongside our flagship in-house talent scheme, Accelerate. 

We empower our people to own their talent and provide an offer that supports them to pursue their career goals, enabling UKHSA to be a scientific and operational leader in health security at a local, national, and global level.

UKHSA is committed to building an inclusive environment for people development, investing, and building the talent of all employees. To ensure our approach is inclusive and aligns to our vision, we recognise everyone as talent, working in partnership with D&I colleagues, business areas and across government to enable individuals to grow and perform their best in UKHSA through a range of development and leadership programmes. As an organisation we take an evidence-based approach in identifying and developing the different types of talent, skills, and experience to deliver the UKHSA remit and for the citizens we serve.

Professional communities

UKHSA has an established Head of Profession network that covers both Civil Service recognised professions and those more aligned to Public Health. Work to understand the level of maturity within these is being conducted using the Professions best practice framework. Building Profession capability and awareness of career progression, talent management, performance evaluation, accreditation, professional registration, and development opportunities will enable individuals and UKHSA to continuously improve and support future evidence-based decisions for workforce planning activities.

Flexible working

UKHSA has always offered all staff a ‘day one’ right to request to work flexibly. UKHSA’s approach to flexible working enables staff to balance their home and working lives. The approach incorporates a Carers Charter, Carers passport and a Carers toolkit for managers. Staff can request a job share, to change their hours, to work from home, or request shared parental leave. The Flexible Working, Parents and Carers Network continue to raise awareness of flexible working for example through work to promote Carers Week and Carers Rights Day.

Gender Pay Gap report

In December 2023 we published our Gender Pay Gap (GPG) report as part of the wider Department Health and Social Care health family report. Our gender pay gap continues to decline and we reported a median pay gap of 8.1% and a mean pay gap of 11.7%.

Alongside the UKHSA equality objectives, we have an ambitious gender pay gap action plan. We seek to mitigate the risk of pay gap rises by continuing to focus on the following workstreams:

• ensuring the fairness and equality of recruitment
• promoting talent, progression, and career paths
• use of effective pay strategies where we can
• policies focused on supporting inclusion for all in the workplace, including family friendly policy
• building an inclusive culture

Annexe 1: UKHSA staff characteristics

Statistics are taken from the UKHSA Human Resources and Payroll system (also called Money and People System (MaPs)). The next 2 tables present information on the proportion of staff on whom details of a particular protected characteristic is currently held.

Table 1. Proportion UKHSA Employees who have declared each of the protected characteristic, March 2024

Percentage	Mar-23	Jun-23	Sep-23	Dec-23	Mar-24
Ethnicity	84%	82%	78%	82%	83%
Disability	82%	74%	73%	76%	77%
Religion and Belief	70%	66%	67%	69%	73%
Sexual Orientation	69%	64%	65%	69%	71%

Table 2. Proportion UKHSA Employees who have declared each of the protected characteristics (excluding Prefer Not to Say), March 2024

Percentage	Mar-23	Jun-23	Sep-23	Dec-23	Mar-24
Ethnicity	76%	72%	73%	77%	79%
Disability	52%	47%	47%	49%	53%
Religion and Belief	63%	59%	60%	62%	65%
Sexual Orientation	60%	57%	57%	61%	63%

Sex

Women make up 65% of the UKHSA workforce, above the economically active population (47.7%) and Civil Service Average (54.6%).

Age

26.7% of UKHSA staff are aged 30 to 39 years. 19.7% are in the 50 to 59 age bracket, 5.9% are aged 60 to 64 years and 18.9% of staff are aged under 30 in the UKHSA workforce (Figure 1).

Figure 1. Age profile of UKHSA staff, March 2024

Figure 1 shows that 73.7% of UKHSA staff describe themselves as white. The next largest ethnic group is Asian or Asian British (13.5%), followed by black or black British (7.8%), a one percentage point increase on the previous year respectively (Figure 2). These patterns are likely to vary across regions reflecting local population profiles by ethnic group, from which the UKHSA workforce is drawn.

Overall, 27.2% of our workforce are from an ethnic minority background. This is above the economically active population (15.7%) and the Civil Service Average (15.4%).

Figure 2. Distribution of UKHSA staff by ethnic group, March 2024

Disability

We know the declared disability status of 77% of our workforce - of those, 9.5% have declared that they have a disability. This is below the economically active population (16.8%) and the Civil Service Average (15.8%). 

Religion and belief

Data on the religion and belief held by staff is shown in Figure 3. 51% of staff report being Christian, a 5% increase on the previous year. The next largest group is those who report being Atheist (20.8%). There are small proportions of staff who report that they are Hindu (4.8%) or Muslim (7.8%). 7.8% have other faiths and 4.3% no faith (Figure 3).

Figure 3. Religion and belief profile reported by UKHSA staff, March 2024

Sexual orientation

Declared sexual orientation information for UKHSA staff is available for 71.3% of the workforce. 93.4% of staff declare themselves to be heterosexual and 6.6% of staff report being Lesbian, Gay, Bisexual (LGB+) (Figure 4).

Figure 4. Sexual orientation reported by UKHSA staff, March 2024

Workforce composition by Grade

This section of the report focuses on the workforce composition by grade and then gender, age, and ethnicity as of March 2024.

Gender Analysis

There are nearly twice as many women (65%) as men (35%) working within UKHSA. Figure 9 shows that the distribution of women is higher across the administrative, executive officer, and middle manager grades. There is a slightly lower percentage of women staff at senior manager grade, which does not reflect the overall gender UKHSA workforce composition. Proportionately men are overrepresented at the senior manager, Senior Civil Servants (SCS) and equivalent level grades. Our SCS is 59% men (Figure 5). The higher proportion of women in the junior grades affects the gender pay gap and is reflected in the actions we are taking to mitigate risk of pay gap rises.

Figure 5. Workforce gender profile by grade, March 2024

Figure 6 illustrates that all age groups are represented up to Senior Manager grade at UKHSA, except for SCS and Medical and Dental (M&D) where there are no staff under 30 years of age. M&D staff are medical consultants, therefore it would be unlikely to appoint someone under 30 to that grade. Staff aged in the 40 to 49 age range are mainly represented at senior manager, SCS and M&D grades. The largest proportion of staff in middle management roles are in the 30 to 39 age range (30%). Within senior manager grades there is a low representation of staff under 30 (5%). A larger proportion of SCS and M&D are over 50 which may have implications for succession and retirement planning (Figure 6).

Figure 6. Workforce age profile by grade

Ethnicity

In UKHSA, of the known parts of the workforce (removing prefer not to say) 74% of the workforce is white, 26% are ethnic minority. Around 6% of people have said that they prefer not to disclose their ethnicity (6% of the declaration rates). UKHSA does not have ethnicity information for 27% of our staff. Figure 7 shows the ethnicities of staff at each grade as a percentage of all staff at that grade. This means that if there were similar representation at all grades, the bars for ethnic minority staff would all show as approximately 26%.

Figure 7. Ethnicity workforce profile by grade