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rather than an approach that puts people into boxes, which can have the effect of ignoring other differences. A generic approach to tackling health inequalities provides the opportunity to review all functions and policies, and to begin embedding equality into the commissioning and provision of services (DH 2010b). In practical terms as nurses, this may mean:

co-operating with each other and social care organizations to ensure that patients’ individual needs are properly managed

having systems in place to ensure that you are treating patients, their relatives and carers with dignity and respect

the views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving healthcare services

all patients can equally access and have choice in access to services and treatment equitably.

(Adapted from DH 2005)

The competencies expected of every nurses associated with equality and diversity are articulated explicitly in the NHS Knowledge and Skills Framework (DH 2004b) (Table 1.3).

Table 1.3 The NHS Knowledge and Skills Framework dimension: equality, diversity and rights

Equality Impact Assessment

As part of the commitment to treating all patients equally, all public organizations are legally required to perform an Equality Impact Assessment (EIA). In its simplest form, the EIA process can be seen as a foundation tool for measuring the effect of policy and practice on people and should encourage greater openness about policy making and service development.

An EIA is a means of ensuring that any policy introduced does not affect one or more groups of people, including staff, patients, carers and other users of the organization’s services, in an adverse way. EIAs help to identify discrimination by requiring policy and service developers to think about how their policy or service will affect service users and staff and what actions or improvements to it may be required to ensure fairer access to services and employment (Box 1.6).

Box 1.6 Equality impact assessment tool used to assess the procedures in the manual

Section 1

Full title of chapter being screened

Chapter owner

Date

Name and title of people completing Equality Checklist

Could the Chapter have an impact on staff, patients, carers or other members of the public?

Yes Please complete the rest of the Equality Checklist.

No Please return the Equality Checklist as above

Section 2

What are the purpose and the aims of the Chapter?

Who is intended to benefit from the Chapter and how?

Section 3

Is there any potential or evidence that the Chapter will or could:

Affect people from any social group differently to others? Yes No

Discriminate unlawfully against any social group? Yes No

Affect the relations between any social groups? Yes No

Prevent the Trust from achieving the aims of its Equality and Diversity policy? Yes No

If Yes, please identify which potential social groups could be affected.

The outcome of the EIA for this manual will be available on the website of both the Royal Marsden NHS Foundation Trust and the Royal Marsden Manual (www.royalmarsdemanual.com).

Technical factors

The impact of rapid advances in technology on the roles and process of nursing will be considered here. Most obviously, this means that more effective treatments as well as the ability to provide care in different settings are now available (DH 2006a).

Competence

For the nurse, the competencies required in the technical area are increasing. Milburn (Milburn et al. 2009), probably not unsurprisingly, found that patients considered that a good nurse is one who knows what she is doing.

The NMC states that:

you must have the knowledge and skills for safe and effective practice without supervision

you must keep your knowledge and skills up to date throughout your working life

you must recognize and work within the limits of your competence.

(NMC 2008a)

There is an expectation that, on qualifying, the nurse will have the competence to carry out fundamental procedures.

Competence is defined in the dictionary