Recognising Unfair Treatment

Unfair treatment is often subtle and builds over time. Direct discrimination can happen, but more often the harm comes from neutral-seeming rules that affect some groups more, or from a culture where "banter" normalises put-downs.

In optical teams, patterns may show in who gets which shifts, who gets training or informal mentoring, and who is asked to handle the most challenging patients. Noticing these signals early allows proportionate action under Standard 11. ^[2][1][4]

Clear definitions

• Direct discrimination: treating someone worse because of a protected characteristic. ^[1][3]
• Indirect discrimination: a rule or practice that disadvantages a group without objective justification. ^[1][3]
• Harassment: unwanted conduct linked to a protected characteristic that violates dignity or creates a hostile environment. ^[1][3]
• Victimisation: detriment after raising or supporting a concern. ^[1][3]

Microaggressions are brief, frequent slights or exclusions that signal non-belonging. Over time, they add mental load, reduce performance and raise error risk. ^[2]

Where it shows up in optical work

• Frequent short-notice shift changes given to the same group. ^[1][4]
• Assumptions about who should lead paediatric or domiciliary visits. ^[1][4]
• Persistent misgendering or "name jokes". ^[1][4]
• Inaccessible SOPs (small fonts, low contrast). ^[1][4]
• Training invitations shared only by word of mouth. ^[1][4]

How to analyse fairly

• Look for a pattern: note dates, decisions and who was involved. ^[1][3]
• Consider other explanations: check the rationale and whether it stands up as objective justification. ^[1][3]
• Explore alternatives: see if there are less discriminatory ways to meet the same aim. ^[1][3]

Why it matters

• Consider the effects on safety (handover quality, escalation, fatigue). ^[2][7][4]
• Consider the effects on access to care and career progression. ^[2][7][4]

Good documentation

It helps to keep notes descriptive rather than accusatory. A simple structure can guide this: What (verbatim quotes or decisions), When (date/time and frequency), Who (roles only; avoid unnecessary personal details), Where (site/department) and Why (the stated rationale at the time). Keep personal impressions separate from facts. Limit sensitive data about protected characteristics to what is necessary and store it in the right governance system. If a clinical incident also occurred, cross-reference the incident number rather than duplicating sensitive details. ^[7][5]

Using the data you already have

You can check for fairness with routine data. ^[4][1][6]

• Appraisal completion by role or team. ^[4][1][6]
• Access to CET/CPD days and overtime allocation. ^[4][1][6]
• Grievance themes and exit interview patterns. ^[4][1][6]

Depending on what you find, you could move from ad hoc to transparent rota requests with clear criteria, or add a second-check on shortlisting to reduce individual bias. In multi-site services, comparing sites can reveal local issues. Staff networks and anonymous speak-up routes help test whether policy matches lived experience, so you can intervene early and proportionately. ^[4][1][6]

References (numbered in text) Why we include references

1. Indirect discrimination - Discrimination at work - Acas (Acas) Find (opens in a new tab)
2. Vimal Desai; Antonio Hernandez Conte; Vu T Nguyen; Philip Shin; Neha T Sudol; Janet Hobbs; Chunyuan Qiu. Veiled Harm: Impacts of Microaggressions on Psychological Safety and Physician Burnout. The Permanente Journal (2023) Find (opens in a new tab)
3. Equality Act 2010 - Explanatory Notes (legislation.gov.uk) Find (opens in a new tab)
4. NHS Workforce Race Equality Standard: technical guidance - NHS England (2021) Find (opens in a new tab)
5. Special category data - ICO (Information Commissioner's Office) (2024) Find (opens in a new tab)
6. Freedom to Speak Up - NHS England (2025) Find (opens in a new tab)
7. Patient Safety Incident Response Framework (PSIRF) - NHS England (2024) Find (opens in a new tab)