Challenging flawed NHS Equality Impact Assessments (EQIAs)

EQIAs are intended to ensure fairness across all groups protected under the Equality Act (2010)

This blog explains how you can use the EQIA to take direct, effective steps against flawed or unlawful policies in the NHS. There is a broader conversation about challenging policies where sex and gender have been conflated, in light of the Supreme Court judgement, which will be covered in a future blog.

Every NHS policy is accompanied by an Equality Impact Assessment (EQIA), intended to ensure fairness across all groups protected under the Equality Act (2010). The EQIA can be used to challenge the policy-makers and ensure they are re-written to be lawful documents by setting out the impact of each policy on each protected group.

Step 1: Understand your legal foundation

Thanks to Maya Forstater’s work and the resulting legal ruling (Forstater v CGD Europe and others), philosophical beliefs are protected under the Equality Act, just like religious beliefs. The belief in the importance of biological sex, is ‘worthy of protection' in law. When challenging a policy, clearly state that philosophical beliefs must be treated equally to religious beliefs.

Step 2: Challenge the HR and legal departments

Many HR and legal teams are unaware or misinformed about the Forstater ruling. They may have insufficient knowledge or have chosen to ignore it. When you first raise your concerns:

• Point out that any EQIA which only references Religion is incomplete and unlawful.

• Insist that the EQIA must properly consider philosophical beliefs.

Don’t be discouraged by a lack of knowledge — their ignorance is not your problem.

Step 3: Insist on equality between beliefs

There is ‘no hierarchy of beliefs’ under the Equality Act. No one belief system can be given automatic priority over another. Remind HR and leadership that:

• It is the employer’s responsibility to ensure fairness to all beliefs.

• You are not asking for special treatment — you are demanding lawful, equal treatment.

Step 4: Push back against ‘values’ overreach

Some NHS Trusts claim to go above the requirements of the Equality Act'. While good intentions are welcome, it has allowed conflict to arise and for Trust policies to be outside the law, as determined by the Supreme Court judgement of April 2025 (FWS v The Scottish Ministers).

If you are challenged with statements like “this doesn’t fit our values,” push back firmly:

• Ask if their values permit unlawful discrimination.

• Remind them that bullying policies cannot be used to silence lawful, protected beliefs.

Step 5: Make it formal

If you can demonstrate that an EQIA is inadequate, then the policy must be withdrawn and rewritten with a new comprehensive EQIA.

Take the following actions:

• Request the EQIA documents.

• Identify where protected characteristics — particularly philosophical belief and sex — have been ignored.

• Submit your concerns in writing

• Demand a formal review and withdrawal of the policy until a lawful EQIA is completed.

Final thoughts: Be knowledgeable and be persistent

• Do not give up. Every successful challenge strengthens lawful practice across the NHS.

• Use the law to your advantage. You are not asking for favours, you are demanding fairness and lawfulness.

• Remember: A flawed EQIA equals a flawed policy.

It worked in one Trust, and it can work for you.