The Scalpel's Blog


Why diversity and inclusion are critical to leading much-needed change in the NHS

Tracie JolliffDespite 30 years of investment, the equality and diversity agenda hasn’t moved forward at anywhere near the pace we would have liked. Indeed, many colleagues have lost sight of the value this work brings. Tracie Jolliff, head of inclusion and systems leadership at the NHS Leadership Academy, explores the need to go back to basics.

The NHS is attempting to shift towards a preventative agenda: rather than treating people who are ill, it’s about making and keeping populations well. This means leaders need to behave differently, working across boundaries and outside of health. We need to get involved and engaged in education, social services and voluntary sector groups who are right there in the heart of the community. The aim is to positively impact on some of the poorest and most excluded communities, empowering them in ways which give them choices about how they can live healthier lives, and which will in turn reduce the pressure on the NHS. Some of our poorest, most excluded communities are the heaviest users of mental health services, for example. While it’s great that the services are being used and accessed by those that need them the most, imagine how the need for such services would reduce if patients felt less excluded, stigmatised and isolated.

This change needs to take place at the very top and right throughout the system, and a key part of it is having chief executives in position from a range of diverse backgrounds.


Despite over 30 years of investment by the public sector and other organisations, we haven’t managed to move inclusion forward. Here are a couple of examples:

  • Of over 500 chief executives, only three are BAME! Yet we often field comments from people in the NHS who are shocked that we offer positive action programmes for BAME colleagues
  • A report published by the Stonewall charity in 2014 highlighted that a quarter of Lesbian Gay Bisexual and Transgender (LGBT+) people had experienced homophobic abuse in the past five years – no wonder so few people from these groups disclose their identities at work, we might all possibly do the same

So, let’s talk some more about positive action. Firstly, it’s lawful – and not discriminatory. It’s about recognising that for groups who’ve been historically discriminated against, the starting point is different to everyone else. Work still remains the quickest way out of poverty, but discrimination has stopped some sections of the community accessing more senior roles – or indeed in many cases working at all.

Where there have been generations of discrimination and social capital has also been degraded over that period, building from the reality of people’s real lived experience, needs to be the starting point. This is often about significant disadvantage, which makes the rungs of the social ladder so far apart towards the bottom, that it becomes really difficult for people to climb up. An example of this is a family I spoke with recently in which the three children under seven had lived a semi-isolated life due to the mother’s severe mental ill health. They had missed out on interactions with others, and two of the children were behind in their speech and language development as a result. One can imagine that just sending the children off the school without the additional support they needed to be successful in that educational environment could have a domino-like effect at each stage of their development, curtailing the opportunities and life chances they’d be able to take advantage of. The children’s mother’s access to adequate mental health services is obviously a factor here and her reluctance to seek help was often linked to stigma. There is additional work to do to for many in order to pave the way towards equality.

Discrimination also prevents people who might have experience and merit from progressing according to their talents in a fair and just way. There are some winners though, discrimination also over-rewards some characteristics, which means you can end up with people in roles they haven’t earned and who might not be as well qualified as other, more diverse candidates might be.

As the saying goes, if you do what you’ve always done, you’ll get what you’ve always got. It’s time for new approaches that shift power from traditional hierarchies to the frontline and to community. One of the first steps in that process is to really listen to - and understand - what those most negatively affected by discrimination have to say about their experiences. They will tell us what we need to focus on to change the lives of the people we say we’re doing this work for.

We’re never going to address this problem unless decision-makers are diverse, reflecting and having insight into the communities they serve. Diversity comes with innovative ideas about how we can move things forward and make the most of our talents and prospects. At times it appears as if we’re still behaving as though it is the 1950s, when there were more monochrome expectations about life and more predictability in how we people operated. We need to catch up! Unless we have diverse groups in leadership, equality will always evade us.

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