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.

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here.   


There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

Ear infections should not be treated with antibiotics, doctors advised

22/09/2017Ear infections should not be treated with antibiotics, doctors advised

Common ear infections should no longer be treated using antibiotics, NICE has this week recommended. Publishing new draft guidance into the ... more >
NHS staff paid £3,800 less per year compared to 2010

22/09/2017NHS staff paid £3,800 less per year compared to 2010

Years of real-terms pay cuts have seen NHS workers earn on average £3,800 less than they would have if salary rises had kept up with inflat... more >
BMA finds ‘chronic shortage’ of doctors across key medical specialities

22/09/2017BMA finds ‘chronic shortage’ of doctors across key medical specialities

Patient safety is at risk due to a “chronic shortage” of doctors across a number of areas of medicine, the BMA has today warned. ... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

Your personality, your leadership

Your personality, your leadership

Deirdre Wallace, clinical skills manager at UCL Medical School, discusses the importance of learning about leadership and self while at medical school. Approximately five years ago, I was charged with leading a team to introduce leadership and management in healthcare to the undergraduate curriculum at UCL Medical School. I am sure some r... more > more last word articles >

the scalpel's daily blog

Ensuring quality in the new NHS

11/09/2017Ensuring quality in the new NHS

Dr Marion Andrews-Evans, member of the NHS Clinical Commissioners (NHSCC) Nurses Forum steering group and executive nurse & quality lead at NHS Gloucestershire CCG, sings the praises of CCG quality leads who are working in often unseen roles to help deliver safe and effective patient care. As the NHS goes through a time of change, we ... more >
read more blog posts from 'the scalpel' >
332 304x150 NHE Callout banner.


We must ensure every STP succeeds

30/08/2017We must ensure every STP succeeds

Niall Dickson, chief executive of the NHS Confederation, considers what else must be done to ensure all sustainability and transformation plans a... more >
Changing our digital culture and safeguarding patient data

08/08/2017Changing our digital culture and safeguarding patient data

Joanna Smith, chief information officer at Royal Brompton & Harefield NHS FT (RBHT), says that as the NHS becomes more digital it has to get ... more >
A centre for medicines optimisation research and education

04/08/2017A centre for medicines optimisation research and education

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharma... more >
Unlocking the benefits of age-friendly cities

04/08/2017Unlocking the benefits of age-friendly cities

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of ... more >

health service focus

View all News


Improving care at the touch of a screen

08/08/2017Improving care at the touch of a screen

When it comes to dementia, having a calm and safe environment can have a substantial impact on a patient’s quality of life. NHE’s Jos... more >
A new approach to talent management

25/07/2017A new approach to talent management

Martin Hancock, national lead for talent management at NHS Leadership Academy, and Gill Rooke, the organisation’s senior operations manager... more >
Enabling greater integration through ACSs

25/07/2017Enabling greater integration through ACSs

At this year’s NHS Confed, Simon Stevens revealed the first wave of accountable care systems (ACSs). NHE speaks to Ian Dodge, the director ... more >
How NHS organisations can protect themselves against cyber crime

25/07/2017How NHS organisations can protect themselves against cyber crime

On 12 May, a global cyber-attack occurred on an unprecedented scale. It affected organisations across the globe and, though it did not specifical... more >