Health Service Focus

Ambition alone will not change diversity landscape in the NHS

NHE’s Rosemary Collins reports on the importance of strong leaders to drive the diversity agenda in the NHS.

This year’s NHS Confederation revealed widespread determination to introduce leadership that can tackle discrimination against ethnic minorities, women and other marginalised groups in the NHS. 

Shortly before the conference, the results of the Workforce Race Equality Standard (WRES) were published, providing the first comprehensive picture of racial discrimination in the NHS. Amongst other worrying findings, it showed that at 75% of all acute trusts, black and minority ethnic (BME) staff reported higher rates of bullying, harassment and abuse from colleagues than white staff. 

Revealing and concerning 

At a session on the WRES report, Sir Keith Pearson, chair of Health Education England, said: “The initial findings are on the one hand revealing and concerning, demonstrating that we have a very long way to go if people from BME backgrounds are to share the same opportunities for advancement in the NHS as those from a white background. 

“On the other hand, one can be encouraged by the honesty reflected in the input in the assessment and by the ambition for change. But ambition alone will not change the landscape and the opportunities for our BME employees. We need a real understanding of what needs fixing and all-level commitment to effect the changes that are needed.” 

As the speakers on the panel made clear, the report exposed a problem that has existed for a long time. “Lots of people have talked about race in the NHS,” said Joan Saddler, co-chair of the NHS Equality and Diversity Council and associate director at the NHS Confederation, “but it took a white guy to write a report to get it the attention it deserves.” Her remarks got a laugh, but also underlined how serious the problem is. 

Saddler told the story of a friend, who is a black woman and chair of an FT, who was mistaken for a member of staff at a professional event by another chair and was asked ‘if she knew where the toilets were’. 

Limited progress 

Roger Kline, NHS England’s director of WRES research and engagement, said that although there had been “some limited progress” in raising awareness of and tackling the problem since the 2014 report ‘The snowy white peaks of the NHS’, initiatives to improve race equality in the NHS in the past have proven unsustainable in the long term. 

He described the problem as particularly urgent because discrimination “impacts on the effectiveness of organisations and it has direct links on the care and safety provided to patients”. 

Kline said a “critical mass of evidence-based good practice”, delivered by NHS leaders, was needed to ensure that change happens. 

“In addition to policies, procedures and training,” he said, “we need leaders that are determined that change will happen, leaders who model themselves on the behaviour they expect of others, leaders who put in place appropriate metrics to hold themselves and their managers to account, and who use research evidence to support and understand what they’re trying to do and why it’s likely to work. 

“Such leaders understand that organisations must be proactive and they must listen to their BME staff in safe places where people feel confident to raise their concerns.” 

Delivering diverse boards 

In a separate session on how to create more diverse boards – incorporating not just gender and race but factors such as economic background, sexual orientation and disability – speakers again stressed the importance of leadership. 

Alaba Okuyiga of the Employers Network for Equality and Inclusion told delegates: “The centrepiece of inclusive leadership is about trust and ego. How do we, as leaders, respond when we are challenged by our teams?” 

Dr Ruth Sealy of City University London said that it is vital to establish a concrete commitment to diversity through ambitious, but realistic targets. Her research shows that in 2011, major banks set a target of having women make up 25% of their boards by 2015, and succeeded despite scepticism. 

“There is no other business objective that we would expect to happen without setting some sort of target,” she said, adding that targets are necessary to allow talented women on the lower levels to rise to the top. “When you set targets, what you do is say ‘we’re opening the door and there is going to be room for you in that place’.” 

Also speaking at the event, Jackie Daniel, who was appointed chief executive of the University Hospitals of Morecambe Bay NHS FT after a scandal over serious failures in maternity care, said she had deliberately set out to recruit a board with equal numbers of men and women, and this had been crucial to improving services at the trust. 

Ed Smith, chair of the NHS Improvement board, has said gender representation on all NHS boards should be at 50:50 by 2020, which Dr Sealy described as “a big stretch target”. “I think it is achievable,” she said, “but it’s going to take a lot of work from everyone.”

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