BME staff underrepresented in NHS at senior levels – report reveals

The number of senior NHS positions held by people of black and minority ethnic (BME) backgrounds has hardly changed since 2006, a new report from Middlesex University has revealed. 

Conducted by Robert Kline, the research – The “snowy white peaks” of the NHS – found that the proportion of people from BME backgrounds appointed to NHS trust boards has fallen from a high of 8.7% in 2006 to just 5.8% in 2013. 

Additionally, at national level, NHS England has only two BME board members, while the NHS Trust Development Authority, the Care Quality Commission and Monitor have none. 

Data has also revealed that the number of BME staff on pay bands 8a-9, which the NHS categorises as “senior managers” and “very senior managers” has increased by only 0.2% to 5.9% in the period 2008-2013. 

However, the proportion of BME medical staff who were registrars and who were consultants has increased significantly in the period 2006-2013 though the BME staff are still underrepresented at senior levels, the report states. 

The research also found the number of BME nursing directors at NHS trusts in England has remained unchanged since 2008 at 3%. 

In 2013, Kline analysed a national sample of NHS Trusts’ recruitment practices, including those of six London Trusts. He found that, nationally, even once BME applicants had been shortlisted (and presumably met the person specifications for the job) white shortlisted applicants were 1.78 times more likely to be appointed; it was 3.48 times less likely that BME applicants would be appointed than white applicants. The figures were similar for London where white shortlisted applicants were 1.64 times more likely to be appointed. 

Kline said: “The glacial pace of change (if there is any at all) is not through any lack of initiatives, but in too many local employers race discrimination against staff is simply not accorded the priority it should be, and ministers largely look the other way.” 

Ten years after the launch of the Race Equality Action Plan (DH 2004), Kline carried out a survey of the leadership of NHS Trusts in London to assess progress against this plan.

London was chosen for this survey as a health “region” because 41% of NHS staff, and 45% of the population, are from BME backgrounds. 

The report’s findings showed that the proportion of London NHS trust board members from a BME background is only 8%, an even lower number than was found in 2006 (9.6%); the proportion of chief executives and chairs from a BME background has  decreased from 5.3%; it currently stands at 2.5%; and two-fifths of London’s NHS trust boards had no BME members (executive or non executive) on them at all. 

Also, the proportion of women on boards is 40%; while this is a slight improvement on the past, the proportion is still well below that of the NHS workforce or the local population. Women are especially under-represented at chair and chief executive level. 

Kline concluded: “At a time when there is a more widespread acceptance that a more transformational rather than transactional leadership style is needed and when the Francis (2013), Keogh (2013) and Berwick (2013) reports have all highlighted the shortcoming of a culture that fails to value staff, it is surely time to urgently and decisively address the widespread, deep-rooted, systemic and largely unchanging discrimination that BME staff within the NHS face. 

“There can be no better time to change, once and for all, the “snowy white peaks” of the NHS.” 

A Department of Health spokesperson told NHE: “The NHS needs to make faster and stronger progress in enabling talented BME staff to take up senior and influential positions across the NHS. 

“NHS England, NHS Employers and the NHS Leadership Academy are undertaking a range of initiatives to help NHS trusts develop their leadership to reflect the communities they serve.” 

DH also noted some examples of the work NHS Employers and NHS England are doing to tackle this issue:

  • With the help of the Department, NHS Employers run the Mary Seacole Award to recognise and acknowledge BME leadership and innovation;
  • NHS England has also launched a coaching and mentoring scheme and is currently working on a strategy alongside the Chief Nursing Officer’s BME advisory group to increase representation at senior levels;  and
  • Over 90% of health and social care employers now use a new equality framework - the Equality Delivery System (EDS2) which contains specific outcomes relating to inclusive leadership and achieving a representative workforce against which they will be measured.

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