Boards, not HR departments, must take the lead on fostering diversity

With providers having to square the circle of transforming care while delivering existing services on tightening budgets, race equality might not seem an obvious priority for boards.

Yet the publication of the 2015-16 contract introduces a new workforce race equality standard (WRES) that puts the issue squarely on all boards’ must do lists.

The new standard is no diversion from the urgent strategic challenges facing trusts; it, and the wider diversity agenda, can and must be a big part of the solution.

‘This is a strategic opportunity to demonstrate commitment to diversity’

This drive on equality can help the NHS capitalise on the best available talent and draw on the innovation we know diverse teams can bring. And in a context where organisational success will increasingly depend on more personalised care, it can help keep NHS staff connected to the diverse needs of the communities they serve.

• Read HSJ’s celebration of BME Pioneers shaping quality healthcare

Dependence on HR

Only determined board leadership and commitment will drive real, sustained change.

‘The likelihood of white staff being senior managers is three times higher than for equivalent BME staff’

This involves moving beyond overreliance on diversity managers and HR directors; it means the whole board leading by example and championing race equality - not to comply with a new national standard, but as a strategic opportunity to demonstrate commitment to diversity, and to leverage its potential to improve patient care.

Recent research on race equality in the NHS workforce makes challenging reading.

Evidence shows that if you are from a black and minority ethnic background, you are:

• less likely to be appointed once shortlisted;
• less likely to be selected for training and development programmes;
• more likely to experience harassment, bullying and abuse; and
• more likely to be disciplined and dismissed.

Worrying trends

Black and minority ethnic staff are significantly underrepresented in senior management positions and at board level.

Research in London found that the likelihood of white staff being senior or very senior managers is three times higher than for equivalent BME staff.

In 2012 just 1 per cent of NHS chief executives came from a BME background, compared to 16 per cent BME representation in the NHS workforce.

‘Greater clarity on the case for change is essential’

Most worryingly, despite a multitude of race equality initiatives and examples of provider good practice since the 2004 Race Equality Action Plan, many key indicators are either static or getting worse.

In London, where 41 per cent of staff are from BME backgrounds, the proportion of BME chief executives and chairs has decreased from 5.3 to 2.5 per cent, and two-fifths of London boards have no BME members at all.

If this opportunity is to be realised, we believe three things are now essential:

• greater clarity on the case for change;
• a renewed focus on leadership from boards; and
• effective national support to facilitate good practice sharing across the NHS.

Better decision making

At board level we know that diverse teams make better and safer decisions.

More representative leadership bodies are in a better position to engage the diverse communities they serve and to tailor their services accordingly, addressing the consistent evidence that BME patients are more likely to report receiving a poorer service.

‘Trusts that fail to reflect diversity are at risk of maintaining cultures that exclude’

And at a time when “business as usual” is not an option for any NHS provider, the proven positive association between board diversity and innovation is compelling.

Most importantly, the strong connection between the treatment of BME staff and the care that patients receive is now beyond doubt.

Research on NHS staff and patient surveys in 2012 by Michael West found “the experience of black and minority ethnic NHS staff is a good barometer of the climate of respect and care for all within the NHS”.

“Put simply, if BME staff feel engaged, motivated, valued and part of a team with a sense of belonging, patients were more likely to be satisfied with the service they received,” he said.

In an increasingly diverse Britain, trusts that fail to reflect that diversity are at risk of delivering inappropriate services, maintaining cultures that exclude, and becoming disconnected from the people they are supposed to serve.

Building organisations fit for our diverse communities is not an optional extra; it is now a matter of addressing the harmful consequences on health and a matter of leadership competence.

Effective national support

To support determined local leadership, much can be done at national level.

We welcome NHS England’s recognition that we need a coherent approach that aligns all the levers available to support delivery of the new race equality standard, and the commitment to apply the same criteria to assess providers’ performance to commissioners and system leaders alike.

‘Only the board can champion equality and diversity as the golden thread running through each organisation’

It is critical that the different processes work together effectively so that trusts are not unnecessarily burdened, as this would undermine the impact of the approach.

What unites organisations that are making real headway is the transfer of responsibility for this agenda from an individual equality and diversity lead, to a position where it commands the support of the whole board.

View from the top

Only the board, from its vantage point, has the ability to demonstrate how race equality and the wider diversity agenda is at the heart of the values espoused by all NHS providers.

And only the board can articulate and champion equality and diversity as the golden thread running through each organisation’s recruitment, development and talent management strategies, quality improvement initiatives and patient and carer engagement.

‘This is a difficult and often intangible process of cultural change that doesn’t happen overnight’

Clarity on the business case is a vital starting point for board leadership. But vision is clearly not enough.

A number of the themes from case studies highlight what else boards must do to translate this vision into real changes in the experience of BME staff and, ultimately, BME service users.

Five building blocks for progress particularly stand out (explained in detail in our new report):

• Understanding the data
• Getting staff on board
• Devising a comprehensive strategy
• Establishing a new focus on talent management
• Building new partnerships to drive change

The new race equality standard may focus on indicators and targets, but we know that this is ultimately about a difficult and often intangible process of cultural change that doesn’t happen overnight. 

Only the board can lead transformations in organisational culture. The case studies in this briefing suggest that, in many organisations, boards are now starting to assume this leadership role. 

The publication of the new workforce race equality standard is an opportunity to build on this momentum.

We want to work with our members to seize it, to encourage honest assessments of the progress already made and to share good practice to support organisations on the road ahead.

Saffron Cordery is director of strategy for the Foundation Trust Network