Fashion fades but the equality conundrum remains

The headline to this article will already have turned some people off. Why? Because you are reading through a haze of NHS dos and don’ts, or with a sense of moral duty. Or because this issue matters to you, yet it doesn’t matter to the bottom line.

‘There may well be merit in reminding the NHS of a problem that seems to fall into and out of fashion every 10 years’

The narrative around competent leadership for equality and inclusion has increasingly become deficit based, woolly and an add-on to core NHS work.

The issue is not about special treatment or creating leadership positions for black and minority ethnic people. Such an approach perpetuates a knee jerk response to a challenge, lacks analysis and leads to short term, sticking plaster solutions.

Similar to the NHS Confederation’s assessment of conditions within emergency care, the NHS needs “to move beyond the headlines and handwringing and find practical whole system solutions”.

Underused levers

The goal is about better services for everyone, where one of the most underused and misunderstood levers connecting us to that goal is leadership for equality and inclusion.

‘While the “hero” leadership model has rightly been discarded, we insist on its use for equality and inclusion’

Indeed, NHS England chief executive Simon Stevens stated that “diversity in leadership is associated with more patient centred care, greater innovation, higher staff morale, and access to a wider talent pool”.

Roger Kline’s 2014 report about the snowy peaks of the NHS restates the problem previously outlined by Aneez Esmail in 2005 of a lack of diverse senior leadership in the NHS.

Diversity exists in the middle of organisations but not at the top. Both reports state the business case as “a recognition that all individuals have unique skills and backgrounds that need to be recognised, respected and valued… In terms of organisations, the harnessing of workforce diversity can enable the creation of more dynamic and flexible organisations,” as Esmail said.

There may well be merit in reminding the NHS of a problem that seems to fall into and out of fashion every 10 years. The reality is that unless we act on the evidence and develop a sustainable approach to leadership for equality and inclusion, one that adds value to outcomes for people using services, we will see another crisis report in 2024.

A refreshed approach

There are three areas that need to be addressed to move us away from the deficit approach.

First, organisations leading for equality and inclusion are characterised by having clear intent for such leadership, linked to core strategic planning.

‘Simon Stevens spoke from a position of strength – he can send and model powerful messages’

They seek out capable, diverse leaders to develop organisational capacity for innovation and service improvement. They also use locally informed metrics to track organisational success, “delivering a personal form of care, using and supporting the diverse talents and experiences of our workforce”.

Second, while the heroic leadership model has rightly been discarded, we insist on its use for equality and inclusion.

Heroic leadership insists on the superman or woman literally coming in to rescue the organisation or issue. The King’s Fund pointed to the need for distributive leadership within a devolved system, where “influence without authority”, as Cohen and Bradford argue, is a predominantly required skill set.

Future adaptive leaders are able to lead across different and integrated services. The Harvard Review documents research suggesting resilience and flexibility are the predominant skill sets of leaders from diverse communities. Surely the question is where can we find leaders of tomorrow with the right skills to add value to today’s leaders?

Change at the top

Simon Stevens refreshingly prioritised this issue recently in his speech to the BME Forum event at this year’s NHS Confederation conference and at the King’s Fund annual leadership summit.

‘The issue is really about competent leadership with regard to diversity, rather than diverse leadership just to make up the numbers’

Not only had he insisted on attending the BME event, but he said: “In my own career, I reflect on the fact that down the years I’ve benefited from having had three black bosses and a woman as my line manager, but in each case that’s been when I’ve been working outside the NHS. That needs to change.”

Stevens spoke from a non-deficit position of strength – he can send and model powerful messages.

Additionally, sustained leadership for equality and inclusion must be developed throughout the system and at local levels.

Leading diversity

Third, as well as acting on informed intent to seek out future leaders, excellent decision making and organisational health cannot be achieved without leadership for equality and inclusion.

Previous debates about board leadership tend to commentate on skilling up increased numbers of BME executives and non-executives. But the issue is really about competent leadership with regard to diversity, rather than diverse leadership just to make up the numbers.

Finally, such leadership must be valued. In his first five months as chief executive of the NHS Confederation, Rob Webster successfully acted upon the intent of the chair, Michael O’Higgins, to significantly improve the diversity of board members. He is also actively integrating this issue into the organisation’s core work, as have member trusts.

That’s what leadership for equality and inclusion is really about, so let’s value it and do something about it.

Joan Saddler is associate director of patients and communities at the NHS Confederation

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