Grasp the nettle of inequality

One of the most ethnically diverse teams in the NHS is the NHS England board, where half of non-executive directors are of a black and minority ethnic background. Sadly, the picture is not the same for many boards in the NHS, particularly for executive directors.

‘In London there is only one CEO from a BME background, just one BME chair and, shockingly, no executive directors of nursing’

During his 2000-05 tenure as NHS chief executive, Lord Crisp publicly noted that the service’s leadership was “snow-capped” − all white at the top. Over the past seven years, progress to change this has been slow and, in fact, the NHS now has fewer leaders from visibly different backgrounds in senior positions.

For example, in London there is only one CEO from a BME background, just one BME chair and, shockingly, no executive directors of nursing.

The obstacles to BME staff progressing to the most senior levels are reflected in many pieces of research. These barriers do not simply exist in the NHS or because the NHS is an outlier having problems with integration, fairness and equality. The problems are social and they are global.

Such issues cannot be resolved by tick-box exercises, or by having an equality and diversity lead at band 6 in the organisation; they need to be debated at board level and consistently championed from the very top.

Raft of reports

Of the NHS’s workforce of almost 1.4m, approximately 18 per cent are from BME backgrounds ­− a substantial number. Evidence shows that if you are from a BME background you are more likely to be disciplined (Bradford Univeristy report, The Involvement of Black and Minority Ethnic Staff in NHS Disciplinary Proceedings), and dismissed (Royal College of Midwives report, Midwives and Disciplinary Proceedings in London).

‘Well meaning initiatives have not fully understood the complexities of race and inequality’

You are also less likely to be shortlisted or promoted (Roger Kline’s report, Discrimination by Appointment), or selected for training and development programmes. The damning list of the inequities is endless and they make the workforce feel depressed, demoralised, demotivated, disenfranchised, angry and sullen.

Perhaps worse, we also know that if you are a BME patient, you are more likely to report receiving a poorer service. A shocking statistic is that in the Morecambe Bay area, where only 2 per cent of the population are from BME backgrounds, 83 per cent of babies that died (five out of six) were from BME backgrounds.

This is not an exaggerated issue; it is serious and pervasive. Years of strategies, ideas and initiatives have not been effective in resolving the problem of underrepresentation. Most initiatives have focused on supporting leaders from BME backgrounds to “fit in” and be more like the leaders already in senior positions.

These well meaning initiatives have not fully understood the complexities of race and inequality. Inequities are embedded in our cultures and systems; and attitudes and behaviours are the consequence of beliefs about certain groups. Models, tools and processes cannot change how people perceive each other. Something more radical is needed.

Better patient care

First, people must acknowledge a problem that affects everyone, that diversity and equality are important and that engaging with people from all backgrounds will improve patient care. Without this, the status quo is maintained.

‘If BME staff feel disheartened, demotivated and uninspired, it lowers patient satisfaction across the board’

Professor Michael West of Lancaster Univeristy said in his report NHS Quality and Staff Engagement: “The greater the proportion of staff from a BME background who report experiencing discrimination at work in the previous 12 months, the lower the levels of patient satisfaction.”

He added: “The experience of BME staff is a very good barometer of the climate of respect and care for all within NHS trusts.”

His research implies that if BME staff feel engaged, motivated, valued and part of a team with a sense of belonging, patients would more likely be satisfied with the service they receive.

I suspect the NHS has more than a few disgruntled BME colleagues. If BME staff feel disheartened, demotivated and uninspired, it lowers patient satisfaction across the board.

As human beings we need to feel cared for in order to care. People will go the extra mile for leaders and colleagues that show them understanding, respect and humility.

Courageous leadership

To make inroads we need courageous leaders that genuinely believe diversity in its wider sense will benefit staff and patients. We need leaders that understand what changes they personally need to do.

‘Distrust and suspicion in many trusts will dissipate once BME staff see that unfair and inequitable practices are being dealt with’

This is not as easy as it sounds; senior leaders must manage the feelings and behaviours of staff from all groups, some of whom will understand the need for change and others who will not.

They will also have to ensure their organisations are fit for purpose from a safety and financial perspective − a challenge for any leader.

At the NHS Leadership Academy we aim to build diversity, inclusion and fairness into all our programmes and practices, to ensure leaders gain an understanding of the importance of this issue.

Wasted talent

There are risk and cost free actions that leaders can take to improve equality in their organisations:

• work towards having a representative executive team;
• ensure there is equality in selection for roles and development opportunities;
• involve everyone in decision making;
• learn about the different people you have in your organisation;
• make inclusion an important issue in your organisation;
• demonstrably live the change you want to see;
• review and keep an eye on ethnicity data in your organisation; and
• promote zero tolerance of bullying and harassment.

Distrust and suspicion in many trusts will dissipate once black and minority ethnic staff see that unfair and inequitable practices are being dealt with − when they see people like them in senior roles to which they can aspire and when patients from all backgrounds report a high standard of service.

The fact that many BME colleagues are so obviously and openly excluded from boards in the NHS is a scandal. In an increasingly diverse country, allowing this talent to go to waste is a travesty.

Yvonne Coghill is the senior programme lead for inclusion at the NHS Leadership Academy, follow her on Twitter at @yvonnecoghill1