Creating a more inclusive culture in the NHS

Whether the NHS offered its black, Asian and minority ethnic workforce the same opportunities and experiences as other staff was once seen as a peripheral issue. The fact it is now on the agenda of every board is due to the seven-strong Workforce Race Equality team at NHS England – winners of the workforce initiative of the year category of the HSJ awards. 

Over the last few years, the team have worked to embed the Workforce Race Equality Standards across the NHS. These nine indicators are now measured in each organisation every year and there has been a slow but steady improvement in them.  

The top tier of the NHS was once almost universally white – in marked contrast to the rest of the workforce, where BAME groups have always played an important part. As a result of the WRES team’s work, BAME representation has significantly improved at the very top level and fewer boards lack a BAME member.  

The WRES team have worked closely with trusts to achieve this, looking at areas such as shortlisting for appointments and the proportion of different staff groups entering disciplinary action. It has also published evidence-based reports to help organisations engage with and support staff.  

Big impact

But how did such a small team have such an impact? Deputy director of the WRES team Habib Naqvi says: “We have got that senior leadership around the agenda. They are open to being involved and contributing. We have been in the right place at the right time.  

“But we have had to work very hard over the last five years to do a number of things – one is to create a social movement around this agenda. The second is to make this a priority for people’s agendas – for the boards of organisations. It has taken a lot of work to do this and get it right.” 

One of the ways this has been achieved is getting the issue recognised in areas such as Care Quality Commission inspections, the NHS long-term plan and the forthcoming NHS People Plan.  

“It is at the top of people’s agendas. Those organisations that are open to this and understand the relationship between staff satisfaction and organisational efficiency are organisations where the leadership are absolutely focused on this agenda and see it as priority.  

“The chief executive, the chair and the non executive directors are focused on this, want to improve and have an open and transparent way in which they engage with their staff.  And they are also organisations which are seeing an improvement in their WRES scores.” 

He describes the current situation as being like a bag of pistachio nuts. The easy nuts have all been taken; what remains are the ones which are hard to crack. “The challenge going forward is to try to crack them open.”  

We have had to work very hard over the last five years to do a number of things – one is to create a social movement around this agenda. The second is to make this a priority for people’s agendas

Part of the success so far has come through getting organisations to understand the facts behind the push for WRES standards, that data showed BAME staff had worse experiences than others with different protected characteristics, and that organisations which were getting it right for their BAME staff were also likely to be getting it right for the whole of their staff. This was shown in figures on bullying and harassment, reducing disciplinaries and so forth.  

“What those organisations are doing is changing the culture to have a more inclusive culture – and that is having a positive impact,” said Dr Naqvi.  

The impact of this has not been limited to the NHS: The WRES team has supported sharing best practice across government departments, social care and police forces. It has developed an expert development programme, drawing participants from all parts of the NHS to share knowledge and expertise, and make the initiative sustainable. 

Winning the HSJ award meant a lot to the small but dedicated team, he added. “We were ecstatic. We have been working hard on this agenda for four to five years as a team. Winning the award was very important for us in order to maintain the momentum of the social movement. It was the highlight of the year for us. It is good to see the hard work of the team members. 

“What are we going to do going forward? For us it is an opportunity. The award has turbo-boosted our journey, has provided us with the added momentum that we will really need going forward.” 

Click here to find out more about how to enter the HSJ Awards 2020.