Our NHS people matter: progress and challenges on workforce race equality in the NHS

The challenge of achieving race equality in the workplace is real, and one that is not unique to the NHS. Yet, as the largest employer of black and minority ethnic people in England, the NHS is meeting this challenge head-on.

The Workforce Race Equality Standard programme was established in 2015. It requires organisations employing the 1.4 million NHS workforce to demonstrate progress against nine indicators of staff experience; and supports continuous improvement through robust action planning to tackle the root causes of discrimination.

Latest WRES data

Published at an event to launch a special edition of the BMJ, which has shown welcome leadership on these issues, the latest WRES data report for NHS trusts in England show a closing in the gap between BME and white staff in the likelihood of being appointed from shortlisting; being subjected to formal disciplinary action and undertaking non-mandatory training. We should be encouraged with the level of progress made on these operational indicators.

Table 1: Operational WRES indicators for NHS trusts in England: 2016 – 2019

WRES indicator	2016	2017	2018	2019
Relative likelihood of white applicants being appointed from shortlisting across all posts compared to BME applicants	1.57	1.60	1.45	1.46
Relative likelihood of BME staff entering the formal disciplinary process compared to white staff	1.56	1.37	1.24	1.22
Relative likelihood of white staff accessing non-mandatory training and CPD compared to BME staff	1.11	1.22	1.15	1.15

The data are compelling; not only do they show progress being made across trusts and parts of the NHS (in relation to WRES indicators 1-4), they also remind us of the immense challenges we face on this agenda. One of which is transforming, often deep-rooted, cultures within organisations.

WRES indicators from the NHS staff survey questions on the perceptions of discrimination, bullying, harassment and abuse (from patients and staff), and on beliefs regarding equal opportunities in the workplace, have remained largely static over time.

Table 2: WRES indicators from the NHS staff survey for NHS trusts in England: 2016 – 2019

WRES indicator		2016	2017	2018	2019
Percentage of staff experiencing harassment, bullying, abuse from patients, relatives or the public in last 12 months	BME	29.1%	28.4%	28.5%	29.8%
	White	28.1%	27.5%	27.7%	27.8%
Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months	BME	27.0%	26.0%	27.8%	29.0%
	White	24.0%	23.0%	23.3%	24.2%
Percentage of staff believing that trust provides equal opportunities for career progression or promotion	BME	73.4%	73.2%	71.9%	69.9%
	White	88.3%	87.8%	86.8%	86.3%
Percentage of staff personally experiencing discrimination at work from a manager/team leader or other colleagues	BME	14.0%	14.5%	15.0%	15.3%
	White	6.1%	6.1%	6.6%	6.4%

 Patterns in the data

Why are some indicators of staff experience showing stillness in data outcomes over time? First, it is not just the data for BME staff that are not improving; responses to those NHS staff survey questions also show a lack of improvement for white staff.

There is something here about the overall levels of pressure and stress in the NHS. Every year, 38 to 40 per cent of all respondents of the NHS staff survey report being unwell because of work-related stress in the previous year. Whilst this may well have a disproportionately severe impact upon BME staff, it is a pattern observed across the workforce.

Every year, 38 to 40 per cent of all respondents of the NHS staff survey report being unwell because of work-related stress in the previous year

Second, we are creating a social movement of fairness and openness across NHS workplaces. Organisations are beginning to create psychologically safe spaces and opportunities for staff to speak up and report on issues such as discrimination, bullying and harassment.

Indeed, we are observing a year-on-year increase in response rates to the NHS staff survey; BME response rate to the annual survey increased from 15 per cent in 2016 to 17 per cent in 2018. Consequently, we may be getting an increasingly more accurate picture of the level of staff experience within the workplace.

Third, the WRES programme has been providing specific and concerted support to many NHS organisations on improving workplace race equality. A large majority of these are organisations that have had the willingness, openness and leadership-drive to seek improvement support.

There are still some NHS organisations that are yet to work more closely with the WRES team – to collaboratively identify the root causes of issues and develop robust action plans for improvement.

Improvement in leadership representation

In 2019, 8.4 per cent of all board members across NHS trusts in England were from a BME background, with NHS trusts across London continuing to show progress in this area. In 2014, the ‘Snowy white peaks of the NHS’ report cited two-fifths of all NHS trusts in London as having zero BME board members.

Yet, as at 1 December 2019, every NHS trust in London had at least one BME board member. Similarly impressive is the big leap in the number of VSM-level staff from a BME background – up 30 per cent in the last three years.

In 2019, 8.4 per cent of all board members across NHS trusts in England were from a BME background, with NHS trusts across London continuing to show progress in this area

While these are milestone achievements, more work needs to be done to ensure board and senior-level representation is reflective of the diverse workforce and communities served.

To help turbo boost BME representation across the workforce pipeline and at senior levels across the NHS, NHSE and NHSI announced the setting of aspirational targets for improved representation by 2028.

Every NHS trust in England now has its own bespoke aspirational targets and is working towards meeting them. This is not just an agenda for local NHS organisations; the national arms’ length bodies (including NHSE and NHSI) are going to take the same approach as the rest of the NHS and set clear trackable goals for enhanced leadership diversity.

Importance of this agenda

Getting this agenda right is critical; evidence shows that a motivated, included and valued workforce helps to deliver high quality patient care, increased patient satisfaction and improved patient safety – it also contributes towards more innovative and efficient organisations.

Fostering diversity and inclusion in the workplace enhances an organisation’s ability to attract and retain top talent. Not only does this widen the pool of quality job applicants, but it also demonstrates a workplace culture that values all staff and demonstrates strong corporate and social responsibility.

We also know that implementing the WRES, and continuously improving against the WRES indicators, is likely to have a positive impact on a range of organisational measures including: lower staff sickness rates and temporary staff spend; better staff engagement levels; better Friend and Family Test outcomes, and attractive Care Quality Commission inspection ratings.

National leadership support is critical in maintaining momentum on this agenda and in achieving the system-wide progress that staff and patients need and deserve

Organisations such as St Helens and Knowsley Hospital Trust (winner of the 2019 HSJ acute trust of the year award) are observing such positive impacts. These findings are presented in the 2019 WRES data report for NHS trusts.

For the very reasons presented above, many NHS trusts are beginning to implement the WRES with an open mind and an honest heart; yet much more work is still needed to shift the dial on workforce race inequality.

National leadership support is critical in maintaining momentum on this agenda and in achieving the system-wide progress that staff and patients need and deserve. Now is the time to close the gap between welcome public commitments and behavioural action – to further thaw the ‘snowy white peaks’ across the NHS.