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Inequality among NHS staff is ‘getting worse’, report finds


By Jess Hacker
8 November 2021

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Inequality among the NHS workforce is standing in the way of its ability to find and retain staff, a new report has shown.

According to the findings, the NHS’ understanding of what works to improve diversity and equity is ‘poor’, with crucial data lacking and less high-profile groups being overlooked.

The report, published by the Nuffield Trust today (8 November), flagged ‘clear evidence’ that poor inclusivity worsens care for patients, with the health service lacking the tools to fix the problem.

The authors said there has been ‘too much emphasis to date on policies’ instead of on addressing culture within the NHS.

They called on the Cabinet Office to establish an ‘official repository of solutions’ backed by the evidence to make sure future local schemes are properly evaluated.

High rates of discrimination

Data analysed indicated that more than one-in-eight (13%) NHS staff reported experiencing discrimination at work in 2020.

It also showed that Black staff are more than twice as likely to experience discrimination at work from a colleague as white staff, while Muslim staff more than twice as likely to experience discrimination as staff of no religion.

Those who prefer to self-describe their gender are twice as likely to experience discrimination as staff who identify as male or female.

Meanwhile, ethnic minority staff are 27% less likely than white staff to be ‘very senior managers’ – the highest executive grades – with significant disparities between regions.

The authors identified 36 trusts where white staff were at least twice as likely to be appointed from a shortlist than someone who is Black or from an ethnic minority background.

The report also showed that only two-in-five deaf healthcare professionals report having had the reasonable adjustments they needed at work during the pandemic.

‘Failure’ to recognise how many groups face exclusion

The report highlighted a ‘failure to recognise’ how may different groups can be subjected to exclusion within the NHS.

The Nuffield Trust, which held interviews with NHS trust staff and reviewed existing data, said that while inequalities of race and gender are recognised, ethnic groups are ‘too often lumped together’ with other disparities overlooked.

Key shortcomings included nationality not being counted in the NHS staff survey and people on apprenticeship schemes only being recorded in large categories, they said.

And although initiatives like staff networks and inclusion ambassadors on interview panels stood out as examples of good practice, the authors warned there is ‘little evidence’ to tell whether increasing apprenticeships, and similar measures, truly advance diversity or not.

Last week, NHS England announced it would relaunch its apprenticeship offering to try and reduce its 16% gender pay gap.

New Integrated Care Boards should have special leads to focus on inclusion, the authors said.

Danny Mortimer, chief executive of NHS Employers – part of the NHS Confederation and who commissioned the report – said: ‘his report highlights action that is being taken but rightly reminds us that far more urgency and impact is needed in every part of the NHS.

‘To be clear, the link between staff and patient experience is irrefutable, and we have an obligation to improve the experience of all parts of the health service’s rich and talented workforce.’

Meanwhile, Dr William Palmer, Nuffield Trust senior policy fellow, said the NHS has for years recognised disparities and discrimination among staff are morally unacceptable ‘on paper’, but that progress in reducing this has been ‘painfully slow’, with signs that ‘bias may be getting worse’.

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