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Change at the top: the NHS needs a more ethnically diverse leadership

By Jyoti Shah Consultant urological surgeon
22 August 2018

The case of Dr Hadiza Bawa-Garba is a case that won’t be forgotten in a hurry. Since 2004, nine doctors have been convicted of gross negligence manslaughter; seven of them have been from a black, Asian or minority ethnic (BAME) background.

Even the General Medical Council (GMC) reports that doctors from outside the UK, as well as BAME UK graduates, tend to receive proportionately more sanctions than their white counterparts. and the differences between ethnic groups do not end there.

The failure rates for postgraduate exams are disproportionately higher among BAME doctors. NHS staff from a BAME background report higher levels of bullying, harassment and abuse than white staff, regardless of trust type or region.

It’s been four years since the publication of the Snowy White Peaks of the NHS report, which found that the NHS in London had the least diverse leadership in the UK despite being a city where 40% of the workforce is BAME. The report found that only one in 40 chairs on London trust boards was from a BAME background, and the figure was the same for BAME trust board chief executives in the capital.

It is not that long ago the Society Guardian coined the phrase ‘the 1% club’ to describe the minute number of NHS BAME chief executives. A flurry of activity followed, as did a false sense of comfort and achievement. It has been said that it will be another 30 years before 40% of the NHS leadership is from a BAME background.

BAME doctors make up 18% of UK-trained graduates and 31% of UK-trained GPs, compared to 58% of non-UK trained doctors. The UK relies heavily on overseas doctors to deliver patient care and in parts of England this percentage is as high as 43% – with the majority of doctors being from South Asia. Thus the dearth of ethnic minority leadership in the NHS is not due to a lack of supply of BAME  candidates in the health sector.

The colour of NHS leadership must reflect the composition of its workforce and the people it serves. There is no hiding the colour of our skin – we need to celebrate it, not mask it. One senior leader describes how frustrated and demotivated she was at constantly being passed over for promotion despite having the knowledge and experience required. Finally, she was appointed to a leadership position but was told by many that this had been done to fill a quota.

It is noteworthy that the ‘white peaks’ of leadership is not unique to the NHS. BAME only accounts for 6% of members of FTSE 100 boards, 1% of local councillors, 8% of MPs and less than 8% of head teachers – to give just a few examples.

The case for change is not just a moral one. Diverse leadership of any organisation allows for better decision-making and the diversity of ideas, perspectives and ways of working afforded by people of different backgrounds can only benefit our patients. Many BAME members of the NHS workforce report feeling excluded from organisational culture, which leads to low staff morale.

An inclusive culture that is both open and transparent and where people are willing to listen and understand will increase morale and confidence. People need to feel like they belong in order to be loyal and diversity at the top will help staff feel valued, engaged and motivated, thereby reducing absenteeism and staff turnover and increasing productivity and innovation.

The key to breaking this glass ceiling is an understanding of BAME culture. NHS leadership may not be the chosen career path of many BAME workers, who have often been brought up with the mantra of  ‘you must be a doctor or a lawyer’ – which are considered ‘valued’ professions.

Understanding that cultural drive may explain why BAME members of staff do not necessarily put themselves forward for leadership positions as much as their white counterparts. Additionally, in many BAME cultures it is not inherent to self-promote in a boastful way, which may affect how members of this group project themselves.

One of the primary drivers for change is sponsorship and mentoring. Senior leaders must actively seek out diverse emerging talent and support their development. NHS leadership needs to open the gate and make full use of the wealth of talent all around.

Jyoti Shah is a consultant urological surgeon at Burton Hospitals NHS Foundation Trust

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