It is no secret that women and BME communities are underrepresented in top-level NHS roles. The 2017 Workforce Race Equality Standard (WRES) report showed that of all very senior manager working in the NHS, only 7% are from a BME background.
Women also have to work harder to be appointed to leadership positions within the NHS. According to a report by NHS Employers and NHS Improvement published in March last year, the proportion of women on trust boards is 42.6%.
A joint report by NHS Providers and the NHS Leadership Academy published in October also showed that clinicians have meagre chances of reaching chief executive roles within the NHS, with only one third currently in the position.
However, Dr Navina Evans, a BME woman and clinician with a background in psychiatry, medicine and paediatrics broke through the glass ceiling and became chief executive at East London NHS Foundation Trust (ELFT) in August 2016.
Q How did you become a chief executive?
It wasn’t my career plan. I was a clinician, but at East London NHS Foundation Trust I was encouraged to take on management and leadership responsibilities so I kind of fell into it really.
I had a very forward thinking and supportive chief executive who wanted to develop the leaders of the future. He helped me shape my path in the six years leading up to me becoming a chief executive myself.
I am now in the start of my third year as chief executive at the trust.
Q What career challenges have you faced?
From a very young age, I assumed that I would have to work harder to do well. There were some jobs I did not get but I don’t know if that was because I’m a woman or because of my ethnicity.
However, I do think that there are assumptions being made about me. People are sometimes still surprised that I am a chief executive.
Q What should NHS boards do to enable BME progression?
They should ask themselves the question: ‘Does race really matter?’ and they should not just follow the WRES because they have been told they have to. Instead, they need to have a debate around why it matters.
It is important that the board is diverse, as diversity brings different challenges, discussions, solutions and attitudes to solving problems. If you have BME members at board level, they have an additional responsibility on top of their role as a board director, as they bring their perspective as BME members into the boardroom. They are role models, advocates, and represent a possibility.
I think this agenda of race equality must be part of the whole board’s objectives. I believe that the chief executive should be held to account when it comes to race equality, to show what is working and what is not.
The other element is that you need to struggle to attain race equality. If you are not struggling, you are not really thinking about it, because there are no easy solutions.
I hear a lot of people say they will have a BME member on the interview panel. I think that is fantastic, but if it stops there, there is a risk that things are tokenistic. We are all brought up with views, and those are the things you have to struggle with. It’s about long-term change, which is not going to happen immediately.
The WRES is not the only thing but is a very helpful source of information and helps us understand if we are on the right track to tackle this problem. But if it tells me I am doing well, I don’t fell assured. From my perspective, if we get good WRES data, it doesn’t mean that things are good in my organisation, because there will be individuals that tell you stories that are not good.
I think it is really important to listen to people. If an individual tells me something about an experience they had which is far from something we can be proud of, I don’t think we can say ‘oh, that only happened once’. How do we know that and why did it happen that one time? If it happened once, it can happen again.
Q Have you ever experienced racism?
I have been told ‘gosh, you speak good English!’ which is quite interesting. Someone in the NHS tried to be nice to me by saying ‘I don’t notice that you are not white’. I do want people to notice that I am not white, it’s a big part of what I am.
I guess their point was that they value me as a colleague. But I think that race does matter, and I told them I wanted them to notice it, because it is an important part of my narrative and how I got here.
Q What are you most proud of in your career?
I am proud of the colleagues I have – although I didn’t do anything to achieve that. But I am most proud of how, I hope, I’ve enabled other people to be successful. I am very proud when I hear others talk about the values of my organisations in a very meaningful way.
I recently received an email from a patient who spelled out the excellent behaviour of ELFT staff and their [positive] experience of care. That makes me proud, more than having a clean hospital or meeting waiting time targets. These are great achievements too, but managing the way people behave is much harder so it’s great when I can feel that it’s natural for my staff to be kind, respectful, inclusive and caring.
Q What advice would you give to women wanting to step into leadership roles?
I think the NHS is a wonderful thing, but it needs more diversity. We are struggling at the moment and I do believe that women and people from minority backgrounds have a huge part to play in the NHS ‘recovery plan’, if we want to call it that.
I would tell women to step up and to not be afraid. I was really lucky as my chief executive encouraged me, picked me up and told me I was one of the people he’d like to develop. However, some of us are not so fortunate as to have a forward-looking leader as the head of their organisation.
If you are a woman and haven’t got that, you have to find a way [to develop], maybe coming together with other women.
Q What are the key qualities of a leader?
Authenticity, kindness and the ability to listen to listen messages you don’t like hearing.
Q In a blog for NHS Confederation, you wrote that we need to make sure that ‘leadership behaviour is fit for purpose’. How can leaders make that happen?
I think leaders should ask themselves this question continuously, because demand changes, staff [have different needs], patients become more sophisticated, resources are changing.
The world we work in isn’t static. If you have a leadership style and you don’t have a way of asking yourself ‘am I still current?’ then I don’t think it’s fair.
Q Who is your role model in the NHS?
I won’t name anybody. My role model is made up of some characteristics – such as compassion and kindness – of a number of people I have observed. I would pull all of those characteristics together into this imaginary role model.
Dr Navina Evans is chief executive at East London NHS Foundation Trust