Roger Kline, formerly joint director of the workforce race equality standard, explains why the NHS still has far to go when it comes diversity at the top
In 2015, the NHS introduced the workforce race equality standard (WRES) following evidence of a pattern of systematic adverse treatment of black and minority ethnic (BME) staff, negatively impacting both employees and patient care and safety.
Earlier this year, NHS England and NHS Improvement published A Model Employer, setting out a strategy for the implementation of the ministerial objective that NHS leadership should be as diverse as the rest of the workforce. This included the aim for BME representation at senior management level to match that across the rest of the NHS workforce within ten years.
Last month saw the publication of the 2018 WRES report covering the eight national healthcare organisations. Unfortunately, the data shows that, so far, progress against the nine WRES indicators has been glacial. While there is some improvement against a number of the indicators across the wider NHS, the report suggests that, on recruitment and promotion in particular, the national bodies lag behind.
Much like the recent NHS Confederation report on the topic, Chairs and non-executives in the NHS: the need for diverse leadership, which shows a decline in the number of trust chairs from a BME background, the WRES report suggests that the NHS needs to step up its game when it comes to diversity at the most senior level.
The report shows that BME staff continue to be over-represented in lower pay grades and significantly underrepresented at senior level, across all eight organisations (NHS England, NHS Digital, NHS Improvement, Health Education England (HEE), NHS Blood and Transplant, Public Health England, NHS Business Services Authority (NHSBSA) and the CQC.
White shortlisted job applicants were more likely to be appointed from shortlisting than their BME counterparts (WRES indicator 2) in all eight organisations. While four organisations improved on this indicator compared to 2017 (notably the CQC and NHSBSA), four of the largest organisations – including NHS England and NHS Improvement – saw a deterioration.
For three of the largest bodies, it was twice as likely that white shortlisted staff would be appointed, compared to shortlisted BME staff, and at NHS Improvement it was three times as likely. When it comes to very senior managers (VSM), there were only three from a BME background across seven of the organisations – down from seven the previous year. The only exception was NHS England, where 23 VSMs are BME. There are just nine BME board members across the eight organisations.
Self-reporting of ethnicity is a good guide to how seriously an organisation takes race equality. For NHS trusts, 4.8% of staff did not declare their ethnicity in 2018. However, for the eight national organisations, more than double that proportion did not. Moreover, the percentage of staff not reporting their ethnicity was the highest in the most senior pay bands – including at board level – precisely the opposite of what good leadership requires.
Staff survey views on whether there are ‘equal opportunities for career progression or promotion’ are much worse across the eight organisations than in NHS trusts. The only national organisation in which the figures were on par with the NHS trust average is PHE, where 78% of BME staff believe that their organisation offers equal opportunities for career advancement – a number that in fact surpasses the NHS trust average of 71.5% for BME employees.
This report suggests progress at the most senior levels in the system has been extremely slow. It is of particular concern that the three regulators with primary responsibility for ensuring that BME representation at senior management level matches that of the NHS workforce as a whole within ten years – NHS Improvement, NHS England and Health Education England – appears to face particular challenges in this area.
This report notes that there is no shortage of BME applicants, nor does the issue lie with this group not being shortlisted. Where progress has taken place in NHS trusts it is because the leadership has shown a determination to hold themselves and their managers to account and have systematically explained why workforce race equality is important. In these trusts, managers have shown what is possible by relentlessly challenging the pervasive influence of bias at every stage of recruitment and development, drawing on evidence of what works.
NHS Improvement Chair Dido Harding and new NHS chief people officer Prerana Issar appear determined to do better. However, getting the balance right between scrutiny, challenge and support will also require a sustained effort by the national organisations. The rest of the NHS will expect these bodies to lead by example.
Roger Kline is also research fellow at Middlesex University Business School