There’s an important debate going on in the NHS right now in relation to difference and inclusion (and therefore exclusion) highlighted recently by the work of Roger Kline, The ‘snowy white peaks’ of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. The report found that the black and minority ethnic (BME) population is largely excluded from senior positions, both as NHS managers and as NHS trust board members.
Some of the findings from this research were astonishing. In London, only one chair out of 40 is from a BME background; there are no BME chief executives in any London trust; and 17 out of 40 trusts have no BME board members, despite 45 per cent of the population and 41 per cent of the NHS workforce in London being from BME backgrounds. You have to wonder how boards so lacking in diversity can make adequate decisions about services that address the needs of their local patient populations. Kline's research found that the absence of BME staff in the leadership of the NHS is serious, systemic and has shown no sign of improving in recent years. Call me cynical, but I can't see much here that offers an opportunity to 'collectively shine a light on achievements' in relation to this agenda.
In fact, I would suggest that these statistics show that we have all failed in relation to this agenda. We have made some progress in relation to women in leadership positions – and the Fund has been active in supporting this. There have been some efforts within the sector, and indeed by the Fund, to improve BME representation in health leadership, but in many ways, NHS organisations have regressed in this area. In fact, Kline’s report found that the number of BME leaders has declined since the mid-2000s.
I wanted to share a story about why this issue is important to me.
Last November, I was in Witham to conduct a focus group for our research on the impact of medical revalidation on doctor behaviour and the culture of organisations. On the way there, a colleague and I (both Indian women) were refused entry to a taxi. We wondered why – was it because of the colour of our skin?
On the way home we found ourselves in a train carriage with a group of young white men. There was an elderly, turbaned Indian man on the platform about to enter the train and we heard one of them shout, if he gets on the train, I’m going to do him. His friend then pointed out to him that there were other people (of the same colour) on the train and that we had heard what he said. He responded with, I don’t care, I will do them too. I was glad we were together: how much more frightening would it have been had I been alone?
We could have responded, but something told me that would have been foolish. Other people on the train had heard this exchange but chose not to intervene. It was an uncomfortable train journey to say the least. I kept my head down.
When the group left the train, a fellow passenger removed his headphones and simultaneously claimed not to have heard anything while apologising for what we had experienced. He was clearly uncomfortable and genuinely apologetic. He might have been scared – as we were – of speaking up.
Roger Kline has done us a service by opening the eyes of the majority to the reality (BME groups already know and experience this). So what are we going to do more than simply shining a light? In the case of BME leadership in the NHS, it is important not only that we see what is going on but also that we have the courage to speak up and act. We need to create space for difference, and difference needs to be talked about – it's there whether we acknowledge it or not. As my story illustrates.