Equality and diversity in the NHS: The King's Fund's work over the years

Comments: 5
Kirsty Morrison

Last month, we read in the newspapers about the ‘poshness test’: a measure of credibility and employability attached to candidates who display certain characteristics usually associated with privately educated graduates.

Recent research has suggested that top firms apply this ‘test' when recruiting, which leads to working class candidates being disadvantaged and, ultimately, promotes social division. 

The health sector is no stranger to these issues. In 2014, Roger Kline’s report into discrimination in governance and leadership, and its knock-on effects on patient care, coined the phrase 'the snowy white peaks of the NHS’. This situation is defined as a pronounced absence of black and minority ethnic (BME) staff from senior roles, as well as a gap between the diversity of the workforce and the local population. The report also expressed concern at the under-representation of women in senior roles.

The King’s Fund’s work on diversity goes back more than 30 years. In 1984, our publication Race and employment in the NHS included case studies on implementing equal opportunities policies, and perspectives from nurses, NHS managers and trades unions on the impact of such policies. The report came three years after the Nationality Act became law, and a year after Lord Scarman’s report cited racial discrimination (with discriminatory recruitment policy given as a specific example) as a main cause of rioting within the country. 

The King’s Fund followed this work up with A model policy for equal opportunities in employment in the NHS, the product of a joint initiative between The King’s Fund and the Department of Health. Racial equality: the nursing profession cited evidence of racial inequality and examined how job applications from black and minority ethnic candidates could be encouraged in order to foster a more diverse workforce.

In 1993, research with the National Association of Health Authorities and Trusts led to the publication of Equality across the board, which sought to promote equality of access to senior posts. The NHS Institute for Innovation and Improvement also commissioned the Fund to assist with its Breaking Through programme, which worked on fast-tracking individuals from ethnic minority backgrounds to board-level positions.

Diversity and inclusion in the NHS is a subject we continue to speak about and work on today. Our Leadership Development team continues to address inequalities in the modern NHS workforce through work such as the Athena programme, our Advancing women in leadership summit and the latest annual leadership and management summit

Over the years, the Fund has carried out a range of work on equality and diversity in patient services, covering the health needs of travelling communities, in collaboration with Save the Children; health issues for single-parent families, older people and community health services, which discussed ageism and racism; a case study of carers, in conjunction with Help the Aged; commissioning services in partnership with disabled people as part of the Prince of Wales Advisory Group on Disability; and the provision of mental health services for black and ethnic minority populations

The Fund’s published work in this area has taken the form of surveys, case studies, workshops and conferences. You can browse hundreds of these past publications in our digital archive.  


#544379 Chris Dalley

Good to see that this issue is being flagged, but needs much more debate. Widening access to promotion and high ranking clinical/managerial roles in NHS for BME would result in better patient experience and working for all across NHS. More jaw, jaw please.

#544381 zed ali
cheif officer VCFS
Project BME Lancashire LTD

to bring about change here in Lancashire the above report needs to be highlighted at a strategic level for any recommendation to go forward , this can only be done in partnership with your self s , other wise nothing is going to change , same people round the table again and again

#544403 Calista Harris
Quality Assurance/Healthcare Policies
University of Birmingham

E&D is another empty letter - loads of policies and systems and no substance at all. Especially in managerial roles, recruitment and selection seems to always favour the usual suspects (White English) and the way E&D reports are produced by most Trusts falls short of capturing the White non British element which is always captured when applications are made but not recorded (so called E&D Co-ordinators are another beautification tool that the organisation complies with E&D legislation). A big travesty at the moment that is only ticking boxes rather than addressing any BME issues. Also have concerns about NHS England's lack of leadership on this issue...

#544476 Survivor
NHS Employee

Whether it is conscious or unconscious, if this trajectory continues ...... soon, there will be no evidence that BAME people were ever in the NHS! I propose a message in a bottle campaign, in memory of those who touched the glass ceiling and lived to tell the tale.

#546006 Kirit Mistry
BAME Patient Leader
Leicestershire South Asian Diabetes Support Group

It would be really good to see how many BAME's broke through the various leadership programmes as the NHS still is a snowy white peak as per Roger Kline report.
Also their seems to be a real lack of equity on BAME PPI as again most of the Expert by Experience or Patient Leaders programmes are lacking BAME PPI so would like to see how this will be addressed.

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