Are opportunities still limited for black and minority ethnic staff in health care leadership?

This content relates to the following topics:

I was recently asked to chair a round-table event for the Health Service Journal on ethnic diversity and equality in health care leadership.

Out of interest I researched the origin of the term ‘round-table’ and discovered that it came from a speech made by HRH Prince Edward, Prince of Wales, to the British Industries Fair in 1927. He urged ‘young business and professional men… to get together round the table and adopt methods that have proved sound in the past, adapt them to changing needs and wherever possible, improve them’. Setting aside the gender focus of the original use, I would like to reflect on issues that were discussed at this particular round-table event in 2016 – namely what leaders in the NHS can adopt, adapt and improve to enable black and minority ethnic (BME) staff to achieve their potential as leaders.

Participants began by sharing their personal emotional response to the topic, an important recognition of the often painful experiences of being treated differently based on ethnicity. An exploration of the existing barriers to progression for black and minority ethnic staff touched on both unconscious bias and conscious bias; there was a recognition that failure to tackle this was in itself a barrier and that talking about the conscious bias that exists in the system is a significant step towards addressing inequality.

One of the known, visible aspects of conscious bias is in the processes and practices used to recruit, develop and retain talent. Recruitment in particular has been spoken about widely by Roger Kline, who most recently pointed out the lack of ethnic minority specialists operating in the executive search agencies who work with the NHS.

There is a lot to learn from the huge progress made at the United Nations on tackling gender inequality. Through setting cultural expectations and mandating the use of a system-wide action plan, the UN were able to bring about a change to global culture. Male shortlists are a thing of the past, and Secretary-General Ban Ki-Moon’s personal commitment to gender equality led to the appointment of 150 women to Assistant Secretary-General or Under-Secretary-General roles over nine years – and to nearly a quarter of UN missions being headed by women, compared to none when he took office.

We explored the issue of intersectionality – the theory of how different types of discrimination interact – raising a discussion about how practical action could be taken to increase BME representation at senior levels of the system. One simple and effective example was given from an acute health provider where the leadership team has invested in development workshops and masterclasses designed by BME leaders; decisions about what should be offered were made in a series of conversations held over a period of one month, often over lunch. Opportunities were offered in a number of areas such as interview practice, help with communication skills and coaching conversations. The short events were attended by staff from all parts of the organisation and at all levels. Repeated over a three-month cycle, these interventions combined to create a culture in which BME leaders had improved confidence and felt valued; an impact assessment is currently under way but anecdotally the organisation reports a threefold increase in applicants for internal vacancies at supervisory and middle management level. Increasing the talent pool in this way will potentially lead to this group being developed and supported to apply for roles at the higher levels. The crucial ingredient was senior leaders acting to promote the development and talent of BME staff in their workforce.

Black and minority ethnic staff make up a disproportionately large part of both the workforce and the patient population of today’s NHS, compared with their proportion in senior leadership roles. We accept a number of factors in modern motivation theory as being critical to the wellbeing and confidence of all people yet five of these factors (possibility of growth, opportunity to do something meaningful, a high level of responsibility, sense of importance to the organisation, recognition for achievements) are consistently being ignored in relation to our BME workforce. Achieving the recent requirements set out in the NHS Workforce Race Equality Standard may force compliance, but as the round-table conversation demonstrated, much more is possible with proactive change.

We can no longer accept the status quo. Within any power system there is always a moment when the act of people uniting to disrupt things that are simply wrong provides the resistance that moves towards righting that wrong. I’d like to think that participating in the round-table event was a small part of such an act.

Comments

Zieda Ali

Position
Lay member public and patient engagement,
Organisation
Bolton CCG
Comment date
09 August 2017
Hi I just wanted to introduce my self ..i am in a leadership position over at Bolton CCG..i have just bern appointed as chair of the EDHR committee, am enjoying the NED role and am passionate about equalities . .please get in touch thanks Zed

Ram Jassi

Comment date
10 June 2016
The recent publication of the workforce race equality standard (WRES) has just confirmed what we have been saying. What is striking is the disparity of BME to Non BME experiences. We have actually gone backwards in addressing equality of opportunity. I recite this requires joined up action and therefore a call to action. #BrokenSpirits
Ram Jassi, views are my own

Vijaya Nath

Position
Director , Leadership Developement,
Organisation
The King's Fund
Comment date
04 May 2016
Deborah ,
Thank you for reading the blog and leaving this comment . Doing better in all aspects of inclusion is vital to society and our NHS & Care sectors .We have much more to do , I do hope that you receive support in scaling those mountains . We will continue to raise these issues as imperatives to be addressed.

Deborah Bennett

Position
Head of Strategic Planning,
Organisation
East Cheshire NHS Trust
Comment date
27 April 2016
I agree with all of the points highlighted and in the original blog post. I also have concerns relating to equality in leadership but in the area of disability. More and more staff within health and social care are hiding disabilities for fear of experiencing stigma and discrimination; I have experienced both as a result of being open about my disabilities. As a disabled woman, I feel I've still got some mountains to climb ...

Vijaya Nath

Position
Director - Leadership Development,
Organisation
The King's Fund
Comment date
26 April 2016
Thank you for leaving these comments both points well made and both will benefit from remedies as identified by you and others writing on this blog .
One suggestion that I & colleagues at The Fund are looking into is inviting those of you who left comments indicating interest in working on these issues to a discussion - where we collectively (and with colleagues who participated in the the roundtable) look at what further options for action may be available .
Thanks again as through the comments left by you and other colleagues more is possible .

Badrinath

Position
Consultant in PH Medicine,
Organisation
Suffolk County Council
Comment date
25 April 2016
Thanks Vijaya for raising this important issue which has started to receive increasing attention. I perceive two issues; the first one is lack of aspiration due to past experience in the BME community. This can be addressed by better training and possibly mentoring and coaching. The second issue is the cultural stereotype directed at members of the BME community when they try to go for senior leadership positions. I feel aspiring BME leaders need to shadow and get support and inspiration from BME existing leaders who can act as role models.

Ram Jassi

Comment date
22 April 2016
Umesh, I agree with you latest comments. We talk about racism quite a lot what about casteism?

There is a great deal of discrimination going on between Asians and furthermore BME to BME.

With regard to changing behaviours, well when you have leaders whose values do not accord to the Nolan principles what can you do? Until you have a national “command and control” over leadership accountability "well led" at every level you are not going to address localised problems and break-up the cosy club culture. Without a united approach we will just carry on fighting localised issues and quite frankly some of us are becoming so battle scared that you can do a sequel to the movie Gladiator.
Ram Jassi, view are my own.

Umesh Prabhu

Position
Medical Director,
Organisation
Wrightington Wigan and Leigh FT
Comment date
17 April 2016
Any change is possible if we get truly values based leaders who value each and every human being irrespective of race, gender, ethnicity, sexual orientation and so on. Leaders simple job is to appoint right people to do the right job and to support and empower them to be leaders. Leaders only job in NHS is to make everyone a great leader and patient safety champions.

NHS needs good leaders and that too good clinical leaders and sad reality is NHS has never trained, encouraged, nurtured or supported good doctors or nurses to be good leaders and never held leaders to account.

Until we get these basics right BME, BAME, Women and BME women will continue to be under-represented and there will be more and more such articles even after few more years in our NHS.

BME or BAME issues are complex as there is not only BME versus White discrimination but sadly inter-ethnic discrimination! I recently heard that someone very senior BME women leader who is Black saying 'I hate Asian men! What an irony!

Leaders must lead from the front and lead by example. Unless there is a culture of holding leaders to account for their own values and behaviours nothing will change.

NHS is a great institution, it has amazing highly values based staff who would do anything for their patients. It simply needs good leaders with good values who are self disciplined and role models for their staff. Who inspire and motivate their staff and who are kind, caring compassionate towards staff and create a culture of staff happiness. All staff matter and that includes BME or BAME.

Vijaya Nath

Position
Director - Leadership Development,
Organisation
The King's Fund
Comment date
15 April 2016
Sohaib ,Thank you for leaving this comment. Your experience and those of others is the very reason that we need to do better in acknowledging the talent from BME / BAME and all ethnic minority communities.
If we feel excluded on the grounds of racial difference , whatever the label attached BME/ BAME -other visible ethnic minorities it is painful . As someone who believes that education is a great leveller then I encourage all to continue to have conversations , and to believe in the human ability to change .

Vijaya Nath

Position
Director - Leadership Development,
Organisation
The King's Fund
Comment date
15 April 2016
Thank you Audrey for reading and leaving a comment. I know the WRES was established as a metric for enabling leaders to take stock and action re BME / BAME leadership . We have much more to do . It sounds like you have experience from other sectors that would be helpful. Going forward we need individuals with experience in how we succeed in this area to share what works.

Add your comment