Closing the gap on BME representation in NHS leadership: not rocket science

London is an outlier in terms of the data – having the most diverse workforce but the least diverse leadership: 40 per cent of the population in London is from a BME background, 43 per cent of the NHS workforce in London is from a BME background, yet only 14 per cent of board-level positions are held by people from a BME background. Simon Stevens, Chief Executive of NHS England, opened the session with a powerful reminder that the issue of race equality is not only about fairness – it’s fundamental to the NHS mission of reducing inequalities in care.  

What is clear from the data is that there has been some progress, but sufficient progress is not being made. One of the panel members noted that, based on current projections, it would be another 30 years before 40 per cent of the leadership positions (ie, band 8a posts and above) at their organisation would be occupied by staff from a BME background.

One of the most important first steps for leaders is to confront the issue directly and openly and we heard from leaders in London about how they were trying to do this. The WRES data offers transparency and enables boards to talk about this issue with an understanding of how they are performing. Discussing this issue at board level and building this into the accountability architecture of boards has been very powerful.

But alongside this, leaders need to have conversations with their BME staff about what it’s really like to work in their organisations and outline concrete actions to address discrimination. The panel talked frankly about how important it was to do this and how dramatically it shifted their understanding of the issue. To hear people’s stories and to understand discriminatory experiences that they had never had to confront themselves, despite being in the same organisation, was huge.

All admitted these experiences were difficult to hear and to understand. They had heard first-hand how many of their staff members had suffered in ‘dignified silence’. And this listening was not a one-off act. It was done on a regular basis with a constant reinforcement of the importance of the issue and determination that it would be worked on every day to ensure improvement is seen, heard and felt among the workforce. And importantly that improvement is evidenced by the data.

As well as listening to staff, boards should be questioning themselves regularly about the culture of their organisation and how inclusion is demonstrated within that organisation. We heard from trusts where equality improvement had been placed at the heart of organisational and individual leader objectives in an attempt to foster focus and increase accountability. And we know accountability is vital in changing behaviours.  

Further suggestions for tackling this issue included focused support and coaching for ‘middle management’ – we know from our previous work that opportunities to bring about change are most likely to be effective at team level, as this is where most discrimination occurs.

Other practical suggestions included ensuring all interview panels, boards and committees reflect the diversity of the organisation and applying some of the evidence around approaching disciplinary processes differently. One organisation is about to implement a potentially powerful approach: when a BME candidate has been shortlisted for a senior role but not offered the role, the chair of the interview panel is required to write to the chair of the trust to explain (giving clear reasons) why the role was not offered to the BME candidate. It is hoped that this level of accountability and transparency will have an impact on behaviours and decision-making.

However, the real driver for improvement on race equality is demonstrable, positive, committed and high-quality leadership. A critical part of leadership is making people feel they belong. Leaders need to listen to understand the issue and talk openly about how they will address it; they must set expectations; they must measure and monitor; they must give people the tools to respond to the challenge; and they must ensure that there are real consequences for failure to improve.