Race inequality is one of the most complex, difficult and intractable problems that we have to deal with in the twenty first century. It is an issue that has been over 400 years in the making and realistically, it will take more than five years and the WRES team of fewer than ten people to put it right.
However, what we can do is to shine a light on the importance of race equality in the NHS, how it benefits our staff and ultimately our patients. This I believe we have done successfully over the last five years. We would love to move at the pace of revolutionary change, but it is evolutionary change that is happening in practice.
So, here’s the good news.
The WRES is an assessment of race equality in the NHS based on a series of indicators. What we call the ‘process’ or ‘operational’ indicators are improving.
Year on year, the gap between BME and white experiences for indicators 2, 3 and 4 is closing (see Table 1), which means the NHS is becoming fairer when it comes to recruitment, entry into formal disciplinary processes and non-mandatory training. Although we still have a long way to go, this should be celebrated and credit given to those in the NHS who have been working hard to make a difference.
Table 1 WRES indicators 2–4, 2016–19
|2. Relative likelihood of white applicants being appointed from shortlisting across all posts compared to BME applicants||1.57||1.60||1.45||1.46|
|3. Relative likelihood of BME staff entering the formal disciplinary process compared to white staff||1.56||1.37||1.24||1.22|
|4. Relative likelihood of white staff accessing non-mandatory training and CPD compared to BME staff||1.11||1.22||1.15||1.15|
I would say that if the NHS puts its shoulder to the wheel and really focuses on these three indicators there is no reason why we can’t reach equity in the experience of BME and white staff on these indicators within the next two years. In anybody’s book that would be really good news.
Making progress on the ‘cultural’ indicators – WRES indicators 5, 6, 7 and 8 which focus on harassment and bullying, opportunities for career progression and discrimination – has been harder and these remained more or less static for the past five years (see Table 2).
The data gives us a very clear picture about people’s experience of working in a very pressured service, how they feel about it and how they perceive they are being treated.
Table 2 WRES indicators 5–8, 2016–19
|5. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in past 12 months||BME||29.1%||28.4%||28.5%||29.8%|
|6. Percentage of staff experiencing harassment, bullying or abuse from staff in past 12 months||BME||27.0%||26.0%||27.8%||29.0%|
|7. Percentage of staff believing that trust provides equal opportunities for career progression or promotion||BME||73.4%||73.2%||71.9%||69.9%|
|8. Percentage of staff personally experiencing discrimination at work from a manager/team leader or other colleagues||BME||14.0%||14.5%||15.0%||15.3%|
There are several things to take from the data including that staff experience is a challenge across the service, regardless of background. The fact that so many NHS staff experience unacceptable behaviour from the public – the very people they are trying to help and care for – is unacceptable. This issue has been highlighted powerfully in the media recently, particularly after a BME consultant surgeon talked about the racial abuse he has endured over many years. Abuse of any member of staff must be stamped out of our NHS. For BME staff that abuse is often even more personal, offensive and hurtful.
Indicator 9 (see Table 3) measures the number of board members, non-executives and executives from BME backgrounds. Between 2018 and 2019 this increased from 7.4 per cent to 8.4 per cent – an improvement but still significantly lower than the proportion of the BME workforce across all NHS trusts and clinical commissioning groups in England (19.9 per cent).
Table 3 WRES indicator 9, 2016–19
|9. BME board membership||7.1%||7.0%||7.4%||8.4%|
In numbers, BME board members in trusts have increased by 35; that comprises an additional 18 executive and 17 non-executive board members. There has also been a decrease in the number of trusts with no BME representation on the boards, from 96 in 2018 to 73 in 2019 and there are now 30 trusts with three or more BME board members compared to 16 in 2016. This is an improvement on 2014 when The ‘snowy white peaks’ of the NHS report was published but we are still very much in the foothills of the change we need to make.
To conclude, we have made progress over the past five years and I am confident that we will continue going in the right direction. The task now is to pick up the pace of change.
I worked in the NHS for 36 years up until I retired in February of last year. The very great part of my career was highly rewarding and I felt valued and supported by my colleagues and managers in providing good patient care.
This changed in the last few years before I retired.
In the final years I experienced and witnessed the following :
Verbal and emotional bullying of staff by managers
Greater emphasis given to electronic data collection than patient care - staff referred to this as “feeding the machine”
Exceptionally high levels of stress in the workplace
Acting out behaviours by staff and managers - swearing, aggressive behaviours towards colleagues
Managers apportioning blame
Managers being highly unprofessional - breaching confidentiality, nepotism, cronyism which resulted in some staff being excluded
Staff being given unrealistic targets
Disregard given to supervision, appraisals and used as tick box exercise
Rivalry between different professional groups
Non adherence to Trust values
Staff not having any influence on decision making
Adoption of “think tank mentality” which only served to disempower staff -
Over processing and standardisation of procedures. It is acknowledged that procedures are necessary but this was to the extent which took away clinical autonomy, clinical discretion and ability to use one’s own clinical experience.
Gimmicky approaches which paper over the problems
Hurrying patients through the system - care process becoming like a production line
In my final year I experienced acute stress which I had never experienced in the previous 35 years, in response to the above. I was advised to “go off sick” by the nursing union which I couldn’t do as I did not want to give into this culture. It took some toll on my health and most importantly my self confidence and self worth .
Since retiring, I remain in contact with some of ex colleagues and nothing has changed. Senior managers have simply tried to oust staff and bring new blood in, but the problems remain. Feedback was given to the employing organisation, but nothing has changed.
When I was leaving I completed a leavers questionnaire and provided honest feedback providing my contact details. I have never been contacted.
12 months later, I have found part-time work in a different sector and once again feel able to use my previous skills and knowledge. I feel valued but also very sad that I cannot do this in the NHS.
The NHS was a badge of honour for me.
I have provided these comments as I feel concerned for the staff I have left behind, who are continuing to struggle and feel unheard.
The Staff Survey was always an area of discussion as to what was done with it and concerns about retaliation - could feedback be traced back to the individual. This gives some insight to the level of fear experienced by staff.
I applaud the work the Kings Fund are trying to do, but how this can truly change things, I am unsure.
An accurate account from Angela in the first comment to this article. Isn’t it sad and unacceptable that more than 25 years after the paper published by Esmail and Everington, we are still talking about this issue. Unfortunately, no one is held accountable. This can only mean that authorities collude with each other in suppressing problems when they are brought up. Data showing microscopic trends in improvements is just positive spin doctoring, not much more.