Addressing race inequalities in the NHS needs engagement, commitment and a plan

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In early July, The King’s Fund will publish a report looking at how to address workforce race inequalities and inclusion, based on research with three NHS provider organisations and the lived experience of ethnic minority staff. This is the product of many months of work, begun in a world before Covid-19 and the death of George Floyd. The presenting problem is well known – despite having an ethnically diverse workforce, long-standing race inequalities in the NHS blight the working lives of many ethnic minority staff who are more likely to be discriminated against, more likely to experience bullying, harassment and abuse, and less likely to reach senior positions than their white colleagues.

The report shows that even those NHS providers that have devoted significant time and energy to race equality still find themselves making slow progress, progress that is often difficult to capture in existing Workforce Race Equality Standard (WRES) indicators. I do not think this is surprising: NHS organisations are attempting to reverse deep-rooted, long-standing inequalities and this is not the stuff of task-and-finish programmes with neat start dates and end dates. If it were that easy it would already be done. Tackling race inequalities will require commitment for the long haul, with locally engaged leadership and staff, including stronger allyship from white leaders and staff. With no magic bullet, it will involve iteration and learning along the way and it will mean ensuring there is good engagement between staff and with leaders to help design each new stage of the work. While this shouldn’t be interpreted as failure, it will require understanding about how to harness the current energy for action and how to ensure this lasts not weeks, but months and years.

'Tackling race inequalities will require commitment for the long haul, with locally engaged leadership and staff, including stronger allyship from white leaders and staff'

Action will need national leadership but there will also need to be local leadership stretching from the board room to the front line. This will need to draw on the undoubted energy there is for change across staff whatever their background. For many reasons this is not something that can be left to ‘leaders’ alone however important they are, not least because they are products of the current inequitable system (however uncomfortable that is to say – and I should add that I include myself in the same group, albeit in the charitable sector rather than the NHS). The King’s Fund has begun exploring these issues with the chief executives and accountable officers of NHS organisations in the London region, an area that does badly on the WRES indicators despite the greater presence of ethnic minority staff in its workforce. This work does attest to the willingness of senior leaders to carve out time from busy diaries, often at short notice (because of the interruptions from Covid-19), to devote to working together as a group to explore their unique role in overcoming inequality.

To harness this leadership and energy I do believe there needs to be a ‘plan’. In the heat of the moment, individuals can express deeply felt allyship and anxieties over inequalities. But it is in the nature of ‘moments’ that they lose their heat. Evidence shows that making progress here is not the stuff of a sudden discovery of the ‘solution’, the current upsurge of energy needs conversion into something that will survive the first mis-steps and the first new crisis (a second wave of Covid-19, for example) that distracts attention. Developing and implementing such a plan is possible both nationally and locally and should be a key element of the forthcoming NHS People Plan.

'Race inequality in the NHS is one facet of wider inequalities we see in England. These enduring inequalities leave parts of our society experiencing persistently poorer health and lower life expectancy than others.'

Race inequality in the NHS is one facet of wider inequalities we see in England. These enduring inequalities leave parts of our society experiencing persistently poorer health and lower life expectancy than others. If the government wishes to tackle these long-standing (and sometimes worsening) outcomes, action by the NHS – important as it is – will never be enough. As the Fund has argued before , only a new national cross-government health inequalities strategy can overcome the root causes of these inequalities across education, health, employment and other wider determinants of health.

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