It’s no longer enough to know, we must act: workforce race inequality in the NHS

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If the sheer weight of reports, reviews and inquiries was a measure of progress, race inequalities would have been consigned to historical textbooks long ago. This has not been the case, and while the pursuit of equity in opportunities and experiences for all has not yet been realised, including in the NHS, its promise still exists.

Employing 1.4 million people, the NHS workplace is a microcosm of the wider socio-political world. It is striking that just as the Black Lives Matter movement is being socialised and reflected in the workplace today, so was the predominant silence on these matters in the years and decades that pre-dated the most recent events.

Seventy-two years on from its birth and built on the values of compassion, dignity and respect, the NHS is still perhaps the most prevailing and visible expression of social justice in UK society. And yet, while it can contribute to a solution to the challenge, it also has further to travel on this journey.

'The effort of explaining and undoing discrimination shouldn’t fall on those most affected by it; this work must also be taken on by those who continue to benefit from it.'

In 2015, NHS England introduced the Workforce Race Equality Standard (WRES) to hold a mirror up to the NHS and to spur action. The latest WRES data report for NHS trusts shows that organisations are making progress towards equalising the core HR processes of recruitment and selection, training opportunities, and disciplinary action – and over the past five years, the number of black and minority ethnic (BME) very senior managers has increased by 30 per cent. However, further and faster action across the NHS is needed. But what should NHS organisations and leaders be doing to turbo-boost progress on the workforce race equality agenda?

Demonstrable leadership on race equality is essential – it should be given similar importance at boardroom discussions as are matters on patient safety and organisational efficiency. Race equality is integral to every facet of an organisation and its functioning – it is not a distinct or unrelated area. There is also work needed to turbo-boost representation of ethnic minority groups at leadership levels. For an NHS that loves targets, the WRES Model Employer strategy presents local NHS organisations with exactly that; but knowing what is needed is no longer enough; organisations must act to make a difference, that is the goal.

Accountability needs to be bolstered further, at both individual level (through appraisal and key performance indicators) and organisational level (through regulation and assurance). Leaders and line managers need to be held to account on evidence of actions in this area, including those relating to decisions on recruitment, progression and disciplinary action.

However, people and organisations need to focus on this agenda because they want to, and not just because they must as a consequence of regulation and assurance. That is why I believe cultural transformation is critical, so that supported and engaged staff can thrive and are better able to provide the compassionate, high-quality care that patients need and deserve.

A first step here is for there to be open and honest conversations, and the sharing of lived experiences between all staff. And yet, conversations on race frequently begin with expecting people from minority ethnic groups to open up and share how racism and discrimination affects them, without other participants being willing to share an equivalent level of vulnerability and self-disclosure. The effort of explaining and undoing discrimination shouldn’t fall on those most affected by it; this work must also be taken on by those who continue to benefit from it. The WRES team is collaborating with The King’s Fund in delivering an ‘action learning set’ programme for all NHS chief executives – from both providers and clinical commissioning groups – in London, focusing on exactly that.

'Covid-19 has shone the brightest of lights on the inequalities in UK society: in communities and workplaces, and yes, within the health service. '

The emerging health and care architecture has an important role to play in helping the NHS to progress on the above. Regional structures and integrated care systems are uniquely positioned to support the WRES programme by facilitating the sharing of expertise and replicable good practice; providing accountability and assurance; and bringing together local innovation and common opportunities for improvement. The NHS Race and Health Observatory – a new and independent centre that will be hosted by the NHS Confederation will also drive improvement on race equality across all parts of the system, and for the diverse communities that use the NHS.

Covid-19 has shone the brightest of lights on the inequalities in UK society: in communities and workplaces, and yes, within the health service. And while the NHS is making some progress on closing race inequality gaps within the service, to be proud of the health service, is not to be blind to its imperfections. Inequalities need to be addressed, not just by words, but by deeds and actions.

This needs to be the watershed moment for change; those who work in the NHS and with the NHS must not let the focus on meaningful and sustained action become a historical footnote.

Tackling workforce race inequalities

Our new report explores how three NHS provider organisations have sought to address workforce race inequalities and develop positive and inclusive working environments.

Find out more

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