Long term support for workforce race equality

Ever since its inception in 1948, the NHS has depended on the talents of its diverse workforce, including those from overseas.

This dependence was set early in the NHS story, as arrivals on the Empire Windrush in 1948 were among the first nurses and doctors offering care in our health service.

Now, as the NHS sets out its plan for the future of our health service we need to do more to ensure that the experiences and opportunities that black and minority ethnic (BME) staff in the NHS encounter, always correspond with the values upon which the NHS proudly stands.

This agenda is critical for several reasons: fostering diversity and inclusion in the workplace enhances an organisation’s ability to attract and retain top talent, deliver high quality patient care, improve patient satisfaction and patient safety.

The Workforce Race Equality Standard (WRES) – a dispassionate and honest assessment of how we’re doing to deliver on these objectives – supports NHS organisations to close the gaps in workplace inequalities between BME and white staff.

The latest WRES data for NHS trusts provides us with trend analyses across three years, highlighting some areas that have shown improvement and others that require further focus and support.

So, what are the headlines? Analyses of WRES data between 2016 and 2018 show continuous improvement across the range of workforce indicators:

  • In 2016, white staff were 1.57 times more likely to be recruited from shortlisting; in 2018 this has dropped to 1.45.
  • In March 2018, there were 226 BME board members across all NHS trusts, an increase of 12 since 2017.
  • In 2016, BME staff were 1.56 times more likely to enter the formal disciplinary process compared with white staff. This likelihood decreased to 1.37 times more likely in 2017 and 1.24 in 2018: a welcomed trend.

Much of this improvement can be attributed to the provision of WRES implementation support across the NHS and in the sharing of evidence-based good practice of operational interventions.

At the same time, we see that indicators related to perceptions of bullying and harassment and discrimination among BME staff have remained largely static over time. Changing deep-rooted cultures takes time: it requires patience and determination and is a marathon, not a sprint.

To pick just one example, North East London NHS Foundation Trust has shown that focusing on and improving the experience of their BME staff is having a significantly positive impact for the whole of their workforce – and the WRES data for that organisations shows exactly that.

It is increasingly clear that if you get this agenda right for BME staff, you are likely to get it right for the rest of the workforce too and, most importantly, by doing so we will improve the care we give our patients.

It is essential for organisations to focus on operational interventions as well as the transformation of deep-rooted cultures within organisations – both are two sides of the same coin.

As we move further from the ‘why’ to the ‘how’ on workforce race equality, we will share good practice from organisations where data suggest performance is continuously improving. To begin this, we recommend that organisations look at a recently published report on the journey taken by five NHS trusts in applying quality improvement (QI) methodology to the workforce race equality agenda.

So, what’s next?

As outlined in the NHS Long Term Plan, we have set an ambitious national goal: that NHS leadership should be as diverse as the rest of the workforce within ten years. The need to ensure BME representation at senior management matches that across the rest of the NHS workforce is not for political correctness; a diverse workforce at all levels will lead to better patient outcomes and increased organisational efficiency.

We know that the NHS is at its best when it reflects the diversity of the country and where the leadership of organisations reflects its workforce. In many organisations in the NHS this is not the case, and sometimes stronger focus is needed to drive improvement. This is why we have set out the strategic approach in supporting NHS organisations to reflect their workforce within their own leadership.

The next phase of the WRES programme will also be aligned to support these key elements.

Habib Naqvi

Dr Habib Naqvi has a background in equality and diversity policy, public health, and health psychology. Habib is the Policy Lead for the NHS Workforce Race Equality Standard, and is leading on the inclusion of the WRES within national policy levers.

Before joining NHS England in 2013, Habib worked on the development of national equality and diversity policy at the Department of Health, where he led on the development of the Equality Delivery System for the NHS, and took the lead for coordinating the health sector’s response to the Ministerial review of the Equality Duty.

Habib has experience in academia and research, including holding a strong portfolio of healthcare research.

Yvonne Coghill

Yvonne Coghill OBE, JP, MSc, DMS, RGN, RMN, HV, CPT, Dip Exec Coaching.

Yvonne commenced nurse training at Central Middlesex Hospital in 1977, qualified as a general nurse in 1980 and then went on to qualify in mental health nursing and health visiting. In 1986 she secured her first NHS management job and has since held a number of operational and strategic leadership posts.

In 2004, she had the unique opportunity to work at the Department of Health as Private Secretary to the Chief Executive of the NHS, Sir Nigel Crisp. In her three years at the Department, Yvonne held several strategic posts, including Programme Director for the Cleaner Hospitals Programme and External Relations Nursing Officer to the Chief Nursing Officer of England.

Yvonne is currently the Director – WRES Implementation in NHS England, and is a member of the equality and diversity council at the Institute for Healthcare Improvement (IHI) in the United States where she has helped develop their inclusion strategy, delivered workshops and was co-chair at their national forum in Orlando 2015. She has also been keynote speaker at the National Association of Health Service Executives (NAHSE) annual conference in New Orleans. She continues to work closely with world expert on health and race Professor D. Williams, of Harvard University School of Public Health.

Recently Yvonne has used her knowledge and experience of mental health to act as a commissioner on a report commissioned by the Royal college of Psychiatrists and chaired by Lord Crisp on ‘Adult mental health in patient services’ which fed into the NHS England task force review on mental health services in England.

In 2013 Yvonne was voted by colleagues in the NHS as one of the top 50 most inspirational women, one of the top 50 most inspirational nurse leaders and one of the top 50 BME pioneers, two years in a row. Yvonne was awarded an OBE for services to healthcare in 2010 and was appointed as Director for WRES Implementation in June 2015.