Diversity in the NHS!


The UK is becoming increasingly diverse. Diversity can be defined as “the state or quality of being different or varied”.

The case for the need to develop a more diverse NHS has been made. Roger Kline’s ‘Snowy White Peaks of the NHS survey of discrimination in governance and leadership and the potential impact on patient care in London and England’ report in 2014 raised public awareness of the scale of the issue. The researcher highlighted the ethnic backgrounds of senior NHS leaders. The results were staggering and in summary are that the black and minority ethnic (BME) population is largely excluded from senior positions, both as NHS managers and as NHS Trust board members.

The challenge for NHS leaders is clear – change is needed and it is required now. It is unacceptable in 2016 for the NHS to appear to be out of touch with the call for embracing diversity. As the UK has increasingly become more diverse year after year, it is somewhat disheartening that there is continued over-representation of black and minority ethnic (BME) staff at lower pay bands and a lack of BME representation at higher pay bands.

The emphasis should now move on to a solution-focused approach and less so on the issues that caused it in the first place. We are where we are! How are we going to make demonstrable improvements in the drive for an NHS that best represents and looks like the population it serves?

Some would ask, does it matter that there is under-representation of BME staff at senior levels in the NHS? I say, it certainly does matter and here’s why.

NHS England has highlighted that research strongly suggests that less favourable treatment of Black and Minority Ethnic staff in the NHS through poorer treatment or opportunities has significant impact on the efficient and effective running of the NHS.
Some of the key benefits of diversity in the NHS as highlighted by research include:

  • Ethnicity bias adversely affects the likelihood of the best people being appointed which means that patient care is not as good as it could be.
  • There is a strong correlation between how staff are treated and higher staff turnover and absenteeism, higher mortality rates and lower patient satisfaction.
  • Discrimination makes people ill which can mean NHS staff members have to take sick leave or can’t work to their full capacity and use health services as patients – further cost to the health service.
  • BME staff are also more likely to be bullied at work. Bullying impacts on whether staff report concerns and work in effective teams, also impacting adversely on patient safety.
  • Organisations which have a diverse leadership are more successful and innovative than those that do not.
  • Diverse leadership teams are likely to be more innovative, an important consideration for the NHS.
  • Organisations that don’t reflect local communities in their own leadership may fail to be sensitive to local health needs, including those linked to reducing health inequalities linked to ethnicity.

Further information on the benefits of diversity can be found at https://www.england.nhs.uk/wp-content/uploads/2015/10/wres-nhs-board-bulletin.pdf

Action area 4 of the Department of Health Compassion in Practice Strategy focuses on Building and strengthening leadership, it reiterates the importance of having a leadership team that reflects patient and staff groups locally to ensure balance and representation.
https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf

Professor Michael West and Jeremy Dawson’s studies in particular focus a lot on the experience of staff working in the NHS and the link to the patient experience of care. Here is one of Professor West’s quotes:

“The experience of BME staff is a very good barometer of the climate of respect and care for all within NHS Trusts”
(Professor M West; NHS Quality and Staff Engagement 2009)

A leading NHS Trust has recognised the need to accelerate the pace of change and has developed personal and professional development programmes for BME staff. As the largest NHS Trust in England, Barts Health NHS Trust provides healthcare services for patients in the East End of London.

Barts Health NHS Trust serves a population of over 2.5 million in one of the most ethnically diverse areas in the country. The London Boroughs of Tower Hamlets, Newham and Waltham Forest appear in the list of top ten Boroughs with highest percentage increase in census population from 2001 and 2011 (ONS, Office of National Statistics). Also, the Boroughs of Tower Hamlets and Newham are recognised as being the only two London boroughs with more people who are from BME backgrounds compared to those who self-report that they are from White backgrounds.

BME staff experiences DVD:

As a nurse leader from a BME background, I have first-hand experience of working on the front line with staff from various ethnic backgrounds. I have also heard the experiences that staff from a range of BME backgrounds and at varying levels of organisation have shared over the years. It is fair to say that the staff accounts of their experiences ranges from positive to negative. It is important to acknowledge both and learn from each.

The challenge for NHS leaders going forward, is to learn from BME staff experiences of working in the NHS and take the actions required to ensure that more BME staff report positive experiences.

What do we need to do now to create a change for BME staff experiences?

NHS leaders need to explore the concept of inclusive leadership or diverse leadership in which it is everybody’s responsibility and we work towards collective leadership. Further details on collective leadership can be found here: Developing Collective Leadership for Healthcare – West et al, 2014 http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care

Thanks to Oyebanji (Banji) Adewumi, Associate Director Inclusion for her support on this post. Follow her on Twitter: @oyebanjiadewumi

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