Too many white faces: let’s all challenge ourselves to address inequalities in senior NHS roles

COVID-19 has highlighted inequalities in the NHS once again – so how do we improve diversity and representation?

The NHS has more than 1.3 million employees and is the largest employer of black and minority ethnic staff in the country.

It’s incredibly sad that our ethnic minority colleagues have lost their lives in greater numbers than any other group.

Understanding and learning about racism from NHS colleagues

This disproportionate impact of COVID-19 on ethnic minority communities and colleagues shines a light on inequalities and hopefully creates a catalyst for change.

But our society still has a lot to understand, share and learn from each other – the Black Lives Matter protests against racism last summer helped highlight this.

The NHS is a microcosm of UK society and mirrors these challenges.

• RELATED: Why bias is key to stopping institutional and structural racism in healthcare and research

As a senior NHS leader who, like so many of my counterparts, happens to be a white, privileged, middle-class man, I’ve found myself asking how seriously does the NHS take equality, diversity, and health inequality?

Do white senior leaders understand the important issues and subtleties of equality and diversity?

How many of us white senior leaders can honestly look at ourselves in the mirror and say we challenge ourselves to think differently?

How many understand the important issues and subtleties of equality and diversity or try to walk in the shoes of someone who isn’t privileged?

‘Viewing leadership through an equality and diversity lens is not always a priority, nor natural behaviour, for many of my colleagues’

It’s been seven years since Roger Kline’s seminal research paper highlighted the paucity of senior ethnic minority leaders on NHS boards or in senior leadership positions.

So, in the 2020s, is the NHS making any headway in thawing the snowy peaks of senior NHS leadership and changing how leaders think and act?

Lack of minority ethnic representation in senior NHS leadership positions needs to be recognised

It’s clear from the most recent NHS Workforce Race Equality Standard data that there have been some improvements.

However, viewing leadership through an equality and diversity lens is not always a priority, nor natural behaviour, for many of my colleagues.

Several personal experiences reinforce how much further the NHS must go to develop, support or mentor staff from ethnic minority backgrounds into senior leadership roles.

Recently, I was in the trust headquarters of one of the country’s largest teaching hospitals waiting to meet the chief executive.

In front of me was a glossy ‘who’s who’ chart of the trust’s board.

Staring back at me were nine white executive directors, eight white non-executive directors and only two non-executive directors from non-white backgrounds.

• RELATED: Racism in the NHS is hiding in plain sight – and we can all do something about it

My point here isn’t a glib or politically correct one about basic numbers and ratios.

It’s about the lack of representation of internally developed minority ethnic staff into senior leadership positions from within the NHS, as opposed to non-executive directors appointed from outside the NHS.

Recruitment and promotion without scrutiny denies suitably qualified staff an opportunity

The second example is around recruitment processes and equality of opportunity afforded to all NHS staff.

In one instance, I know of a white, senior staff member in a trust that was given an additional portfolio of work and became an associate director overnight, without the job being advertised.

In financial terms, this meant an uplift from an Agenda for Change band 8c role to an 8d one.

Such a move included no consideration of equal opportunities and therefore denied any opportunity for other suitably qualified members of staff to apply.

It’s executive behaviours and human resource processes like this – happening across the NHS every week – that demonstrate that equality legislation and the aspirations of the NHS People Plan are far from making a real difference.

How to address health inequalities in recruitment processes

There are opportunities for all of us to challenge and encourage senior colleagues to think laterally and explore how we can bring equality and diversity into all our recruitment processes.

For example, recently, a senior colleague and I were looking for a senior programme manager to lead an important 12-month programme of post-COVID recovery work.

My colleague had initially identified a white, male colleague from within the existing team as a potential secondee into the role.

Through discussion we talked about the learning from COVID-19 and its effect on ethnic minority communities and staff, and the importance of addressing health inequalities within the programme.

• RELATED: Revealed: the extent of the mortality risk BAME nurses face from coronavirus

I suggested that it would be a great development opportunity for a senior manager from an ethnic minority background.

Now, we are jointly exploring how we can offer the opportunity up as a ethnic minority development fellowship.

Leadership teams need to act faster on diversity and equality issues

The NHS is finally starting to gain traction and make headway around equality and diversity issues, which is cause for celebration.

However, I would argue that awareness, progress, personal challenge and reflection around these important issues are often still too slow in some leadership teams.

In some workplaces, they are frankly inert.

My challenge is for us all to look long and hard in the mirror at ourselves as leaders and ask, ‘Have I tried walking in the shoes of someone less privileged than myself?’

---

Mike Hayward is currently deputy director of surgical recovery and reset – West Yorkshire Association of Acute Trusts