‘As BME people we need to put ourselves forward’

BME nurses’ achievements too often go unsung – but RCNi Nurse Awards chair Yvonne Coghill is determined to change that 

If you ever get the chance to spend a couple of hours in Yvonne Coghill’s company, take it.

Warm, whip-smart and with an energy that charms rather than overwhelms, she makes you want to think faster, do more. We meet to discuss her new role as chair of the RCNi Nurse Awards 2019 judging panel.

I know she is going to say nice things about the awards and encourage people to enter. What I’m not prepared for is the extent of her enthusiasm and her commitment to the whole idea of nursing awards. For her, the awards aren’t just a nice thing for the winners – they’re necessary.

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‘You might be sceptical about awards – until you get one,’ she says, with a smile. ‘People recognising what you have done, your work, your value, it really is very special. And if you have never had an award before it is even more wonderful – and it’s wonderful for your friends and family and for the nursing population.’

She has always been struck by the ‘phenomenal quality’ of the applicants to nurse awards. ‘The things nurses are doing, their commitment to patients and to nursing is outstanding. These nurses are so brilliant and a lot are unsung.’

A proper reflection of BME nurses’ talents

If nurses generally are ‘unsung’, there is a particularly pressing need to celebrate the achievements of black and minority ethnic (BME) nurses, who have been under-represented in previous years’ awards. Ms Coghill is determined to put that right. Her aim is to double the number of entries from, and nominations for, BME nurses.         

‘We need to say to BME people, nominate yourself, get yourself out there’

There is probably no one better placed to reach out to BME nurses. Ms Coghill has made her career in race equality and is impeccably connected with BME networks inside and outside the health service.

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As director of the workforce race equality standard (WRES) since its introduction in 2015, she leads NHS England’s programme to improve the experience of BME staff in NHS workplaces and tackle the discrimination that blocks them from senior roles.

It’s a role that brings her into direct contact with people at all levels of NHS organisations, from ward to board room. She is used to having conversations about race equality that other people find difficult, and she expects to make a difference.

Confidence to talk about race

The latest phase of the WRES is focusing on embedding change and making organisations comfortable about race.

Ms Coghill says the best-performing organisations, such as North East London Foundation Trust, have leaders who are confident talking about race.

Chief executive John Brouder has worked closely with nurse and honorary board member Wellington Makala, who chaired the trust’s award-winning ethnic minority network.

Ms Coghill says the test for NELFT will be maintaining its good performance in race equality when Mr Makala moves on.

Trusts who are lagging behind are ‘frightened of getting it wrong’, she says.

‘Race is something they worry about. I say to improve you have to know where you are and own it.’ She adds she told one NHS leader: ‘I will hold your hand and lead you through the minefield.’ As a consequence, she says, they have made progress.

She is not surprised that the WRES indicators which show what people think and feel about their workplace have been slow to improve. ‘It takes five to ten years to change culture’. For people to feel ‘safe’, she adds, they have to believe improvements in areas such as recruitment practices will last.

The impact of everyday racism

One barrier is that white managers do not appreciate how debilitating it is for BME staff to live with everyday racism, and that it can affect their performance: ‘If you are white you are living in a world that is designed for you.’

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At a recent meeting with BME nurses in London she discovered all of them knew someone whose son had been stabbed.

She says sometimes data show that white and BME staff are equally harassed by patients but the latter will be abused because of their skin colour, and that does make it harder: ‘Organisations need to understand that.’

They should also never make the mistake of treating BME staff as if they are the problem, for example, bringing in white staff to treat someone who says ‘I don’t want those black hands on my baby’. ‘There should be zero tolerance so people know that nonsense won’t be tolerated.’

When I ask her what she will bring to the RCNi Nurse Awards as chair of the judging panel, she says: ‘I think it’s very good that it’s me. Not to blow my own trumpet but I’m well known to BME people. It’s an endorsement – “Yvonne Coghill is doing this, so maybe there is an opportunity here”. We need to say to BME people, nominate yourself, get yourself out there.

‘I am absolutely determined. There are networks we need to tap into. I do a lot of public speaking and I will be sharing this with my networks and making sure they put themselves up. As BME people we need to put ourselves forward. You have to be in it to win it.’

A perception that awards are for white people

So why aren’t BME people as keen to enter awards as their white colleagues? ‘There’s a perception that at these awards it is mostly white people and even if we put ourselves up, we are not going to be the ones that win. It’s like “I’m not going to get that job, so I won’t apply”.’

She says the success of the NHS England Windrush awards, launched in 2018 to celebrate the contribution of BME people to the NHS from the 1948 Windrush arrivals to the present day, show that BME people will enter awards if they believe they have a chance of winning. She won’t hesitate to suggest how RCNi can improve its awards and increase their appeal to BME nurses: ‘I will comment on what I think can work a little bit better.’ 

Ms Coghill is the daughter of Windrush parents; her mother came to England from Guyana in 1955, the year after Yvonne was born. It was seeing her mother enjoying working as a nurse in Frenchay Hospital in Bristol that gave the young Yvonne ‘a taste’ for nursing.

‘When primary care trusts disappeared that took out a whole tier of senior BME people’

Her own early experiences in nursing were overwhelmingly positive. She trained at Central Middlesex Hospital in London, still keeps in touch with her ‘set’ (‘we met for our 40th anniversary last year’) and remembers it as ‘a great time to be a nurse, a great time to train’.

There were many black role models at Central Middlesex. It was only later it occurred to her that racism might have been a factor in her failure to land a place in some prestigious nursing schools in London.

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At the time, she was anything but crushed. ‘I thought, “I have my A Levels – what a cheek!”.’ She says it is hard to know for sure why she wasn’t accepted by those nursing schools, ‘but if you look at pictures of nurses who trained back then, I suspect there are very few who look like me’.

She points out that where people start their careers does appear to influence where they end up, with top jobs in nursing often filled by people who, decades earlier, trained in hospitals ‘that are seen as the elite’.

‘More vulnerable in their careers than white peers’

When it comes to race equality in the NHS, progress is not something that just happens naturally or consistently over time. According to NHS Digital data obtained by Nursing Standard in 2017, only 2% of nurses at the top of the NHS in England are BME.

Ms Coghill says that in 2004 there were 12 BME directors of nursing in England; now there are eight. ‘People say it has got worse because there aren’t the same number of top jobs anymore. Primary care trusts (PCTs) had lots of senior BME people. When PCTs disappeared that took out a whole tier and lots of BME nurses lost their positions.’

So even those BME nurses who break through to the top jobs are more vulnerable in their careers than their white peers? ‘Yes, when things get tough BME nurses are in a very difficult place and they lose their jobs. We know they do disproportionately badly compared to their white colleagues. We have the evidence that shows that.’

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In November, she brought together England's eight BME directors of nursing to discuss how to keep them in their jobs, or help them get to chief executive level if they want to, and enable them to help the people coming up behind them – the assistants and the deputies.

She is looking at putting together a support programme to focus specifically on this issue and prevent senior BME nurses’ careers from stalling or going backwards: ‘We have a serious pipeline problem. The peak for black nurses is band 5. We have to do some targeted work to get these nurses through.’

Bias in the system

When she raises the pipeline problem with chief executives and senior NHS leaders they sometimes suggest their hands are tied: ‘[They say] “They have to be able to do the job, Yvonne”. And I say, what are we saying? Is it that BME people are not good enough to do the job or is the system fixed so they are not able to do the job? Which do you mean?’

‘You are 1.6 times more likely to get the job if you are white than BME, across the board’

She adds that it is ‘obvious’ that the system is not conducive to BME staff progressing as they should. And it is not just the top jobs that BME people can struggle to land. ‘You are 1.6 times more likely to get the job if you are white than BME, across the board.’

Under the WRES, NHS employers are expected to show progress against equality indicators. They are not penalised if they fail but it is a formal requirement and ‘nobody wants to be at the bottom of the pile’, says Ms Coghill.

The 2017 WRES data report showed:

• A significant increase in the number of BME nurses and midwives entering senior grades – almost 2,000 appointed over the past three-year period.
• More BME members of trust boards (25 trusts have three or more BME board members, an increase of nine since 2016).
• A reduced chance of BME staff entering formal disciplinary procedures – from 1.56 times more likely than white staff in 2016 to 1.38 times in 2017.

Progress was slower against other indicators, with BME staff still more likely to be bullied. The 2018 report is out soon.

Ms Coghill says that improvements in career prospects for BME staff are not being matched by improvements in their experience in the workplace.

There may be more BME people on the board or in senior positions but ward-level nurses ‘couldn’t feel it at their level’. Their experience is more influenced by the behaviour of middle managers who are focused on daily pressures such as staffing shortages.

‘An engaged workforce is a more productive workforce – it saves lives and money, that’s my message’

‘When I speak to a middle manager she leans back and crosses her arms. They don’t see it as relevant to the work they are doing. “You want me to think about race? Get a grip!”

‘What they don’t know is that, in London particularly, BME nurses are leaving at a rate of knots and are being employed back as bank nurses, and they are doing that because they have a very poor experience.

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‘An engaged workforce is a more productive workforce – it saves lives and money, that’s my message.’

‘RCN needs to reach out to all members, not just activists’

A lack of engagement is also, she suggests, an issue for the RCN. The college has had a torrid few months, with the row over mistakes in representing England's NHS pay deal to members leading to the general secretary and council stepping down. As the RCN's new deputy president, Ms Coghill hopes to contribute to the rebuilding process.

She says the college should reach out to all its members, not just to activists. ‘We have to engage with nurses who are not engaged with the RCN in an obvious way, and that’s the majority of nurses. The RCN needs to work with all of the people and all of the talents to pick itself off the floor.’

She is particularly keen, as a recently created RCN Fellow, to listen to nurses at the start of their careers. ‘We need to hear from the youngsters to make sure what we are doing is relevant to them.’  

‘I have been incredibly lucky and I have a responsibility to use that to work for other people’

Ms Coghill knows how important it is to feel listened to, and supported by, senior leaders. She says she wouldn’t be where she is today without former NHS chief executive Lord Crisp, her longstanding mentor: ‘He has encouraged and coached me, and has never abandoned me.’  

And she is unstinting in her praise of former chief nursing officer for England Jane Cummings, who has been ‘outstanding’ in her support for WRES: ‘A lot of what we have achieved is down to her. I will miss her tremendously.’

She is herself, of course, a support to and a role model for nurses, particularly BME nurses. ‘I have been incredibly lucky and I have a responsibility to use that to work for other people.’

Having spent her career working to ensure nurses are valued and rewarded in the workplace, chairing the RCNi Awards will come naturally to Ms Coghill.  

Nurses are often reluctant to do anything that smacks of ‘showing off’. But sometimes the best thing you can do, for yourself and your profession, is shine. ‘I get very frustrated with BME nurses who hide their light under a bushel.’

RCNi Nurse Awards 2019 – click to enter or nominate   

Thelma Agnew is commissioning editor, Nursing Standard