Race equality in the NHS: a plan for progress
The second report of the Workforce Race Equality Standard has found signs of improvement in some trusts, while others have a long way to go. What is clear now is what works honest assessment, strong senior leadership and tailored support for individuals
Two years ago it became compulsory for NHS organisations to show how they are addressing race equality for their staff. With the aim of closing the gap between the experiences of black and white staff, the Workforce Race Equality Standard (WRES) mandates employers to chart their progress on issues such as bullying and harassment, gaining promotion, training opportunities and black and minority ethnic (BME) representation on trust boards.
But is it making a difference? Whats measured matters, says NHS England's WRES implementation programme director Yvonne Coghill....
The second report of the Workforce Race Equality Standard has found signs of improvement in some trusts, while others have a long way to go. What is clear now is what works – honest assessment, strong senior leadership and tailored support for individuals
Two years ago it became compulsory for NHS organisations to show how they are addressing race equality for their staff.
With the aim of closing the gap between the experiences of black and white staff, the Workforce Race Equality Standard (WRES) mandates employers to chart their progress on issues such as bullying and harassment, gaining promotion, training opportunities and black and minority ethnic (BME) representation on trust boards.
But is it making a difference? ‘What’s measured matters,’ says NHS England's WRES implementation programme director Yvonne Coghill. ‘WRES is a tool to get organisations thinking about race equality. If you pull together data that shows black staff get a worse deal than white, then the theory is you’ll ask why, what’s different and what do we need to do to make the NHS fair and equitable.’
Published in April, the second WRES data report for NHS trusts is more comprehensive than the first, and the picture it paints is far from rosy. Among the key findings are that BME staff are significantly more likely to face disciplinary action than white colleagues. They are also less likely than white staff to believe their trust provides equal opportunities for career progression.
Behaviours and beliefs
Meanwhile, BME representation at executive board and senior management level remains significantly lower – despite almost one in five NHS employees having a BME background.
One ray of sunshine is that the number of BME nurses at bands 6 to 9 rose by 4,187 between 2014 and 2016. For Ms Coghill, this improvement shows different initiatives paying dividends, including targeted leadership programmes and the chief nursing officer’s BME advisory group. ‘There were things happening in the system beforehand,’ she says. ‘But without WRES we wouldn’t be able to promote this good news.’
Ms Coghill is the first to acknowledge that making progress overall is difficult. ‘We’ve done a fantastic job of raising awareness of this issue in the NHS,’ she says. ‘Changing behaviours, beliefs and attitudes is another story altogether.’
Keen to put theory into practice, she has been working closely with Sheffield Teaching Hospitals NHS Foundation Trust, one of the largest in the country, employing around 16,000 people. ‘Sheffield has all the issues that every organisation has,’ says Ms Coghill. ‘I want people to see that if we can do it here, they can do it too.’
Among the many lessons she has learned is that senior staff need to be involved for sustained progress to be made. ‘It needs someone to drive it continuously at a level that will make it move,’ says Ms Coghill. ‘What we have at the moment are lots of equality and diversity leads who are at bands 6 and 7. They have to go through another three or four levels to reach the top. And sometimes that means the messages get changed, because people don’t want the board to hear bad news. Here I’m working at executive level, so I can say to senior leaders: this isn’t working, can we do this instead?’
Later this year she hopes to launch the first training programme to develop 75 diversity ‘champions’, who are likely to be a mix of clinical and non-clinical staff, based in trusts and helping to spread best practice. ‘The most important thing is that they have a passion for equality and want to make a difference around this complex agenda,’ says Ms Coghill.
Talent not used
For the RCN, the report’s findings are worrying. ‘This further evidence about the nature of discriminatory practices in the workplace only adds to our level of concern about the future of nursing,’ says RCN equalities lead Wendy Irwin. ‘Organisations are not using the talent that they have. That’s unsustainable, uneconomic and fundamentally unfair.’
She believes an evidential tipping point has been reached. ‘It now requires a clear response on behalf of employers to tackle this issue properly,’ says Ms Irwin. She cites several approaches that create change, including leadership ‘from boards to wards’, holding people accountable, and an intelligent and coherent narrative. ‘This isn’t about benefits for one group at the expense of another,’ says Ms Irwin. ‘It’s about saying that if we deal with these issues there are better outcomes for everyone, including patients.’
‘We need to admit that what’s happened in the past and our ways of thinking have not necessarily been useful, successful or sustainable in tackling long-term systemic issues. Let’s have a real focus on reducing and eventually eliminating these patterns.’
‘We’re brave enough to lift the lid on problems’
In 2015, Bradford Teaching Hospitals NHS Foundation Trust set a ten-year target to achieve a workforce reflecting its local working age population, which was 35% BME. At the time its workforce was just 25% BME.
‘From our current trajectory, it looks like we’ll exceed that target by around 5%, heading towards 40% BME overall,’ says the trust’s head of equality and diversity Lorraine Cameron. ‘We’re really encouraged by that.’
It’s that commitment to achieving equality and diversity that attracted the trust's new chief nurse, Karen Dawber, to join the trust last August. ‘Bradford was held up as a place that was actively making a stand – and that’s very close to my heart,’ says Ms Dawber, who previously worked for nine years as a nursing director in three foundation trusts. ‘My view is how can you possibly provide excellent healthcare if you don’t fully understand your population, and your workforce doesn’t reflect it?’
Shortly after coming into her post she agreed to carry out a detailed independent survey of nursing and midwifery staff, who form the largest cohort in the trust. It has just concluded and has received more than 500 responses – equivalent to just over 30% of applicable staff. ‘The analysis is still taking place but the findings show different experiences of continuing professional development (CPD) between BME and white staff,’ says Ms Cameron. ‘Now we know that more work needs to be done around the numbers of BME nursing staff accessing opportunities.’
Gathering robust evidence is vital, Ms Cameron believes. ‘Often the experts are forced to talk in anecdotes because they don’t have the raw data,’ she says. ‘What comes out of this survey may not be glowing in terms of our organisation. But we’re prepared to challenge ourselves and find out exactly what’s going on. As we can see from the WRES report, our problems aren’t unique – but we’re brave enough to lift the lid. There may be hard lessons and uncomfortable truths, but we’re honest and we say we know there’s a problem but we want to do something.’
Ms Dawber agrees: ‘As healthcare professionals we’re wired to like facts and figures,' she says. 'So when someone shows you an independent research study that concludes people are treated differently because of the colour of their skin, there’s not a lot you can argue with. Anecdotes and softer data can help drive the message home and bring it to life.’
She has spent the past few months on her own fact-finding mission, talking to experts in the field to find out what delivers change. It seems that leadership courses may not have much impact. ‘But what does seem to work is talent-spotting in your organisation,’ says Ms Dawber.
Once staff are identified, individual support can be provided, including one-to-one mentoring for those who have been unsuccessful at gaining promotions. ‘It’s really to understand how they can develop or come across better at interviews, so they can get into these posts,’ she says.
The trust’s board has now increased its BME membership to three, from one in 2014. ‘They are all high-profile people in Bradford,’ says Ms Dawber. ‘They bring their expert knowledge of harder-to-reach communities. For me, it sends a clear message that we are serious about this. It’s opened my eyes to seeing things from different perspectives. We’re seen as a more equal place to come, either as a member of staff or a patient.’
For the first time, during Ramadan, the month in which Muslims fast during daylight hours, the trust will provide dried dates at strategic locations. The aim is to provide a snack when it’s not convenient for people to have a full meal at the time they can break their fast. ‘It also makes people more aware of Ramadan and that we understand and are supportive,’ says Ms Dawber.
She believes small steps such as this can make a difference. ‘You can do the big bang stuff and make bold statements,’ says Ms Dawber. ‘But if you’re going to change behaviours and how people think, then it’s drip, drip, until it becomes part of daily life.’
How to create sustainable change
- Be unflinching. ‘If you’re honest about the problems you have, you will be forgiven as long as you have a plan to change it,’ says the head of equality and diversity at Bradford Teaching Hospitals NHS Foundation Trust Lorraine Cameron.
- Stick up for your colleagues. ‘All nurses have a responsibility to support their fellow staff,’ says NHS England WRES implementation programme director Yvonne Coghill. If you see bullying and harassment, speak up. It will go a long way towards closing the gap in the experience for BME staff.’
- Be aware of unconscious bias. ‘Challenge your own views and beliefs,’ says Bradford Teaching Hospitals NHS Foundation Trust chief nurse Karen Dawber.
- Think critically. ‘We need to work out what’s going wrong that delivers these kinds of [negative] results,’ says RCN equalities lead Wendy Irwin. ‘What’s the experience we need to sculpt for our staff so they can deliver care that makes them proud? We need inclusion in the shape of what good looks like.’
Lynne Pearce is a freelance health writer
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