Trailblazing trust: 'We think about race in everything we do'

East London NHS Foundation Trust's honest, committed approach to equality and diversity has opened up the trust's top jobs to BME staff. But success has thrown up some surprising challenges - and there is no room for complacency.

East London NHS Foundation Trust's honest, committed approach to equality and diversity has opened the trust's top jobs to BME staff. But success has thrown up some surprising challenges - and there is no room for complacency 

ELFT chief nurse Jonathan Warren with modern matron Aileen Valydon (centre)
and chief executive Navina Evans. Picture: Tim George

In August 2016, East London NHS Foundation Trust (ELFT) became the first in the country to have a black and minority ethnic (BME) chief executive and chair, both of whom are women.

‘Race equality is something that we think about in everything we do,’ says Navina Evans, who was promoted to chief executive from director of operations and deputy chief.

‘Whether we are looking at recruitment, quality improvement, taking on new services or how we work with patients, it’s something we analyse and take a view on how to tackle. For us, it’s embedded in the practice of how we think about delivering care.’

Cultural diversity

Rated ‘outstanding’ by the Care Quality Commission in 2016, ELFT provides a range of mental health, community and forensic services. The trust covers the London boroughs of Newham, Hackney, Tower Hamlets, the City of London, Barnet, Richmond and Redbridge, as well as areas in Essex, Hertfordshire, Bedfordshire and Luton.

Of around 5,500 staff, more than half come from a BME background, while more than 64% of nursing staff are BME – probably the highest proportion in the country.

‘But that’s what you’d expect,’ says ELFT’s chief nurse and deputy chief executive Jonathan Warren. The trust serves one of the most culturally diverse parts of the UK, with half its population having a BME background and more than 100 languages spoken in the borough of Newham alone.

‘The important thing is that it’s talked about openly and not in closed-door conversations’

Jonathan Warren

Professor Warren sees the trust’s attempts to improve race equality as an evolving story, rather than something that can be fixed within a specific time frame. ‘It’s a constant drumbeat and a focus for us all,’ he says. ‘The important thing is that it’s talked about openly and not in closed-door conversations, where people feel they can’t say anything about the issues we face.’

Since the inception of the Workforce Race Equality Standard (WRES) in April 2015 (see box), the UK has voted in favour of leaving the European Union. The months following the referendum saw the highest number of race hate crimes ever recorded by regional police forces.

For Professor Warren, reporting of these tensions has presented an opportunity. ‘I’ve tried to use it to have some of the tricky and difficult conversations around race in a positive way,’ he says. ‘Inevitably, it has provided more opportunities for this to happen.’

Developing leaders

Among the issues the WRES looks at is the representation of BME staff at various bands, including senior management. To develop nurse leaders, those at senior level are encouraged to attend established leadership programmes run by the King’s Fund or the NHS Leadership Academy.

In addition, ELFT runs a variety of internal development courses, including a nursing leadership programme for each of the bands from 8a down to 3. It has been running for eight years, with several annual cohorts, and is often over-subscribed.

‘Staff love it,’ says ELFT’s director of nursing, London mental health, Lorraine Sunduza. ‘When we started, people were a bit suspicious and felt it might be too good to be true. But now the programme is very popular and people ask to go on it, with huge numbers coming forward.’

‘Opportunities are equal because the trust’s leadership is very open’

Lorraine Sunduza

Ms Sunduza joined ELFT 15 years ago as a band 6 charge nurse; her current role is band 9. ‘Speaking as a BME person, I see that opportunities are equal because the trust’s leadership is very open,’ she says. ‘I had feedback, nurturing, coaching and mentoring from all the leaders, who were accessible.

ELFT director of nursing, London mental health, Lorraine Sunduza

‘I felt that I had an equal shot. Obviously, I’ve put myself forward too, but the environment here has made it easier for me,’ she adds.

Specific initiatives for BME staff include a mentoring scheme to help staff progress into senior leadership roles. Professor Warren mentors two staff, who chose him after reading his CV. ‘One of the joys is that it’s a two-way thing,’ he says. ‘I see it as a partnership – I learn from them and vice versa.’

For Dr Evans, seeing people follow her own lead and progress within the trust is close to her heart. ‘There’s something about looking after our own. I want to see people grow up within the organisation,’ she says.

Values and vision

‘I’m acutely aware that it’s difficult to get highly skilled nursing staff with the right values and behaviours. We’re particular about our vision, expectations and how we want to relate to one another here. That’s really important to us.’

Where ELFT has struggled to make progress, is primarily in the few areas where it has faced recruitment problems, such as district nursing. ‘It’s hard to sit down and tackle issues of race equality and inclusion when you have a high vacancy rate and are using lots of bank and agency staff, rather than having a stable team,’ Dr Evans says. ‘That’s where we need to focus more attention.’

‘I want to get the best out of everyone and I know we’re not doing that yet’

Navina Evans

She believes that many of those who trained outside the UK could be an untapped resource. ‘I want to seek out those people.’

She adds: ‘How can we help them get training and qualifications to improve their skills? We’re actively trying to look at what they bring that we can help to develop. I want to get the best out of everyone and I know we’re not doing that yet.’

ELFT has put itself forward for the national pilot for the new trainee nursing associate role. ‘We know this programme will particularly attract those who don’t have the necessary academic qualifications,’ says Ms Sunduza. ‘The majority of those we’ve chosen are BME staff, and it’s also a route into some form of qualification for some of our overseas-trained BME staff.’

Investing in staff potential has created an unforeseen challenge. ‘The difficulty we face is that there are fewer opportunities the further people progress,’ says Dr Evans. ‘Those lower down can get disgruntled about career progression at the top, but they don’t want to leave our organisation. In a way, it’s a nice problem to have.’

Looking to the future, Professor Warren says: ‘We have a great pipeline of lead nurses who we’re doing a lot of work with and they’re fantastic. We want to bring them on and get them ready for when jobs become available. I want to see them in positions of influence. We have such potential here.’

Standard shines a light on issues

In April 2015, the Workforce Race Equality Standard (WRES) became part of the NHS contract, with trusts first publishing their baseline data in July that year. WRES requires NHS organisations to demonstrate progress against a number of indicators of workforce equality, including the current low levels of BME board representation.

‘WRES gives us rich information,’ says Dr Evans. ‘We use it as an internal tool, in combination with other information we collect, such as staff surveys and exit interviews. We can also learn from other organisations’ good practice.’

No glory yet

Professor Warren says the WRES ‘shines a light on the difficult issues we face’.  But he is also critical of how it can be used as a crude instrument of measurement.

‘My worry is that because it compares trusts, those in the top section can become complacent. But when the whole of the NHS is actually doing quite badly, none of us are covered in glory, even the best-performing trusts. Continuous improvement isn’t helped by league tables.’

Lynne Pearce is a freelance health journalist

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