‘We’re beating the BME bias’

When Bradford Teaching Hospitals NHS Foundation Trust discovered BME candidates for senior nursing posts had a much lower chance of being appointed than white candidates, it introduced changes to raise awareness of the unconscious causes of bias.

Three years ago, the board at Bradford Teaching Hospitals NHS Foundation Trust read an update on the recruitment chances of black and minority ethnic (BME) candidates compared with white candidates.

People agree how shocking the figures are, but then forget

– Lorraine Cameron

‘The figures were shocking,’ says the trust’s head of equality and diversity Lorraine Cameron. Evidence she had gathered showed that shortlisted BME candidates at bands 8 and 9 had a one in 17 chance of being appointed – in contrast to one in four for their white counterparts.

The findings were the catalyst for a major workforce initiative on race equality at the trust. With a staff of around 5,500, the trust provides acute, community inpatient and children’s health services to more than 500,000 residents in Bradford and its surroundings. Almost one third of the population live in areas listed among the 10% most deprived in England.

One of the first steps was to introduce mandatory training for senior managers. Two-hour briefing sessions focus on workforce and recruitment data and possible reasons for disparities. These include conscious and unconscious bias and how that might lead to unfair treatment. ‘All of us have frailties and preferences, identifying with some people who we think we would like to work with,’ says Ms Cameron.

The process highlighted the number of shortlisted BME candidates who secure an interview but then fail to turn up on the day. Ms Cameron found one such BME nurse who agreed to an in-depth discussion.

‘She was applying for a position as a matron and the interview was in early January. She told me she had decided that she didn’t want to start another year with another rejection from the NHS. I was shocked to hear that.’

From left to right: staff nurses Anisa Tariq, Camille Mitchell and Vincent Rios

Picture credit: John Houlihan

Although the nurse had reached a band 7 post in her late twenties, she had failed to progress any further despite applying for many positions over more than a decade. ‘She was always told she had just been pipped at the post,’ says Ms Cameron. ‘This was the first time she had ever been asked about her experiences.’

The nurse’s story is now used as part of the senior manager training sessions, with lessons drawn from it including how to give feedback to unsuccessful candidates. ‘We advise managers to ask whether the person wants honesty first of all,’ says Ms Cameron. ‘If they do, then be clear about the reasons they were not offered the job. Clarity is what people learn from – not being told they were nearly there.’

The majority of this training took place between April and September 2013, and statistics for the same period demonstrate tangible change – at this time BME candidates for band 8 and 9 posts had exactly the same one in four chance of being appointed as their white colleagues.

‘But that has not been sustained,’ says Ms Cameron. Figures show that the gap widened again for the same six-month period one year later. ‘I think it’s to do with memory. When you talk about the facts, people nod and agree how shocking they are – but then a few months later they forget.’

Interview process

The external advertisement of all band 8 and 9 posts is among the recent actions taken by the trust. For a trial period, Ms Cameron or an assistant director from human resources sat on every interview panel for these posts, assessing whether there were any issues that needed addressing. Nothing specific was identified, but advertisements now include an interview date to counter any perception that a post is a ‘done deal’ for an internal candidate.

The trust is considering what else it can do to regain momentum. In February, board members agreed to set a ten-year target to achieve a workforce that reflects the local working age population, which is 35% BME– currently, the trust’s figure is just below 25%.

‘As a trust board we are absolutely committed to increasing our BME workforce,’ says chief nurse Jackie Ardley.

The trust has also taken significant steps to achieve greater diversity on the board, which was entirely white. In July 2014, the trust appointed a chair from a BME background, and from Bradford, Lord Kamlesh Patel. Non-executive director job descriptions and recruitment packs were also reviewed and amended. Last autumn, advertisements for an extra two of these posts targeted those with an understanding of Bradford’s diverse population and their healthcare needs. All six shortlisted candidates were from BME backgrounds.

Ms Ardley says the trust has a ‘board to ward’ approach: ‘One of our mantras here is to grow our own leaders. It is part of a continuous improvement programme – how do we create a career ladder for our staff?’

She believes nurses in particular face considerable challenges. ‘Developing nurse leaders is a key area for everyone. To move from band 6 to 7, 7 to 8, 8 to 9 – these are big jumps. We need to give nurses the skills to be ready to step up.’

To help individuals make the transition, a new nursing leadership programme has been established. Intended for those at band 7 and above, its first cohort of six nurses will develop their skills and learn from each other.

Alongside detailed six-monthly reports about the nursing workforce, Ms Ardley meets weekly with ward sisters to talk about recruitment and retention. ‘We need to show that this is a good place to work and we value our staff.’

Although Ms Cameron and Ms Ardley readily admit that sustained progress has not come easily, statistics demonstrate that positive change is happening. In 2013 BME shortlisted applicants at every level had a one in eight chance of being appointed; a year later this had increased to one in six.

While the new Workforce Race Equality Standard introduced by NHS England earlier this year means that all NHS employers must track their performance on race equality, Bradford feels it is ahead of the pack. ‘We jumped before we were pushed,’ says Ms Cameron. ‘For us, there is no place to hide’.

Initiating change in BME recruitment

Collect evidence and monitor what is happening. ‘People cannot argue with the facts,’ says trust head of equality and diversity Lorraine Cameron.

Do not be deterred by setbacks – sustaining progress takes commitment.

Share your learning. ‘We have been approached by another trust, keen to find out what we have done and what they can learn,’ says Ms Cameron.

Give useful feedback – don’t just tell unsuccessful candidates that they came close.

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