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The workforce with strength in diversity

In 2000, three community trusts merged to become East London NHS Foundation Trust, a large specialist mental health trust. Since then its remit and geographical area has expanded and it has come to reflect one of the most ethnically diverse regions of the country.

East London NHS Foundation Trust serves one of the most culturally diverse parts of the country, with half of its population made up of black and minority ethnic (BME) people and more than 100 languages spoken in the borough of Newham alone.

‘I’ve worked in London all my life, but the difference here is the extent of the diversity. It’s more mixed than anywhere else,’ says the trust’s director of nursing, Jonathan Warren, who was appointed in 2010.

East London NHS Foundation Trust director of nursing Jonathan Warren and deputy chief executive Navina Evans

Picture credit: Tim George

Formed in 2000, East London NHS Foundation Trust (ELFT) brought together mental health services from three community trusts in Tower Hamlets, Newham, The City and Hackney to become a large specialist mental health trust. Since then, its remit has broadened to encompass community health. Its geographical area has expanded beyond east London and it is spread across more than 100 sites.

Of its 5,000 or so permanent staff, around 55% come from a BME background. ‘Having such a diverse workforce means they are hugely culturally competent and confident,’ says Professor Warren. ‘That brings a strength to us. It is a joy to work here.’

High among the benefits is a better connection between patients and staff. ‘They see staff who look like them,’ he explains. ‘And I don’t just mean in terms of colour, but things like dress and age too. I’d imagine that for a Muslim woman seeing a Muslim nurse is reassuring. It is important in terms of building trust.’

Professor Warren is executive lead on equalities, but says the board sees equality as everyone’s responsibility. ‘I don’t feel alone in it,’ he says.

Recruitment

The values of caring, respect and inclusivity are placed explicitly at the heart of the trust’s approach. ‘People have to live by those values in our organisation,’ says Professor Warren. ‘That includes recruitment.’

Yet recruitment has not been without its challenges. While the latest figures show staff from Asian backgrounds are better represented in the trust’s workforce now than five years ago – up from 13% to 15.2% – there are still difficulties recruiting Muslim women, especially nursing students and unqualified staff.

ELFT has a strong relationship with nearby City University London, which recruits nursing students using the same principles. The trust also works closely with East London Business Alliance, which is trying to improve the employment prospects of local people, partly through contact with schools. ‘We are definitely making inroads now,’ says Professor Warren. ‘My view is that once you get a good supply line, things begin to take care of themselves. People tell everyone what a good place this is to work, so the message spreads.’

Diversity in action

Talk about issues openly and honestly ‘You lose credibility with your staff if you don’t,’ says ELFT’s director of nursing Jonathan Warren. ‘I’ve yet to see a trust where there isn’t a problem.’

Think about setting up staff networks ‘I’ve become a convert from not being a fan,’ says Professor Warren.’

Highlight BME staff who hold senior positions as positive examples

Bring in the expertise of other organisations, such as Stonewall ‘Their guidance has been helpful,’ says deputy chief executive Navina Evans. ‘They’ve put us in touch with other organisations that do things well but are not necessarily in the NHS.’

Another key issue is recruiting enough BME people at senior levels. Although the board is around 40% BME, there is under-representation at band 8b and above.

People say what a good place this is to work, so the message spreads

– Jonathan Warren

‘It drops off a cliff,’ says Professor Warren. ‘The first thing you do to start to tackle it, is to be honest about it. We know it’s a problem. The next question is: “What can we do to change it?”. In terms of nursing, we need to recruit good people, get them in as qualified nurses and then train the living daylights out of them. That way we get a big pond to fish from right from the start.’

‘All your experiences are valid and you can be yourself’

Neil Lad (pictured) joined East London NHS Foundation Trust as a healthcare assistant. After ten months his manager asked if he would like to train as a nurse, sponsored by the trust. He jumped at the chance and has started as a mental health nurse.

Picture credit: Tim George

‘It’s a great place to work,’ he says. ‘All your experiences are valid and you can be yourself. In other places it almost feels like Jekyll and Hyde, where you have your work personality and your home one. Here I can be me.’

The trust’s approach to diversity is one of the attractions. ‘It’s such a diverse area and there’s that same mix on the wards too, with both staff and patients,’ says Mr Lad.

‘What’s great is that if you have a patient from a culture or with beliefs that you may not have encountered before, you can always find a member of staff who will have that cultural expertise. It’s the melting pot that is east London. Here you can individualise someone’s care.’

Mr Lad believes understanding people’s backgrounds is particularly important in mental health, especially because in some cultures it can be a taboo subject. ‘Sometimes it can be seen as akin to evil spirits,’ he says.

‘On the face of it, you may think the person has delusional beliefs. But the training we have in diversity helps you to take a step back and be much more aware of their cultural background, and how that might affect their illness.’

The issue has been discussed at the trust’s BME network, which is led by Professor Warren and open to all staff. Among the suggestions to increase the number of senior BME staffwas ‘reverse mentoring’, in which junior BME staff are paired with senior managers to improve their understanding.

‘It’s a great idea and we’re going to do it,’ says Professor Warren. ‘I’m sat here at the top of the tree, but sometimes you can miss the point. I pride myself on knowing my staff, but it will be great to build a good relationship with someone who can tell me when I’m talking rubbish – you need people to do that.’

Deputy chief executive and director of operations Navina Evans leads the trust’s network for lesbian, gay, bisexual and trans (LGBT) staff. A review of all the trust’s networks was carried out around a year ago with the charity Stonewall, which advised on how the LGBT network in particular might work better.

‘In the past, networks tended to be about groups getting together and running themselves,’ explains Dr Evans. ‘In practice, that meant some were productive while others fell by the wayside. As executive leaders, we wanted to be more active in their running, but not set them up as another committee. There is a balance between being an informal network and having structure, focus and outcomes.’

Among the debates was whether someone from the LGBT community should lead the network. ‘I am an Asian woman and not LGBT,’ says Dr Evans. ‘But we took Stonewall’s advice, which was not to be too rigid, and that it was more about allies. In other words, straight people can be in an LGBT network because they are an ally.’

Tackling homophobia

Dr Evans recognises there can be intolerance of homosexuality. ‘There are staff who come from different cultures who find it difficult to feel comfortable with LGBT issues,’ she says. ‘The question is how do we help them, rather than demonise or criticise? This is one of the more subtle issues that we want to tackle.’

At the moment, all new employees receive diversity training, with other training available. This includes transgender awareness through a project reflecting the experiences of some nursing staff, who felt a lack of understanding. Staff now spend time at Charing Cross Hospital’s gender identity clinic, the largest of its type.

In 2012, the trust was one of 20 NHS organisations chosen to become part of the Stonewall health champions programme. One of the initiatives that came from this programme was ‘train the trainer’ workshops to improve understanding of the needs of LGBT people and tackle any health inequalities they face.

‘Unfortunately this is one of the areas that has not worked so well,’ admits Dr Evans. ‘Everyone who did the training was enthusiastic, but we need to make more time and build it into our training programme.’

‘Promotion is possible with hard work’

‘Last year I was one of the luckiest people in the trust,’ says Odilia Gamor, acting integrated team manager for school nursing, with responsibility for transforming and managing the school health service in Newham.

ELFT sponsored Ms Gamor (pictured) to take part in the Mary Seacole leadership programme, which is aimed at those undertaking or considering their first leadership role. She graduated in March, passing with a merit.

Picture credit: Tim George

‘It was tough,’ she says, ‘but I felt supported. I could implement what we were asked to study back at my workplace. From talking to other people on the course, some were not given time off work to do it, but I was – and that makes me feel that my trust is a good employer.’ Her line manager also attended her graduation ceremony. ‘We were told we could invite them, but some didn’t go, which is a shame,’ she says. ‘It was a proud day.’

Ms Gamor joined the trust in 2009 and was seconded to her current role in January. ‘As long as you are prepared to study and work hard, career progression is possible here,’ she says.

‘Whenever there is an opportunity for development or a secondment becomes available the information is sent to all the staff. That doesn’t happen at other trusts, where sometimes you don’t find out what was available until you meet the person doing the role. Here it’s transparent.’

Recently the board invited a young member of staffwho is gay to speak about his experiences at work and how some people might treat him. ‘There was an excellent response from the board,’ says Dr Evans. ‘With the networks, it’s always a listening exercise and there may be some things that we can do immediately that make a difference’.

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