Everyone stands to gain from diversity in leadership

To improve BME staff representation at senior level, the NHS must start by ensuring all staff feel part of the conversation, a recent conference heard.

To improve BME staff representation at senior level, the NHS must start by ensuring all staff feel part of the conversation, a recent conference heard

A lack of black and minority ethnic (BME) nurses in senior positions has long been an issue for the NHS.


BME staff make up more than a third of Nursing and Midwifery Council (NMC) registrants, according to the regulator's latest annual equality and diversity report, 2015-16, yet their representation in leadership roles is significantly lower than this.

NHS Digital figures obtained exclusively by Nursing Standard last month highlight the scale of the challenge. Just 2.2% of nursing director jobs in England are filled by people who identify as of ‘black, Asian or mixed’ heritage – that’s just six individuals out of 261 chief nurse posts in England.

Reflecting communities

At an NHS Employers conference on diversity and inclusion late last month, a former nursing director of African descent reported having heard sighs from NHS board members after insisting that diversity remain an agenda item.


of nursing director jobs in England are filled by people who identify as of ‘black, Asian or mixed’ heritage

Source: NHS Digital

The London conference was attended by staff from across the NHS workforce, ranging from front-line nurses to board members and chief executives, as well as experts in workplace well-being and diversity and inclusion.

East London NHS Foundation Trust chief executive Navina Evans told the conference NHS staff cannot do their job ‘if people don’t identify with us’ – and this includes reflecting the communities they serve.

University Hospitals of Leicester NHS Trust chair Karamjit Singh said nearly 34% of his trust’s staff are BME, yet this drops to only 12% at senior management level. He added that 26% of the consultant staff are BME.

His board aims to highlight and monitor the issue via sixth-monthly diversity reports. ‘It’s an important way of reminding the organisation that this is really a key issue,’ he said.

Others at the conference pointed out that while more consultant roles may be filled by BME staff, these are often not clinical lead roles. One nurse reported that while 40-45% of consultants at her trust were BME, the proportion dropped significantly in clinical leadership roles.

Unconscious bias

Chartered Institute of Personnel and Development chief executive Peter Cheese says it is important to think about diversity across all settings, from social events to recruitment.

He says everyone in the NHS needs to consider culture and conscious and unconscious bias (when we make quick, implicit judgements influenced by our background, culture and personal experiences).


of UK registered nurses and midwives are BME

Source: Nursing and Midwifery Council

‘We are far more comfortable with people who think, behave and look like us,’ says Mr Cheese, adding this derives from the primal instinct that a person or thing that looks different is more likely to be a threat.

He warns that there is a danger that diversity will become a ‘compliance issue’, and that trusts will feel compelled to find some explanation for the figures. Conversely, it is ‘what we are going to do about it’ that matters’, he says.

The founder and chief executive of the Canadian Centre for Diversity and Inclusion, Michael Bach, told the conference that part of the problem is that diversity is put into one category and ‘Bob’, the white male in charge, in another category – but it is important to get everyone talking and acting on this issue.

‘The big problem is that Bob is running the place and if he does not feel part of the conversation then he has the ability to shut it down,’ Mr Bach says.

Mr Bach illustrated his point with images of the senior executive teams at the NHS Confederation and NHS Employers, which are largely white and male.

‘This is not about white men losing; it’s about everyone gaining,’ he says.

Open discussion

In workshop discussions, nurses reported that often when diversity is discussed, non-BME staff say nothing ‘for fear of saying the wrong thing’, making inclusion and open discussion even more elusive.


of senior managers at University Hospitals of Leicester NHS Trust are BME

Source: University Hospitals of Leicester NHS Trust

Paul Wallace, director of employer relations and reward at NHS Employers and one of the men pictured in Mr Bach’s presentation, admitted the conference had raised some uncomfortable, but vital personal experiences.

He says it is important to see what it means to walk in other people’s shoes.

‘Diversity is about making you think. This issue is not going to go away and we have a lot of work to do individually, collectively and organisationally.’

How can you improve diversity and inclusion?

Advice from Michael Bach, chief executive and founder of the Canadian Centre for Diversity and Inclusion:

  1. Mentor someone who does not look like you – and get to know them. Mentoring is a two-way process. ‘If you find yourself uncomfortable, then you’re going in the right direction.’
  2. Speak up if something is inappropriate. ‘If you hear a joke that’s inappropriate, you have to say something. It may not make you the most popular kid in school but that’s okay. You can take them aside and let them know it’s not okay.’
  3. Education, education. ‘People need to understand the differences that are around them.’
  4. Embrace the differences around you.
  5. Create inclusive messaging. Mr Bach, who has a disability, found the term ‘disabled staff’ used in an NHS England document, instead of ‘staff living with disabilities’. ‘I am not some poor pathetic person who needs your help, I am living with a disability,’ he said.
  6. Provide a safe space for discussion. Do not blame or shame. Mr Bach cites the recent example at Google, where an employee was fired for sending an anti-diversity memo. He said it would have been better if the company had provided an opportunity for the staff member to discuss their reasons for doing this, rather than dismissing them.
  7. Work together.

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