NHS workforce diversity: how to speed up the ‘glacial’ pace of progress

Can boycotting interview panels that don't have BME representation make a difference?

Can boycotting interview panels that don't have BME representation make a difference?

Caption. Picture: iStock

The most senior nurse at NHS Improvement (NHSI) says she will no longer sit on interview panels that do not include a black and minority ethnic (BME) member, in an effort to improve diversity.

NHSI executive director of nursing Ruth May’s intentions are laudable. But could this apparently simple strategy improve diversity at the highest levels of the health service?

Underrepresentation at senior level

It is well documented that career opportunities offered to BME nurses and midwives decline as they move up through the NHS Agenda for Change (AfC) bands.

Chances of getting the job

White applicants are 1.6 times more likely to be appointed than BME candidates

Source: NHS WRES

In 2017, data from the NHS Equality and Diversity Council showed BME nurses and midwives are, in general, poorly represented in the higher AfC pay bands.

Equal access to career opportunities and fair treatment in the workplace are important because studies show that a motivated, included and valued workforce promotes high-quality patient care, patient satisfaction and patient safety.

But a quarter of all BME staff in the nursing, health visiting and midwifery professions are at band 5, according to the NHS workforce race equality standard (WRES) analysis. 

Conversely, just 7% of people in the 'very senior managers' (VSMs) category are from BME backgrounds, despite them making up 18% of the NHS workforce as a whole and 12% of the population in England.

'We must ensure we support our BME colleagues to maximise their leadership potential, for the benefit of patients and colleagues'

Ruth May, NHS Improvement executive director of nursing

Figures obtained by Nursing Standard last year revealed that of 261 people in director of nursing job roles in NHS trusts and clinical commissioning groups in England, only six (2.2%) self-categorised as being of black, Asian or mixed heritage.

Widespread problem

The problem is not confined to NHS hospital or community trusts. A WRES report last year focusing on England-wide NHS bodies revealed that four of the six organisations had fewer BME staff than the national average for NHS trusts in England.

Clearly, something needs to change.

Dr May says the WRES provides clear evidence that while some progress is being made in the NHS to assist BME staff into more senior roles, there is a need to ‘accelerate the pace and momentum’ of these efforts.

Ruth May: 'NHS leaders are calling for action.'

She says: ‘As important as the national imperative is the personal one. As a nursing leader, I have made a commitment that I will no longer sit on any senior interview panels that do not have a BME member, and I encourage colleagues throughout England to consider doing the same, as this offers a much needed broader perspective on the leadership appointments process.

‘I follow in the footsteps of other NHS leaders who are vocalising the need for action. Together, we must ensure we support our BME colleagues to maximise their leadership potential, for the benefit of patients and colleagues alike, and for future generations of NHS staff.’

Dr May, whose own board has no BME representation at all, is not alone in her recent public declaration of inclusion.

‘If you are a BME person and you have a BME person on the panel, it sends an encouraging message. However, putting BME people on panels in isolation won’t make the difference needed’

Roger Kline, author of the 2014 Snowy White Peaks of the NHS report

England's outgoing chief nurse Jane Cummings says she is pleased the interview panel for her replacement will include a professional with a BME background.

1 in 5

NHS staff are from BME backgrounds

Source: NHS WRES

Professor Cummings says: 'It is important we do all we can to encourage and support BME staff into senior leadership positions and ensure interview panels include a BME representative.

'I encourage all senior leaders involved in the recruitment of staff to include BME representation, demonstrating inclusive best practice, in line with the recommendations I launched last year.'

Framework for employers

NHS England and NHS Improvement devised a framework to support the promotion of BME nurses and midwives into senior leadership positions. Published in December 2017, it includes six priorities for employers. These are best practice recommendations and are not binding on organisations.

  1. Ensure trust boards review their WRES data and know how well they are performing so they can prioritise areas such as improving the experiences of BME staff
  2. Create an improvement strategy and set targets that are understood by all staff and monitored by the board
  3. Establish development programmes, for example providing unconscious bias training, and coaching for BME staff
  4. Ensure middle manager engagement by building the improvement programme – to ensure BME staff can progress – into their objectives
  5. Review recruitment processes to ensure they are fair and reduce unconscious bias
  6. Set up a BME inclusion group that has a direct line to the board


In April this year, Birmingham Women's and Children’s NHS Foundation Trust chief executive Sarah-Jane Marsh made a similar statement on Twitter about abstaining from all-white interview panels.

I have taken the decision that I will no longer sit on any Interview Panel that does not have a BME Member.We need to end "the white wall".

— Sarah-Jane Marsh (@BWCHBoss) April 20, 2018

Her pledge attracted support and derision in equal measure; some protesting that people should be selected for panels based on merit, not skin colour, and others suggesting the strategy is a step in the right direction.

Composition of interview panels

Middlesex University business school research fellow Roger Kline has been a key figure in collecting data and evidence detailing discrimination in the NHS workforce.

Roger Kline: 'Panels need to recognise potential.'

Mr Kline is a former director of the NHS WRES (research and engagement) and wrote the influential 2014 Snowy White Peaks of the NHS report into discrimination in NHS leadership, which said some organisations showed a 'glacial' pace of change.

He explains: ‘The composition of interview panels is very important and it is a good idea to have diverse panels. There should never be an all-white male panel as 75% of NHS staff are female. 

‘If you are a BME person and you have a BME person on the panel, it sends an encouraging message and is symbolic. However, putting BME people on panels in isolation from other things won’t make the difference needed.’

Mr Kline says panels need to be conscious of the need to ensure there is a level playing field and understand that a major obstacle to progressing to senior positions for BME people and women is the lack of opportunities to prove their ability.

‘Opportunities to act up to temporary positions to lead projects that enable them to demonstrate they can act up at a high level – these posts disproportionately go to men.

Wendy Irwin: 'Too many organisations
are looking for a quick fix.'

‘Panels need to recognise what they are looking for is not past opportunities but future potential.’

Mr Kline also says panels bring all sorts of unconscious bias to the interview process.

He offers the example of an interviewee scoring system that involves the chair of the panel announcing their score first and explains that other panel members are likely to adjust their scoring in line with that of the chair.

RCN diversity and equalities coordinator Wendy Irwin says work on inclusion is crucial because the evidence is incontrovertible about the benefits it brings, including money saving, engaging staff and delivering better outcomes for patients.

Ms Irwin worries that too many organisations are looking for a quick fix and says putting a lone black person on an interview panel will not be enough to change ‘decades of poor communicating’.

‘Discrimination issues are institutional so organisations should focus on how to design out bias at every stage of the recruitment process’

Wendy Irwin, RCN diversity and equalities coordinator

14% versus 6%

The proportion of BME staff in the NHS who experience discrimination from colleagues and managers, compared to the proportion of white staff in the same situation

Source: NHS WRES

She says: ‘For a while, there were some organisations doing good work, but in recent years we have seen people stripping out equality roles, believing this work isn't important and that set back a lot of progress that could have been made quickly.

'A silver bullet doesn’t exist – this involves hard work over time. There have been many points in organisations’ histories where they have needed to take a close look at people’s experiences in the workplace and do a deep analysis of these – sadly, organisations are looking for a quick fix.

‘Discrimination issues are systemic and institutional so organisations should focus on how to design out bias at every stage of the recruitment process, from how they recruit people, to how they spot talent, to people’s experiences in the workplace.’

Ms Irwin says there needs to be a package of measures that tackle inclusion with 'candour, rigour, intelligence and resources'.

She says organisations need to think about creating change in five key areas:

  • Accountability How employers can be both transparent and held accountable for their words and measurable actions on equality and inclusion
  • Leadership Many people say this agenda has to be driven from the top, but all nurses have a responsibility to ensure inclusion
  • Metrics How we make sure that what is measured is meaningful; such as ensuring any data collected is analysed and acted on
  • Narrative Improving how we tell stories that illustrate why nurturing diversity in the NHS is important and how it benefits organisations
  • Voice Ensuring a wide cross section of voices in health and social care, reflecting diversity across race, age and sex, are heard and acted on

Ms Irwin believes that in a workforce not primarily motivated by salary, one thing organisations can control is staff experience. Without nurturing this, the NHS is in danger of losing staff – and being unable to recruit too – at a time of staffing crisis.

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