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Yvonne Coghill: The evidence on race discrimination in the NHS can no longer be ignored

Data collected under the Workforce Race Equality Standard proved that BME staff have a worse experience in the NHS than their white colleagues. Now the standard is entering a new phase, focused on helping organisations to implement change   
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Data collected under the Workforce Race Equality Standard proved that BME staff have a worse experience in the NHS than their white colleagues. Now the standard is entering a new phase, focused on helping organisations to implement change

Black History Month 2017 will mark the anniversary of my 40th year in the NHS.

I started my nurse training at Central Middlesex Hospital (CMH) in 1977, and remember it as if it was yesterday. I arrived in London from Bristol fresh faced and enthusiastic, determined to be the best nurse ever.

The senior lecturer at the school of nursing was Mr Adigun, a proud Nigerian, and there were a lot of people from the Caribbean working at the hospital.

It wasnt until years later that I learned that many of the central London hospitals that had rejected my application had

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Data collected under the Workforce Race Equality Standard proved that BME staff have a worse experience in the NHS than their white colleagues. Now the standard is entering a new phase, focused on helping organisations to implement change

bme
Picture: Daniel Mitchell

Black History Month 2017 will mark the anniversary of my 40th year in the NHS.

I started my nurse training at Central Middlesex Hospital (CMH) in 1977, and remember it as if it was yesterday. I arrived in London from Bristol fresh faced and enthusiastic, determined to be the best nurse ever.

The senior lecturer at the school of nursing was Mr Adigun, a proud Nigerian, and there were a lot of people from the Caribbean working at the hospital.

It wasn’t until years later that I learned that many of the central London hospitals that had rejected my application had few black people training to be registered general nurses, and even fewer in senior positions.

‘I felt comfortable, and very much a part of the hospital community’

But at CMH, many ward sisters and several nursing officers were from black and minority ethnic (BME) backgrounds. Perhaps it was my youth and relative naivety, but there did not seem to be an issue with race or race inequality back then.

Living in multicultural Harlesden and working with colleagues from all over the world, maybe I just didn’t see or recognise it. I felt comfortable, and very much a part of the hospital community.

In 1986, I became a health visitor and worked at Parkside Health. Now long gone, it is part of the rich history of continuous organisational and structural change that characterises the NHS.

There were several localities within the organisation, with many managers and senior nurses from BME backgrounds. Many became friends, and still are.

Serious issues

It was only in 2004, after being seconded to the Department of Health, that I started to become fully conscious of the serious issues related to race equality in the NHS. It was here that I realised that only five NHS chief executives were from BME backgrounds, and just 12 executive directors of nursing.

In April 2015 the Workforce Race Equality Standard (WRES) was introduced to the NHS. It was the first time that race equality had been mandated and built into the NHS standard contract – a real challenge, and something that a lot of people worked incredibly hard to make happen.

It wasn’t that other protected characteristics were less important, but there was recognition that a focus on race equality was needed, and I was lucky enough to be involved in its development.

‘A motivated, included and valued workforce helps deliver high quality patient care’

The WRES was introduced to ensure employees from BME backgrounds have equal access to career opportunities and receive fair treatment in the workplace. This is important not just because it is fair and morally right, but because there is overwhelming evidence that a motivated, included and valued workforce helps deliver high quality patient care, improving patient satisfaction and safety.

The first WRES data return in 2015 showed contrasting experiences between BME staff and their white counterparts, highlighting the challenges of race equality at organisational, sector and regional levels. There were few senior nurses from BME backgrounds, which came as no surprise.

The 2016 WRES data return provided important information about the situation for BME nurses across the system. It showed an increase in the number of BME nurses between bands 6 and 9 in the NHS compared with the year before – a step in the right direction, but more work needs to be done.

Band breakdown

For nursing and midwifery staff overall, the proportion of BME staff at band 5 remained at 24%. There were small increases in the proportion of BME staff at bands 6 and above, as follows: 

  • 6.3% increase at band 6 (increase of 1,173) 
  • 7% increase at band 7 (increase of 452)  
  • 13% increase at band 8a (increase of 121) 
  • 12.4% increase at band 8b (increase of 23)

In the upper bands, the increases were smaller in terms of numbers but two were big in percentages:

  • 0% increase at band 8c (number remains at 55)
  • 54% increase at band 8d (increase of four to 11)
  • 100% increase at band 9 (increase of three to six)

‘Black History Month is designed to remind people of the contribution of black people to society’

BME nurses have been working in the NHS since its inception ­­– 70 years in 2018 – but the data shows their progress to posts at the top of organisations has been, and remains, very slow.

Black History Month is designed to remind people of the contribution of black people to society. In the NHS, there is growing recognition that engaging with all staff reaps rewards in terms of improved patient care.

Phase one of the WRES focused on helping organisations collect and submit data about the experiences of their BME and white staff. Phase two will focus on helping organisations to implement the transformational change necessary to ensure the progress we are making on race equality continues.

Fit for purpose

In 1977, when I started my nurse training, we did not have the research, information or evidence we have now on many things, not least race equality.

In 2017, we have evidence that can no longer be ignored, and the data showing that the experiences of BME staff are poorer than those of white staff is irrefutable.

The WRES is helping to make the changes we need to ensure the NHS is fit for purpose.

I have more time in the NHS behind me than I have in front of me. My wish for the service is that it takes the opportunities afforded through the WRES to make the necessary changes now.

In 40 years from now I hope that another BME nurse will look back over their career during Black History Month and say things have improved for all NHS staff, but particularly BME staff, and those changes really began in 2017.


Yvonne Coghill is director of the Workforce Race Equality Standard implementation programme at NHS England

@WRES_team

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