In 2014 the NHS Equality and Diversity Council announced that it had agreed action to ensure employees from black and minority ethnic (BME) backgrounds have equal access to career opportunities and receive fair treatment in the workplace. The NHS Workforce Race Equality Standard (WRES) is an obligatory system introduced in 2015. NHS commissioners and NHS healthcare providers, including independent organisations, through the NHS standard contract, are required to implement the standard. The relative experiences of BME staff, compared with the rest of each providers’ workforce, are reported using nine specific metrics. The results are then published and comparisons are made between trusts.
Kline (2014) highlighted the abysmally low representation from BME groups at senior levels of the NHS in London, particularly on trust boards. According to the most recent analysis, since 2002 the gender gap for chairs and non-executive roles has widened, ensuring the domination of male non-executives on NHS boards (NHS Confederation, 2019). The percentage of BME people in these roles by 2017 was smaller than that reported in 2002 (NHS Confederation, 2019). Our NHS is an organisation dominated by female employees and also an organisation where BME staff play key roles. This anomaly contrasts with other public sector and commercial organisations that have a smaller proportion of women and BME employees but actively support and advocate for women as well as those from BME backgrounds in applying for board and leadership roles. Only 8% of NHS chief executives and chairs are black, Asian or of other minority ethnicities (NHS Confederation, 2019).
In June 2016 the first WRES report was published, feeding back on data obtained in 2015 (NHS England, 2016), with the 2016 data published in 2017. These first reports found there had been improvements in some trusts, although a number of organisations still had much work to do. The 2018 report brought with it some slightly better news, with evidence of a trend of continued improvement in a number of areas, but there was still no room for complacency (NHS England, 2018).
NHS providers are expected to show progress against the nine indicators of workforce equality: four indicators relating to workforce data, four concerning responses from the national NHS Staff Survey questionnaire and one on the number of BME board members across the organisation. If there are any differences highlighted between the experiences of white staff and BME staff, an action plan is developed and implemented with a view to focus on continuous improvement (NHS England, 2016).
Dawson et al (2019) have undertaken an independent review of the initial evaluation that was conducted in 2018 (NHS Equality and Diversity Council, 2019). Analysis demonstrates that, with three of the nine indicators, there has been some statistically significant evidence of improvement over the 3 or 4 years since WRES data collection. Much of the data in the other indicators are not statistically significant. However there are early indicators of positive change.
The high profile of the WRES team nationally is considered to be key in establishing its acceptance within individual trusts, making it impossible for trust boards to ignore what the data produced is revealing. This is a positive outcome. However, those staff on the shop floor are generally not aware of or have no understanding of what the WRES aims to achieve—and this needs to change.