This month my Chief People Officer and I brought a staff story to our Trust board. It detailed how a nurse felt victim to racism and bullying and the consequences this had had. The story had a significant impact on the board as a whole and wider Trust, and resulted in a desire for assurance around the actions that we had committed to deliver to improve to our Workforce Race Equality Standards (WRES) results. According NHS England (NHSE) (2021), although improvements have been made to race equality, no single organisation is doing everything well. There are pockets of good practice across all WRES indicators, but no single organisation is exemplary.
Ford (2021) reflected that the pandemic has provided an unexpected opportunity to accelerate action to improve progress on equality, diversity and inclusion in health and social care. He felt ‘quite positive, as influential nursing figures had told us they believed some progress had recently been made for minority ethnic staff, though they called for an upping in momentum’.
The WRES programme was established in 2015. It requires organisations to report against nine indicators of race equality and supports continuous improvement through action planning to tackle the root causes of discrimination. The NHSE (2021) report detailing the 2020 results does show some improvements, however, there continues to be disparities continue for black and minority ethnic staff compared with their white colleagues.
The NHSE (2021) findings on the WRES 2020 are impossible to separate from the context within which the report is published. The country and the NHS have been hugely challenged by the COVID-19 pandemic, a disease that has been shown to disproportionately affect black and minority ethnic people (BME). The murder of George Floyd in the USA spurred a global conversation about race inequality, and the recent racial abuse following the Euro 2020 football tournament shocked the country and put race equality at the top of the national news agenda, reaching and a much wider younger population who responded.
With 5 years of data collected against several indicators, the NHS is now able to better track progress and identify where more needs to be done. Although the NHSE (2021) report presents some positive data for 2020, I would argue that some are marginal gains and more needs to be done to make improvements. The report states that:
- 6.8% of very senior managers in NHS trusts are from a BME background (5.4% in 2016)
- 10% of all trust board members are from a BME background (7.0% in 2017)
- The relative likelihood of BME staff entering the disciplinary process is at the lowest level since this data collection began
- The relative likelihood of BME staff accessing non-mandatory training is at the lowest level since data collection began.
Key lessons
Sam Roger, NHS England and NHS improvement strategy and policy lead for the WRES (Roger, 2020), set out four key lessons to help make improvements:
- Appreciate the scale of the challenge and the evidence base that exists globally, that people from BME backgrounds living in white majority countries, such as the USA, UK, Canada, Australia and New Zealand, have poorer life chances and experiences compared to their white counterparts
- What works. Rogers highlights a set of fundamental principles that focus on demonstrating compassionate leadership, with equality on everyone's agenda at all levels. However, organisational context is key. The use of continuous improvement is advocated to drive change using tools such as decision-tree checklists, consisting of a series of structured questions to guide managers on whether formal action is appropriate and post action audits where disciplinary decisions are reviewed on an annual or bi-annual basis to check for biases and systemic weaknesses
- What doesn't work (in isolation). Rogers cites interventions that fail, often because they are too short-term or based on a deficit model, where the person who is the victim of structural discrimination is the target of an intervention. Such interventions can help build momentum, but evidence suggests that, for example reverse mentoring or unconscious bias training, do not change things in isolation
- There is always more to be done. The WRES has been effective in improving representation, but it has been less effective in changing organisational cultures.
Several trusts are sharing their improvements on the NHSE website and there are some impressive results to review.
The issue is summed up for me by NHS Chief People Officer Prerana Issar, in the forward for the WRES 2020 results report: ‘We need to act now to ensure that the cumulation of events of 2020 spur us to improve both equality for our black and minority staff and the experience of patient care for all. This is within our collective gift’ (NHSE, 2021).