The NHS is the largest employer of black and minority ethnic (BME) staff in the UK. 20% of nurses and 37% of doctors are from BME backgrounds. Yet at Board level and very senior management level, the NHS is often seriously unrepresentative of the workforce or the population it serves.
In London, for example, where over 40% of the workforce and population are from BME backgrounds, research established that:
• Just 1 in 40 Board chairs and no CEO in London is from a BME background
• 17 of 40 Trusts have all white Boards
• There has been a decrease in BME Board members in recent years
• There has been a decrease in the proportion of BME nurse managers in recent years despite a rise in the BME nursing workforce
Such absence or exclusion appears to be largely caused by discrimination in career development and appointment processes.
The likelihood of white staff being appointed once shortlisted compared is 1.76 times greater than the likelihood of BME staff being appointed from shortlisting. The likelihood of BME professional staff accessing non-mandatory training and continuing professional development is substantially less than for white staff. It takes much longer for BME staff to get promoted and the likelihood of BME staff being bullied and harassed by managers and colleagues is substantially greater (NHS staff survey).
Moreover, there is now robust evidence of links between the treatment and experience of BME staff, and the care patients receive.
“Research suggests that the experience of black and minority ethnic (BME) NHS staff is a good barometer of the climate of respect and care for all within the NHS.
“Put simply, if BME staff feel engaged, motivated, valued and part of a team with a sense of belonging, patients were more likely to be satisfied with the service they received”.
West, M et al,(2012).
There is equally strong evidence of the benefits of diversity for innovation in leadership teams and the NHS Leadership Academy’s definitive Healthy Board 2013 guidance makes clear the importance of having Boards that reflect local populations.
The failure to achieve race equality in the NHS, including at senior management and Board level has led to the introduction of a Workforce Race Equality Standard requiring NHS organisations to scrutinise the treatment of their own staff and their absence from leadership positions, and close the gap between the treatment of white and BME staff.
Discrimination towards ethnic minorities in recruitment processes have been documented in studies in the UK and internationally, including where matched applications on race/ethnicity or applications only differing in name show that applications from minority backgrounds are far less likely to get call-backs for interviews or offered jobs. (Pager D, Sheperd H. The Sociology of Discrimination: Racial Discrimination in Employment, Housing, Credit, and Consumer Markets. Annual Review of Sociology. 2008;34:181-209)
Another UK, study found only 39% of ethnic minority applications received positive responses from employers compared to 68% for white British applications.. (; Clark K, Drinkwater SAa. Ethnic minorities in the labour market. Bristol, UK: Joseph Rowntree Foundation, 2007.)
I have recently spoken to a number of NHS chairs and chief executives who have expressed their frustration at the failure of the established commercial executive search firms who are often engaged to recruit to board posts to address this agenda. In particular, they are concerned that even when it is clear that the population served or the existing workforce has a substantial BME population they are too often presented with all-white shortlists for board and senior management posts despite many of the fine words used by those search firms with regards to their commitment to diversity.
It would be hard to draw a direct causal link between the composition of short lists and the make-up of the search firm in question. But the shared lack of diversity in both NHS boards and the commercial search firms that support the appointments to them, does raise questions. The almost complete BME absence in the senior positions of the biggest and most established commercial search firms who work with the NHS suggest to me that these agencies may talk-the-talk, but don’t appear to walk-the-walk in their own recruitment. Check their websites for yourself as I did and you will find that most, if not all, of the big established agencies have overwhelmingly white non-executives, senior partners and senior staff. Three of the six I examined have no BME senior executives, partners or senior staff at all, and the overall picture is one of overwhelmingly white-led organisations not necessarily best equipped to help change the complexion of the NHS Boards.
If we are to change the complexion of boards and senior management, the NHS will need a determined effort that starts by recognising the scale of the challenge and uses organisations whose own practices seek to model the diversity that the NHS needs. I’m surprised that more use is not made of the NHS’s own recently established and rapidly growing NHS Executive Search team (part of the NHS Leadership Academy) who have sought to tackle this challenge and it shows in the make-up of their senior staff – and the good reports I’ve had of their work.
When Martin Hancock of NHS Executive Search says “the issue of inclusion and diversity is one which we take extremely seriously as a team when trying to address the imbalance in NHS board composition that research has highlighted,” his own team’s make up gives adds credence to the claim. A pleasant surprise: an executive search agency, made up of highly capable people of whom almost half has a BME background.
Maybe boards seeking good quality candidates might start with agencies that walk-the-walk as well as talk-the-talk on diversity, especially when one of them is already part of the NHS?
Roger Kline is the author of The Snowy White Peaks of the NHS and is a research fellow at Middlesex University.