In support of a Race Equality Standard

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I was really pleased to read that NHS England’s Equality & Diversity Council (EDC) chaired by Simon Stevens, CEO of NHS England had agreed to consult on a proposal that would expect NHS organisations to take the race equality agenda seriously; a proposal that I believe will make a real difference for the many BME men and women working in the NHS, as well as the thousands of patients from BME backgrounds that use our services every day.

Consulting on a mandatory standard for race equality in the NHS is a very brave and courageous thing to do. It would, I imagine bring out a number of naysayers, both black and white that will come up with 100 reasons why the standard is not a good idea. I guess that is why something as controversial as this must be consulted on and people given the opportunity to comment. It would however be a real shame if the standard did not become a reality.

So why do I believe the standard is a good thing? Well, let’s be fair, we’ve tried everything else. I’ve lost count of the number of initiatives that have been tried – and failed – to increase the number of BME staff at senior levels and to improve the experiences of BME staff and ultimately BME patients in the NHS. Nothing has worked and I believe they have not worked because to all intents and purposes we are relying on the good will of people to make it work. There is an old mantra in the NHS and you hear it often and it’s, ‘what’s measured matters!’

We know the number of senior leaders from BME backgrounds is down on numbers compared to 10 years ago. Simon Stevens himself commented on the fact that the situation as far as race is concerned is worse now than when he left the NHS to go to the US 10 years ago. Surely in 2014, with 48% of the population in London being from BME backgrounds and not having even one CEO from a BME background has to raise eyebrows. When you dig a little deeper, the evidence is that there are very few executive directors and a handful of BME staff at band 9 (The Snowy White Peaks of the NHS, Roger Kline)

I have written a lot about Race Equality in my blogs and have been trying, along with colleagues, to influence, cajole and persuade people to change their attitudes and behaviours with regards to race equality from the side lines for many years; the fact of the matter is that no amount of persuasion that it’s the right thing, a good thing, has led to improvements for BME staff. The facts are that the NHS has 1.4 million people working in it, nearly 19% are from BME backgrounds and currently there is only 1 substantive CEO from a BME background in the whole of England. There are very few executive directors of nursing; one or two at best. Less than 3% of medical directors are from BME backgrounds, yet over 40% of hospital doctors are from BME backgrounds. Surely that cannot be seen as right, fair or appropriate, particularly if – as we all say we do – believe in the NHS constitution and want a fully inclusive and successful NHS.

The evidence shows that BME people are less likely to be recruited to posts, more likely to be disciplined, more likely to bullied and harassed, less likely to be promoted, less likely to be offered development opportunities and generally have a worse experience in the NHS than their white counterparts. This has a profound and lasting impact on people’s self-esteem, their motivation and not to mention their health.

Fairness aside, the evidence we have accumulated over the last few years on the impact that a lack of engagement has on staff generally and how that lack of engagement and motivation impacts on patient care and patient satisfaction is overwhelming:

Professor Michael West and his colleague Jeremy Dawson highlight in their work that an engaged and cared for workforce cares.

Surely, everyone has a right to be encouraged and enabled to be the best they can be at work, to feel valued and appreciated, encouraged and supported; to feel that what they have to offer is of worth.

I don’t think Simon Stevens or the EDC were being kind or benevolent to BME people in seeking to implement a race equality standard. I believe they have looked at the data, the facts and evidence and decided that the present situation is untenable, that in order to have an NHS that delivers for all members of our population, we can no longer rely on the good will of a few kind souls having brave conversations about race and everyone agreeing how terrible the situation is then doing nothing practical or proactive to change the situation.

In every document you read about making a difference, it highlights the importance of commitment from the top, well here we have it. We need commitment, not just from the top and a few well-meaning individuals but of the many. The NHS is littered with the many failed initiatives on race, Race for Health, Delivering Race Equality, LREAP and the EDS, all of which have been discretionary. None have achieved the changes that are on the scale needed to make a difference to patients and staff. It’s time to try something different, something we have not tried before.

The late great, Martin Luther King in his address to colleagues in Newcastle when he was accepting his honorary degree in 1967 said, ‘Morality cannot be legislated but behavior can be regulated.’ He also said, ‘The law cannot change the heart but it can restrain the heartless’ Amazing that in 2014, 47 years after MLK made his speech it is as relevant today as it was then. We need the Standard to help people to start to change their behaviours with regards to working with race and difference.

The NHS prides itself on being evidence based. Well let’s look at the evidence that has made Simon Stevens and the EDC support a race equality standard. To be clear, the standard isn’t about punishing people or beating them up for what they haven’t done, it’s more about helping people to be better at working with difference and appreciating and valuing the diversity in their workforce. The standard is not about quotas or positive discrimination, this often being the charge, levelled at any change that can potentially make a significant and positive difference for people of colour in the NHS. The standard does not require organisations to recruit vast numbers of unqualified and inexperienced BME staff to board level. It expects organisations to take note of the quality, skills, expertise and professionalism of its entire workforce and act accordingly, something the best performing organisations are doing anyway.

12 thoughts on “In support of a Race Equality Standard

    1. The Equality and Diversity is showing great leadership on equality issues. Workforce race equality is an important agenda that should be tackled, as we know that previous race equality initiatives such as Breaking Through, which Yvonne Coghill herself led on, have not worked. The majority of the NHS is currently using an inclusive equality framework called the Equality Delivery System (EDS). The EDS is not a ‘race equality initiative’ as this blog states. But can be used and be adapted to include a race Standard within it. As an E&D lead in a large NHS hospital trust, the last thing I want is another system or Standard when existing tools can be used.

  1. Excellent blog Yvonne. Now is the time for NHS to act. EDC to make sure there is less talk and more action. NHS has always been good at policies, mission statements and actions plans and when it comes to race equality mostly just talk the talk and don’t walk the walk. Mostly because many senior NHS leaders (Simon Stevens is probably an exception) have not understood the relation between BME staff issues and patient safety and staff well-being. NHS makes many staff mediocre. Many poor leaders at the top of many Trusts and CCGs. Leadership is dominated by few poor leaders. Many of them are not bad people but simply not good enough to be leaders. This suppresses many good clinicians from being leaders and many are not encouraged to be leaders.

    In Wigan just by focusing on value based leaders, culture, governance and robust staff and patient engagement we have transformed our Trust. We are not perfect but got 15 Awards and many quality measurements have improved. We have very open and honest culture and emotional contract with our staff. 45% of our medical leaders are BME which reflects ethnicity of our consultants and we did not appoint them to show our values but they are the right leaders to uphold our values. Our staff told us who will be good leaders and now they are proving it. This also means 55% of our leaders are White and they are also upholding our values. Appointing right people to the right job is one of the most important job of leaders. NHS, patients and staff benefit from value based leaders but leaders and the Board must have right values. Our value is ‘put patients at the heart of everything you do and look after all our staff well. Happy staff – happy patients

  2. Great leadership from the Equality and Diversity Council. It’s good to see that focus is bein given to equality in the te NHS. A plea to the Council and to NHS England – consult thouroughly on the proposed Standard for race – we need one yes – but as an E&D lead in a hospital trust, I don’t want replication and more metrics. Build in a race Standard in the EDS and make that mandatory.

  3. Great leadership shown by the Equality and Diversity Council. We need a focus on workforce equality within the NHS and there is much learning to take from the private sector. We know that Breaking Through and other race-focused programmes failed. But as an E&D lead in a hospital trust, my plea is for thorough consultation on the proposed Race Standard. Yes we need a focus on race but we do we need yet another Standard, when we have the Equality Delivery System, which is used by most of the NHS. Why can’t we refine the EDS, place the Standard in that and mandate it? We don’t need more systems when we can make use of existing ones.

  4. The Equality and Diversity Council is showing great leadership on equality and has been doing since I’ve known about it. As a fairly new equality lead in the NHS, I welcome a push to improve workforce equality – and for this to begin with race. But why do we need yet another (race) equality tool? The NHS has seen many workforce race initiatives in the past including ‘Breaking Through’. These clearly have failed to improve the issue at a ‘system-wide’ level, otherwise we wouldn’t be where we are today, having this debate. Right now we have the EDS, which is an inclusive-equality system, and which, I believe, could be used as a vehicle to deliver on workforce race equality by adding measures within it. Do we need more systems?!

  5. What can I say well done for speaking up for BME who at all times struggle, I know that for fact, because I am living proof. as a HCA I had a go at doing the MSP through my work and the OU, but unfortunately my 4th assignment I only just pass and my tutor is now saying I should not do the final part of the course, because I will not pass, this course has been hard and there is no way I am not doing the final piece of work even if I don’t pass, but as a BME worker in the NHS when one steps out of line to the norm no support is given. But it was a good experience doing the course, but I will not be repeating it.

  6. As an E&D lead and a BME member of NHS staff, I am pleased to see the leadership that the Equality and Diversity Council continues to show. I am cautious however, that we will be asked to respond to another system / standard, when we already have the Equality Delivery System (EDS) in the NHS. Although the EDS is not a ‘race initiative’ as Yvonne Coghill states, it should / could be used to deliver on workforce race equality – where this is an issue at local level. We know that previous ‘race initiatives’ such as Breaking Through have failed – but what we need is an outcome-focused approach and not a ‘one-size fits all’ metric measurement tool.

  7. Dear Mohammed, thank you for your comments, you are absolutely right, I did lead the Breaking Through (BT) programme, I am proud and privileged to have done so.

    It was one of the best jobs I’ve had in my 37 years in the NHS as it enabled me to meet and get to know some amazingly talented, committed and professional BME staff. The programmes aims were to develop black and minority ethnic (BME) staff and support them so that they were able to progress in their careers, particularly those people wanting to be executive directors and to date, over 70% of participants that were on the BT top talent programme are now exec directors, directors or heads of, a brilliant achievement by anyone’s standards and a much higher conversion statistic than many main stream development programmes. The programme was never designed to change culture, or the attitudes, values or beliefs of the majority NHS workforce.

    I totally agree with you that the Equality and Diversity council (EDC) is showing great leadership on the issue of equality in the NHS, I also believe they are taking the bull by the horns and really tackling the thorny issue of race. Simon Stevens is setting a great example to others in the service and I applaud him for his leadership on this issue. We know that we have previously not done very well when tackling the issue of race – as an E&D lead you will know that black staff are more likely to be disciplined, more likely to be dismissed, less likely to be sent on development programmes and over their lifetime in the service less likely to earn as much as their white counterparts. Put quite simply, the situation isn’t fair.

    The EDS, whilst a useful tool and one which gets people to think, has been around for a while. It is discretionary and as such, might or might not be used, it also does not squarely focus on Race, organisations can choose to focus on other equality issues if they so wish. We know there are organisations in the NHS that have great EDS data, so can tick all the boxes but are some of the most challenged in terms of how their BME staff are treated (fact). I believe success will come from many directions and through a plethora of activity, however we need to focus people’s minds on the issue of race particularly. Why? Because there is a strong and undeniable evidence base that staff that feel included, part of something, staff that feel valued and appreciated are motivated to give high quality patient care and deliver a first class service to our increasingly diverse population. I genuinely believe the race equality standard will go someway to doing exactly that.

    1. Yvonne, you say on your reply: “…we need to focus people’s minds on the issue of race particularly. Why? Because there is a strong and undeniable evidence base that staff that feel included, part of something, staff that feel valued and appreciated are motivated to give high quality patient care and deliver a first class service to our increasingly diverse population”
      But Yvonne, shouldn’t female staff, lesbian, gay staff etc. feel included, part of something, valued and appreciated too? Why take such an exclusive approach? Surely this must be about making things better for all groups – no one is immune from discrimination, so why move away from the inclusive approach of the Equality Act?