Is it enough?

thumb image

I am not being funny – because some of my best friends are middle aged, white men – but…have we come to this? The only choice we can make for these big system roles?

I know the Department of Health response to Francis, Patients First and Foremost, is out now and the document deserves some scrutiny and debate. There will be plenty of people putting together their thoughts and comments, and I am inclined to absorb some of those reflections before I respond. And anyway, so far I am stuck on page 12. Of the 14 senior system leaders that join Jeremy Hunt in signing up to a common statement of purpose, only one is a woman (Una O’Brien from the DH) and none as far as I know are of black or ethnic minority origin. There may be other less visible protected characteristics represented amongst the group, but diverse it isn’t.

I had a Twitter exchange with Michael White (@MichaelWhite) recently about one of his parliamentary commentaries. In it he made some snarky reference to what Theresa May was wearing and I called him on it since he wasn’t doing the same of the men (I am happy to join in with anyone on sartorial snippery but let’s be fair and do it to everyone!). He responded that we should be over that now since there were so many more women in the Commons, ‘it isn’t a question of 50;50 is it?’, he said (as if that was such a ludicrous suggestion).  Well no, I don’t think it is, but balance is a problem.

As an organisation that provides universal health care to our whole community as diverse as it is, with a staff group as diverse as it is, and based on the values enshrined in the NHS, I think we have a moral  duty to make sure we serve those diverse communities well. I also think that to do that we need our leaders to reflect those communities too.  If that isn’t enough there are very sound business reasons why diversity matters – increasing evidence about the safety of board decisions where there are diverse boards, greater sustainable performance from companies with diverse boards and so on. But in the NHS I think it matters even more.

I am not saying that the events of Mid-Staffordshire would not have happened if the board had been much more diverse…or maybe I am? As the research suggests, better decisions would probably have been made. How do we avoid group think, collusion and complicity if there is only one voice heard at these senior levels, however well intentioned that one voice is? And I am not talking about one lone black face, or a woman: singularity, I think, often leads to greater compliance rather than difference. I am talking about  genuinely diverse boards, with different histories, different backgrounds and different perspectives. Voices who all share power, authority and respect. A room where no one voice is privileged over another. Where genuine dissent and difference is valued and recognised, not sidelined or undermined. I think that is why diversity matters in our NHS.

So imagine a room with Jeremy Hunt and the 14 signatories all gathered together to discuss what we can do differently that might make the difference to our NHS.  There are some really fabulous people amongst those 14; deeply thoughtful, intelligent, informed, with a passion for the NHS. All I am asking is…is that enough?