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The snowy white peaks of the NHS: time to end the denial

Roger Kline, 11 April 2014

See also:

Enough anti-PC jokes: women who are black, LGBT or have a disability are bullied more

Discrimination by Appointment: how black and minority ethnic applicants are disadvantaged in NHS recruitment

The Best Workplace: staff involvement to improve quality, productivity and working lives

The Duty of Care of healthcare professionals: a handbook and advice notes

Last year Public World published a report of my research on recruitment in the NHS, Discrimination by Appointment. It showed, in results similar to those of earlier surveys, that Black and Minority Ethnic (BME) staff are disadvantaged in recruitment, even after being shortlisted for posts. White shortlisted applicants were found to be 1.74 times more likely to be appointed that shortlisted BME applicants.

My latest research considers the governance and leadership of the NHS and finds remarkable under-representation of BME people at senior levels.  I examined London in great detail and then checked whether similar patterns existed nationally in NHS Trusts and in the national bodies of the NHS.

The “snowy white peaks” of the NHS finds that the BME population is largely excluded from senior management and trust board positions to a degree that is serious and systemic.

I found no evidence that NHS Boards and senior management have become more diverse in recent years, as government ministers have suggested.

The gap between the diversity of the local population and the local workforce on the one hand, and the leadership and governance of the NHS on the other, appears to be particularly serious in London. Despite 45% of the Lonodon population and 41% of the NHS workforce being from BME backgrounds:
•The proportion of London NHS Trust Board members from a BME background is 8%, an even lower number than the 9.6% reported in 2006.
• The proportion of chief executives and chairs from a BME background has decreased so much that there is currently one BME chair and (as of this month) no BME chief executive.
• Two fifths of London’s 40 NHS Trust Boards had no BME members (executive or non executive) on them at all, and most did not have both a BME executive and non-executive member.
• There has been no significant change in the proportion of BME non-executive appointments to Trust Boards in recent years.
• The proportion of senior and very senior managers who are BME has not increased since 2008, when comparable grading data was last available, and has fallen slightly in the last three years.
• The likelihood of white staff in London being senior or very senior managers is three times higher than it is for black and minority ethnic staff.

The research also found that there is not a single BME executive member on the board of any of the key national English NHS bodies, and that BME people and women are under-represented on those boards as a whole.

Research evidence suggests BME under-representation in the leadership and management of the NHS nationally and locally is likely to have adverse effects on the provision of services. It also denies the NHS the potential contribution a diverse leadership could make.

In his last interview before retiring, former NHS England Chief Executive David Nicholson said he “regrets not making more progress in increasing the number of black and minority ethnic senior NHS leaders,” and that senior NHS management was “too monocultural”.  He described the barriers to improvement as a “systemic problem”.

I hope this report will finally lead to an acceptance that things are bad and getting worse, and will prompt a radical rethink of strategy. The strategy used for the last decade has failed BME staff and their patients.

There is much talk about staff “engagement” but it is an empty vessel unless BME staff who make up one in five nurses and over a third of doctors are central to it.

We need to work together to urgently embed a new strategy on race equality for everyone’s sake.

  • Roger Kline is an Associate Consultant with Public World and Research Fellow at Middlesex University Business School. He tweets at @rogerkline.
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