The unplanned racist impact of reform

25 July, 2012 | By Alastair McLellan

The NHS is undermanaged.

The evidence demonstrates this. Sadly, however, this is an argument that is lost for the time being. In a time of austerity few are brave enough to argue for the importance of management capacity in terms of both improved efficiency and patient outcomes.

But the savage reduction in management numbers is having other unintended consequences. It is, for example, in danger of making the leadership of the NHS whiter.

NHS Commissioning Board transformation director Jim Easton has warned that black and minority ethnic staff are “at risk of being significantly disadvantaged” as the system downsizes to fit within its new economic constraints.

The board is to be commended for raising this issue and attempting to ensure a staffing mix with a representative spread of ethnic backgrounds.

This is especially important because, as board commissioning development director Dame Barbara Hakin had to effectively admit last week, there is no guarantee the leadership of clinical commissioning groups will be representative of the communities they serve.

What former NHS chief executive Lord Crisp called the “snowy peaks” of NHS leadership have long been a stain on the service’s impressive record of offering equal opportunities. The fact there was just one non-white face in the latest HSJ100 list of the most influential people in health shows the situation is not improving.

Tokenism is not the answer. But an NHS leadership cadre whose ethnic mix would not look out of place in the 1970s will struggle to develop services which are responsive to a 21st century population. A greater role for the more representative third sector would help tackle this problem while the NHS gets its act together.

Readers' comments (5)

Patrick Newman | 25-Jul-2012 8:40 pm
Has the shake out/down sizing/culling of senior managers has disproportionately affected BME staff I would have thought unlikely. There is a good ethnic representation among GP's but obviously senior NHS echelons are white dominated and would not be improved by more use of the third sector. Main worry is the BME and gender impact in terms of security and T&C's of the widespread privatisations that seem to be on the Coalitions agenda.
Unsuitable or offensive?
roger kline | 27-Jul-2012 10:41 am
Excellent article Alastair.

Thank you.

Patrick says that he thinks it is unlikely that "the shake out/down sizing/culling of senior managers has disproportionately affected BME staff ".

Why? Appointments procedures systematically (even if often unwittingly) disccriminate on the basis of race. There is plenty of evidence of that. Why wouldnt restructuring and redundancy have similar outcomes?

More pertinently what is the DoH etc going to do about it?
Unsuitable or offensive?
Cassander | 27-Jul-2012 11:33 am
I'd love to see an answer to your last question, Roger.

I'm sure there are plenty of people at the DH and throughout the NHS who understand and want to do something about racial equality, but for some reason it doesn't ever seem to get national attention.

Each round of the Staff Survey highlights significant differences in the experience of White and BME staff (disabled and non-disabled staff, too, for that matter). I'd love to know more about why BME staff report fewer opportunities for career progression and more physical violence from colleagues, yet also higher levels of job satisfaction and less pressure to work if they're ill.

There's a lot more which could be discovered from existing data - for example whether some differences can be accounted for by adjusting for the over-representation of BME staff in certain job categories, but there doesn't currently seem to be the will to go looking.
Unsuitable or offensive?
Kosta Manis | 27-Jul-2012 6:03 pm
Hypocrisy rules OK.
Racism? Unplanned?
May I refer you to HSJ100 supplement "the people with the greatest influence on health policy and the NHS?" I did spot ONE out a hundred, poor old Darzi, and look what happened to him. Ah yes, out of the hundred, there were 16 (sixteen) women. The NHS Elite have been around well before the reforms.
We, The Ethnics, run more than 50% of the NHS, but none has even been able to make it to the pantheon.

And now for the punchline. Out of the 15 members of the HSJ100 panel, 4(four) were women, and with one (probably) ethnic. Shall we blame Andrew Lansley for that too?
I ask myself, is it time for another BBC cutting edge programme?

Any chance of this been published in the HSJ printed edition. I am not holding my breath.
Unsuitable or offensive?
Anonymous | 30-Jul-2012 2:13 pm
Here is the mechanism by which this happens.

I was lucky enough to participate in the local Aspiring Directors development programme. Having completed that programme, I started secondments which were part of the programme which would give me hands on experience and, hopefully, lead to a substantive Director post.

Then "The Announcement" came. All PCT managers were to be sacked. All development stopped. Any existing Directors sat still and didn't move so they could either make sure they got a job in the new model or got a pay off.
Then clustering happened, only SUBSTANTIVE Directors and Chief Execs could apply. Then CCGs and CSSs and NCB postes started to appear. Only SUBSTANTIVE VSMs or SHA Band 9s could apply.
As a substantive 8D I have not been able to apply for any of the senior roles yet advertised.

But I am a white man. What has that got to do with equal opportunities? The point is that the make up of the cohorts going through the development programmes, both the general and those aimed at under-represented groups was considerably more diverse than existing incumbents.

The newly developed and more diverse cohorts have never been given a chance because the selection process has been based first on incumbency and only secondly on talent.

Now, I don't mind pitching for jobs on the basis of skills and ability. I am glad that the talent pool is being expanded through better inclusion of people previously excluded on the basis of their race or gender. If they are better than me and get the job, I at least get a better leadership and therefore a better NHS.

I do mind that people are being prefered to me because they were an incumbent in a job and a role that no longer exists. I have no chance to pitch a fresh offer against their "experience"

If I feel like this coming from a group that has traditionally benefitted from the old institutionally racist and sexist NHS, I can only begin to imagine how those who thought they might finally be given a fair crack at the top jobs might be feeling.
Unsuitable or offensive?