A truly representative NHS needs more diversity among trusts’ non executive directors, reports Daloni Carlisle

In June 2009, the Government Equalities Office and Cabinet Office set new targets and an action plan to increase diversity in public appointments - including NHS non-executives.

We are not doing this because it is the politically correct thing to do - we are doing it because there is a real value in having these different perspectives around the board table

These are important, paid roles responsible for the stewardship of billions of pounds of taxpayers’ money, for services that touch people at their most vulnerable and for thousands of staff in their organisations. They should be open to as wide a range of people as possible so that boards can reflect the make-up of modern society.

As of late 2009, one of the targets has been achieved in the NHS. People from black and ethnic minorities account for just over 10 per cent of NHS non-executive directors.

In part at least, that is down to the Appointments Commission, which is responsible for recruiting and appointing non-executives.

Commission chief executive Andrea Sutcliffe has adopted a strategy of attracting as wide a range of people as possible to apply for non-executive roles. For example, she has worked with the Progressive Muslims Forum both to identify high calibre candidates and uncover the barriers to them applying. More locally, she has worked with trusts and primary care trusts to identify places they might advertise vacancies to attract a broad range of candidates.

She insists the target has been achieved without any compromise on quality of appointments.

“We absolutely will continue to appoint on merit the best people to these jobs,” she says.

“We are not doing this because it is the politically correct thing to do,” she says, “we are doing it because there is a real value in having these different perspectives around the board table.”

Delving down

Although the figures look reasonable, she adds: “If you delve down to local areas you do not necessarily get boards that reflect their local populations. Boards only have five non-executives so they are never going to represent every minority. We need to consider whether board members reflect and connect to the communities they serve.”

The question is this: how do boards move beyond the tick box? How do they avoid the danger that the BME member is seen as the representative for all BME communities and uniquely qualified to chair the equalities committee?

“I think there is a crucial role for chairs here,” says Ms Sutcliffe.

Ranjit Sondhi, chair of Heart of Birmingham Teaching PCT, and Naaz Coker, chair of St George’s Healthcare Trust in London, would both agree.

Ms Coker says: “The target should be the starting point, not the end point.”

At St George’s she set up a board level equality and human rights group that assesses all new services for their equality impact.

“I started it and used to chair it but now I have handed over to another board member - a female barrister. There is enough knowledge on the board now for me to do that,” she says.

She is moving to a focus on equality. She says: “The agenda now is to focus on who we exclude and why.”

Mr Sondhi, chair of Heart of Birmingham since 2002, points out that over 70 per cent of its population is classified BME - but even that fails to capture the richness of “super diversity”.

“We have people from new communities that are not captured in the census, such as Yemeni and Somali,” he says. “We have increasing numbers of people of mixed race. And then cutting through that are all the other categories of diversity, such as age, gender, sexual orientation and poverty.”

A board cannot be representative of such complexity and anyway, he says: “Representativeness does not mean effectiveness and understanding.”

But service delivery to such a diverse community depends on an awareness of what this means at board level.

“If it is not happening at board level, it will not happen at service delivery level,” he says.

His approach has been to recruit a wide range of non-executives who are connected to their communities.

“We have had all sorts of people,” he says. “Among the best were an 82 year old African Caribbean person and a Muslim bus driver.”

He has filtered notions of diversity and equality with a board led induction programme for all PCT staff and beyond that focused on quality.

“We try to maintain the principle that we maintain the same high quality of service to everybody, regardless of their background.”

Plans to increase diversity by 2011

Government Equalities Office/Cabinet Office public appointments targets

  • 50% to be women (33% in the NHS now)
  • 14% to be disabled people (4.5% in the NHS now)
  • 11% to be Asian, black and minority ethnic (10% in the NHS now)

Achieving diversity

  • Work with different religious and community groups to promote the role of non-executive directors
  • Think carefully before reappointing a non-executive; this is one of the main barriers identified to increasing diversity
  • Work with the Appointments Commission to develop creative campaigns to attract applicants. For example, one London trust developed a poster campaign using a well known figure