Some green shoots amid the snowy peaks of the NHS workforce

The NHS in England is comfortably the largest employer in the country, with over 1.3 million employees. Almost one in every five NHS staff is from a black and minority ethnic (BME) background. Yet research and evidence show that the treatment and opportunities of BME staff in the workplace often do not match the values and principles that the NHS represents; a fair and equitable NHS for all.

For decades, reports like the ‘Snowy White Peaks of the NHS’, research, articles and countless commentaries have highlighted the poorer experiences of BME staff compared to their white colleagues across the NHS.

The list includes a lower likelihood of being appointed from shortlisting, and higher likelihood of experiencing bullying and harassment or facing formal disciplinary action. Opportunities for promotion and non-mandatory training are few and far between.

Staff suffer, patients suffer

It is no surprise that such challenges often lead to adverse impacts on the wellbeing of those affected. In return, this undeniably affects the quality of care received by the patients in their care. Staff that are cared for and given the opportunities and experiences that they deserve are more likely to deliver high quality care for all patients.

To help tackle and eradicate such deep-rooted issues, NHS England and the NHS Equality and Diversity Council (NHS EDC) introduced the Workforce Race Equality Standard (WRES) in 2015. This is the healthcare sector’s collective response to the undeniable evidence that ongoing action on this agenda is needed.

Since April 2015, NHS organisations are compelled to review their workforce race equality performance and to develop action plans to make continuous improvements on the challenges that face them on this agenda.

The WRES is made up of nine indicators; the first four measure staff experience over a 12-month period for harassment, bullying, or abuse from patients, relatives or the public. Another four measure workforce data, in relation to fellow colleagues, managers or team leaders and progression opportunities. Indicator nine considers BME representation on executive boards, in relation to the workforce.

Data analyses indicate that some parts of the NHS, such as the ambulance services, are working towards positive change, and while they are still a long way from ‘mission accomplished’, the numbers appear to be moving in the right direction in some areas.

Over the last two years, the WRES has held a mirror up to individual employers’ practices in supporting race equality. The latest data from NHS trusts on the nine WRES indicators, up to March 2016, were published earlier this year.

These data reports are snapshots of individual NHS trusts, geographical regions in England (North, Midlands and East, South, and London), and NHS trust sectors (acute, ambulance, community provider, and mental health and learning disability).

Data analyses indicate that some organisations and parts of the NHS, such as the ambulance services, are working towards positive change, and while they are still a long way from ‘mission accomplished’, the numbers appear to be moving in the right direction in some areas.

For example, in nursing and midwifery, which is the backbone of the health service, there is a slight but consistent increase of 4,187 in the number of BME staff in Agenda for Change Bands 6-9 in 2014-2016.

Although we cannot in good faith claim that all positive trends in this area are as a direct consequence of the WRES, it is a happy coincidence that these figures have grown during the lifetime of the WRES programme. While BME nurses and midwives in the NHS are still significantly under-represented in senior positions, the latest WRES data suggest some progress, though limited, is under way.

Vast inequalities remain

We should not get carried away with the early green shoots of hope that are appearing, because the data also shows that across the wider system, we still have figures and statistics showing vast inequalities.

Data from NHS provider trusts show that white shortlisted job applicants in England are at least 1.57 times more likely to be appointed from shortlisting than BME candidates of the same ability and qualification. When you look at the boards and senior management of organisations, neither the BME workforce ratio, nor the local BME communities served, are represented.

For every 14 white very senior managers (VSM), there is one BME equivalent per trust. This is neither reflective of the workforce nor of the populations served.

The first two years of the WRES programme focused on supporting the NHS to implement the WRES and to make continuous improvements on this agenda, including establishing the architecture for data collection and embedding the WRES within key policy levers for provider and commissioner organisations.

Organisations can now self-assess on this agenda, and are actively working towards continuous improvements. Some have embraced the challenge well; however, many organisations across the country have more progress to make.

Over the coming years, we aim to see improvements in BME workforce data and representation at senior and leadership levels across the NHS. As it stands, on average, for every 14 white very senior managers (VSM), there is one BME equivalent per trust. This is neither reflective of the workforce nor of the populations served.

We know that data, regulation and compliance can help to change behaviour. Looking ahead, we also need to focus on demonstrating how these can help to change deep-rooted cultures within NHS organisations. This is perhaps the toughest challenge we are likely to face, but achieving our aims will reinforce the visions on which the NHS is built.

Replicating good practice

We will seek to build on the initial work of sharing the narrative on this agenda, and on constructing the foundations for transformational change. There will be an increased need to support local threads of replicable good practice initiatives, as well as implementing whole-system wide approaches to the agenda.

As a starting point, we have published ‘Improving through inclusion’, a guide for organisations to develop and support staff networks for BME colleagues. It shares good practice of existing networks across the NHS.

The Next Steps on the Five Year Forward View set the goal to become a better and more inclusive employer, by making full use of the talents of its diverse workforce and communities served. NHS organisations are expected to show year-on-year improvements in closing the gaps in experience and opportunity between white and BME staff. We owe our staff and the people using NHS services nothing less.

Dr Habib Naqvi, Policy Lead - NHS Workforce Race Equality Standard

Yvonne Coghill, OBE, Director – NHS Workforce Race Equality Standard