Leaders must get to grips with equality if the NHS is to reflect the needs of a fast-changing population. We look at some of the tools available to help employers recruit a representative workforce

The NHS in England is currently facing huge challenges. There is the £20bn productivity target, huge pressures facing the social care system and the need to keep on driving up quality and healthcare outcomes. At the same time the health service is moving towards a model of clinically led commissioning that is radically reshaping the healthcare landscape.

During this period of rapid change and transition, it is critical that workforce leaders engage with equality, diversity and inclusion.

From 2001 to 2005, ethnic minorities accounted for over four fifths of the growth in the working-age population in England. By 2008 the number of disabled people had risen to 10.8 million – around 20 per cent of the population. We also have an ageing workforce - currently 17.2 per cent of the population is aged 65 and over and this is set to rise to 24 per cent by 2051. The demographic of the UK’s population is evolving at pace and workforce leaders will need to ensure that their organisations and services adequately reflect its needs.

“Workforce leaders must get to grips with equality,” explains Carol Baxter, head of equality, diversity and human rights at NHS Employers. “We have legal obligations and what’s more there is a clear cut business case for equality and diversity that is perhaps more pertinent today than it has ever been – the structure of the NHS is changing and so are the demographics of the communities that we serve”.

The case for equality

That clear cut business case is backed up by research. For example, evidence shows that people who have personal experience of mental health issues are better at delivering services to people with mental health problems because they have a deeper level of empathy and understanding. This can lead to more productive organisations. “A diverse workforce is better equipped to achieve positive outcomes for patients,” explains Professor Baxter.

“Staff morale is highest when talent is able to flourish free from discrimination and there is equitable access to education, training and development opportunities. It cannot be disputed that low morale ultimately leads to poor outcomes for patients,” says Professor Baxter. “Staff need to feel engaged in making the NHS the best that it can be. Ensuring all members of staff are valued and feel appreciated will ultimately cost the NHS less and help us to deliver more. Where staff engagement is high, Care Quality Commission annual health check scores are higher, patient satisfaction is higher and mortality rates are lower and let’s be frank, it’s the right thing to do.”

From a staff perspective, there is a correlation between staff morale and patient satisfaction. Aston University analysed links between the 2007 acute trust inpatient and NHS staff surveys and found that patient satisfaction was highest where there were fewer reported incidents of workplace discrimination. The lower the proportion of staff from black and ethnic minority backgrounds who reported experiencing discrimination, the higher the level of patient satisfaction. And patients were more likely to say that they had trust and confidence in the nursing staff.

New obligations

The Equality Act 2010 means that a new legal framework now underpins all of this is, and public bodies, including the NHS, will need to meet their responsibilities in order to mitigate the risk of legal action. The act came into effect in October 2010 and placed a general duty on the NHS to eliminate unlawful discrimination and harassment; advance equal opportunity; and foster good relations between different groups. This involves publishing equality information annually, which trusts did for the first time on 31 January 2012.

The NHS has invested resources in two important programmes to help address current priorities around equality and diversity: the Equality Delivery System and the Personal, Fair and Diverse champions campaign.

The Equality Delivery System is designed as a tool to “help the NHS improve its equality performance for patients, communities and staff”, for example by supporting commissioners to identify local needs and priorities then shape services around them. The tool enables organisations to assess how well embedded equality, diversity and human rights are within their systems and processes, and to identify future priorities for action. 

“The EDS supports measurement and compliance from a strong regulatory perspective,” explains Professor Baxter. “This is really important but what is also crucial is engagement with staff from a hearts and minds perspective. That is where the Personal, Fair and Diverse champions campaign comes in.”

The Personal, Fair and Diverse champions campaign aims to create a vibrant network of champions who are committed to taking some action, however small, to help create a fairer more inclusive NHS for patients and for staff. More than 500 champions joined the campaign during its first three months and, based on current sign-up rates and levels of interest, it is anticipated that up to 1,000 will have joined this growing network by April 2012. The campaign, which is led by NHS Employers on behalf of the Equality and Diversity Council, is helping NHS organisations to engage with staff around equality and diversity issues.

“The Personal, Fair and Diverse champions campaign is gathering momentum because it’s something that all staff can get involved in,” says Professor Baxter. “It isn’t about running big projects or radically shaking up the way that things are done. It’s about the little things that we can all do in our day-to-day jobs to ensure that the NHS continues to put patients at its heart and is a place where skilled people from all backgrounds will want to work.

“The campaign is an opportunity to engage with staff in a meaningful way – and to help them champion equality and fairness for patients and colleagues.”

The campaign is open to staff at all levels including managers, clinicians, administrators, technicians and support staff. Everyone can sign up on the NHS Employers website.  As part of the campaign, a twitter page has been set up and a LinkedIn group has been launched. Staff are already using these media to tell others what they are doing to champion equality in their own organisations.

Old barriers

Despite all of the good work that is going on in the NHS around equality and diversity, there is still a long way to go. “Women make up 80 per cent of the NHS workforce, yet only a small minority achieve senior leadership positions on NHS boards,” points out Professor Baxter.

She adds: “This under-representation is now being mirrored in emerging clinical commissioning groups where only 15 per cent of GP leaders are female. We must continue to ask ourselves what we are doing to address these challenges – and what we could do better. As the largest employer in Europe the NHS has a responsibility to provide leadership by attracting, retaining and progressing the most talented staff and engaging a wider range of perspectives, knowledge and expertise.”

The latest thinking on equality and diversity in the NHS will shape the agenda at two events in May, one is taking place at Dexter House, London on 22 May, and the other is at Manchester City Football on 23 May. These events are aimed at equality and diversity leads, HR practitioners and workforce leaders and will form part of the first NHS Equality, Diversity and Human Rights Week. This is a week of equality-focused activity to celebrate best practice and raise the profile of equality and diversity issues in the NHS. The theme for 2012 is “Changing behaviours, creating champions” and NHS Employers is inviting trusts to use the week as a platform to celebrate equality and diversity successes.

To attend one of these events telephone 0844 800 5987 or email eventbookings@nhsconfed.org. To find out more about NHS Equality, Diversity and Human Rights Week 2012 and how your organisation can get involved, email equalityanddiversity@nhsemployers.org