People from minorities face many obstacles in their careers. The NHS needs to view every individual fairly, says Lubna Haq

The NHS South East Coast figures on race equality made for depressing reading. They revealed the difficulties black and minority ethnic people face in getting NHS jobs and also the disproportionate number who are involved in grievances once employed. But now the strategic health authority has announced new funding for diversity and equality networking in all its organisations.

The issue of a lack of diversity in leadership and the challenges BME staff face in progressing their careers have been recognised in the health service for some time. But while the service has tried hard to tackle these issues, it would appear that not only does the problem remain but also that little progress is being made. As the survey would suggest, the blockages BME staff face may be as bad as ever.

Marginal improvements

So, what is the NHS failing to get right? So far, it has focused either on providing programmes for BME people (so, perhaps by default partly treating BME staff as the ‘problem’ that needs to be solved) or on equal opportunities and cultural awareness training for managers. The fundamental issue may be that this neither addresses the whole picture nor gets to the heart of the problem.

As a result, regardless of how much money is spent on BME development, only marginal improvements may ever be made.

Certainly, the level of investment the health service has made in programmes for BME staff has been both valuable and commendable. The focus on behavioural leadership development demonstrates a clear recognition that focusing solely on skills will not lead to either improved integration or career advancement for BME staff. These programmes have also helped people to improve their personal effectiveness and leadership impact, to navigate the complex political systems of the NHS and to recognise the importance of networking internally and externally.


However, away from the training situation and back in their own organisations, BME staff still face the same obstacles and barriers. Only now there is the added burden of having to ‘educate’ their seniors - to manage upwards while maintaining delivery of high performance within their own teams.

Getting to the heart of the problem means understanding that it is managers who need better skills in dealing with people who are different from themselves.

This is not unique to the health service, but as one of country’s largest employers and as a provider of core public services, the NHS has an obligation to do better.

The nettle that has not yet been grasped is to go beyond giving managers ‘cultural competence’ and equality legislation training, and to recognise they need targeted help to understand and empathise with BME staff as individuals.

Individuals bring perceptions and approaches that are defined by their experiences and BME people in British society need to operate successfully in a work culture that at times is very different from other cultures. Valuing and understanding those differences is the key to solving this problem.

This is more than cultural awareness - it has at its core an element of emotional intelligence and in particular gaining empathy and understanding of others’ experiences and perceptions.

Managers’ failures

Research shows that some of the major issues BME staff face may be attributed to the behaviour of their managers.

Many BME staff end up in grievance or disciplinary procedures as a result of their managers’ failure to address and discuss performance issues early on in an informal and ongoing manner. The usual stages of escalation are missed, giving rise to rapidly entrenched positions on both sides.

Looking forward, the health service needs to address this issue by taking a whole system approach, focusing on four key areas.

Continue to support BME staff The behavioural development programmes currently being run have had a good impact at the individual level and are an important part of the solution.

The approach for BME staff should not be focused on skills deficits but on providing help to develop and navigate through the complex environment they face. Development needs to be tailored at different levels and not only focused on senior managers aspiring to board roles. If it fails to recognise this, the NHS will not develop the deeper pipeline of talented BME leaders it needs for the future.

Give non-BME managers the skills to deal with people different from themselves Sending managers on equality legislation training has its place, but it will not help them empathise with BME staff as individuals. Achieving this will require focused leadership development that addresses how to get past the perceptions people have of unfamiliar groups, and how to value and understand those differences in order to get the best out of the whole team’s potential.

In order to ensure this positive leadership intervention makes a real difference, it needs to happen at all levels of the organisation, from supervisors upwards.

Dealing with this at the grass roots level of leadership will help to address issues of stereotyping, recognising and ensuring that they are not perpetuating ‘in and out’ groups or promoting self-limiting behaviours among BME staff.

Most importantly, it would focus all managers on dealing with issues of performance in a balanced and supportive way.

Skill up your managers to manage performancePerformance management and giving development feedback is never easy. It is even harder for white managers who do not understand the BME staff they manage, or who are scared of being accused of racism.

A lack of constructive feedback throughout their careers has resulted in many middle and senior BME staff being at a disadvantage to white peers who have had continuous coaching and feedback as they move up the ladder. This means many development issues are left until it is too late. The NHS needs to support managers in the constructive and empathetic development of all staff and especially BME employees.

Model behaviour at the top Finally, individual boards need to demonstrate clear and indisputable role modelling of good diversity practice. They should take part in behavioural leadership training, which, although it may be uncomfortable for some, will help them to progress BME staff within their own organisations.

The service has made great efforts to address the leadership capabilities of BME leaders - particularly those nearing board level roles. But it has not yet consistently attempted to address the issue of changing NHS culture to be more open for BME staff to progress. To do this, managers and supervisors need to be confident to recognise and acknowledge the needs of BME staff as individuals, whatever their cultural backgrounds, and to manage their performance and development as fairly as everyone else. l