Trawling NHS organisations' websites turned up few boards with truly diverse representation. Nicola Bullen asks why this is the case

"If we are to achieve a richer culture, rich in contrasting values, we must recognise the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place".

These are fine words from the US cultural anthropologist Margaret Mead - how could anyone disagree? But of course, it is the practice rather than the words that count. Indeed, the NHS's commitment to equality and diversity is clearly outlined in the 2000 NHS Plan. For many areas of the workforce these ideals are upheld, particularly within mid to junior pay grades, where people from diverse communities are generally very well represented.

However, this does not appear to be the case in terms of the diversity of executive and non-executive directors that make up our NHS leadership teams. While it is heartening to see gender and age well represented on the top tables, the other elements of diversity, including disability, sexuality and ethnicity, are not.

In researching this article, I spent two hours reviewing trust websites across the country, in search of good examples of diverse boards outside of London to talk to. Sadly, I simply could not find one. I did not check every NHS trust in the UK, but my due diligence did include sampling a number of organisations in each strategic health authority. No doubt I missed "your" particular one, but I am left with an uneasy feeling about the national picture.

However, one organisation I did find that has embraced diversity as part of its corporate vision is Newham primary care trust in London. On its board, six of the 11 members are from black and minority ethnic backgrounds, including chair Marie Gabriel. Newham is a borough with high levels of deprivation, and the community is culturally the most diverse in the capital, with people from a rich variety of ethnic, religious and linguistic backgrounds.

The PCT has a good record of developing and commissioning responsive services and tackling local health inequalities. Could it really have achieved that good record without a diverse board? Possibly - yes, but probably - no.

Advantages of diversity

Through our experience of working across public, private and not-for-profit sectors, we believe that a diverse workforce produces better results. That is because diverse teams harness people's differences, create an inclusive, supportive environment where staff are more satisfied and empower staff to respond better to the needs of their service users.

How much more effective would NHS boards be if the needs of the communities in which they served were thoroughly understood and solutions were tailored accordingly through good representation at a senior level?

So, with such compelling reasoning, why don't more diverse boards exist? Sometimes, it is just because they have thought to connect the experience of users with the experience of leaders and the latter can inform the former. But more often than this, they start with strong sentiments with regard to diversity but the closer they get to making an appointment, the more they revert to caution. After all, bringing in people with less traditional experience is seen as a risky business. But what is more disappointing, a hire that breaks the mould or a suite of services not in tune with service users' needs?

We appreciate that it takes a proactive approach to attract candidates who bring a fresh perspective to the boardroom, and those under-represented on boards may not easily come forward. Indeed, an area where we have had particular success is transferring the best of talent in one sector to another - particularly from private to public sector. This has been the case especially in disciplines such as finance, human resources and in non-executive appointments.

And the demographics around this? Let's see how well informed you are in terms of the diversity of the UK population (questions and answers below).

This is not about criticising the NHS. There are many initiatives at a national level that are redressing the balance, including the transformational leadership programme provided by the King's Fund in partnership with the NHS Institute for Innovation and Improvement's Breaking Through programme.

This is encouraging diversity at a senior level through training under-represented groups, particularly from black and minority ethnic communities, to realise their potential and join the ranks as future leaders of the NHS.

Also, the work being carried out by the NHS Confederation is a positive step to help raise awareness and put the subject of diversity back on the map.

This is a milestone year for the NHS as it celebrates its 60th anniversary in July. It is viewed by others across the globe as an enviable service.

The reality is that there is much to be done for staff and patients all to agree with this notion. This should be a time for reflection, to take from the lessons learned so far and to realise that diversity is a source of opportunity, an appreciation that the differences within any one workforce fuels group dynamics and helps create an environment where senior teams can perform to their full potential. That is our experience. We hope it can be yours too.

Test your knowledge

1. What percentage of the workforce is over 35?

A: 80 per cent B: 64 per cent C: 71 per cent

2. By 2012, what percentage of the workforce will be male?

A: 25 per cent B: 33 per cent C: 41 per cent

3. What percentage of the working age population has a disability?

A: 10 per cent B: 15 per cent C: 20 per cent

4. Of those, what percentage is employed?

A: 11 per cent B: 14 per cent C: 18 per cent

5. By 2010, what percentage of the growth in working age population will be female?

A: 60 per cent B: 76 per cent C: 84 per cent

6. What percentage of the UK population is lesbian or gay?

A: 6 per cent B: 12 per cent C: 20 per cent

7. What percentage of the total minority ethnic population of Britain lives in London ?

A: 35 per cent B: 48 per cent C: 52 per cent

Answers: 1: C, 2: B, 3: C, 4: A, 5: B, 6: A, 7: B

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