Published: 30/06/2005, Volume II5, No. 5962 Page 27 28 29

Commitment to acceleration of race equality schemes has been heard at the highest level of government. But as Mary-Louise Harding reports in a joint feature with HSJ's sister magazine LGC, there are barriers to progress both in the NHS and local government. Overleaf, Colleen Shannon examines how some organisations are succeeding in engaging directly with BME communities

The climate that allowed a softly-softly approach to the promotion of race equality is over.

The Department of Health has pledged to get tough in its revised race equality scheme for 200508 (news, page 5, 2 June). It has charged its top policy delivery staff with responsibility for ensuring its massive NHS reform programme does not inadvertently worsen the health inequalities of ethnic minority communities.

The DoH wants to shake off the 'could do better' label bestowed by Commission for Racial Equality chief Trevor Phillips last November at a conference on race equality in the NHS. He told his audience: 'I do not think the NHS has got that far yet [in race equality] because I do not think that everything that could have been done is being done.' Mr Phillips' desire to see improvement is hardly surprising given that the NHS is the largest employer of ethnic minority staff in England - 13 per cent of its workforce - and is charged with delivering equal access to healthcare to all.

Meanwhile, the Office of the Deputy Prime Minister, which has overall responsibility for local authority governance, has pledged determination to meet the 'challenging targets' set out in its 'living' 2005-08 racial equality scheme, which, unlike the DoH's version, is open to consultation to interested parties until the end of August.

Ensuring that local government managerial and political leaders 'more closely reflect the diversity of local communities they serve' and actively increasing engagement among 'ethnic minority citizens' from the current financial year onwards are among the myriad targets John Prescott has set for his department.

The two departments are not alone. All public sector organisations were statutorily required to review and update their race equality schemes by 31 May, setting out their plans for how they will promote race equality as service providers and employers for the next three years. Although it is vitally important for central government to set the tone, it is undoubtedly what happens on the ground that counts in the fight to ensure equal access to employment and services for all.

Effective senior leadership - getting the board to grasp the race equality nettle - remains the single most important ingredient to mainstreaming the race debate within organisations. Unfortunately, it also seems to be the most elusive challenge across both the NHS and local government.

'It is very hard to get a consistently good approach in local government, ' says CRE policy and public sector director Nick Johnson. 'They might have a very good approach on one aspect of their work but a very poor approach elsewhere.

Partly It is down to leadership within the local authority. This should be driven by the mayor, the chief executive and senior management team, but too often It is left to an individual staff member in a separate unit.' NHS organisations do not fare any better in Mr Johnson's analysis. He refers to Mr Phillips' famous description of NHS management as 'snowy peaks': senior levels made up almost exclusively of people of white British origin.

'Snowy peaks is an issue across the public sector, but the NHS is different because the general workforce is very diverse. There is clearly a serious issue around progression and promotion, ' says Mr Johnson.

However, the CRE applauds the DoH's efforts to get chief executives engaged with the equality issue. Since NHS chief executive Sir Nigel Crisp committed himself to mentoring a black -27 middle manager in February 2004 and publicly demanded that other chief executives follow his example, more than 600 leaders have been trained as mentors for black and minority ethnic staff in the past year, and a further 480 people have been trained and matched with mentees.

Former DoH head of equality and diversity Lutfur Ali, who is now head of diversity at public sector consultancy Tribal Group, argues that the NHS has travelled a great distance. 'When I first joined the department three and a half years ago, the NHS was bleeding in terms of workforce.

Black and minority ethnic staff were leaving in large numbers and discouraging people from their communities to join, ' he says.

'We found this was due largely to negative perceptions of the health service. Today, It is seen in much more of a positive light. For example, Mori did a survey last August that found the NHS was rated the fifth best employer for graduates. A few years ago it wouldn't have been on the radar.' He says Sir Nigel's personal commitment had a profound effect, and that the big leap in ethnic minority representation on trust boards - currently at 7 per cent - is testament to the power of leadership engagement in promoting race equality. However, the NHS had a lot of improving to do. It famously finished last in the CRE 2003 survey of public sector compliance with the Race Equality (Amendment) Act, and the commission says that the vast majority of discrimination complaints it receives are about NHS services.

Anecdotal evidence shows that ignorance among NHS managers is still rife. A manager attending a DoH management training scheme for ethnic minority staff complained that her boss had tried to force her to take her days spent on the course as holiday and refused to sign off her trainingrelated expenses.

Mr Ali says the political imperative to ensure that the interests of all communities are represented in local government is the main reason councils are more representative and scored higher in the study.

'One can't underestimate the impact that more representative decision making has in local government, ' he says. He adds that the recipient/ provider relationship between local government and communities is a 'lot more tied down' than the patient/provider relationship in the NHS.

However, Mr Johnson says that neither health nor local government services are likely to score particularly highly in the next CRE public sector review, due for publication at the end of this year, because of their continued poor performances in policy making, interpretation and implementation, and procurement.

'There is a little bit of 'after the horse has bolted' across the whole public sector, and health and local government tend to be very weak on equality impact assessment across the board, ' he says.

Mr Johnson expects the review to show the NHS has improved on 'technical' compliance, but adds that the poor record for both the health service and local government on measuring outcomes, race equality monitoring and lack of 'vigorous' race equality impact assessment processes will see both sectors marked down.

The public sector will be told: you have had three years to understand and experiment with the requirements of the act; now it is time for action.

The Healthcare Commission is expected to include the general duty under the act as a core standard from 2006-07, according to the CRE, while the Audit Commission is expected to include a race equality target in its new ratings, which will also come into force in the next financial year.

'While people had good intentions when the law first came in, they didn't really think through their response and it was passed off to relatively junior members of staff to tick the box, ' says Mr Johnson. 'We at the CRE are now talking about wanting to see real changes of service outcomes in the lifetime of a race equality scheme [three years].

Mr Ali believes local strategic partnerships should be broadened in scope to spread best practice and encourage benchmarking on race equality between public sector organisations and the private and voluntary sectors.

'Ultimately there are not sustained mechanisms in place that are easily identifiable [for sharing], apart from strategic partnerships, which have always had a regeneration slant to them. Perhaps now is the time to have broad areas of services, so a proper debate needs to be had about how better to share - but it needs to start from the top. If government doesn't work in partnership, it will not happen further down the line, ' he says.


In 2000, the Commission for Racial Equality received an anonymous call from an employee of an NHS trust to say that it did not have a race equality scheme.

After initial investigations, the CRE told the trust it would issue a compliance notice unless it published a scheme that complied with the Race Relations Act 1976 (Statutory Duties) Order 2001.

The trust sent the CRE a draft scheme but it was deficient: the trust did not adequately set out its arrangements for consulting on any new policies it would introduce. CRE officers worked with the trust, which produced a compliant scheme within the agreed deadline.

Local government In May 2003 the CRE issued a compliance notice under the Race Relations Act 1976 (Statutory Duties) Order 2001 to Conwy County borough council for not having a race equality scheme.

Only when the compliance notice was issued did the council produce a scheme.

But the scheme was seriously non-compliant and the CRE set the council a deadline to publish a compliant scheme. The council ultimately produced a suitable scheme.

Source: Commission for Race Equality