Published: 30/09/2004, Volume II4, No. 5925 Page 26 27

Race equality in the health service shouldn't be about do-gooders and acts of charity, says the Commission for Racial Equality chair. He's happy for managers to find pragmatic reasons for changing their ways

Question: the front-page headline of your Daily Beast reads: 'Ministers launch bid to halt HIV threat'. Is the story most likely to describe: a) A robust public health initiative to find ways to prevent a new HIV epidemic among certain communities in Britain? Or b) Urgent government action to halt a dangerous wave of health tourists from spreading death and disease at huge cost to British taxpayers?

The answer is depressingly obvious and summarises the government's reported response when figures showing spiralling rates of HIV infection among some ethnic minority communities in Britain were revealed last November.

Speaking in a lecture at Warwick University at the time, Commission for Racial Equality chair Trevor Phillips capitalised on this instance of discriminatory perspective to mount a challenge to Whitehall.

'You could say the principal reason for acting on the issue of AIDS and tuberculosis is that there is a danger, but not to the population at large, ' he said. 'It faces specific communities, so there is a reason, in a health service that truly believes in diversity, for working with those communities to protect them.'

He added: 'But it seems that alternative is not really in fashion in Whitehall.'

The message could not have been clearer: policy makers were dangerously out of touch. So it is now, less than a year later, no small accolade when Mr Phillips praises the Department of Health, saying it is an example to Whitehall.

When HSJ visited the CRE last week, the enigmatic former broadcaster and London Assembly chair was full of praise for the NHS top brass's efforts to raise the profile of race equality this year. 'The first thing to say is, as young people in my community would say, props to Nigel [Crisp], because it is rather courageous of him to take on the job of chairing the [race equality action] group and taking ownership of this strategy himself, ' he says.

Mr Phillips was asked by NHS chief executive Sir Nigel Crisp to head an independent scrutiny panel monitoring 'the top echelons' of the health service on progress against a 10-point race equality action plan, unveiled in March.

'I would imagine he's caused a certain amount of anxiety among the other permanent secretaries by inviting an independent panel to essentially monitor his progress.'

Speaking the day after his second meeting with NHS chief executives this month, he says the first big step is overcoming fear.

'The first battlefront is, oddly enough, an emotional one, ' he explains. 'One point I made yesterday is people have to start detaching this issue from their personal experience.'

He insists: 'Health service managers have to get past the idea that race equality is about them as individuals, that It is about whether they like black or Asian people or not.

'Look at the numbers, think about it in a more removed way, such as with financial control and financial integrity. Stop thinking about this as a test of your personal moral health, because I do not really care about that.What most people - patients and employees - really care about is what you do, not whether you have a righteous glow, ' he adds.

Taking a pragmatic approach to ensuring equality of access to both management jobs and NHS services, regardless of 'what you were born', is the theme running through Sir Nigel's action plan, echoing an approach being taken by some of the largest corporate employers in Britain and the US.

Mr Phillips cites an example from broadcasting to underline the business case for stamping out exclusion. 'One provider improved its service to disabled viewers by approaching it as part of growing the business, not as a patronising do-gooding venture, ' he says. 'The director of diversity said to the sales guys: 'You give me enough money to do subtitling and various other things that will make accessing services easier for disabled people, and I will give you 60,000 extra subscribers, because I know these people are not buying the service because they can't use it.'

'So they made the deal and she did it - she delivered 60,000 extra subscribers and the sales people got back their investment.'

He adds: 'It was a perfect example of an internal business deal and it is what I would like to see in the health service.'

Models from the private sector are set to become increasingly relevant as competitive drivers such as payment by results and choice get under way, effectively acting as 'a new set of teeth', in the words of Sir Nigel on launching the action plan in March.

Mr Phillips says his panel is now looking for similar practical examples from NHS organisations that show how an initiative has improved a service, rather than demonstrating a 'bit of charity'.

He says the panel is also looking for senior managers to help it define best practice in NHS leadership. 'We are looking for volunteers to come and sit with us and talk about what the successful chief executive in the race equality arena looks like, ' he explains. 'What does he or she actually do? How does he or she spend their time? Do they talk to the community? How do they deal with real-life problems?

'For example, one of the things that was brought up yesterday [at the chief executives conference in London] was: 'What happens when I've tried my best and I've tried to give people from ethnic minorities opportunities but, frankly, they're just not up to it?

How do I talk to them about it?

What do I do?'' Next on the panel's agenda is putting the finishing touches to its NHS partnership programme with Sir Nigel over the next year, following Mr Phillips' chief executives meetings, and a handful of visits to trusts.

'What I have in mind is that we will give Sir Nigel a pretty regular bulletin on what we think is happening, both in terms of trends, and also specific things I think he ought to pay attention to, both good and bad, as ways of keeping the plan active, ' he says.

Returning to his Walter Rodney memorial lecture in Warwick last November, in which he pointed to the dramatic shift from 1970s bigotry to condemnation of racism at football matches today, HSJ asks what would signal success in efforts to address race equality in the health service.

He replies: 'A health service in which, when you look at the patterns of promotion and progression, the ethnicity of an employee is not a guide to where they are in the hierarchy or what occupations they have - because there is a tendency to occupational segregation.

'Similarly, when we look at the patient experience, we shouldn't be able to predict what a patient is going to say or feel by their ethnicity, like we can do all too easily today.'